SUMMARYPurpose: In this retrospective study; a total of 86 patients with soft tissue sarcoma who underwent post operative or primary definitive radiotherapy at our radiation oncology disclipline, treatment results and prognostic factors evaluated.Materials&Methods: Between january 1990 and january 2005 the soft tissue sarcoma patients who underwent post operative or primary definitive radiotherapy evaluated retrospectively. Median patient age was 45 (range18-80 years); 45 patients (%52) were male and 41 patients (%48) were female.According to AJCC staging; 9 patients (%11) were Stage I, 53 patients (%61) were Stage II and 24 patients (%28) were Stage III. Localization of the tumors in; 68 (%79) cases were located in the extremities,13 (% 15) located in the trunk, 3 (%4) were retroperitone and 2 (% 2) located in the head and neck regions.According to hisopathological types; 23 cases (%27) were malignant fibrous histiocytoma, 17 cases (%20) were liposarcoma, 10 cases (%12) were fibrosarcoma, 12 cases (%14) were snovial sarcoma, 9 cases (%10) were malignant peripheral nerve sheath tumor, 8 cases (%9) leiomyosarcoma, 1 case ( %1) was rhabdomyosarcoma and 6 cases (%7) were malignant mesenchymal tumor.According to histopathological degree; 49 (%57) cases were grade I-II and 37 (%43) cases were grade III-IV. Tumor size; on 26 (%30) cases less then 5 centimeters, On fifty (%58) cases between 5 to 10 centimeters and 10 (%12) cases more then 10 centimeters. According to the type of surgical; on 49 (%57) cases wide excision; on eleven (%14) cases marginal excision, on 24 (%28) cases excisional biopsy and no surgery was applied 1 (%1) case, 44 (%51) of patients who were operated had negative surgical margins; 30 (%35) cases had positive margins and 7 (%8) cases had close surgical margins and 45 (%52) patients had received adjuvant chemotherapy.The median total radiotherapy dose was 60 Gy (range 40-70 Gy) delivered at 1.8?2.0 Gy per fraction. In the first years had used Co 60; after 1999 was planned to 3D conformal techniques. Acute and late complications were eveluated according to RTOG toxicity criteria and were limited to grade I-II. Grade III-IV late toxicity was observed in 3 (%3) cases.Findings: The median follow up duration was 53 months (range 3-246 months). Five year overall survival (OS), disease free survival (DFS) and local control rates were; % 68, %61 and % 76, respectively.On univariate analysis; tumor size more than 10 centimeters (p=0.01), deep placement (p=0.001), grade III-IV (p=0.0001), stage III (p=0.02) and positive surgical margins (p=0.002) in overall survival; grade III-IV (p=0.0001), stage III (p=0.030) and positive surgical margins (p=0.012) in disease free survival (DFS); tumor localizasion ((extremity vs. another placement)(p=0.028)), grade III ?IV (p = 0.004) and positive surgical margins (p=0.0001) were found significant prognostic factors.On multivariate analysis; grade III-IV, in overall survival and disease free survival (DFS) was significant (p=0.004 and 0.001, respectively). Surgical margins (p=0.001) and tumor localization (p=0.06) were prognostic factors in local control.Results: In our series; High grade; positive surgical margins and non extremity placement were determinate most prognostic factors. These results are consistent with previous studies and treatment planning must be taken into consideration.Key Words: Grade, local control, prognostic factors, radiotherapy, soft tissue sarcoma.

Amaç: Anabilim Dalımızda postoperatif veya primer radyoterapi (RT) ile tedavi edilen 86 yumuşak doku sarkomlu hastada tedavi sonuçları ve prognostik faktörler retrospektif olarak değerlendirildi.Gereç ve Yöntem: Ocak 1990-Ocak 2005 tarihleri arasında postoperatif veya primer RT alan yumuşak doku sarkomlu hastalar retrospektif olarak değerlendirildi. Hastaların medyan yaşı 45(18-80) olup, 45'i (%52) erkek, 41'ü (%48) kadındı. AJCC 2010 evrelemesine göre evre I; 9 hasta(%11), evre II; 53 hasta(%61) ve evre III; 24 hasta(%28) idi. Tümör lokalizasyonu 68 hastada(%79) ekstremite, 13 hastada gövde(%15), 3 hastada(%4) retroperiton ve 2 hastada(%2) baş-boyun bölgesinde idi. Histopatolojik tiplere göre; 23(%27) malign fibröz histiyositom, 17(%20) liposarkom, 10 (%12) fibrosarkom, 12 (%14) sinoviyal sarkom, 9 (%10) malign periferik sinir kılıf tümörü, 8(%9) leyomyosarkom, 1(%1) rabdomyosarkom ve 6(%7) malign mezenkimal tümör idi. Histopatolojik derecelendirmede grade I-II; 49(%57), grade III-IV; 37(%43) olduğu görüldü. 26 (%30) hastada tümör < 5 cm, 50(%58) hastada tümör 5-10 cm ve 10 (%12) hasta da > 10 cm idi. Cerrahi olarak, 49(%57) hastaya geniş eksizyon, 11 (%14) hastaya marjinal eksizyon, 24 hasta(%28) eksizyonel biyopsi yapılmış olup 1(%1) hastada cerrahi yok idi. Hastaların 44(%51)'ünde cerrahi sınır negatif iken, 30(%35)'unda pozitif, 7(%8) hasta da ise yakın cerrahi sınır var idi. Hastaların 45(%52)'inin adjuvan kemoterapi aldığı görüldü. Radyoterapi 1.8-2Gy/ fraksiyon dozunda median 60(40-70) Gy olarak, ilk yıllarda Co60, 1999'dan sonra 3D konformal yöntemlerle planlanmıştı. Akut ve geç komplikasyonlar RTOG toksisite kriterlerine göre değerlendirildi ve grade 1-2 ile sınırlı idi. Üç(%3.3) hastada grade III-IV geç komplikasyon gözlendi.Bulgular: Olguların medyan takip süresi 53 (3-246 ay) ay olarak bulundu. Beş yıllık genel sağkalım (GS), hastalıksız sağkalım (HS) ve lokal kontrol (LK) sırası ile %68, %61 ve%76 idi. Tek değişkenli analizde GS için tümör boyutu >10 cm (p=0.01), derin yerleşim (p=0.001), grade III-IV (p=0.0001), evre III (p=0.02) ve (+) cerrahi sınır (p=0.002), HS için grade III-IV (p=0.0001), evre III (p=0.030) ve (+) cerrahi sınır (p=0.012); LK içinse tümör lokalizasyonu (ekstremite vs diğer) (p=0.028), grade III-IV (p=0.004), derinlik (p=0.035 ) ve (+) cerrahi sınır (p<0.0001) anlamlı prognostik faktörler olarak bulundu. Çok değişkenli analizde GS ve HS için sırasıyla grade III-IV (sırasıyla p=0.004 ve p=0.001), LK için cerrahi sınır (p=0.0001) ve istatiksel olarak anlamlı olmasa da tümör lokalizasyonu (p=0.06) önemli prognostik faktörler olarak bulundu.Sonuç: Serimizde yüksek grade, cerrahi sınırların (+) olması ve ekstremite dışında tümör lokalizasyonu en önemli prognostik faktörler olarak bulunmuştur. Bu sonuçlar daha önceki çalışmalar ile uyumlu olup tedavi planlamalarında mutlaka göz önünde bulundurulmalıdır.Anahtar Kelimeler: Grade, lokal kontrol, prognostik faktör, radyoterapi, yumuşak doku sarkomu.