Neoadjuvant radiation improves margin-negative resection rates in extremity sarcoma but not survival.
Adolescent
Adult
Aged
Aged, 80 and over
Bone Neoplasms
/ mortality
Databases, Factual
Extremities
/ pathology
Female
Humans
Limb Salvage
/ methods
Male
Margins of Excision
Middle Aged
Neoadjuvant Therapy
Neoplasm Recurrence, Local
/ mortality
Radiotherapy, Adjuvant
Retrospective Studies
Sarcoma
/ mortality
Soft Tissue Neoplasms
/ mortality
Survival Rate
United States
/ epidemiology
Young Adult
extremity
margins
radiation therapy
sarcoma
survival
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
received:
13
02
2020
accepted:
16
02
2020
pubmed:
2
4
2020
medline:
11
6
2020
entrez:
2
4
2020
Statut:
ppublish
Résumé
Radiation improves limb salvage in extremity sarcomas. Timing of radiation therapy remains under investigation. We sought to evaluate the effects of neoadjuvant radiation (NAR) on surgery and survival of patients with extremity sarcomas. A multi-institutional database was used to identify patients with extremity sarcomas undergoing surgical resection from 2000-2016. Patients were categorized by treatment strategy: surgery alone, adjuvant radiation (AR), or NAR. Survival, recurrence, limb salvage, and surgical margin status was analyzed. A total of 1483 patients were identified. Most patients receiving radiotherapy had high-grade tumors (82% NAR vs 81% AR vs 60% surgery; P < .001). The radiotherapy groups had more limb-sparing operations (98% AR vs 94% NAR vs 87% surgery; P < .001). NAR resulted in negative margin resections (90% NAR vs 79% surgery vs 75% AR; P < .0001). There were fewer local recurrences in the radiation groups (14% NAR vs 17% AR vs 27% surgery; P = .001). There was no difference in overall or recurrence-free survival between the three groups (OS, P = .132; RFS, P = .227). In this large study, radiotherapy improved limb salvage rates and decreased local recurrences. Receipt of NAR achieves more margin-negative resections however this did not improve local recurrence or survival rates over.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Radiation improves limb salvage in extremity sarcomas. Timing of radiation therapy remains under investigation. We sought to evaluate the effects of neoadjuvant radiation (NAR) on surgery and survival of patients with extremity sarcomas.
MATERIALS AND METHODS
METHODS
A multi-institutional database was used to identify patients with extremity sarcomas undergoing surgical resection from 2000-2016. Patients were categorized by treatment strategy: surgery alone, adjuvant radiation (AR), or NAR. Survival, recurrence, limb salvage, and surgical margin status was analyzed.
RESULTS
RESULTS
A total of 1483 patients were identified. Most patients receiving radiotherapy had high-grade tumors (82% NAR vs 81% AR vs 60% surgery; P < .001). The radiotherapy groups had more limb-sparing operations (98% AR vs 94% NAR vs 87% surgery; P < .001). NAR resulted in negative margin resections (90% NAR vs 79% surgery vs 75% AR; P < .0001). There were fewer local recurrences in the radiation groups (14% NAR vs 17% AR vs 27% surgery; P = .001). There was no difference in overall or recurrence-free survival between the three groups (OS, P = .132; RFS, P = .227).
CONCLUSION
CONCLUSIONS
In this large study, radiotherapy improved limb salvage rates and decreased local recurrences. Receipt of NAR achieves more margin-negative resections however this did not improve local recurrence or survival rates over.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1249-1258Informations de copyright
© 2020 Wiley Periodicals, Inc.
Références
Siegel RI, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65:5-29.
Burningham Z, Hashibe M, Spector L, Schiffman JD. The epidemiology of sarcoma. Clin Sarcoma Res. 2012;2:14. https://doi.org/10.1186/2045-3329-2-14
von Mehren M, Lor Randall R, DeLaney T, et al. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Soft Tissue Sarcoma. 2014;2.2014:126.
Tran QNH, Kim AC, Gottschalk AR, et al. Clinical outcomes of intraoperative radiation therapy for extremity sarcomas. Sarcoma. 2006;2006(1):91671-91676.
Rosenberg SA, Tepper J, Glatstein E, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg. 1982;196:305-315.
Gutierrez JC, Perez EA, Franceschi D, Moffat FL, Livingstone AS, Koniaris LG. Outcomes for soft-tissue sarcoma in 8249 cases from a large state cancer registry. J Surg Res. 2007;141:105-114.
Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16(1):197-203.
O'Sullivan B, Davis AM, Turcotte R, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomized trial. Lancet. 2002;359(9325):2235-2241.
Koshy M, Rich SE, Mohiuddin MM. Improved survival with radiation therapy in high-grade soft tissue sarcoma of the extremities: a SEER analysis. Int J Radiat Oncol Biol Phys. 2010;77:203-209.
