Mortality after cure of soft-tissue sarcoma treated with conservation surgery and radiotherapy

B Ashleigh Guadagnolo, Gunar K Zagars, Matthew T Ballo, Sara S Strom, Raphael E Pollock, Robert S Benjamin
Cancer 2008 July 15, 113 (2): 411-8

BACKGROUND: The objective of the current study was to analyze the potential treatment-related mortality in long-term survivors of soft-tissue sarcoma (STS) treated with radiotherapy (RT) and conservation surgery.

METHODS: Between 1960 and 2000, 629 of 1089 patients treated with conservation surgery and RT for nonmetastatic STS at the University of Texas M. D. Anderson Cancer Center never developed disease recurrence. Long-term survival and causes of death were evaluated using the person-years method to determine the standardized mortality ratio (SMR). SMRs were calculated for death from all causes, cancer, and cardiac disease using standard U.S. data.

RESULTS: The median follow-up was 13.2 years. The 10-year, 20-year, and 30-year actuarial survival rates were 88%, 69%, and 52%, respectively. The overall all-case mortality was 1.14 (95% confidence interval [95% CI], 0.98-1.33). The all-cause mortality exceeded that expected for female patients with an SMR of 1.48 (95% CI, 1.15-1.88), patients aged <or=50 years with an SMR of 1.46 (95% CI, 1.06-1.95), and patients with nonextremity tumors with an SMR of 1.57 (95% CI, 1.15-2.08). The overall cardiac mortality was not found to be significantly elevated. Overall cancer mortality was also not excessive, with an SMR of 1.33 (95% CI 0.99-1.66). Subgroup analyses revealed an increased cancer mortality over the population expected for female patients aged <or=50 years with nonextremity tumors.

CONCLUSIONS: In the current study, survivors of STS who were treated with conservation surgery and RT with or without chemotherapy did not appear to experience significant excess mortality compared with controls from the U.S. general population. Subgroup analyses did demonstrate that females aged <or=50 years at the time of diagnosis with nonextremity primary tumors did have higher all-cause mortality and this increase may be due to cancer mortality.

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