Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2018

01-03-2018 | Bone and Soft Tissue Sarcomas

External Beam Radiation Therapy for Resectable Soft Tissue Sarcoma: A Systematic Review and Meta-Analysis

Authors: Markus Albertsmeier, MD, Alexandra Rauch, MPH, Falk Roeder, MD, Sandro Hasenhütl, MD, Sebastian Pratschke, MD, Michaela Kirschneck, Alessandro Gronchi, MD, Nina L. Jebsen, MD, Philippe A. Cassier, MD, Paul Sargos, MD, Claus Belka, MD, Lars H. Lindner, MD, Jens Werner, MD, Martin K. Angele, MD

Published in: Annals of Surgical Oncology | Issue 3/2018

Login to get access

Abstract

Purpose

The aim of this study was to evaluate the role of preoperative and postoperative external beam radiation therapy (EBRT) in the treatment of resectable soft tissue sarcomas (STSs) of different tumor locations.

Methods

A systematic literature search was performed to identify studies investigating the effects of EBRT (versus no EBRT) on local recurrence (LR) and overall survival (OS) or comparing different EBRT sequences. Random effects meta-analyses were calculated and presented as cumulative odds ratios (ORs).

Results

Sixteen studies (n = 3958 patients) comparing EBRT versus no EBRT, including one randomized controlled trial (RCT) in extremity sarcoma, were analyzed. EBRT appeared to reduce LR in both retroperitoneal tumors (OR 0.47, p < 0.0001) and other locations (OR 0.49, p = 0.001). OS was improved by EBRT in retroperitoneal STSs (OR 0.37, p < 0.0001) but not in other tumor locations. Eleven studies (n = 2140), including one RCT, compared preoperative and postoperative radiotherapy. LR was less frequent following preoperative EBRT in retroperitoneal STSs (OR 0.03, p = 0.02), as well as in other tumor locations (OR 0.67, p = 0.01), while wound complications in extremity sarcoma were more frequent following preoperative EBRT (OR 2.92, p < 0.0001). Several studies included in this meta-analysis bear a high risk of bias and no RCT has been published for retroperitoneal STS.

