The effect of preoperative radiotherapy on surgical resectability, tumor volume and the necrosis rate of soft tissue sarcomas: A retrospective single-center analysis

Objectives: To determine if radiological response to preoperative radiotherapy is related to oncologic outcome in patients with extremity soft tissue sarcomas (STS). Methods: 309 patients with extremity STS who underwent preoperative radiation and wide resection were identified from a prospective database. Pre-and post-radiation MRI scans were retrospectively reviewed. Radiological response was defined by the modified Response Evaluation Criteria in Solid Tumours (RECIST).Local recurrence-free (LRFS), metastasis-free (MFS) and overall survival (OS) were compared across response groups. Results: Tumour volume decreased in 106 patients (34.3%; PR- Partial Responders), remained stable in 97 (31.4%; SD- Stable Disease), increased in 106 (34.3%; PD- Progressive Disease). The PD group were older (p = 0.007), had more upper extremity (p = 0.03) and high grade tumours (p < 0.001). 81% of myxoid liposarcomas showed substantial decrease in size. There was no difference in initial tumour diameter (p = 0.5), type of surgery (p = 0.5), margin status (p = 0.4), or complications (p = 0.8) between the three groups. There were ten (3.2%) local recurrences with no differences between the three response groups (p = 0.06). Five-year MFS was 52.1% for the PD group versus 73.8 and 78.5% for the PR and SD groups respectively (p < 0.001). OS was similar (p < 0.001). Following multivariable analysis, worse MFS and OS were associated with higher grade, larger tumour size at diagnosis and tumour growth following preoperative radiation. Older age was also associated with worse OS. Conclusion: STS that enlarge according to RECIST criteria following preoperative radiotherapy identify a high risk group of patients with worse systemic outcomes but equivalent local control. Advances in knowledge: Post radiation therapy, STS enlargement may identify patients with potential for worse systemic outcomes but equivalent local control. Therefore, adjunct therapeutic approaches could be considered in these patients.

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Preoperative radiotherapy of soft-tissue sarcomas: surgical and radiologic parameters associated with local control and survival

Clinical Sarcoma Research ◽

10.1186/s13569-018-0106-x ◽

2018 ◽

Vol 8 (1) ◽

Cited By ~ 4

Author(s):

Panagiotis Tsagozis ◽

Otte Brosjö ◽

Mikael Skorpil

Keyword(s):

Soft Tissue ◽

Local Control ◽

Preoperative Radiotherapy ◽

Soft Tissue Sarcomas

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Fluorescence-guided visualization of soft tissue sarcomas by targeting vascular endothelial growth factor-A: a phase 1 single-center clinical trial

Journal of Nuclear Medicine ◽

10.2967/jnumed.120.245696 ◽

2020 ◽

pp. jnumed.120.245696

Author(s):

Pieter Jan Steinkamp ◽

Bobby Klaas Pranger ◽

Meifang Li ◽

Matthijs D Linssen ◽

Floris Jan Voskuil ◽

...

Keyword(s):

Clinical Trial ◽

Vascular Endothelial Growth Factor ◽

Growth Factor ◽

Soft Tissue ◽

Phase 1 ◽

Soft Tissue Sarcomas ◽

Vascular Endothelial ◽

Single Center ◽

Endothelial Growth Factor

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RTOG Sarcoma Radiation Oncologists Reach Consensus on Gross Tumor Volume (GTV) and Clinical Target Volume (CTV) on Computed Tomography Images for Preoperative Radiotherapy of Primary Soft Tissue Sarcoma of Extremity in RTOG Studies

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2010.07.233 ◽

2010 ◽

Vol 78 (3) ◽

pp. S87 ◽

Cited By ~ 1

Author(s):

T.F. DeLaney ◽

W.R. Bosch ◽

D. Roberge ◽

S.E. Finkelstein ◽

I.A. Petersen ◽

...

