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

Abstract

Background: To assess the long term clinical outcome of preoperative radiotherapy with or without chemotherapy followed by limb sparing surgery in patients with non-metastatic soft tissue sarcomas (STS) of the extremities. Materials and Methods: Sixty patients with locally advanced STS were retrospectively analyzed. The median tumor diameter was 12 cm. All patients were treated with preoperative radiotherapy delivered with two different fractionation schedules (35Gy/10fr or 46-50Gy/23-25fr). Neoadjuvant chemotherapy was added to 44 patients with large and/or high grade tumors. Surgery was performed 2-6 weeks after radiotherapy. Chemotherapy was completed up to 6 courses after surgery in patients who had good responses. Results: Median follow-up time was 67 months (8-268 months). All of the patients had limb sparing surgery. The 5-year local control (LC), disease free (DFS) and overall survival (OSS) rates for all of the patients were 81%, 48.1% and 68.3% respectively. 5-year LC, DFS and cause specific survival (CSS) were 81.7%, 47%, 69.8%, and 80%, 60%, 60% in the chemoradiotherapy and radiotherapy groups, respectively. On univariate analysis, patients who were treated with hypofractionation experienced significantly superior LC, DFS and CSS rates with similar rates of late toxicity when compared with patients who were treated with conventional fractionation and statistical significance was retained on multivariate analysis. Conclusions: Treatment results are consistent with the literature. As neoadjuvant chemoradiotherapy provides effective LC and CSS with acceptable morbidity, it should be preferred for patients with large and borderline resectable STS.

Prognostic Factors in Extremity Soft Tissue Sarcomas Treated with Radiotherapy: Systematic Review of the Literature

“…When specified, the interval between surgery and postoperative RT was between 3 and 6 weeks in most of the studies [ 24 , 28 , 34 , 37 , 45 , 47 , 48 ]. The interval between preoperative RT and surgery varied from 10 days to 6 weeks [ 29 , 30 , 34 , 44 , 46 ].…”

“…Three-dimensional conformal radiotherapy (3D-CRT) was used for all patients in two studies [ 25 , 41 ]. McGee et al, Roeder et al, and Dincbas et al used 3D-CRT after 1993, 1995, 2000, respectively [ 36 , 37 , 46 ]. One study used 2D-RT, 3D-CRT and intensity-modulated radiotherapy (IMRT) [ 38 ].…”

“…Two studies used brachytherapy (BRT) [ 28 , 40 ]. Three studies [ 26 , 33 , 47 ] used external beam radiation therapy (EBRT) with photons only, four [ 24 , 29 , 36 , 41 ] combined photons and electrons, four used cobalt 60 and photons [ 25 , 42 , 46 , 48 ] and one did not specify [ 34 ].…”

(Neo)adjuvant chemotherapy and interdigitated split-course hyperfractionated radiation in high risk soft tissue sarcoma – Results from a large single-institution series

“…18 1986–200244A 30 mg × 1 3 days30/3 or 33/1.65 × 2preS4596 (5)68 (5)73 (5)11Dincbas et al . 27 1989–200744IA × 635/3.5 or 46–50/2preSNA82 (5)47 (5)70 (5)30Mantravadi et al . 19 NA32A 10 mg/m 2 i.a.…”

“…RT fraction size and preoperative treatment are probably important factors for the risk of developing local complications. In five neoadjuvant studies using hypofractionation (single dose >3 Gy) wound complications requiring intervention were frequent (11–29%) 12,15,25,27,28 . On the other hand, in three neoadjuvant trials with smaller than conventional RT fraction size (<2 Gy) wound complications were very rare 23,29,39 .…”