Managing Extremity Soft Tissue Sarcoma Patients: Surgery Alone or in Combination with Radiotherapy? An Editorial on the Paper by Fiore et al.

Abstract

Dr Fiore and colleagues are to be congratulated on their analysis of local control probability after surgery alone in high-risk extremity soft tissue sarcomas (ESTSs). 1Although both national comprehensive cancer network (NCCN) 2 and European society for medical oncology (ESMO) 3 guidelines suggest combining limb salvage surgery with radiotherapy (RT), and although no data are currently available from randomized studies suggesting to refrain from RT, the results from the study by Dr Fiore et al. are remarkable in several ways, but also need to be considered in the right perspective. WHAT ARE THE REMARKABLE FINDINGS?There were less R0 resections (69.4% vs. 78.9%; p = 0.182) in patients in group B (without RT) compared with those in group A, yet local control in both groups was comparable. What one would expect is that, specifically in a subgroup with R1 resections, perioperative RT would compensate for these microscopically positive margins with respect to local control, which it did not-66.3% vs. 72.1%.The local failure rate without RT in R1 resections was 27.9%. As found by Alektiar (manuscript reference #24) and many others, radiation would decrease the local failure rate with a factor of 2-3, mounting to a failure rate of 9-14%, and therefore a local control estimate of 86-91%.This rate is comparable with the literature; however, in the study by Fiore et al., it is unexpectedly lower at 66.3%.The local failure rate without RT in R0 resections was fairly low at 14.8%. If, again, the risk on local relapse was reduced with a factor of 2-3, a local failure rate of 5-8% would be expected, leading to a local control estimate of 92-

Effectiveness criteria for application of the isolated limb perfusion in soft tissue sarcoma

“…Неоадъювантная ЛТ, как правило, предполагает суммарную ежедневную нагрузку в 50 Гр и проводится в течение 5 недель с применением методики суточного дробления дозы на фракции по 2 Гр, после чего осуществляют оперативное вмешательство в исходе восстановительного периода длительностью от 4 до 6 нед. Адъювантная ЛТ начинается по истечении послеоперационного периода или после адекватного заживления операционной раны [1,11].…”