Preoperative radiotherapy for soft tissue sarcoma: The Peter MacCallum Cancer Centre experience
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
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Cited by (28)
Intraoperative radiation therapy (IORT) for soft tissue sarcoma – ESTRO IORT Task Force/ACROP recommendations
2020, Radiotherapy and OncologyCitation Excerpt :The series reported by Tinkle et al. found 58% in recurrent cases [28]. Those results seem at least equal to major non-IORT series, reporting 5-year LC rates of 83–93% [11,39–47], especially considering the higher proportions of patients with unfavourable prognostic factors in the IORT series [4]. Aside from direct oncological outcomes, IORT-containing approaches result consistently in very high limb preservation rates (81–100%) [4,26,27–31,33,35–37] with good functional outcome (59–100%) [4,27–29,33,35,36].
Differences in recurrence and survival of extremity liposarcoma subtypes
2018, European Journal of Surgical OncologyCitation Excerpt :Radiotherapy has proven to be effective in preventing LR in LPS patients, as shown in this study in WDLPS, as well as in literature in all LPS subtypes, and especially in MLPS [7,20–25]. Nevertheless, radiotherapy has some well-known, serious side effects and disadvantages, such as wound complications, fibrosis, pathological fractures, functional impairment, oedema and secondary tumours [26–33]. The results of this study point out that radiotherapy as a local therapy should be applied very selectively, for example only in those patients in whom a possible local recurrence will lead to treatment issues and in whom re-resection is not feasible, so that the risk of having a LR should be minimized.
Intraoperative electron radiation therapy combined with external beam radiation therapy and limb sparing surgery in extremity soft tissue sarcoma: A retrospective single center analysis of 183 cases
2016, Radiotherapy and OncologyCitation Excerpt :These assumptions are, at least in part, supported by our results. We observed a postoperative complication rate of 19%, which is similar to series using postoperative EBRT alone [6] and compares favorably with series using preoperative EBRT [6,21] underlining that the use of an IOERT boost does not increase the wound complication rate [46]. Moreover, the rate of acute radiation-related side effects was very low and compares favorably with series using postoperative EBRT alone [25], which is probably related to the reduced EBRT doses, at least by omitting the external boost.
Preoperative hypofractionated radiotherapy in the treatment of localized soft tissue sarcomas
2014, European Journal of Surgical OncologyWound complications in preoperatively irradiated soft-tissue sarcomas of the extremities
2013, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :Cannon et al (2006) (8) retrospectively evaluated the experience at MD Anderson Cancer Center with preoperatively irradiated STS and found an acute wound complication rate of 34% for 269 patients with preoperatively irradiated STS. Another smaller study of 48 patients found a wound complication rate of 41% and a secondary operation rate of 18% with a similar definition of wound complication (11). Temple et al (2007) (12) reported a favorable 11% rate of secondary operation, but this study included only upper-extremity tumors, which were typically smaller, and patients only received 30 Gy in 10 fractions preoperatively.
Disparity in limb-salvage surgery among sarcoma patients
2010, American Journal of Surgery