Research Article

The Use of Radiation Therapy in Well-Differentiated Soft Tissue Sarcoma of the Extremities: An NCDB Review

Table 1

Baseline characteristics for all patients with well-differentiated tumors.

VariableOverall
()
Surgery alone
()
Adjuvant RT
()
value

Patient characteristics
Age, yrs. (IQR)55 (43, 68)55 (43, 69)54 (43, 67)0.419
Female1,035 (48%)752 (48.1%)283 (47.8%)0.957
Race0.792
 White1,774 (84%)1,290 (84%) 484 (84%)
 Black 255 (12.1%) 188 (12.2%) 67 (11.6%)
 Other 83 (3.9%) 58 (3.8%) 25 (4.3%)
Charlson Comorbidity Score0.777
 01,265 (88.6%)908 (88.3%)357 (89.5%)
 1 140 (9.8%)103 (10%) 37 (9.3%)
 ≥2 22 (1.5%) 17 (1.7%) 5 (1.3%)
Education above median1,239 (60.9%)878 (59.7%)361 (63.9%)0.091
Income above median1,406 (69.1%)1,005 (68.3%) 401 (71%)0.269
Distance to cancer center (IQR)13.4 (5.6, 36.4)14.7 (5.7, 41.3)10.9 (5.1, 24.6)0.611
Treatment facility0.288
 Community Cancer Program 117 (5.5%) 82 (5.4%) 35 (6%)
 Comprehensive Community Cancer Program 827 (39.2%)585 (38.3%)242 (41.5%)
 Academic/Research Program1,165 (55.2%)859 (56.3%)306 (52.5%)
Uninsured76 (3.7%)53 (3.5%)23 (4%)0.697

Tumor characteristics
Limb location0.61
 Upper limb and shoulder 499 (23.1%) 367 (23.5%) 132 (22.3%)
 Lower limb and hip1,658 (76.9%)1,198 (76.5%) 460 (77.7%)
Tumor size (mm)90 (40, 170)84 (35, 170)97 (50, 159.2)0.504
Tumor size<0.001
 <5 cm582 (31.3%)449 (33.9%)133 (24.7%)
 5–9.9 cm406 (21.8%)268 (20.2%)138 (25.7%)
 10–19.9 cm527 (28.3%)344 (26%)183 (34%)
 >20.0 cm347 (18.6%)263 (19.9%) 84 (15.6%)
Histology0.001
 Clear cell sarcoma 4 (0.2%) 4 (0.3%) 0 (0%)
 Epithelioid sarcoma 8 (0.4%) 5 (0.3%) 3 (0.5%)
 Fibrosarcoma 91 (4.2%) 73 (4.7%) 18 (3%)
 Leiomyosarcoma 231 (10.7%) 185 (11.8%) 46 (7.8%)
 Liposarcoma1,418 (65.7%)1,014 (64.8%) 404 (68.2%)
 Malignant fibrous histiocytoma 103 (4.8%) 70 (4.5%) 33 (5.6%)
 Mixed mesenchymal sarcoma 3 (0.1%) 3 (0.2%) 0 (0%)
 MPNST 64 (3%) 44 (2.8%) 20 (3.4%)
 Myxosarcoma 19 (0.9%) 9 (0.6%) 10 (1.7%)
 Rhabdomyosarcoma 2 (0.1%) 1 (0.1%) 1 (0.2%)
 Sarcoma NOS 122 (5.7%) 98 (6.3%) 24 (4.1%)
 Small cell sarcoma 2 (0.1%) 0 (0%) 2 (0.3%)
 Spindle cell sarcoma 45 (2.1%) 33 (2.1%) 12 (2%)
 Synovial sarcoma 44 (2%) 25 (1.6%) 19 (3.2%)
 Undifferentiated sarcoma 1 (0%) 1 (0.1%) 0 (0%)

Treatment specifics
Surgery type0.002
 Local excision 723 (33.5%)525 (33.5%)198 (33.4%)
 Radication resection1,365 (63.3%)976 (62.4%)389 (65.7%)
 Limb amputation 65 (3%) 60 (3.8%) 5 (0.8%)
 Major amputation 4 (0.2%) 4 (0.3%) 0 (0%)
Amputation (versus no amputation)69 (3.2%)64 (4.1%) 5 (0.8%)<0.001
Days to definitive surgery (IQR)0 (0, 34)0 (0, 33)10 (0, 35.2)0.598
Neoadjuvant chemo1 (0.3%)0 (0%)1 (1.2%)0.256
Adjuvant chemo6 (1.8%)1 (0.4%)5 (6%)0.005

Endpoints and outcomes
Surgical margins0.001
 Negative1,534 (78.5%)1,133 (80.5%) 401 (73.3%)
 Microscopic 234 (12%) 146 (10.4%) 88 (16.1%)
 Macroscopic 186 (9.5%) 128 (9.1%) 58 (10.6%)
30-day readmission35 (2.6%)27 (2.7%) 8 (2.1%)0.626
Hospital LOS (IQR)1 (0, 3)1 (0, 3)1 (0, 3)0.427