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Neoadjuvant Radiotherapy is Associated with R0 Resection and Improved Survival for Patients with Extremity Soft Tissue Sarcoma Undergoing Surgery: A National Cancer Database Analysis

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neoadjuvant radiotherapy (RT) is increasingly advocated for the management of soft tissue sarcoma (STS). Therefore, this study sought to characterize the impact of neoadjuvant RT on rates of R0 resection and overall survival (OS) in extremity STS patients undergoing surgery.

Methods

From January 2003 to December 2012, the study identified patients with a diagnosis of extremity STS from the National Cancer Database. After exclusion of patients younger than 18 years, not treated by surgery, who had metastases at diagnosis, intraoperative RT, and missing or unknown data, 27,969 patients were identified. Logistic regression and Cox-proportional hazard analysis were used to compare rates of R0 resection among preoperative, postoperative, and no-RT cohorts and to determine predictors of R0 resection and OS.

Results

The mean age of the patients was 59.5 ± 17.1 years, and 45.9% were female. The median tumor size was 10.5 cm. The data showed that 51% of the patients did not receive RT, 11.8% received preoperative RT, and 37.2% received postoperative RT. The rates of R0 resection were 90.1% for the preoperative RT cohort, 74.9% for the postoperative RT cohort, and 79.9% for the no-RT cohort (P < 0.001). The independent predictors for achievement of R0 resection included academic facility type (odds ratio [OR] 1.36; 95% confidence interval [CI] 1.20–1.55), histologic subtype, tumor size (OR 0.99; 95% CI 0.99–0.99), Charlson score (OR 0.92; 95% CI 0.84–0.99), and preoperative RT (OR 1.83; 95% CI 1.61–2.07). Both R0 resection and RT (pre- or post-operative) were associated with increased OS.

Conclusions

Preoperative RT independently predicts higher rates of R0 resection for patients with extremity STS undergoing surgical resection. Negative surgical margins and pre- or postoperative RT are associated with improved OS.

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Acknowledgement

This work was supported in part by the Dr. Mark Starr Family Fund. It also was supported by the National Center for Advancing Translational Sciences, National Institutes of Health (NIH) through grant no. UL1TR001860 and by the Agency for Health Care Research and Quality through grant no. T32HS 022236. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, UC Davis Medical Center, Sacramento, CA, USA

    Alicia A. Gingrich MD, Sarah B. Bateni MD, Amanda R. Kirane MD, Richard J. Bold MD & Robert J. Canter MD

  2. Department of Radiation Oncology, UC Davis Medical Center, Sacramento, CA, USA

    Arta M. Monjazeb MD

  3. Department of Pathology, UC Davis Medical Center, Sacramento, CA, USA

    Morgan A. Darrow MD

  4. Department of Orthopedic Surgery, UC Davis Medical Center, Sacramento, CA, USA

    Steven W. Thorpe MD

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  1. Alicia A. Gingrich MD
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Correspondence to Robert J. Canter MD.

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Gingrich, A.A., Bateni, S.B., Monjazeb, A.M. et al. Neoadjuvant Radiotherapy is Associated with R0 Resection and Improved Survival for Patients with Extremity Soft Tissue Sarcoma Undergoing Surgery: A National Cancer Database Analysis. Ann Surg Oncol 24, 3252–3263 (2017). https://doi.org/10.1245/s10434-017-6019-8

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  • DOI: https://doi.org/10.1245/s10434-017-6019-8

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