Background
Neoadjuvant radiotherapy (RT) is increasingly advocated in the management of soft tissue sarcoma (STS). Therefore, we sought to characterize the impact of neoadjuvant RT on rates of R0 resection and overall survival (OS) in extremity STS patients undergoing surgery.
Methods
From January 2003 to December 2012, we identified patients with a diagnosis of extremity STS from the National Cancer Database. After excluding patients with age < 18 years, not undergoing surgery, metastases at diagnosis, intraoperative RT, and missing/unknown data, we identified 27,969 patients. Using logistic regression and Cox-proportional hazard analysis, we compared rates of R0 resection among preoperative, postoperative and no RT cohorts and determined predictors of R0 resection and OS.
Results
The mean age was 59.5 (±17.1) years, and 45.9% were female. Median tumor size was 10.5cm. 51% of patients did not receive RT, 11.8% received pre-operative RT and 37.2% received post-operative RT. Rates of R0 resection for preoperative RT, postoperative RT, and no RT cohorts were 90.1%, 74.9%, and 79.9%, respectively (P<0.001). Independent predictors of achieving R0 resection included academic facility type (OR 1.36, 95% CI 1.20-1.55), histologic subtype, tumor size (OR 0.99, 95% CI 0.99-0.99), Charlson score (OR 0.92, 95% CI 0.84 – 0.99), and preoperative RT (OR 1.83, 95% CI 1.61-2.07). R0 resection as well as RT (pre-operative or post-operative) was associated with increased OS.
Conclusions
Pre-operative RT independently predicts higher rates of R0 resection in patients with extremity STS undergoing surgical resection. Negative surgical margins and pre-operative or post-operative RT are associated with improved OS.