Radiological progression of extremity soft tissue sarcoma following preoperative radiotherapy predicts for poor survival

2021 ◽  
Author(s):  
Christian Isaac ◽  
John Kavanagh ◽  
Anthony Michael Griffin ◽  
Colleen I Dickie ◽  
Rakesh Mohankumar ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Local Control ◽  
Preoperative Radiotherapy ◽  
Multivariable Analysis ◽  
Group Versus ◽  
Soft Tissue Sarcomas ◽  
Preoperative Radiation ◽  
Radiological Response ◽  
Post Radiation ◽  
Response Groups

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.

Soft Tissue Sarcomas of the Extremities: Improved Local Control and Limb Preservation with Preoperative Radiation and Doxorubicin

1997 ◽  
Vol 10 (1) ◽  
pp. 5-8
Author(s):  
John S. Bradfield ◽  
R. Pickett Scruggs ◽  
Wynne M. Snoots ◽  
John C. O'Brien ◽  
Z. H. Lieberman ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Local Control ◽  
Soft Tissue Sarcomas ◽  
Preoperative Radiation ◽  
Limb Preservation

Preoperative radiation in soft tissue sarcomas

1998 ◽  
Vol 42 (1) ◽  
pp. 383
Author(s):  
Edward W. Kiggundu ◽  
Barbara Buis ◽  
H.J. Mankin ◽  
M.C. Gebhardt ◽  
A.E. Rosenberg ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcomas ◽  
Preoperative Radiation

scholarly journals Preoperative Radiation Therapy Followed by Reexcision May Improve Local Control and Progression-Free Survival in Unplanned Excisions of Soft Tissue Sarcomas of the Extremity and Chest-Wall

2016 ◽  
Vol 2016 ◽  
pp. 1-8
Author(s):  
Hina Saeed ◽  
David M. King ◽  
Candice A. Johnstone ◽  
John A. Charlson ◽  
Donald A. Hackbarth ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Proportional Hazards Model ◽  
Performance Status ◽  
Soft Tissue Sarcomas ◽  
Progression Free Survival ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Preoperative Radiation ◽  
Free Survival ◽  
Unplanned Excision

Background. The management for unplanned excision (UE) of soft tissue sarcomas (STS) has not been established. In this study, we compare outcomes of UE versus planned excision (PE) and determine an optimal treatment for UE in STS.Methods. From 2000 to 2014 a review was performed on all patients treated with localized STS. Clinical outcomes including local recurrence-free survival (LRFS), progression-free survival (PFS), and overall survival (OS) were evaluated using the Kaplan-Meier estimate. Univariate (UVA) and multivariate (MVA) analyses were performed to determine prognostic variables. For MVA, Cox proportional hazards model was used.Results. 245 patients were included in the analysis. 14% underwent UE. Median follow-up was 2.8 years. The LR rate was 8.6%. The LR rate in UE was 35% versus 4.2% in PE patients (p<0.0001). 2-year PFS in UE versus PE patients was 4.2 years and 9.3 years, respectively (p=0.08). Preoperative radiation (RT) (p=0.01) and use of any RT for UE (p=0.003) led to improved PFS. On MVA, preoperative RT (p=0.04) and performance status (p=0.01) led to improved PFS.Conclusions. UEs led to decreased LC and PFS versus PE in patients with STS. The use of preoperative RT followed by reexcision improved LC and PFS in patients who had UE of their STS.

Influence of the Interval Between Preoperative Radiation Therapy and Surgery on Downstaging and on the Rate of Sphincter-Sparing Surgery for Rectal Cancer: The Lyon R90-01 Randomized Trial

1999 ◽  
Vol 17 (8) ◽  
pp. 2396-2396 ◽  
Author(s):  
Yves Francois ◽  
Chantal J. Nemoz ◽  
Jacques Baulieux ◽  
Jacques Vignal ◽  
Jean-Paul Grandjean ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Preoperative Radiotherapy ◽  
Short Interval ◽  
Group Versus ◽  
Optimal Timing ◽  
Preoperative Irradiation ◽  
Preoperative Radiation ◽  
Term Survival ◽  
Group V

