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Radiation-Associated Undifferentiated Pleomorphic Sarcoma is Associated with Worse Clinical Outcomes than Sporadic Lesions

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Radiation therapy is used increasingly as a component of multidisciplinary treatment for many solid tumors. One complication of such treatment is the development of radiation-associated sarcoma (RAS). Undifferentiated pleomorphic sarcoma (UPS), previously termed “malignant fibrous histiocytoma” (MFH) is the most common histologic subtype of RAS. This study investigated the clinical outcomes for patients with radiation-associated UPS (RA-UPS/MFH).

Methods

The study identified 1068 patients with UPS/MFH treated at the authors’ institution. Patient and tumor factors were collected and compared. Regression analysis was performed to identify independent predictors of survival. A matched-cohort survival and recurrence analysis was performed for radiation-associated and sporadic UPS/MFH.

Results

The findings showed that RA-UPS/MFH comprised 5.1 % of the UPS population. The median latency to the development of RA-UPS/MFH was 9.3 years. The 5-year disease-specific survival (DSS) was 52.2 % for patients identified with RA-UPS/MFH (n = 55) compared with 76.4 % for patients with unmatched sporadic UPS/MFH (n = 1,013; p < 0.001). A matched-cohort analysis also demonstrated that the 5-year DSS was significantly worse for RA-UPS/MFH (52.2 vs 73.4 %; p = 0.002). Furthermore, higher local recurrence rates were observed for patients with RA-UPS/MFH than for patients with sporadic lesions (54.5 vs 23.5 %; p < 0.001). Radiation-associated status and incomplete resection were identified as independent predictors of local recurrence.

Conclusion

This study demonstrated worse clinical outcomes for patients with RA-UPS/MFH than for patients with sporadic UPS/MFH. Local recurrence was significantly higher for patients with RA-UPS/MFH, suggesting a unique tumor biology for this challenging disease.

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Acknowledgment

Funding for this research was provided in part by NIH/NCI K08CA160443 (to K.T.), the Sally M. Kingsbury Sarcoma Research Foundation (to K.T.), the Amschwand Foundation (supporting C.M), and NIH/NCI 2P30CA016672-38 (supporting S.Z.).

Disclosure

There are no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, UT MD Anderson Cancer Center, Houston, TX, USA

    Sean P. Dineen MD, Christina L. Roland MD, Rachel Feig, Caitlin May BS, Kelly Hunt MD, Janice Cormier MD, Barry Feig MD & Keila E. Torres MD, PhD

  2. Department of Biostatistics, UT MD Anderson Cancer Center, Houston, TX, USA

    Shouhao Zhou PhD

  3. Department of Pathology, Mount Sinai Hospital, New York, NY, USA

    Elizabeth Demicco MD, PhD

  4. Department of Pathology, UT MD Anderson Cancer Center, Houston, TX, USA

    Ghadah Al Sannaa MD, Davis Ingram BS, Wei-lein Wang MD & Alex Lazar MD, PhD

  5. Department of Sarcoma Medical Oncology, UT MD Anderson Cancer Center, Houston, TX, USA

    Vinod Ravi MD

  6. Department of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TX, USA

    Ashleigh Guadagnolo MD

  7. Deparment of Surgery, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel

    Dina Lev MD

  8. Department of Surgery, The Ohio State University, Columbus, OH, USA

    Raphael E. Pollock MD, PhD

Authors
  1. Sean P. Dineen MD
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  2. Christina L. Roland MD
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  3. Rachel Feig
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  4. Caitlin May BS
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  5. Shouhao Zhou PhD
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  6. Elizabeth Demicco MD, PhD
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  7. Ghadah Al Sannaa MD
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  8. Davis Ingram BS
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  9. Wei-lein Wang MD
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  10. Vinod Ravi MD
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  11. Ashleigh Guadagnolo MD
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  12. Dina Lev MD
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  13. Raphael E. Pollock MD, PhD
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  14. Kelly Hunt MD
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  15. Janice Cormier MD
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  16. Alex Lazar MD, PhD
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  17. Barry Feig MD
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  18. Keila E. Torres MD, PhD
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Corresponding author

Correspondence to Keila E. Torres MD, PhD.

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Dineen, S.P., Roland, C.L., Feig, R. et al. Radiation-Associated Undifferentiated Pleomorphic Sarcoma is Associated with Worse Clinical Outcomes than Sporadic Lesions. Ann Surg Oncol 22, 3913–3920 (2015). https://doi.org/10.1245/s10434-015-4453-z

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  • DOI: https://doi.org/10.1245/s10434-015-4453-z

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