Combined treatment involving surgery and radiotherapy is a reasonable
alternative to surgery alone in high-risk patients with dermato-fibrosarcoma
protruberans (DFSP), Canadian researchers reported at the American
Society for Therapeutic Radiology and Oncology (ASTRO) meeting.
Dermatofibrosarcoma protruberans is an uncommon, low-grade sarcoma
of the dermis and subcutis. Primary surgery is the preferred treatment;
however, wide surgical clearance in certain sites may result in
cosmetic and/or functional loss.
For their study, Brian O'Sullivan, MD, and his colleagues at the
Princess Margaret Hospital, Toronto, reviewed all 45 DFSP cases
referred to their radiation oncology department between August,
1958, and March, 1994. The tumors originated in the extremities
in 16 patients, the head and neck in 17 cases, and the torso in
They found that excellent control rates were achievable even in
high-risk cases. Their results showed local control in 17 of 19
such cases, for a rate of 89%.
Dr. O'Sullivan, associate professor of radiation oncology, University
of Toronto, emphasized that surgery is the recommended initial
approach in all cases of DFSP, with the expectation that all cases
will be controlled with margins greater than or equal to 1 cm.
However, adjuvant radiotherapy should be considered for microscopic
residuum--especially in locations where cosmesis or function would
be compromised by radical surgery--and in select sites when the
risk of recurrence is high and there is potential for significant
morbidity from tumor relapse or subsequent surgery.
In this retrospective study, this approach to microscopic residual
disease, yielded the same impressive extent of control evident
in other soft-tissue sarcomas, he noted.