Neoadjuvant radiation improves margin‐negative resection rates in extremity sarcoma but not survival. Issue 8 (30th March 2020) - Shelby, Rita D.
Abstract: Background and Objectives: Radiation improves limb salvage in extremity sarcomas. Timing of radiation therapy remains under investigation. We sought to evaluate the effects of neoadjuvant radiation (NAR) on surgery and survival of patients with extremity sarcomas. Materials and Methods: A multi‐institutional database was used to identify patients with extremity sarcomas undergoing surgical resection from 2000‐2016. Patients were categorized by treatment strategy: surgery alone, adjuvant radiation (AR), or NAR. Survival, recurrence, limb salvage, and surgical margin status was analyzed. Results: A total of 1483 patients were identified. Most patients receiving radiotherapy had high‐grade tumors (82% NAR vs 81% AR vs 60% surgery; P < .001). The radiotherapy groups had more limb‐sparing operations (98% AR vs 94% NAR vs 87% surgery; P < .001). NAR resulted in negative margin resections (90% NAR vs 79% surgery vs 75% AR; P < .0001). There were fewer local recurrences in the radiation groups (14% NAR vs 17% AR vs 27% surgery; P = .001). There was no difference in overall or recurrence‐free survival between the three groups (OS, P = .132; RFS, P = .227). Conclusion: In this large study, radiotherapy improved limb salvage rates and decreased local recurrences. Receipt of NAR achieves more margin‐negative resections however this did not improve local recurrence or survival rates over.