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External Beam Radiation Therapy for Resectable Soft Tissue Sarcoma: A Systematic Review and Meta-Analysis

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to evaluate the role of preoperative and postoperative external beam radiation therapy (EBRT) in the treatment of resectable soft tissue sarcomas (STSs) of different tumor locations.

Methods

A systematic literature search was performed to identify studies investigating the effects of EBRT (versus no EBRT) on local recurrence (LR) and overall survival (OS) or comparing different EBRT sequences. Random effects meta-analyses were calculated and presented as cumulative odds ratios (ORs).

Results

Sixteen studies (n = 3958 patients) comparing EBRT versus no EBRT, including one randomized controlled trial (RCT) in extremity sarcoma, were analyzed. EBRT appeared to reduce LR in both retroperitoneal tumors (OR 0.47, p < 0.0001) and other locations (OR 0.49, p = 0.001). OS was improved by EBRT in retroperitoneal STSs (OR 0.37, p < 0.0001) but not in other tumor locations. Eleven studies (n = 2140), including one RCT, compared preoperative and postoperative radiotherapy. LR was less frequent following preoperative EBRT in retroperitoneal STSs (OR 0.03, p = 0.02), as well as in other tumor locations (OR 0.67, p = 0.01), while wound complications in extremity sarcoma were more frequent following preoperative EBRT (OR 2.92, p < 0.0001). Several studies included in this meta-analysis bear a high risk of bias and no RCT has been published for retroperitoneal STS.

Conclusions

This meta-analysis supports the use of EBRT for local tumor control in patients with resectable STSs. Based on a small number of non-randomized studies, a positive effect on OS may exist in the subgroup of retroperitoneal STSs.

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Acknowledgments

The authors thank Maud Toulmonde (Department of Medical Oncology, Institut Bergonié, Bordeaux, France), Linn Trovik (Department of Oncology, Haukeland University Hospital, Bergen, Norway), and Philippe Cassier (Department of Medical Oncology, Centre Léon Bérard, Lyon, France) for providing unpublished data. The authors also thank Eberhard Stoeckle (Department of Surgery, Institut Bergonié, Bordeaux, France) for reviewing the manuscript.

Funding

The costs of this study were paid for by regular hospital funds. The authors did not receive financial support from government or private institutions for this study.

Conflict of interest

Markus Albertsmeier, Alexandra Rauch, Falk Roeder, Sandro Hasenhütl, Sebastian Pratschke, Michaela Kirschneck, Alessandro Gronchi, Nina L. Jebsen, Philippe A. Cassier, Paul Sargos, Claus Belka, Lars H. Lindner, Jens Werner, and Martin K. Angele report no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, Ludwig Maximilian University Hospital, Marchioninistr. 15, 81377, Munich, Germany

    Markus Albertsmeier MD, Sandro Hasenhütl MD, Sebastian Pratschke MD, Jens Werner MD & Martin K. Angele MD

  2. Department of Medical Informatics, Biometry and Epidemiology—IBE, Research Unit for Biopsychosocial Health, Chair for Public Health and Health Care Research, Ludwig Maximilian University, Munich, Germany

    Alexandra Rauch MPH & Michaela Kirschneck

  3. Department of Radiation Oncology, Ludwig Maximilian University Hospital, Ludwig-Maximilians-University, Munich, Germany

    Falk Roeder MD & Claus Belka MD

  4. Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Alessandro Gronchi MD

  5. Department of Oncology, Musculo-Skeletal Tumour Service, Haukeland University Hospital, Bergen, Norway

    Nina L. Jebsen MD

  6. Department of Medical Oncology, Centre Léon Bérard, Lyon, France

    Philippe A. Cassier MD

  7. Department of Radiotherapy, Institut Bergonié, Bordeaux, France

    Paul Sargos MD

  8. Department of Medical Oncology, Ludwig Maximilian University Hospital, Munich, Germany

    Lars H. Lindner MD

  9. Furtwangen University, Furtwangen, Germany

    Alexandra Rauch MPH

  10. Department of Molecular Radiation Oncology, German Cancer Research Center, Heidelberg, Germany

    Falk Roeder MD

  11. Department of Clinical Science, University of Bergen, Bergen, Norway

    Nina L. Jebsen MD

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  1. Markus Albertsmeier MD
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  2. Alexandra Rauch MPH
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  14. Martin K. Angele MD
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Corresponding author

Correspondence to Martin K. Angele MD.

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Albertsmeier, M., Rauch, A., Roeder, F. et al. External Beam Radiation Therapy for Resectable Soft Tissue Sarcoma: A Systematic Review and Meta-Analysis. Ann Surg Oncol 25, 754–767 (2018). https://doi.org/10.1245/s10434-017-6081-2

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  • DOI: https://doi.org/10.1245/s10434-017-6081-2

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