Adjuvant Radiation for Stage IIB Soft Tissue Sarcoma of the Extremity
Authors: Robert D. Timmerman, Kaled M. Alektiar
Journal: Journal of Clinical Oncology (2002)

Article Tools SPECIAL DEPARTMENTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2002.02.880 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 12228214 Adjuvant Radiation for Stage IIB Soft Tissue Sarcoma of the Extremity Robert D. TimmermanxRobert D. TimmermanSearch for articles by this author Kaled M. AlektiarxKaled M. AlektiarSearch for articles by this author Show More Indiana University School of Medicine, Indianapolis, INMemorial Sloan-Kettering Cancer Center, New York, NY https://doi.org/10.1200/JCO.2002.02.880 First Page Full Text PDF Figures and Tables © 2002 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyResponse15092002In Reply:We would like to thank Dr Timmerman for his interest in our article. He made some interesting remarks to which we would like to respond.First, the randomized trial by Yang et al1 did show a 100% local control for high-grade sarcomas, something that everyone would like to duplicate. But the fact is that almost all other reports in the literature, especially those addressing patients with stage II-B disease,2,3 have reported similar local control rates to ours.4 More importantly, in the same trial,1 patients with low-grade sarcomas did not have 100% local control and, in a prior trial from the same institution using the same radiation techniques, showed a somewhat lower local control rate for patients with high-grade sarcomas.5Second, with regard to the influence of brachytherapy on local control, we clearly stated throughout the article the lack of difference in local control and the type of radiation used ie, brachytherapy versus external-beam radiation. Furthermore, the benefit of adjuvant brachytherapy for patients with high-grade sarcomas has been demonstrated in a prospective randomized trial.6Third, we were able to identify a subset of patients with central location (axilla or groin) who need further improvements in their multimodality treatment. And finally, we stated that the only way to answer the question of whether adjuvant radiation is needed in this subset of patients would be through a prospective randomized trial. We believe, however, that data such as ours is needed first to determine whether such a question could be answered.1. Yang J, Chang A, Baker A, et al: Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 16:: 197,1998-203, Link, Google Scholar2. Fleming J, Berman R, Cheng S, et al: Long-term outcome of patients with American Joint Committee on Cancer stage IIB extremity soft tissue sarcomas. J Clin Oncol 17:: 2772,1999-2780, Link, Google Scholar3. Cheng E, Dusenbery K, Winters M, et al: Soft tissue sarcomas: Preoperative versus postoperative radiotherapy. J Surg Oncol 61:: 90,1996-99, Crossref, Medline, Google Scholar4. Alektiar K, Leung D, Zelefsky , et al: Adjuvant radiation for stage II-B soft tissue sarcoma of the extremity. J Clin Oncol 20:: 1643,2002-1650, Link, Google Scholar5. Rosenberg S, Tepper J, Galtstein E, et al: The treatment of soft-tissue sarcoma of the extremities: Prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg 196:: 305,1982-315, Crossref, Medline, Google Scholar6. Pisters PW, Harrison LB, Leung DH, et al: Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 14:: 859,1996-868, Link, Google Scholar