THE ROLE OF RADIATION-THERAPY IN THE MANAGEMENT OF DERMATOFIBROSARCOMA PROTUBERANS

Purpose: To evaluate the outcome for dermatofibrosarcoma protuberans t reated with conservation surgery and radiation therapy. Methods and Ma terials: A retrospective review was performed of 19 consecutive patien ts with pathologically confirmed dermatofibrosarcoma protuberans who r eceived radiation as an adjuvant to surgical resection. Results: The p atients ages ranged from 19-76 years (median, 40 years); 12 were men. Lesions were located on the trunk in 8, in the head and neck area in 7 , and in an extremity in 4, Tumor size ranged from 1.2 to 15 cm (media n, 4 cm). Ten patients had at least 1 prior recurrence following earli er resection, Two patients received preoperative radiation to 50 Gy in 5 weeks, Sixteen patients underwent resection followed by radiation ( 6 of these had positive resection margins). In another patient, the tu mor regrew rapidly after resection and definitive radiation was delive red for gross disease, The 6 patients with positive microscopic margin s received a median dose of 60 Gy, as did the 10 with negative margins . The 1 patient with gross disease received 65 Gy. At a median follow- up of 6 gears, the only patient to develop local recurrence was treate d with definitive radiotherapy for gross disease. Actuarial local cont rol was 95% at 10 years. Conclusion: Dermatofibrosarcoma protuberans i s a radioresponsive tumor and radiation to doses of 50-60 Gy should be considered as an adjuvant to resection if margins are positive, Combi ned conservation resection and postoperative radiation should also be considered for situations where adequate wide excision alone would res ult in major cosmetic or functional deficits. (C) 1998 Elsevier Scienc e Inc.