Neoadjuvant Treatment with Preoperative Radiotherapy for Extremity Soft Tissue Sarcomas: Long-Term Results from a Single Institution in Turkey

Background: To assess the long term clinical outcome of preoperative radiotherapy with or withoutchemotherapy followed by limb sparing surgery in patients with non-metastatic soft tissue sarcomas (STS) ofthe extremities. Materials and
Methods: Sixty patients with locally advanced STS were retrospectively analyzed.The median tumor diameter was 12 cm. All patients were treated with preoperative radiotherapy deliveredwith two different fractionation schedules (35Gy/10fr or 46-50Gy/23-25fr). Neoadjuvant chemotherapy wasadded to 44 patients with large and/or high grade tumors. Surgery was performed 2-6 weeks after radiotherapy.Chemotherapy was completed up to 6 courses after surgery in patients who had good responses.
Results: Medianfollow-up time was 67 months (8-268 months). All of the patients had limb sparing surgery. The 5-year localcontrol (LC), disease free (DFS) and overall survival (OSS) rates for all of the patients were 81%, 48.1% and68.3% respectively. 5-year LC, DFS and cause specific survival (CSS) were 81.7%, 47%, 69.8%, and 80%, 60%,60% in the chemoradiotherapy and radiotherapy groups, respectively. On univariate analysis, patients who weretreated with hypofractionation experienced significantly superior LC, DFS and CSS rates with similar ratesof late toxicity when compared with patients who were treated with conventional fractionation and statisticalsignificance was retained on multivariate analysis.
Conclusions: Treatment results are consistent with theliterature. As neoadjuvant chemoradiotherapy provides effective LC and CSS with acceptable morbidity, itshould be preferred for patients with large and borderline resectable STS.