Conclusions

This meta-analysis supports the use of EBRT for local tumor control in patients with resectable STSs. Based on a small number of non-randomized studies, a positive effect on OS may exist in the subgroup of retroperitoneal STSs.
Appendix
Available only for authorised users
Literature
1.
Bonvalot S, Rivoire M, Castaing M, et al. Primary retroperitoneal sarcomas: a multivariate analysis of surgical factors associated with local control. J Clin Oncol. 2009;27(1):31–7.CrossRefPubMed
2.
The ESMO/European Sarcoma Network Working Group. Soft tissue and visceral sarcomas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25(Suppl 3):iii102–12.CrossRef
3.
Baldini EH, Goldberg J, Jenner C, et al. Long-term outcomes after function-sparing surgery without radiotherapy for soft tissue sarcoma of the extremities and trunk. J Clin Oncol. 1999;17(10):3252–9.CrossRefPubMed
4.
Rydholm A, Gustafson P, Rööser B, et al. Limb-sparing surgery without radiotherapy based on anatomic location of soft tissue sarcoma. J Clin Oncol. 1991;9(10):1757–65.CrossRefPubMed
5.
Stojadinovic A, Yeh A, Brennan MF. Completely resected recurrent soft tissue sarcoma: primary anatomic site governs outcomes. J Am Coll Surg. 2002;194(4):436–47.CrossRefPubMed
6.
Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Journal of epidemiology and community health. 1998;52(6):377–84.CrossRefPubMedPubMedCentral
7.
Coindre J-M. Grading of soft tissue sarcomas: review and update. Arch pathol Lab Med. 2006;130(10):1448–53.PubMed
8.
Review Manager (RevMan) [computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration; 2014.
9.
Trovik LH, Ovrebo K, Almquist M, et al. Adjuvant radiotherapy in retroperitoneal sarcomas. A Scandinavian Sarcoma Group study of 97 patients. Acta Oncol. 2014;53(9):1165–72.CrossRefPubMed
10.
Cassier PA, Kantor G, Bonvalot S, et al. Adjuvant radiotherapy for extremity and trunk wall atypical lipomatous tumor/well-differentiated LPS (ALT/WD-LPS): a French Sarcoma Group (GSF-GETO) study. Ann Oncol. 2014;25(9):1854–60.CrossRefPubMed
11.
Jebsen NL, Trovik CS, Bauer HCF, et al. Radiotherapy to improve local control regardless of surgical margin and malignancy grade in extremity and trunk wall soft tissue sarcoma: a Scandinavian sarcoma group study. Int J Radiat Oncol Biol Phy. 2008;71(4):1196–203.CrossRefPubMed
12.
Toulmonde M, Bonvalot S, Méeus P, et al. Retroperitoneal sarcomas: patterns of care at diagnosis, prognostic factors and focus on main histological subtypes: a multicenter analysis of the French Sarcoma Group. Ann Oncol. 2014;25(3):735–42.CrossRefPubMedPubMedCentral
13.
Richter HJ, Treiber M, Wannenmacher M, Bernd L. Intraoperative radiotherapy as part of the treatment concept of soft tissue sarcomas. Der Orthop. 2003;32(12):1143–50 [in German].CrossRef
14.
Pradhan A, Cheung YC, Grimer RJ, et al. Soft-tissue sarcomas of the hand: oncological outcome and prognostic factors. J Bone Joint Surg. 2008;90(2):209–14.CrossRef
15.
Stoeckle E, Coindre JM, Bonvalot S, et al. Prognostic factors in retroperitoneal sarcoma: a multivariate analysis of a series of 165 patients of the French Cancer Center Federation Sarcoma Group. Cancer. 2001;92(2):359–68.CrossRefPubMed
16.
Kelly KJ, Yoon SS, Kuk D, et al. Comparison of perioperative radiation therapy and surgery versus surgery alone in 204 patients with primary retroperitoneal sarcoma: a Retrospective 2-Institution Study. Ann Surg. 2015;262(1):156–62.CrossRefPubMedPubMedCentral
17.
Lane WO, Cramer CK, Nussbaum DP, et al. Analysis of perioperative radiation therapy in the surgical treatment of primary and recurrent retroperitoneal sarcoma. J Surg Oncol. 2015;112(4):352–58.CrossRefPubMed
18.
van Doorn RC, Gallee MP, Hart AA, et al. Resectable retroperitoneal soft tissue sarcomas. The effect of extent of resection and postoperative radiation therapy on local tumor control. Cancer. 1994;73(3):637–42.CrossRefPubMed
19.
