What is the prognosis of postradiation sarcoma (PRS)?

Updated: Jul 01, 2020
  • Author: Nagarjun Rao, MD, FRCPath; Chief Editor: Omohodion (Odion) Binitie, MD  more...
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Answer

The overall reported 5-year survival rates for patients with PRS have been poor, ranging from 8.7% to 22% in different studies. [11, 12, 17, 18, 19, 20] However, patients with resectable peripheral lesions at stage IIB or lower have a relatively better prognosis. In the Mayo Clinic series, the 5-year survival rate was 68%. [10] The overall poor prognosis in these patients is thought to be due to a number of interrelated factors, such as the following:

  • Significant delay in diagnosis
  • Large unresectable lesions
  • Older age
  • Anaplastic nature of lesions
  • Lack of effective adjuvant treatment

In a retrospective review of histopathologic features, surgery, and outcome in 67 patients with radiation-induced sarcoma followed for a median of 53 months, Neuhaus et al found that median sarcoma-specific survival was 54 months (2-year survival, 75%; 5-year survival, 45%).23 The local relapse rate was 65%, and negative histopathologic margins were a significant predictor of sarcoma-specific survival. Grade and size of tumor approached, but did not attain, significance.

In a study of the prevalence and outcome of radiation-induced sarcomas in 90 sarcoma patients, Bjerkehagen et al reported a sarcoma-related 5-year crude survival rate of 33%. [19]  Unfavorable prognostic factors were metastases at presentation, incomplete surgery, and presence of tumor necrosis. According to the authors, complete surgical resection is mandatory for cure.

In a retrospective study of 52 patients with PRS (45 with bone sarcoma and 7 with soft-tissue sarcoma), Mavrogenis et al reported survival figures of 85% at 1 year, 51% at 2 years, 48% at 3 years, and 45% at 5 years. [21] On univariate analysis, sarcoma type was the sole predictor of survival; on multivariate analysis, no variable was a significant predictor of survival.


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