External Beam Radiation Therapy for Resectable Soft Tissue Sarcoma: A Systematic Review and Meta-Analysis
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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.
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).
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.
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.
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Bergen, Norway), and Philippe Cassier (Department of Medical Oncology, Centre Léon Bérard, Lyon, France) for providing unpublished data.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.
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.
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