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A Mouse Model of Incompletely Resected Soft Tissue Sarcoma for Testing Neoadjuvant Therapies
Published on: July 28, 2020
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Does Timing Matter? Surgical Outcomes in High-Grade Sarcomas after Neoadjuvant Radiation Therapy
Raphael J Louie1, Kyle Wang2, Trevor J Royce2
1Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
The Journal of Surgical Research
|May 20, 2020
Summary
Surgical timing after neoadjuvant radiation therapy for high-grade sarcomas did not impact recurrence or survival. However, delaying surgery beyond six weeks increased overall complications, though not wound infections.
Area of Science:
- Oncology
- Surgical Oncology
- Radiation Oncology
Background:
- The optimal timing for surgical resection following neoadjuvant external beam radiation therapy (EBRT) in high-grade soft tissue and retroperitoneal sarcomas remains unclear.
- Understanding the impact of surgical timing on oncologic and perioperative outcomes is crucial for treatment planning.
Purpose of the Study:
- To evaluate how the interval between neoadjuvant EBRT and surgical resection affects disease-free survival, overall survival, and perioperative complications in high-grade sarcoma patients.
- To identify predictors of recurrence and complications in this patient cohort.
Main Methods:
- A retrospective cohort study included 146 patients with high-grade sarcoma who underwent neoadjuvant EBRT and resection between 1999 and 2018.
- Patients were stratified into groups based on the time interval between EBRT and surgery: <6, 6-8, 8-10, and >10 weeks.
- Oncologic outcomes (recurrence, survival) and perioperative complications were analyzed.
Main Results:
- Surgical timing did not significantly affect overall or local recurrence rates (P=0.82) or overall survival (P=0.88).
- Positive surgical margins were a significant predictor of recurrence (OR 2.7, P<0.05).
- Patients undergoing surgery >6 weeks after EBRT had a higher rate of overall postoperative complications (38%) compared to those operated on <6 weeks (15%, P<0.05), primarily driven by non-wound-related issues.
Conclusions:
- The timing of surgical resection after neoadjuvant EBRT does not appear to influence oncologic outcomes in high-grade sarcomas.
- Resection delayed beyond six weeks is associated with an increased risk of overall perioperative complications, but not specifically wound infections.
- Further research should focus on optimizing preoperative patient management to mitigate perioperative risks, especially for those requiring delayed surgical planning.
