Neoadjuvant chemoradiation tied to better disease control of high-risk soft tissue sarcoma

Management of high-risk soft tissue sarcoma (STS) with neoadjuvant chemoradiation (NA-CRT) shows favourable disease control, reports a new study.

On the other hand, a delay in surgical resection leads to inferior local control (LC). Such finding warrants further research in a larger cohort, according to the investigators.

In this study, the investigators obtained data on delay to surgical resection, resection margin status, extent of necrosis, tumour cell viability, presence of hyalinization, positron emission tomography (PET)/computed tomography data, and treatment toxicities. They estimated 5-year overall survival, disease-free survival, distant metastasis-free survival, and LC using the Kaplan-Meier survival analysis.

Finally, the log-rank test was used to assess clinicopathologic features and PET/computed tomography avidity changes for their potential predictive impact.

Thirty-seven consecutive cases of localized high-risk STS were identified from 2011 to 2018, of whom 29 underwent ifosfamide-based NA-CRT at a median dose of 50 Gy before en bloc resection. Estimated 5-year overall survival, disease-free survival, distant metastasis-free survival, and LC at a median follow-up of 40.3 months were 86.1 percent, 70.2 percent, 75.2 percent, and 86.7 percent, respectively.

A median reduction of 54.7 percent was observed in tumour PET avidity following NA-CRT. In 13.8 percent of patients, a median tumour necrosis of 60.0 percent with no viable tumour cells was detected once resected.

All patients had negative post-treatment resection margins, with 27.6 percent having a margin of ≤1 mm. Nearly one in five patients (20.7 percent) had delays of over 6 weeks following the end of radiation treatment to surgical resection; such delay indicated inferior LC (92.8 percent vs 68.6 percent; p=0.025).