Skip to main content

Advertisement

SpringerLink
Log in

Preoperative radiotherapy with concomitant chemotherapy in extremity soft tissue sarcomas: long-term results of a single center

  • Original Article
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Purpose

To assess oncological outcomes of patients receiving neoadjuvant radiochemotherapy (RCT) for soft tissue sarcoma (STS) of the extremities.

Methods

Patients who were treated with preoperative radiotherapy and concomitant chemotherapy—3 cycles of mitomycin/doxorubicin/cisplatin (MAP) or 2–4 cycles of doxorubicin/cisplatin (AP)—followed by surgery were analyzed retrospectively. Survival rates were estimated, and prognostic factors were identified.

Results

Between 1994 and 2017, a total of 108 patients were included. Median ages were 43 years and 51 years for patients receiving MAP and AP, respectively. The 5‑year local relapse-free survival (LRFS), disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS) were 94.1, 63.6, 75.3, and 71.9%, respectively. In the multivariate analysis, significant predictors were identified as follows: de novo or R1/R2 resected tumor on admission before RCT (p = 0.017; hazard ratio [HR] 0.112, 95% confidence interval [CI] 0.019–0.675) and R0 resection after RCT (p = 0.010; HR 0.121, 95% CI 0.024–0.598) for LRFS; female gender (p = 0.042; HR 0.569, 95% CI 0.330–0.979) and liposarcoma histology (p = 0.014; HR 0.436, 95% CI 0.224–0.845) for DFS; liposarcoma histology (p = 0.003; HR 0.114, 95% CI 0.027–0.478) and AP regimen (p = 0.017; HR 0.371, 95% CI 0.165–0.836) for DSS; age ≤ 45 years (p = 0.043; HR 0.537, 95% CI 0.294–0.980) and liposarcoma histology (p = 0.006; HR 0.318, 95% CI 0.141–0.716) for OS, respectively.

Conclusion

An increased risk for local failure seems to exist for patients with relapsed tumor on admission and having positive surgical margins after neoadjuvant RCT. Intensity of chemotherapy influenced DSS but not OS, which could be due to younger patients receiving MAP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. The WHO Classification of Tumours Editorial Board (2020) WHO classification of tumours soft tissue and bone tumours, 5th edn. IARC, Lyon

    Google Scholar 

  2. Gamboa AC, Gronchi A, Cardona K (2020) Soft-tissue sarcoma in adults: An update on the current state of histiotype-specific management in an era of personalized medicine. CA Cancer J Clin 70(3):200–229

    Article  PubMed  Google Scholar 

  3. Blay JY, Honore C, Stoeckle E, Meeus P, Jafari M, Gouin F et al (2019) Surgery in reference centers improves survival of sarcoma patients: a nationwide study. Ann Oncol 30(7):1143–1153

    Article  PubMed  PubMed Central  Google Scholar 

  4. Coindre JM (2006) Grading of soft tissue sarcomas: review and update. Arch Pathol Lab Med 130(10):1448–1453

    Article  PubMed  Google Scholar 

  5. Kaushal A, Citrin D (2008) The role of radiation therapy in the management of sarcomas. Surg Clin North Am 88(3):629–646

    Article  PubMed  PubMed Central  Google Scholar 

  6. Spalek MJ, Kozak K, Czarnecka AM, Bartnik E, Borkowska A, Rutkowski P (2020) Neoadjuvant treatment options in soft tissue sarcomas. Cancers (Basel) 12(8):2061

    Article  CAS  PubMed  Google Scholar 

  7. Kraybill WG, Harris J, Spiro IJ, Ettinger DS, DeLaney TF, Blum RH et al (2010) Long-term results of a phase 2 study of neoadjuvant chemotherapy and radiotherapy in the management of high-risk, high-grade, soft tissue sarcomas of the extremities and body wall: Radiation Therapy Oncology Group Trial 9514. Cancer 116(19):4613–4621

    Article  CAS  PubMed  Google Scholar 

  8. O’Sullivan B, Davis A, Turcotte R, Bell R, Wunder J, Catton C et al (2004) Five-year results of a randomized phase III trial of pre-operative vs post-operative radiotherapy in extremity soft tissue sarcoma. J Clin Oncol 22(14_suppl):9007

    Article  Google Scholar 

  9. Sarcoma Meta-analysis Collaboration (SMAC) (2000) Adjuvant chemotherapy for localised resectable soft tissue sarcoma in adults. Cochrane Database Syst Rev 2:CD1419

    Google Scholar 

  10. Edmonson JH, Petersen IA, Shives TC, Mahoney MR, Rock MG, Haddock MG et al (2002) Chemotherapy, irradiation, and surgery for function-preserving therapy of primary extremity soft tissue sarcomas: initial treatment with ifosfamide, mitomycin, doxorubicin, and cisplatin plus granulocyte macrophage-colony-stimulating factor. Cancer 94(3):786–792

    Article  CAS  PubMed  Google Scholar 

  11. DeLaney TF, Spiro IJ, Suit HD, Gebhardt MC, Hornicek FJ, Mankin HJ et al (2003) Neoadjuvant chemotherapy and radiotherapy for large extremity soft-tissue sarcomas. Int J Radiat Oncol Biol Phys 56(4):1117–1127

    Article  PubMed  Google Scholar 

  12. Edmonson JH, Ryan LM, Blum RH, Brooks JS, Shiraki M, Frytak S et al (1993) Randomized comparison of doxorubicin alone versus ifosfamide plus doxorubicin or mitomycin, doxorubicin, and cisplatin against advanced soft tissue sarcomas. J Clin Oncol 11(7):1269–1275

