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Combination Therapy for Rare Dermal Sarcoma Effective, Avoids Radical Surgery

Combination Therapy for Rare Dermal Sarcoma Effective, Avoids Radical Surgery

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 12.

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.

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