What is the role of surgery in the treatment 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

Surgical options for PRS include wide or radical resection (limb salvage) and amputation, and the choice depends on the stage and location of the tumor and the age and performance status of the patient. In patients with peripherally located tumors at Musculoskeletal Tumor Society (MSTS) stage IIB and below (see Workup, Staging), it is feasible to expect resection to provide a reasonable 5-year survival rate. (In one study, the 5-year survival rate for this group approached 68%.) Brachytherapy or postoperative external beam radiation can be added if the margins are close to the tumor.

Chan et al conducted a retrospective study that included 25 patients treated for PRS after radiotherapy for nasopharyngeal carcinoma. [26] Of the 25 patients, 20 underwent surgery with curative intent. All 25 received postoperative adjuvant chemoradiation, and six underwent brachytherapy as well. Local recurrence occurred in 71.4%. Median survival was significantly better for surgical patients with clear margins than for those with positive margins. Surgery was found to be effective in symptom palliation, including tumor pain, bleeding, and trismus.


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