    Article  CAS  PubMed  Google Scholar 

  13. Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/ctcae_v5_quick_reference_5x7.pdf. Accessed 17 July 2022

  14. Endo M, Lin PP (2018) Surgical margins in the management of extremity soft tissue sarcoma. Chin Clin Oncol 7(4):4

    Article  Google Scholar 

  15. Sambri A, Caldari E, Fiore M, Zucchini R, Giannini C, Pirini MG et al (2021) Margin assessment in soft tissue sarcomas: review of the literature. Cancers (Basel) 13(7):1687

    Article  PubMed  Google Scholar 

  16. Woll PJ, Reichardt P, Le Cesne A, Bonvalot S, Azzarelli A, Hoekstra HJ et al (2012) Adjuvant chemotherapy with doxorubicin, ifosfamide, and lenograstim for resected soft-tissue sarcoma (EORTC 62931): a multicentre randomised controlled trial. Lancet Oncol 13(10):1045–1054

    Article  CAS  PubMed  Google Scholar 

  17. Fiore M, Grosso F, Lo Vullo S, Pennacchioli E, Stacchiotti S, Ferrari A et al (2007) Myxoid/round cell and pleomorphic liposarcomas: prognostic factors and survival in a series of patients treated at a single institution. Cancer 109(12):2522–2531

    Article  PubMed  Google Scholar 

  18. Temple WJ, Temple CL, Arthur K, Schachar NS, Paterson AH, Crabtree TS (1997) Prospective cohort study of neoadjuvant treatment in conservative surgery of soft tissue sarcomas. Ann Surg Oncol 4(7):586–590

    Article  CAS  PubMed  Google Scholar 

  19. Kraybill WG, Harris J, Spiro IJ, Ettinger DS, DeLaney TF, Blum RH et al (2006) Phase II study of neoadjuvant chemotherapy and radiation therapy in the management of high-risk, high-grade, soft tissue sarcomas of the extremities and body wall: Radiation Therapy Oncology Group Trial 9514. J Clin Oncol 24(4):619–625

    Article  CAS  PubMed  Google Scholar 

  20. Spałek M, Koseła-Paterczyk H, Borkowska A, Wągrodzki M, Szumera-Ciećkiewicz A, Cieszanowski A et al (2019) OC-0069 5x5 Gy with chemotherapy in borderline resectable soft tissue sarcomas: early results of a trial. Radiother Oncol 133:S31–S32

    Article  Google Scholar 

  21. Eilber FR, Eckardt JJ, Rosen G, Fu YS, Seeger LL, Selch MT (1993) Neoadjuvant chemotherapy and radiotherapy in the multidisciplinary management of soft tissue sarcomas of the extremity. Surg Oncol Clin N Am 2(4):611–620

    Article  Google Scholar 

Download references

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir, Turkey

    Ugur Yilmaz,  Serra Kamer &  Yavuz Anacak

  2. Department of Radiation Oncology, Kartal Dr. Lutfi Kirdar City Hospital, Cevizli Mh Semsi Denizer Cad. E-5 Karayolu Cevizli Mevkii, 34890, Istanbul, Turkey

    Ugur Yilmaz

  3. Department of Orthopedics and Traumatology, Ege University Faculty of Medicine, Izmir, Turkey

    Huseyin Kaya &  Dundar Sabah

  4. Department of Medical Oncology, Ege University Faculty of Medicine, Izmir, Turkey

    Ulus Ali Sanli

  5. Department of Radiology, Ege University Faculty of Medicine, Izmir, Turkey

    Ipek Tamsel

  6. Department of Pathology, Ege University Faculty of Medicine, Izmir, Turkey

    Banu Yaman &  Taner Akalin

Authors
  1. Ugur Yilmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Serra Kamer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Huseyin Kaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dundar Sabah
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ulus Ali Sanli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ipek Tamsel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Banu Yaman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Taner Akalin
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yavuz Anacak
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: Ugur Yilmaz, Serra Kamer, Yavuz Anacak; Methodology: Ugur Yilmaz, Serra Kamer, Yavuz Anacak; Formal analysis and investigation: Ugur Yilmaz, Serra Kamer, Yavuz Anacak; Writing—original draft preparation: Ugur Yilmaz, Serra Kamer; Writing—review and editing: Yavuz Anaca; Resources: Ugur Yilmaz, Serra Kamer, Huseyin Kaya, Dundar Sabah, Ulus Ali Sanli, Ipek Tamsel, Banu Yaman, Taner Akalin, Yavuz Anacak; Supervision: Serra Kamer, Yavuz Anacak.

Corresponding author

Correspondence to Ugur Yilmaz.

Ethics declarations

Conflict of interest

U. Yilmaz, S. Kamer, H. Kaya, D. Sabah, U.A. Sanli, I. Tamsel, B. Yaman, T. Akalin and Y. Anacak declare that they have no competing interests.

Ethical standards

This study was approved by the institutional ethics committee (21-8T/56).

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yilmaz, U., Kamer, S., Kaya, H. et al. Preoperative radiotherapy with concomitant chemotherapy in extremity soft tissue sarcomas: long-term results of a single center. Strahlenther Onkol 199, 585–594 (2023). https://doi.org/10.1007/s00066-022-02041-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00066-022-02041-x

Keywords

Search

Navigation