Preoperative Radiation Therapy Followed by Reexcision May Improve Local Control and Progression-Free Survival in Unplanned Excisions of Soft Tissue Sarcomas of the Extremity and Chest-Wall.

Hina Saeed,John A Charlson,John C Neilson,Candice A Johnstone,Manpreet Bedi,Donald A Hackbarth,David M King

doi:10.1155/2016/5963167

Hina Saeed, John A Charlson + Show 5 more

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https://doi.org/10.1155/2016/5963167

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Abstract

Background. The management for unplanned excision (UE) of soft tissue sarcomas (STS) has not been established. In this study, we compare outcomes of UE versus planned excision (PE) and determine an optimal treatment for UE in STS. Methods. From 2000 to 2014 a review was performed on all patients treated with localized STS. Clinical outcomes including local recurrence-free survival (LRFS), progression-free survival (PFS), and overall survival (OS) were evaluated using the Kaplan-Meier estimate. Univariate (UVA) and multivariate (MVA) analyses were performed to determine prognostic variables. For MVA, Cox proportional hazards model was used. Results. 245 patients were included in the analysis. 14% underwent UE. Median follow-up was 2.8 years. The LR rate was 8.6%. The LR rate in UE was 35% versus 4.2% in PE patients (p < 0.0001). 2-year PFS in UE versus PE patients was 4.2 years and 9.3 years, respectively (p = 0.08). Preoperative radiation (RT) (p = 0.01) and use of any RT for UE (p = 0.003) led to improved PFS. On MVA, preoperative RT (p = 0.04) and performance status (p = 0.01) led to improved PFS. Conclusions. UEs led to decreased LC and PFS versus PE in patients with STS. The use of preoperative RT followed by reexcision improved LC and PFS in patients who had UE of their STS.

Highlights

Soft tissue sarcomas (STS) are heterogenous rare malignancies that vary in the way they present and behave unpredictably.The mainstay of treatment of localized stage I-III soft tissue sarcomas (STS) of the extremity and chest-wall is wide local excision with radiation with or without chemotherapy
Intervention after unplanned excision (UE) No radiation therapy Chemotherapy alone Reexcision alone Observation alone Radiation therapy RT alone Reexcision followed by postoperative RT Preoperative RT followed by reexcision
Our study reports a lower incidence of UEs compared to other reports in the literature, this may reflect a well-established stable referral base to our tertiary sarcoma center and, hopefully, increased recognition that preoperative imaging is recommended for large, deep masses

Summary

Introduction

Soft tissue sarcomas (STS) are heterogenous rare malignancies that vary in the way they present and behave unpredictably.The mainstay of treatment of localized stage I-III STS of the extremity and chest-wall is wide local excision with radiation with or without chemotherapy. Due to the rare nature of this disease process and the higher propensity for patients to present with benign masses, there are a considerable number of patients with STS of the extremity and chest-wall who do not undergo the appropriate workup and instead undergo nononcologic or unplanned excisions (UEs), especially by nonsurgical oncologists in the community [5]. Preoperative radiation (RT) (p = 0.01) and use of any RT for UE (p = 0.003) led to improved PFS. On MVA, preoperative RT (p = 0.04) and performance status (p = 0.01) led to improved PFS. UEs led to decreased LC and PFS versus PE in patients with STS.

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