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Low‐dose preoperative radiation, resection, and reduced‐field postoperative radiation for soft tissue sarcomas
Author(s) -
Konieczkowski David J.,
Goldberg Saveli I.,
Raskin Kevin A.,
LozanoCalderon Santiago,
Mullen John T.,
Chen YenLin,
DeLaney Thomas F.
Publication year - 2021
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.26503
Subject(s) - medicine , surgery , port (circuit theory) , cohort , soft tissue , radiation therapy , retrospective cohort study , soft tissue sarcoma , cancer , sarcoma , pathology , electrical engineering , engineering
Background and Objectives Radiotherapy (RT) enables conservative surgery for soft tissue sarcoma (STS). RT can be delivered either pre‐operatively (PreRT) or postoperatively (PORT), yet in some patients, neither approach is fully satisfactory (e.g., urgent surgery or wound healing risk prevents PreRT, yet PORT alone cannot cover the entire surgical field). We hypothesized that, in such situations, low‐dose PreRT (LD‐PreRT) would decrease the risk of intraoperative tumor seeding and thus permit PORT to a reduced volume (covering the high‐risk tumor bed but not all surgically manipulated tissues). Methods We identified a single‐institution retrospective cohort of 78 patients treated with LD‐PreRT (10–30 Gy), resection, and PORT between 1980 and 2018. Results At a median follow‐up of 8.2 years, 8‐year overall survival (OS) was 65.9%, disease‐free survival (DFS) 50.5%, and local control (LC) 76.7%; in 45 patients with extremity/superficial trunk (E/ST) STS, 8‐year LC was 80.9%. Both before and after propensity score adjustment, there were no differences in OS, DFS, or LC between this cohort and a separate cohort of 394 STS (221 E/ST‐STS) patients treated with surgery and PORT alone. Conclusions In patients for whom neither PreRT nor PORT alone is optimal, LD‐PreRT may prevent intraoperative tumor seeding and enable PORT to a reduced volume while preserving oncologic outcomes.