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Neoadjuvant radiation improves margin‐negative resection rates in extremity sarcoma but not survival
Author(s) -
Shelby Rita D.,
SuarezKelly Lorena P.,
Yu Peter Y.,
Hughes Tasha M.,
Ethun Cecilia G.,
Tran Thuy B.,
Poultsides George,
King David M.,
Bedi Meena,
Mogal Harveshp,
Clarke Callisia,
Tseng Jennifer,
Roggin Kevin K.,
Chouliaras Konstantinos,
Votanopoulos Konstantinos,
Krasnick Bradley A.,
Fields Ryan C.,
Pollock Raphael E.,
Howard J. Harrison,
Cardona Kenneth,
Grignol Valerie
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25905
Subject(s) - medicine , sarcoma , resection , radiation therapy , margin (machine learning) , resection margin , overall survival , radiology , oncology , surgery , pathology , machine learning , computer science
Background and Objectives Radiation improves limb salvage in extremity sarcomas. Timing of radiation therapy remains under investigation. We sought to evaluate the effects of neoadjuvant radiation (NAR) on surgery and survival of patients with extremity sarcomas. Materials and Methods A multi‐institutional database was used to identify patients with extremity sarcomas undergoing surgical resection from 2000‐2016. Patients were categorized by treatment strategy: surgery alone, adjuvant radiation (AR), or NAR. Survival, recurrence, limb salvage, and surgical margin status was analyzed. Results A total of 1483 patients were identified. Most patients receiving radiotherapy had high‐grade tumors (82% NAR vs 81% AR vs 60% surgery; P < .001). The radiotherapy groups had more limb‐sparing operations (98% AR vs 94% NAR vs 87% surgery; P < .001). NAR resulted in negative margin resections (90% NAR vs 79% surgery vs 75% AR; P < .0001). There were fewer local recurrences in the radiation groups (14% NAR vs 17% AR vs 27% surgery; P = .001). There was no difference in overall or recurrence‐free survival between the three groups (OS, P = .132; RFS, P = .227). Conclusion In this large study, radiotherapy improved limb salvage rates and decreased local recurrences. Receipt of NAR achieves more margin‐negative resections however this did not improve local recurrence or survival rates over.