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Predicting Interval Pulmonary Metastasis in Extremity Soft Tissue Sarcoma Treated with Preoperative Radiotherapy: A
Sadegh Saberi1, Alireza Talebi1, Hamed Naghizadeh1
1Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
JB & JS Open Access
|July 10, 2026
Summary
Interval metastasis during preoperative radiotherapy for extremity soft tissue sarcoma is rare, occurring in 7.8% of patients. Factors like large tumor size and younger age predict this progression, necessitating routine chest restaging.
Area of Science:
- Oncology
- Surgical Oncology
- Radiotherapy
Background:
- Preoperative radiotherapy (RT) is standard for high-risk extremity soft tissue sarcoma (STS) to improve local control and preserve function.
- Concerns exist about interval distant metastases developing between diagnosis and surgery, especially in aggressive STS.
- Limited data exists on the incidence and predictors of interval metastatic progression in extremity STS.
Purpose of the Study:
- To determine the incidence of interval distant metastases in patients with extremity STS undergoing preoperative RT.
- To identify independent predictors of interval metastatic progression.
- To develop a clinical risk score for stratifying patients based on metastasis risk.
Main Methods:
- Retrospective cohort study of 378 adult patients with nonmetastatic extremity STS treated with preoperative RT and surgery (2018-2024).
- All patients had baseline staging and mandatory preoperative chest CT.
- Multivariable logistic regression analyzed predictors; a 4-factor risk score was developed.
Main Results:
- Interval distant metastases occurred in 29 patients (7.8%), primarily in the lungs.
- Independent predictors included tumor size >12 cm, synovial sarcoma histology, FNCLCC grade 3, and age ≤50 years.
- A 4-factor risk score stratified patients into low (2.4%), intermediate (8.4%), and high-risk (25.6%) groups for metastasis.
Conclusions:
- Interval metastasis during preoperative RT for extremity STS is uncommon and associated with adverse tumor biology.
- Routine preoperative chest CT restaging is crucial for detecting interval metastases.
- A 4-factor risk score can identify high-risk patients needing closer surveillance and tailored counseling.