Radiotherapy for Soft-tissue Sarcoma of the Extremities: A 10-Year Analysis of Treatment Outcomes and Toxicity at a...

In soft-tissue sarcoma (STS) of the extremities, radiotherapy (RT) is known to improve local control, overall survival (OS) and preserve extremity function. Whether RT should be applied pre- or postoperatively is still commonly discussed. This study aimed to gather data about the treatment reality at a certified sarcoma centre and investigate the impact of RT timing on local control, OS and progression-free survival (PFS).

This was a retrospective analysis of all patients who received curative RT for STS of the extremities between 2012 and 2022. Patients were identified using the ICD-10 diagnosis codes C49.1, C49.2 and C49.9. Patient-specific data, such as sex and relevant medical history, were collected. Tumour-specific data included histological subtype, staging, grading and location of the tumour. Therapy-specific data included the type and number of operations, postoperative complications, chemotherapy, RT, and acute and long-term toxicities. All cases were discussed pre-therapeutically in an entity-specific Interdisciplinary Tumour Board.

A total of 67 patients were included; 49 who received adjuvant RT were compared to 18 that received neoadjuvant RT. Mean follow-up was 17.83 months for the neoadjuvant RT cohort and 21.29 months for the adjuvant RT cohort. PFS for the neoadjuvant RT cohort averaged 25.7 months (range=5.2-52.7 months) compared to 15.1 months for the adjuvant RT cohort (range=0.8-51.1 months) (p=0.162). At 2 years, OS rates were 95.9% for patients treated with adjuvant RT and 94.4% for the neoadjuvant RT group.

STS is a heterogeneous and rare oncological entity and clear data on subtype-adapted therapy are still lacking. This study highlights the complexity and the influence of various factors on the choice of treatment approach and outcome, suggesting that neoadjuvant RT may be beneficial.