Coindre JM, Terrier P, Bui NB, et al. Prognostic factors in adult patients with locally controlled soft tissue sarcoma. A study of 546 patients from the French Federation of Cancer Centers Sarcoma Group. J Clin Oncol. 1996;14(3):869–77.CrossRefPubMed
20.
Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16(1):197–203.CrossRefPubMed
21.
Choong PF, Petersen IA, Nascimento AG, Sim FH. Is radiotherapy important for low-grade soft tissue sarcoma of the extremity? Clin Orthop Relat Res. 2001;(387):191–9.CrossRef
22.
Nishida Y, Tsukushi S, Nakashima H, Ishiguro N. Clinicopathologic prognostic factors of pure myxoid liposarcoma of the extremities and trunk wall. Clin Orthop Relat Res. 2010;468(11):3041–6.CrossRefPubMedPubMedCentral
23.
Sanfilippo R, Miceli R, Grosso F, et al. Myxofibrosarcoma: prognostic factors and survival in a series of patients treated at a single institution. Ann Surg Oncol. 2011;18(3):720–5.CrossRefPubMed
24.
Mutter RW, Singer S, Zhang Z, Brennan MF, Alektiar KM. The enigma of myxofibrosarcoma of the extremity. Cancer. 2012;118(2):518–27.CrossRefPubMed
25.
Moreau L-C, Turcotte R, Ferguson P, et al. Myxoid\round cell liposarcoma (MRCLS) revisited: an analysis of 418 primarily managed cases. Ann Surg Oncol. 2012;19(4):1081–8.CrossRefPubMed
26.
Baroudi MR, Ferguson PC, Wunder JS, et al. Forearm soft tissue sarcoma: tumors characteristics and oncologic outcomes following limb salvage surgery. J Surg Oncol. 2014;110(6):676–81.CrossRefPubMed
27.
Baxter KJ, Govsyeyev N, Namm JP, Gonzalez RJ, Roggin KK, Cardona K. Is multimodality therapy necessary for the management of pure myxoid liposarcomas? A multi-institutional series of pure myxoid liposarcomas of the extremities and torso. J Surg Oncol. 2015;111(2):146–51.CrossRefPubMed
28.
Suit H, Mankin HJ, Wood W, Proppe K. Preoperative, intraoperative, and postoperative radiation in the treatment of primary soft tissue sarcoma. Cancer. 1985;55(11):2659–67.CrossRefPubMed
29.
Frezza G, Barbieri E, Ammendolia I, et al. Surgery and radiation therapy in the treatment of soft tissue sarcomas of extremities. Ann Oncol. 1992;3 Suppl 2:S93–5.CrossRefPubMed
30.
Cheng EY, Dusenbery KE, Winters MR, Thompson RC. Soft tissue sarcomas: preoperative versus postoperative radiotherapy. J Surg Oncol. 1996;61(2):90–9.CrossRefPubMed
31.
O’Sullivan B, Davis AM, Turcotte R, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002;359(9325):2235–41.CrossRefPubMed
32.
Zagars GK, Ballo MT. Sequencing radiotherapy for soft tissue sarcoma when re-resection is planned. Int J Radiat Oncol Biol Phys. 2003;56(1):21–7.CrossRefPubMed
33.
Kuklo TR, Temple HT, Owens BD, et al. Preoperative versus postoperative radiation therapy for soft-tissue sarcomas. Am J Orthop. 2005;34(2):75–80.PubMed
34.
Schoenfeld GS, Morris CG, Scarborough MT, Zlotecki RA. Adjuvant radiotherapy in the management of soft tissue sarcoma involving the distal extremities. Am J Clin Oncol. 2006;29(1):62–5.CrossRefPubMed
35.
Zagars GK, Ballo MT, Pisters PWT, Pollock RE, Patel SR, Benjamin RS. Preoperative vs. postoperative radiation therapy for soft tissue sarcoma: a retrospective comparative evaluation of disease outcome. Int J Radiat Oncol Biol Phys. 2003;56(2):482–8.CrossRefPubMed
36.
Moore J, Isler M, Barry J, Mottard S. Major wound complication risk factors following soft tissue sarcoma resection. Eur J Surg Oncol. 2014;40(12):1671–6.CrossRefPubMed
37.
Pollack A, Zagars GK, Goswitz MS, Pollock RA, Feig BW, Pisters PWT. Preoperative vs. postoperative radiotherapy in the treatment of soft tissue sarcomas: a matter of presentation. Int J Radiat Oncol Biol Phys. 1998;42(3):563–72.CrossRefPubMed
38.
Angele MK, Albertsmeier M, Prix NJ, et al. Effectiveness of regional hyperthermia with chemotherapy for high-risk retroperitoneal and abdominal soft-tissue sarcoma after complete surgical resection: a subgroup analysis of a randomized phase-III multicenter study. Ann Surg. 2014;260(5):749–56.CrossRefPubMedPubMedCentral
39.
