Preoperative Versus Postoperative Radiotherapy in Extremity Soft Tissue Sarcoma: A Changing Trend Towards Preoperative Radiotherapy in the UK

Panwar, Udaiveer; Sankaye, P

doi:10.1016/j.clon.2015.01.008

Cited by 11 publications

(9 citation statements)

References 4 publications

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“…The main argument against neoadjuvant RT is the elevated rate of surgery-related morbidity in terms of wound complications. This has been shown in several retrospective series, as well as in prospective trials randomizing pre-operative vs. post-operative RT [20–24]. However, the main arguments for pre-operative RT generally outweigh this risk.…”

Section: Discussionmentioning

confidence: 95%

Neoadjuvant image-guided helical intensity modulated radiotherapy of extremity sarcomas – a single center experience

et al. 2019

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BackgroundAdvanced radiotherapy (RT) techniques allow normal tissue to be spared in patients with extremity soft tissue sarcoma (STS). This work aims to evaluate toxicity and outcome after neoadjuvant image-guided radiotherapy (IGRT) as helical intensity modulated radiotherapy (IMRT) with reduced margins based on MRI-based target definition in patients with STS.MethodsBetween 2010 to 2014, 41 patients with extremity STS were treated with IGRT delivered as helical IMRT on a tomotherapy machine. The tumor site was in the upper extremity in 6 patients (15%) and lower extremity in 35 patients (85%). Reduced margins of 2.5 cm in longitudinal direction and 1.0 cm in axial direction were used to expand the MRI-defined gross tumor volume, including peritumoral edema, to the clinical target volume. An additional margin of 5 mm was added to receive the planning target volume. The full total dose of 50 Gy in 2 Gy fractions was sucessfully applied in 40 patients. Two patients received chemotherapy instead of surgery due to systemic progression. All patients were included into a strict follow-up program and were seen interdisciplinarily by the Departments of Orthopaedic Surgery and Radiation Oncology.ResultsThirty eight patients that received total RT total dose and subsequent resection were analyzed for outcome. After a median follow-up of 38.5 months cumulative OS, local PFS and systemic PFS at 2 years were determined at 78.2, 85.2 and 54.5%, respectively. Two of 6 local recurrences were proximal marginal misses. Negative resection margins were achieved in 84% of patients. The rate of major wound complications was comparable to previous IMRT studies with 36.8%. RT was overall tolerable with low toxicity rates.ConclusionsIMRT-IGRT offers neoadjuvant treatment for extremity STS with reduced safety margins and thus low toxicity rates. Wound complication rates were comparable to previously reported frequencies. Two reported marginal misses suggest a word of caution for reduction of longitudinal safety margins.Electronic supplementary materialThe online version of this article (10.1186/s13014-019-1207-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 95%

Neoadjuvant image-guided helical intensity modulated radiotherapy of extremity sarcomas – a single center experience

et al. 2019

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“…Pathological complete remission (pCR) was observed in ten cases (13%), near-total remission in 8 cases (11%), subtotal remission in 8 cases (11%) and partial remission in 34 cases (46%), whereas 14 patients (19%) showed a stable disease. Of those patients with pCR, five patients had an undifferentiated pleomorph sarcoma (50%), the rest consisted of liposarcoma (1), alveolar sarcoma (1), spindle cell sarcoma (1), fibroplastic sarcoma (1) and sarcoma NOS (1). Nine out of ten patients with a pCR had primarily undergone an incomplete tumor resection elsewhere.…”

Section: Clinical and Pathological Response To The Neoadjuvant Therapymentioning

confidence: 99%

“…Although neoadjuvant treatment modalities of STS of the extremities have become more and more popular over the last decade [1,2], little is known about the advantages of a combined radiochemotherapeutic approach. There have been few studies focused on this interaction to date.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Follow-Up of Patients Receiving Neoadjuvant Treatment Modalties for Soft Tissue Sarcomas of the Extremities

Rauch

Agaimy

Semrau

et al. 2021

Cancers

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Background: Neoadjuvant treatment modalities in soft tissue sarcoma (STS) of the extremities have become more popular in recent years, but because of the rarity and heterogeneity of STS, there are yet few studies on the long-term impact of neoadjuvant treatment modalities, especially in terms of neoadjuvant radiochemotherapy. Methods: The study enrolled 136 patients with primary STS of the extremities who underwent surgery with curative intent or neoadjuvant therapy, followed by surgery in a 15-year period. Neoadjuvant treatment consisted of radiotherapy (RT) with 60 Gy and in most cases simultaneous chemotherapy (CTx) with ifosfamide (1.5 g/m2/d, d1–5, q28) and doxorubicine (50 mg/m2/d, d3, q28). We investigated the clinical, (post)-operative and histopathological data and the oncological follow-up as well. The median follow-up period was 82 months (range 6–202). Results: A total of 136 patients (M:F = 73:63) with a mean age of 62 years (range; 21–93) was observed. Seventy-four patients (54.4%) received neoadjuvant therapy (NT), 62 patients (45.6%) received primary surgery (PS). When receiving NT, patients with high-risk STS had a lower risk to develop distant metastasis (p = 0.025). Age, histological type, tumor size and surgical margins (R0 vs. R1) had no influence on any survival rates. There was an association between NT and the occurrence of postoperative complications (p = 0.001). The 5-year local recurrence free survival (LRFS), metastasis free survival (MFS), disease free survival (DFS) and overall survival (OS) rate of the whole cohort was 89.9%, 77.0%, 70.6% and 72.6%; whereas the 5-year LRFS, MFS, DFS and OS rate was 90.5%, 67.2%, 64.1% and 62.8% for the NT group and 89.5%, 88.3%. 78.4% and 83.8% for the PS group. Conclusion: Multimodal treatment strategies in patients with STS of extremities lead to excellent oncological outcomes. Patients with high-risk STS had a significantly better MFS when receiving NT than patients with low-risk STS. NT was associated with a higher probability of postoperative but well-manageable complications.

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“…In most centres, external radiation therapy is used postoperatively, as it does not require postponing surgery and eliminates the residual disease after surgery. In addition, the pathology sample and surgical margins will be at the disposal of the pathologist for detailed examination [7,8]. This method provides the best local control, but since target therapy is not specifically defined, the treatment should be administered with higher dose and greater volume, which leads to physical disability and reduced quality of life [9].…”

Section: Mini Reviewmentioning

confidence: 99%

Neoadjuvant Radiotherapy for Soft Tissue Sarcoma

Mirkazemi¹

2018

BJSTR

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Preoperative Versus Postoperative Radiotherapy in Extremity Soft Tissue Sarcoma: A Changing Trend Towards Preoperative Radiotherapy in the UK

Cited by 11 publications

References 4 publications

Neoadjuvant image-guided helical intensity modulated radiotherapy of extremity sarcomas – a single center experience

Neoadjuvant image-guided helical intensity modulated radiotherapy of extremity sarcomas – a single center experience

Long-Term Follow-Up of Patients Receiving Neoadjuvant Treatment Modalties for Soft Tissue Sarcomas of the Extremities

Neoadjuvant Radiotherapy for Soft Tissue Sarcoma

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