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

• Published in: Strahlentherapie und Onkologie Vol. 199; no. 6; pp. 585 - 594
• Main Authors: Yilmaz, Ugur, Kamer, Serra, Kaya, Huseyin, Sabah, Dundar, Sanli, Ulus Ali, Tamsel, Ipek, Yaman, Banu, Akalin, Taner, Anacak, Yavuz
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2023; Springer Nature B.V
• Subjects: Adult; Cancer surgery; Chemoradiotherapy; Chemotherapy; Cisplatin; Clinical outcomes; Doxorubicin; Extremities - pathology; Female; Histology; Humans; Liposarcoma; Liposarcoma - drug therapy; Liposarcoma - pathology; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Neoadjuvant Therapy; Neoplasm Recurrence, Local - pathology; Oncology; Original Article; Radiation therapy; Radiotherapy; Retrospective Studies; Sarcoma; Sarcoma - pathology; Sarcoma - therapy; Soft Tissue Neoplasms - surgery; Soft tissues; Survival; Tumors; Second primary cancers; Neoadjuvant radiochemotherapy; Mitomycin/doxorubicin/cisplatin; Doxorubicin/cisplatin; Extremities
• ISSN: 0179-7158; 1439-099X
• DOI: 10.1007/s00066-022-02041-x

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.