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Smolle MA, Andreou D, Wölfel J, Acem I, Aj Van De Sande M, Jeys L, Bonenkamp H, Pollock R, Tunn PU, Haas R, Posch F, Van Ginkel RJ, Verhoef C, Liegl-Atzwanger B, Moustafa-Hubmer D, Jost PJ, Leithner A, Szkandera J. Effect of radiotherapy on local recurrence, distant metastasis and overall survival in 1200 extremity soft tissue sarcoma patients. Retrospective analysis using IPTW-adjusted models. Radiother Oncol 2023; 189:109944. [PMID: 37832791 DOI: 10.1016/j.radonc.2023.109944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/18/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND AND PURPOSE Neoadjuvant (NRTX) and adjuvant radiotherapy (ARTX) reduce local recurrence (LR) risk in extremity soft tissue sarcoma (eSTS), yet their impact on distant metastasis (DM) and overall survival (OS) is less well defined. This study aimed at analysing the influence of NRTX/ARTX on all three endpoints using a retrospective, multicentre eSTS cohort. MATERIALS AND METHODS 1200 patients (mean age: 60.7 ± 16.8 years; 44.4 % females) were retrospectively included, treated with limb sparing surgery and curative intent for localised, high grade (G2/3) eSTS. 194 (16.2 %), 790 (65.8 %), and 216 (18.0 %) patients had received NRTX, ARTX and no RTX, respectively. For the resulting three groups (no RTX vs. NRTX, no RTX vs. ARTX, NRTX vs. ARTX) Fine&Gray models for LR and DM, and Cox-regression models for OS were calculated, with IPTW-modelling adjusting for imbalances between groups. RESULTS In the IPTW-adjusted analysis, NRTX was associated with lower LR-risk in comparison to no RTX (SHR [subhazard ratio]: 0.236; p = 0.003), whilst no impact on DM-risk (p = 0.576) or OS (p = 1.000) was found. IPTW-weighted analysis for no RTX vs. ARTX revealed a significant positive association between ARTX and lower LR-risk (SHR: 0.479, p = 0.003), but again no impact on DM-risk (p = 0.363) or OS (p = 0.534). IPTW-weighted model for NRTX vs. ARTX showed significantly lower LR-risk for NRTX (SHR for ARTX: 3.433; p = 0.003) but no difference regarding DM-risk (p = 1.000) or OS (p = 0.639). CONCLUSION NRTX and ARTX are associated with lower LR-risk, but do not seem to affect DM-risk or OS. NRTX may be favoured over ARTX as our results indicate better local control rates.
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Affiliation(s)
- Maria A Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5 8036, Graz, Austria
| | - Dimosthenis Andreou
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5 8036, Graz, Austria
| | - Judith Wölfel
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5 8036, Graz, Austria
| | - Ibtissam Acem
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40 3015 GD, Rotterdam, the Netherlands; Department of Orthopedic Surgery, Leiden University Medical Centre, Albinusdreef 2 2333 ZA, Leiden, the Netherlands
| | - Michiel Aj Van De Sande
- Department of Orthopedic Surgery, Leiden University Medical Centre, Albinusdreef 2 2333 ZA, Leiden, the Netherlands.
| | - Lee Jeys
- The Royal Orthopaedic Hospital, NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, United Kingdom
| | - Han Bonenkamp
- Radboud University Medical Center, Department of Surgery, Nijmegen 6525GA, the Netherlands
| | - Rob Pollock
- Department of Orthopaedic Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom
| | - Per-Ulf Tunn
- Tumour Orthopaedics, HELIOS Klinikum Berlin-Buch, Schwanebecker Chaussee 50 13125, Berlin, Germany
| | - Rick Haas
- Department of Radiotherapy , The Netherlands Cancer Institute, Plesmanlaan 121 1066 CX, Amsterdam, the Netherlands
| | - Florian Posch
- Division of Clinical Oncology, Internal Medicine, Medical University of Graz, Auenbruggerplatz 15 8036, Graz, Austria
| | - Robert J Van Ginkel
- University of Groningen, University Medical Center Groningen (UMCG), Department of Surgery, Laboratory for Translational Surgical Oncology, Hanzeplein 1 9713 GZ, Groningen, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40 3015 GD, Rotterdam, the Netherlands
| | - Bernadette Liegl-Atzwanger
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstraße 6 8010, Graz, Austria
| | - Dalia Moustafa-Hubmer
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Auenbruggerplatz 32 8036, Graz, Austria
| | - Philipp J Jost
- Division of Clinical Oncology, Internal Medicine, Medical University of Graz, Auenbruggerplatz 15 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5 8036, Graz, Austria
| | - Joanna Szkandera
- Division of Clinical Oncology, Internal Medicine, Medical University of Graz, Auenbruggerplatz 15 8036, Graz, Austria
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Affiliation(s)
- P. Jacob
- Institut für Strahlenschutz, Gesellschaft für Strahlen- und Umweltforschung mbH München 8042 Neuherberg, Federal Republic of Germany
| | - H. G. Paretzke
- Institut für Strahlenschutz, Gesellschaft für Strahlen- und Umweltforschung mbH München 8042 Neuherberg, Federal Republic of Germany
| | - J. Wölfel
- Institut für Strahlenschutz, Gesellschaft für Strahlen- und Umweltforschung mbH München 8042 Neuherberg, Federal Republic of Germany
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