PURPOSE: The optimal timing of surgery after preoperative radiotherapy in rectal cancer is unknown. The aim of this trial was to evaluate the role of the interval between preoperative radiotherapy and surgery. PATIENTS AND METHODS: Patients with rectal carcinoma accessible to rectal digital examination, staged T2 to T3, NX, M0, were randomized before radiotherapy (39 Gy in 13 fractions) into two groups: in the short interval (SI) group, surgery had to be performed within 2 weeks after completion of radiation therapy, compared with 6 to 8 weeks in the long interval (LI) group. Between 1991 and 1995, 201 patients were enrolled onto the study. RESULTS: A long interval between preoperative radiotherapy and surgery was associated with a significantly better clinical tumor response (53.1% in the SI group v 71.7% in the LI group, P = .007) and pathologic downstaging (10.3% in the SI group v 26% in the LI group, P = .005). At a median follow-up of 33 months, there were no differences in morbidity, local relapse, and short-term survival between the two groups. Sphincter-preserving surgery was performed in 76% of cases in the LI group versus 68% in the SI group (P = 0.27). CONCLUSION: A long interval between preoperative irradiation and surgery provides increased tumor downstaging with no detrimental effect on toxicity and early clinical results. When sphincter preservation is questionable, a long interval may increase the chance of a successful sphincter-saving surgery.

Local Control after Perfusion, Surgery and Perioperatory Radiation Therapy in Limb Soft Tissue Sarcomas

2002 ◽  
Vol 88 (4) ◽  
pp. S14-S14
Author(s):  
G Scarzello ◽  
R Mazzarotto ◽  
MS Buzzaccarini ◽  
A Franchi ◽  
L Pilati ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Soft Tissue ◽  
Local Control ◽  
Soft Tissue Sarcomas

Neoadjuvant chemotherapy for adult soft tissue sarcomas: A phase II trial.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 10069-10069
Author(s):  
Samuel Aguiar ◽  
Fabio Oliveira Ferreira ◽  
Ranyell Spencer Sobreira Batista ◽  
Alexsander Kurowa Bressan ◽  
Celso Lopes Mello ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Neoadjuvant Chemotherapy ◽  
Phase Ii ◽  
Soft Tissue Sarcomas ◽  
Pathological Response ◽  
Amputation Rate ◽  
Wound Complications ◽  
Complication Rates ◽  
Preoperative Radiation ◽  
Chemotherapeutic Regimen

10069 Background: Treatment of soft tissue sarcomas (STS) is characterized by high rates of local control, but poor overall survival because of distant relapses and high rates of wound complications, when preoperative radiation is used. The objective of this study was to test the effectiveness of a protocol with neoadjuvant chemotherapy for STS. Methods: A phase II single-arm prospective trial was carried out. Only adult patients with high grade extremity lesions and tumors deep and larger than 5 cm were included. A total of four cycles of chemotherapy was administered pre-operatively. The chemotherapeutic regimen was: ifosfamide – total of 9.0 g/m2 per cycle, infused in 2 hours from Day 1 to Day 5 (1.8 mg/m2/day). Half of the equivalent dose of mesna was infused 15 min pre-ifosfamide and 4 hours post-ifosfamide. Doxorubicin – total of 60mg/m2 per cycle, was infused in bolus on Day 1. Filgrastima 300 mcg, SC, was administered after the last dose of chemotherapy for 5 days. Radiation was given after surgery. Toxicity was classified by the NIH Toxicity Criteria and response was determined by the RECIST criteria. The others endpoints were the amputation and the wound-related complication rates. Results: Between January, 2005 and May, 2011, 42 patients were included. 21(50%) patients have completed the 4 cycles. Nineteen patients (45.2%) have grade 3 or 4 toxicity, and one (2.3%) death related to treatment had occurred. Between severe complications, febrile neutropenia was the most frequent. By using the RECIST criteria, we observed 10(24.5%) cases of progression, 24(58.5%) cases of stable disease, and 7(17%) partial responses. No complete clinical or radiological response was observed. In the pathological analysis of the surgical specimens, 4(9.7%) cases showed no residual disease (complete pathological response), and a total of 6 (14.6%) showed ≤ 5% of viable residual cells. The amputation rate was 4.8% (2 cases) and complications related to the wound were observed in 9 patients (21.9%). Conclusions: The protocol showed a good rate of objective and pathological response, low rate of complications related to the operative wound, and maintained an acceptable amputation rate. On the other hand, we observed high rate of progression, by RECIST criteria.

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