Preoperative radiotherapy for soft tissue sarcoma: The Peter MacCallum Cancer Centre experience

https://doi.org/10.1016/j.ejso.2006.04.003Get rights and content

Abstract

Aim

Radiotherapy has been shown to improve local control in combination with limb-sparing or conservative surgery in the management of localised soft tissue sarcoma. Our centre's treatment protocol is to offer preoperative external beam radiotherapy (50.4 Gy in 28 fractions) followed by surgery four to six weeks later. The aim of this study is to review the treatment outcome and toxicity of patients treated with this protocol.

Methods

Consecutive patients with localised extremity or truncal soft tissue sarcoma who presented between January 1996 and December 2000 and treated with preoperative radiotherapy followed by limb-sparing surgery were reviewed. Patients with recurrent disease or metastatic disease at diagnosis and patients below the age of 16 years were excluded. Local and distant recurrence, overall survival and treatment toxicity were analyzed.

Results

Sixty-seven cases were identified (41 males and 26 females). The median age was 52 years (range 17 to 82). The majority (79%) had tumours located in the lower limb. The most common histological diagnoses were malignant fibrous histiocytoma and liposarcoma. The median follow-up was 4.1 years (range 0.6 to 6.9). There were six local recurrences, two of which were successfully salvaged. Twenty patients developed distant metastases. The estimated 5-year actuarial local recurrence free, distant recurrence free and overall survival were 93%, 68% and 73% respectively. Acute radiotherapy toxicity and wound complications were acceptable and late toxicity was uncommon.

Conclusion

Preoperative radiotherapy followed by surgery provides effective local control in the management of soft tissue sarcoma.

Introduction

Adjuvant radiotherapy has an established role in the management of localised soft tissue sarcoma. It improves local control while maximizing the potential for limb preserving surgery. Local control rates of over 80% have been reported for extremity sarcoma.1, 2, 3, 4 It remains controversial what the optimal timing of external beam radiotherapy is (preoperative versus postoperative).5, 6, 7 Our centre's policy is to use preoperative radiotherapy followed by surgical excision.

Patients who are referred to our centre with likely localised soft tissue sarcoma are assessed in a multidisciplinary clinic followed by thorough staging investigations including a magnetic resonance imaging (MRI) scan of the primary tumour site, computed tomography (CT) scan of the chest and functional imaging with Thallium-201 (and occasionally FDG-PET) nuclear scan. A histological diagnosis is then obtained through image guided needle biopsies. If a biopsy has been performed prior to referral, the histopathology is reviewed by our pathologists. Those suitable for combined modality treatment receive a course of preoperative radiotherapy followed by repeat staging investigations and then surgical excision of the tumour. Functional imaging is performed before and after radiotherapy to help to exclude metastatic disease and to assess tumour response following radiotherapy.8

The aim of this study is to review the treatment outcome and toxicity of patients with localised soft tissue sarcoma treated with this combined approach of preoperative radiotherapy followed by surgery at our centre.

Section snippets

Patients and endpoints

Patients who presented to the Peter MacCallum Cancer Centre between January 1996 and December 2000 with a localised extremity or truncal soft tissue sarcoma were identified from the hospital database. Patients with recurrent or metastatic disease, patients under the age of 16 years, and patients with head and neck or retroperitoneal sarcoma were excluded. Patients with the histological diagnoses of desmoid tumour and dermatofibrosarcoma protuberans were also excluded.

The medical records of all

Patient and tumour characteristics

Sixty-seven patients that fit the inclusion criteria were identified. The distribution of clinicopathologic characteristics is outlined in Table 1. The median age was 52 years (range 17 to 82) with a slight male predominance. The majority of tumours were located in the lower extremity and the most common primary site was the thigh. The median maximal tumour dimension was 6 cm (range 3 to 28 cm) based on preoperative imaging or clinical assessment if imaging was not performed prior to excision

Discussion

External beam radiotherapy in combination with limb-sparing or conservative surgery has an established role in the management of localised adult soft tissue sarcoma. Randomised evidence suggests that this combined modality treatment is equivalent (and therefore preferable) to a radical amputation in terms of disease-free and overall survival.10, 11 Another randomised trial shows improved local control with the addition of radiotherapy over limb-sparing surgery alone.1

The optimal timing of

References (21)

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