A Levy1, S Bonvalot2, S Bellefqih1, L Vilcot3, F Rimareix4, P Terrier5, D Belemsagha1, A Cascales1, J Domont6, O Mir6, C Honoré2, A Le Cesne6, C Le Péchoux7. 1. Department of Radiation Oncology, Gustave Roussy, Université Paris Sud, Villejuif, France; Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France. 2. Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France; Department of Surgery, Gustave-Roussy, Villejuif, France. 3. Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France; Department of Radiology, Gustave-Roussy, Villejuif, France. 4. Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France; Department of Surgery, Gustave-Roussy, Villejuif, France; Plastic Surgery Unit, Gustave-Roussy, Villejuif, France. 5. Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France; Department of Pathology, Gustave-Roussy, Villejuif, France. 6. Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France; Department of Medical Oncology, Gustave-Roussy, Villejuif, France. 7. Department of Radiation Oncology, Gustave Roussy, Université Paris Sud, Villejuif, France; Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France. Electronic address: cecile.lepechoux@gustaveroussy.fr.
Abstract
AIM: To evaluate the indications and results of preoperative radiotherapy (RT) on a series of selected patients treated at our institution with curative intent for a limb sarcoma (STS). PATIENTS AND METHODS: From 05/1993 to 12/2011, 64 STS patients received preoperative RT. RESULTS: RT was delivered as a "limb salvage treatment" prior to surgery for the following reasons: as the preferential induction treatment in 53 patients (83%) or as a second intent (17%) after the failure of neoadjuvant systemic chemotherapy/isolated limb perfusion. Surgery was performed after RT in 54 (84%) patients and final limb salvage was performed in 98%. Musculo-cutaneous flap reconstruction was planned upfront in 44% patients, and 19% had a skin graft. Seven patients (13%) had a postoperative RT boost. Thirteen (20%) patients had grade (G) 3/4 adverse events, one after RT and 12 after surgery. At a median follow-up of 3.5 years, the 3-year actuarial overall survival (OS) and distant relapse (DR) rates were 83% and 31%, respectively. Two patients developed a local relapse and two a local progression (non-operated patients). In the multivariate analysis (MVA), histological subtype (leiomyosarcoma) and grade 3 were predictive of poorer survival. Patients with >3 month delay between the start of RT and surgery at our institution had an increased risk of DR in the MVA. CONCLUSION: Induction RT should be personalised according to histological subtype, tumour site and risks-benefit ratio of preoperative radiotherapy and is best managed by a multidisciplinary surgical and oncology team in a specialist sarcoma centre.
AIM: To evaluate the indications and results of preoperative radiotherapy (RT) on a series of selected patients treated at our institution with curative intent for a limb sarcoma (STS). PATIENTS AND METHODS: From 05/1993 to 12/2011, 64 STS patients received preoperative RT. RESULTS: RT was delivered as a "limb salvage treatment" prior to surgery for the following reasons: as the preferential induction treatment in 53 patients (83%) or as a second intent (17%) after the failure of neoadjuvant systemic chemotherapy/isolated limb perfusion. Surgery was performed after RT in 54 (84%) patients and final limb salvage was performed in 98%. Musculo-cutaneous flap reconstruction was planned upfront in 44% patients, and 19% had a skin graft. Seven patients (13%) had a postoperative RT boost. Thirteen (20%) patients had grade (G) 3/4 adverse events, one after RT and 12 after surgery. At a median follow-up of 3.5 years, the 3-year actuarial overall survival (OS) and distant relapse (DR) rates were 83% and 31%, respectively. Two patients developed a local relapse and two a local progression (non-operated patients). In the multivariate analysis (MVA), histological subtype (leiomyosarcoma) and grade 3 were predictive of poorer survival. Patients with >3 month delay between the start of RT and surgery at our institution had an increased risk of DR in the MVA. CONCLUSION: Induction RT should be personalised according to histological subtype, tumour site and risks-benefit ratio of preoperative radiotherapy and is best managed by a multidisciplinary surgical and oncology team in a specialist sarcoma centre.
Authors: Maria Anna Smolle; Per-Ulf Tunn; Elisabeth Goldenitsch; Florian Posch; Joanna Szkandera; Marko Bergovec; Bernadette Liegl-Atzwanger; Andreas Leithner Journal: Ann Surg Oncol Date: 2017-01-20 Impact factor: 5.344
Authors: Rémi Bourdais; Samir Achkar; Charles Honoré; Matthieu Faron; Andrea Cavalcanti; Guillaume Auzac; Carine Ngo; Leila Haddag-Miliani; Benjamin Verret; Sarah Dumont; Eric Deutsch; Axel Le Cesne; Olivier Mir; Cécile Le Péchoux; Antonin Levy Journal: Clin Transl Radiat Oncol Date: 2021-06-04