Trans-Atlantic RPS Working Group. Management of primary retroperitoneal sarcoma (RPS) in the adult: a consensus approach from the Trans-Atlantic RPS Working Group. Ann Surg Oncol. 2015;22(1):256–63.CrossRef
40.
Gronchi A, Strauss DC, Miceli R, et al. Variability in patterns of recurrence after resection of primary retroperitoneal sarcoma (RPS): a report on 1007 patients from the multi-institutional collaborative RPS Working Group. Ann Surg. 2016;263(5):1002–9.CrossRefPubMed
41.
Tan MC, Brennan MF, Kuk D, et al. Histology-based classification predicts pattern of recurrence and improves risk stratification in primary retroperitoneal sarcoma. Ann Surg. 2016;263(3):593–600.CrossRefPubMedPubMedCentral
42.
Cheng H, Miura JT, Lalehzari M, et al. Neoadjuvant radiotherapy for retroperitoneal sarcoma: a systematic review. J Surg Oncol. 2016;113(6):628–34.CrossRefPubMed
43.
Nussbaum DP, Rushing CN, Lane WO, et al. Preoperative or postoperative radiotherapy versus surgery alone for retroperitoneal sarcoma: a case-control, propensity score-matched analysis of a nationwide clinical oncology database. Lancet Oncol. 2016;17(7):966–75.CrossRefPubMed
44.
Al-Absi E, Farrokhyar F, Sharma R, et al. A systematic review and meta-analysis of oncologic outcomes of pre-versus postoperative radiation in localized resectable soft-tissue sarcoma. Ann Surg Oncol. 2010;17(5):1367–74.CrossRefPubMed
45.
Davis AM, O’Sullivan B, Turcotte R, et al. Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma. Radiother Oncol. 2005;75(1):48–53.CrossRefPubMed
46.
Brennan MF, Hilaris B, Shiu MH, et al. Local recurrence in adult soft-tissue sarcoma. A randomized trial of brachytherapy. Arch Surg. 1987;122(11):1289–93.CrossRefPubMed
47.
Smith MJF, Ridgway PF, Catton CN, et al. Combined management of retroperitoneal sarcoma with dose intensification radiotherapy and resection: long-term results of a prospective trial. Radiother Oncol. 2014;110(1):165–71.CrossRefPubMed
48.
Livi L, Santoni R, Paiar F, et al. Late treatment-related complications in 214 patients with extremity soft-tissue sarcoma treated by surgery and postoperative radiation therapy. Am J Surg. 2006;191(2):230–4.CrossRefPubMed
49.
Roeder F, Schulz-Ertner D, Nikoghosyan AV, et al. A clinical phase I/II trial to investigate preoperative dose-escalated intensity-modulated radiation therapy (IMRT) and intraoperative radiation therapy (IORT) in patients with retroperitoneal soft tissue sarcoma. BMC Cancer. 2012;12:287.CrossRefPubMedPubMedCentral
Metadata
Title
External Beam Radiation Therapy for Resectable Soft Tissue Sarcoma: A Systematic Review and Meta-Analysis
Authors
Markus Albertsmeier, MD
Alexandra Rauch, MPH
Falk Roeder, MD
Sandro Hasenhütl, MD
Sebastian Pratschke, MD
Michaela Kirschneck
Alessandro Gronchi, MD
Nina L. Jebsen, MD
Philippe A. Cassier, MD
Paul Sargos, MD
Claus Belka, MD
Lars H. Lindner, MD
Jens Werner, MD
Martin K. Angele, MD
Publication date
01-03-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 3/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-6081-2

Other articles of this Issue 3/2018

Annals of Surgical Oncology 3/2018 Go to the issue

Pancreatic Tumors

Neoadjuvant Therapy Versus Upfront Resection for Pancreatic Cancer: The Actual Spectrum and Clinical Burden of Postoperative Complications

Health Services Research and Global Oncology

Global Curriculum in Research Literacy for the Surgical Oncologist

Melanomas

Melanoma Surveillance Strategies: Different Approaches to a Shared Goal

Health Services Research and Global Oncology

Global Variations in the Level of Cancer-Related Research Activity and Correlation to Cancer-Specific Mortality: Proposal for a Global Curriculum

Reconstructive Oncology

Comparative Effectiveness of Preoperative Paravertebral Block for Post-Mastectomy Reconstruction: A Systematic Review of the Literature

Pancreatic Tumors

Intrinsic Contact Between T and N Classifications in Resected Well–Moderately Differentiated Locoregional Pancreatic Neuroendocrine Neoplasms