Outcomes of local therapies for recurrent and radiation-associated soft tissue sarcomas of the extremities and trunk: is there a role for re-irradiation?

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-09-10 DOI:10.1016/j.radonc.2025.111136

Reinhardt Krcek , Anthony M. Griffin , Charles N. Catton , Peter W.M. Chung , Brian O’Sullivan , Amy Parent , Siyer Roohani , David B. Shultz , Philip Wong , Peter C. Ferguson , Kim Tsoi , Jay S. Wunder , David G. Kirsch

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Abstract

Background and purpose

Managing locally relapsed soft tissue sarcomas (STS) after prior radiotherapy (RT) and radiation-associated sarcomas (RAS) is challenging. Limb-sparing surgery without repeated RT may be suboptimal in anatomically constrained cases, while amputation compromises function and quality of life. This study evaluates outcomes of patients treated with re-irradiation plus surgery versus surgery alone.

Material and methods

This retrospective cohort study included patients treated at a single sarcoma centre (Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto) for locally relapsed STS after prior RT and surgery, or for RAS, diagnosed between October 1985 and August 2024. Treatment and outcome data were analyzed to compare local control, limb preservation, complications, distant failure, and overall survival between patients receiving re-irradiation plus surgery versus surgery alone.

Results

A total of 93 patients with recurrent STS and 13 with RAS were analyzed. RT for re-irradiation was mostly administered preoperatively using a twice-daily (BID) fractionation scheme. The 5-year local control rate for recurrent STS was 82.8 % in the re-irradiation plus surgery group and 67.9 % in the surgery-only group (p = 0.336). The 5-year limb preservation rate was significantly higher with re-irradiation (80.8 %) versus surgery alone (40.2 %) (p < 0.001). Complications requiring intervention were more frequent with re-irradiation for relapses (13/43 vs. 3/50, p = 0.002). Freedom from distant failure and overall survival (OS) at 5 years were similar between the groups (65.1 vs. 71.7 % and 57.3 % vs. 55 %). The 5-year OS after RAS diagnosis was 75.2 %, with five complications, four local failures, and four patients developing distant failure during follow-up.

Conclusion

Re-irradiation combined with surgery represents a viable alternative to amputation or surgery alone in selected patients with locally relapsed STS or RAS, with high rates of limb salvage and acceptable toxicity.

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局部治疗复发性和放射相关肢体和躯干软组织肉瘤的结果：是否有再照射的作用？

背景和目的：治疗先前放疗（RT）和放射相关肉瘤（RAS）后局部复发的软组织肉瘤（STS）是具有挑战性的。在解剖结构受限的病例中，不进行重复RT的保肢手术可能是次优的，而截肢会损害功能和生活质量。这项研究评估了再照射加手术治疗与单独手术治疗的结果。材料和方法：本回顾性队列研究纳入了1985年10月至2024年8月期间在单一肉瘤中心（多伦多玛格丽特公主癌症中心/西奈山医院）接受治疗的既往放疗和手术后局部复发STS或RAS的患者。分析治疗和结果数据，比较再照射加手术与单独手术患者的局部控制、肢体保留、并发症、远处衰竭和总生存率。结果：共分析93例复发性STS患者和13例RAS患者。再照射的RT大多在术前使用每日两次（BID）分馏方案。再照射加手术组5年局部控制率为82.8 %，单纯手术组为67.9% % （p = 0.336）。再照射的5年肢体保存率（80.8 %）明显高于单纯手术（40.2 %）（p ）。结论：对于局部复发的STS或RAS患者，再照射联合手术是一种可行的替代截肢或单纯手术的方法，具有较高的肢体保存率和可接受的毒性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.