Beane JD, Yang JC, White D, Steinberg SM, Rosenberg SA, Rudloff U. Efficacy of adjuvant radiation therapy in the treatment of soft tissue sarcoma of the extremity: 20-year follow-up of a randomized prospective trial. Ann Surg Oncol. 2014;21(8):2484-2489.
Gronchi A. Individualizing the use/non-use of radiation therapy (RT) in soft tissue sarcoma (STS): When abstention is better than care. J Surg Oncol. 2015;111:133-134.
Tiong SS, Dickie C, Haas RL, O'Sullivan B. The role of radiotherapy in the management of localized soft tissue sarcomas. Cancer Biol Med 2016;13(3):373-383. https://doi.org/10.20892/j.issn.2095-3941.2016.0028
Mahmoud O, Tunceroglu A, Chokshi R, et al. Overall survival advantage of chemotherapy and radiotherapy in the perioperative management of large extremity and trunk soft tissue sarcoma; a large database analysis. Radiother Oncol. 2017;124:277-284.
Baldini EH, Raut C. Radiation therapy for extremity soft tissue sarcoma: in the absence of a clear survival benefit, why do we give it? Ann Surg Oncol. 2014;21(8):2463-2465.
Larrier NA, Czito BG, Kirsch DG. Radiation therapy for soft tissue sarcoma: indications and controversies for neoadjuvant therapy, adjuvant therapy, intraoperative radiation therapy, and brachytherapy. Surg Oncol Clin N Am. 2016;25:841-860.
Nathenson MJ, Sausville E. Looking for answers: the current status of neoadjuvant treatment in localized soft tissue sarcomas. Cancer Chemother Pharmacol. 2016;78:895-919. https://doi.org/10.1007/s00280-016-3055-1
Davis LE, Ryan CW. Preoperative therapy for extremity soft tissue sarcomas. Curr Treat Options Oconcol. 2015;16:25.
Karakousis CP, Driscoll DL. Treatment and local control of primary extremity soft tissue sarcomas. J Surg Oncol. 1999;71:155-161.
O'Sullivan B, Davis A, Turcotte R, et al. Five-year results of a randomized phase III trial of pre-operative vs post-operative radiotherapy in extremity soft tissue sarcoma. J Clin Oncol. 2004;22:9007.
Zagars GK, Ballo MT, Pisters PW, et al. Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy. Cancer. 2003;97:2530-2543.
Gronchi A, Miceli R, Fiore M, et al. Extremity soft tissue sarcoma: adding to the prognostic meaning of local failure. Ann Surg Oncol. 2007;14:1583-1590.
Eilber FC, Rosen G, Nelson SD, et al. High-grade extremity soft tissue sarcomas: factors predictive of local recurrence and its effect on morbidity and mortality. Ann Surg. 2003;237:218-226.
Grimer RJ. Size matters for sarcomas! Ann R Coll Surg Engl. 2006;88(6):519-524.
Zagars GK, Ballo MT, Pisters PWT, Pollock RE, Patel SR, Benjamin RS. Surgical margins and resection in the management of patients with soft tissue sarcoma using conservative surgery and radiation therapy. Cancer. 2003;97:2544-2553.
Pisters PW, Leung DH, Woodruff J, Shi W, Brennan MF. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol. 1996;14(5):1679-1689.
Gingrich AA, Bateni SB, Monjazeb AM, et al. Neoadjuvant radiotherapy is associated with R0 resection and improved survival for patients with extremity soft tissue sarcoma undergoing surgery: a national cancer database analysis. Ann Surg Oncol. 2017;24:3252-3263.
Coindre J, Terrier P, Guillou L, et al. Predictive value of grade for metastasis development in the main histologic types of adult soft tissue sarcomas. Cancer. 2001;91:1914-1926.
Verschoor AJ, Litière S, Marréaud S, et al. Prognostic relevance of distant metastases versus locally advanced disease in soft tissue sarcomas: an EORTC-STBSG database study. Eur J Cancer. 2018 May;94:187-198.
Bujko K, Suit HD, Springfield DS, Convery K. Wound healing after preoperative radiation for sarcoma of soft tissues. Surg Gynecol Obstet. 1993;176(2):124-134.
Peat BG, Bell RS, Davis A, et al. Wound-healing complications after soft-tissue sarcoma surgery. Plast Reconstr Surg. 1994;93:980-987.
Cannon CP, Ballo MT, Zagars GK, et al. Complications of combined modality treatment of primary lower extremity soft-tissue sarcomas. Cancer. 2006;107:2455-2461.
Davis A, Osullivan B, Turcotte R, et al. Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma. Radiother Oncol. 2005;75:48-53.
Townley WA, Mah E, O'Neill AC, et al. Reconstruction of sarcoma defects following pre-operative radiation: free tissue transfer is safe and reliable. J Plast Reconstr Aesthetic Surg. 2013;66:1575-1579.