Preoperative radiation, surgical margins, and local control of extremity sarcomas of soft tissues

Abstract

The relationship between status of the surgical margin and local control of soft tissue sarcoma of the extremities by preoperative radiation therapy has been assessed in 132 consecutive patients from 1974 to 1988. The 5-year actuarial local control rate was 94% for all patients; the rates were 97% and 82% for the 104 tumors with negative margins and the 28 tumors with positive margins, respectively. The local control rate was independent of the extent of the negative margin. For primary sarcomas, the local control rates were 96%, 97%, and 100%, respectively, for margins that were negative at < or = 1 mm or > 1 mm, or the specimens were negative for tumor; for positive margins the result was 83%. The overall local control rate was lower (not significant) for recurrent than for primary sarcomas: 88% vs. 94%. On the other hand, when stratifying by margin status, no difference was observed in local control results, i.e.: (1) 97% and 91% for primary and recurrent tumors with negative margins, respectively, and (2) 83% and 80% for primary and recurrent tumors with positive margins, respectively. Local control was not significantly higher in those patients who were treated by surgical resection (S), radiation (RT), and re-excision of the previous tumor bed than in those whose radiation therapy was started after the biopsy and followed by one surgical resection. For primary sarcomas that were resected with negative margins the results were: 100% of 15 patients treated by S-RT-S and 96% of 75 patients treated by RT-S.

Neoadjuvant Treatment with Preoperative Radiotherapy for Extremity Soft Tissue Sarcomas: Long-Term Results from a Single Institution in Turkey

“…Although we didn't find any significance for tumor size within the range of 5 cm multiples, it seems to be an independent prognostic factor for DFS when we reanalyze it regarding the median size. Positive surgical margin increases the local recurrence rate even in patients with combined surgery and radiotherapy (Rosenberg et al, 1982;Sadoski et al, 1993;Pisters et al, 1996;Zagars et al, 2003). In our series, there were 19 patients with positive margin after resection.…”

“…Easier tumor delineation and eradication of microscopic tumor seeding are the other advantageous of preoperative radiotherapy. Although wound complications are reported more in the patients treated by means of preoperative treatment than the patients treated by postoperative radiotherapy, less late toxicity were seen compared with postoperative radiotherapy in the long-term follow-up analysis (Suit et al, 1985;Nielsen et al, 1991;Sadoski et al, 1993;O'Sullivan et al, 2002;Davis et al, 2005). Furthermore, delay of adjuvant radiotherapy due to wound healing after surgery is prevented by using radiotherapy in the preoperative setting.…”

Radiographic response to neoadjuvant chemotherapy is a predictor of local control and survival in soft tissue sarcomas

“…[11][12][13] In our study, we observed significantly higher margin-negative resection rates in the patients who had a radiographic response than in those who had no response. Although reports in the literature on the impact of tumor size on local control have been mixed, [11][12][13][14] higher rates of radiographic response in patients with smaller tumors (Յ 11.5 cm) may have contributed to the better local control observed in the patients who had any radiographic response.…”

Soft Tissue Sarcomas

“…Second, they maintain that lower doses of radiation can more easily be delivered preoperatively to an undisturbed tumor bed, which may also have improved tissue oxygenation. 46,51,52 Third, the preoperative radiation fields can be smaller and the number of joints included in those fields fewer than those in postoperative radiation fields, which may result in an improved functional outcome. 53 And finally, advocates of preoperative radiation therapy contend that by shrinking the tumor, radiation therapy can facilitate surgical resection.…”