Keyword(s):

Computed Tomography ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Gross Tumor Volume ◽

Clinical Target Volume ◽

Tumor Volume ◽

Preoperative Radiotherapy ◽

Target Volume ◽

Computed Tomography Images ◽

Radiation Oncologists

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Prognostic Factors in Extremity Soft Tissue Sarcoma Patients Treated with Preoperative Radiotherapy

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol04-i03/579 ◽

2019 ◽

Vol 4 (03) ◽

Author(s):

Berrin Inanc, MD ◽

Kubilay Inanc, MD

Keyword(s):

Prognostic Factors ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Preoperative Radiotherapy ◽

Soft Tissue Sarcomas ◽

Tumor Grade ◽

Metastatic Recurrence ◽

Extremity Soft Tissue Sarcoma ◽

Metastatic Relapse

Purpose: The purpose of the study was to investigate the prognostic factors and survival after preoperative radiotherapy in Extremity Soft Tissue Sarcomas (ESTS). Materials and Methods: In this retrospective study, all patients treated for an extremity sarcoma with pre-operative radiotherapy followed by surgery. Results: The mean follow-up for all 24 ESTS patients was 15.5 (range: 10-39 months). At last follow-up, 9 patients (37%) were alive, 15 patients (62%) had died of distant disease progression. Among the patients died, there were 15 with metastatic relapse (13 lung and 2 cranial metastasis), 5 with both local and metastatic recurrence. The median OS was 16 month. The 2-years actuarial OS rate and 3-years OS rate were 39% and 26%, respectively. The median RFS was 14(12.5-15.4) month. The 2-years and 3-years RFS rate was 71%.The median MFS was 12 months. The 2-years and 3-years MFS rate were 33%, 17%, respectively. The effects of age, sex, histopathologic type, tumor size, tumor localization, tumor grade, tumor depth, radiation doses and recestion margin on OS, RFS, MFS were not observed. In univariate and multivariate model, it was observed that recurrence decreased OS time significantly (p<0.05). Conclusion: Recurrens and metastasis are strong and negative prognostic factor for survival in extremity soft tissue sarcoma patients.

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When SUV Matters: FDG PET/CT at Baseline Correlates with Survival in Soft Tissue and Ewing Sarcoma

Life ◽

10.3390/life11090869 ◽

2021 ◽

Vol 11 (9) ◽

pp. 869

Author(s):

Ruben I. Hack ◽

Anton S. Becker ◽

Beata Bode-Lesniewska ◽

G. Ulrich Exner ◽

Daniel A. Müller ◽

...

Keyword(s):

Soft Tissue ◽

Ewing Sarcoma ◽

Fdg Pet ◽

Tumor Volume ◽

Soft Tissue Sarcomas ◽

Standardized Uptake Value ◽

Short Survival ◽

Long Survival ◽

Pet Ct ◽

Bone Sarcomas

Introduction: The role of positron-emission tomography/computed-tomography (PET/CT) in the management of sarcomas and as a prognostic tool has been studied. However, it remains unclear which metric is the most useful. We aimed to investigate if volume-based PET metrics (Tumor volume (TV) and total lesions glycolysis (TLG)) are superior to maximal standardized uptake value (SUVmax) and other metrics in predicting survival of patients with soft tissue and bone sarcomas. Materials and Methods: In this retrospective cohort study, we screened over 52′000 PET/CT scans to identify patients diagnosed with either soft tissue, bone or Ewing sarcoma and had a staging scan at our institution before initial therapy. We used a Wilcoxon signed-rank to assess which PET/CT metric was associated with survival in different patient subgroups. Receiver-Operating-Characteristic curve analysis was used to calculate cutoff values. Results: We identified a total of 88 patients with soft tissue (51), bone (26) or Ewing (11) sarcoma. Median age at presentation was 40 years (Range: 9–86 years). High SUVmax was most significantly associated with short survival (defined as <24 months) in soft tissue sarcoma (with a median and range of SUVmax 12.5 (8.8–16.0) in short (n = 18) and 5.5 (3.3–7.2) in long survival (≥24 months) (n = 31), with (p = 0.001). Similar results were seen in Ewing sarcoma (with a median and range of SUVmax 12.1 (7.6–14.7) in short (n = 6) and 3.7 (3.5–5.5) in long survival (n = 5), with (p = 0.017). However, no PET-specific metric but tumor-volume was significantly associated (p = 0.035) with survival in primary bone sarcomas (with a median and range of 217 cm3 (186–349) in short survival (n = 4) and 60 cm3 (22–104) in long survival (n = 19), with (p = 0.035). TLG was significantly inversely associated with long survival only in Ewing sarcoma (p = 0.03). Discussion: Our analysis shows that the outcome of soft tissue, bone and Ewing sarcomas is associated with different PET/CT metrics. We could not confirm the previously suggested superiority of volume-based metrics in soft tissue sarcomas, for which we found SUVmax to remain the best prognostic factor. However, bone sarcomas should probably be evaluated with tumor volume rather than FDG PET activity.

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