Preoperative radiotherapy of soft-tissue sarcomas: surgical and radiologic parameters associated with local control and survival

Abstract

BackgroundPreoperative radiotherapy is often used to facilitate excision of soft-tissue sarcomas. We aimed define factors that affect local tumour control and patient survival.MethodsA single institution registry study of 89 patients with non-metastatic soft-tissue sarcomas having preoperative radiotherapy between 1994 and 2014. Radiologic (presence of peritumoural oedema and volume change following radiotherapy) and histopathologic (tumour volume, grade and surgical margin) parameters were recorded. Outcomes were the events of local recurrence, amputation, metastasis and death.ResultsLocal recurrence rate was low (12%) and marginal excision gave equal local control to wide excision. Pelvic localization was associated with a higher risk for amputation. The absence of peritumoural oedema on MRI defined a subgroup of tumours with more favourable oncologic outcome. Reduction of tumour volume following radiotherapy was also associated with better patient survival. Both these radiologic parameters were associated with lower tumour grade. Tumour necrosis was not significant for patient survival. The local complication rate, mainly wound healing problems and infection, was high (40%), but did not lead to any amputation.ConclusionPreoperative radiotherapy of high-risk soft-tissue sarcomas allows for good local control rate at the expense of local wound complications, which are however manageable. Marginal excision is sufficient for local control. Absence of peritumoural oedema on MRI, as well as tumour size reduction following radiotherapy are associated to superior patient survival and can be used ass early prognostic factors.Electronic supplementary materialThe online version of this article (10.1186/s13569-018-0106-x) contains supplementary material, which is available to authorized users.

Neoadjuvant radiation for cutaneous and soft tissue angiosarcoma

“…26,27 Furthermore, current NCCN guidelines encourage consideration of radiation in the neoadjuvant setting for all extremity sarcomas in which radiation therapy is planned, as neoadjuvant radiation has been shown to be associated with improved complete resection rates and functional outcomes. 18,21,28,29 It is perhaps not surprising that neoadjuvant radiation was not directly associated with improved survival in this study, given similar results shown in multiple other prospective trials in sarcoma. 8,11 Even so, the association demonstrated in this study between complete (R0) angiosarcoma resection and survival may be important, and is largely concordant with multiple prior studies which have demonstrated that margin negative resection is a prognostically significant outcome in sarcoma management.…”

“…Small institutional studies of head and neck angiosarcoma have shown a utility of radiotherapy with improvement in local control 15,16 and OS. 15,17 Neoadjuvant radiation (NRT) has gained increasing popularity in the management of soft tissue extremity sarcoma, with its potential advantages of improving rates of complete tumor resection 18 and function preservation. 19 To what extent neoadjuvant radiation is used for cutaneous and soft tissue angiosarcoma, and its impact on short-and long-term oncologic outcomes remain understudied.…”

Sarcomas in the groin and inguinal canal: A 16-year single-centre experience

“…This approach involves case-by-case multidisciplinary discussion, reimaging and offering a re-excision with curative intention when possible. Even though the use of neo-adjuvant radiotherapy has been described for previous incomplete resections 19 , our experience suggests that a wide excision leads to similar outcomes with patients that obtained clear margins in the first instance. We believe that the role of reconstructive surgery for the treatment of sarcomas is to facilitate these adequate oncological resections, by means of providing immediate resurfacing of the resulting large defects.…”

Effect of Favorable Pathologic Response After Neoadjuvant Radiation Therapy Alone in Soft-tissue Sarcoma

“…Nevertheless, the use of PN as a clinically meaningful surrogate is controversial, because other investigators have found no association between pathologic response and oncologic outcomes, 11 , 12 , 13 even when stratified with the endpoints of PN ≥95% 14 , 15 , 16 or ≥80%. 17 However, these series were limited by smaller sample sizes and confounded by a number of patients receiving concurrent chemotherapy.…”