Neoadjuvant Chemoradiation Compared With Neoadjuvant Radiation Alone in the Management of High-Grade Soft Tissue Extremity Sarcomas

Sarah Z Hazell; Chen Hu; Sara R Alcorn; Kingsley O Asiedu; Gillian Pulido; Deborah A Frassica; Christian Meyer; Adam S Levin; Carol D Morris; Stephanie A Terezakis

doi:10.1016/j.adro.2019.08.015

Neoadjuvant Chemoradiation Compared With Neoadjuvant Radiation Alone in the Management of High-Grade Soft Tissue Extremity Sarcomas

Adv Radiat Oncol. 2019 Oct 7;5(2):231-237. doi: 10.1016/j.adro.2019.08.015. eCollection 2020 Mar-Apr.

Authors

Affiliations

¹ Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
² Johns Hopkins University School of Medicine, Baltimore, Maryland.
³ Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
⁴ Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
⁵ Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota.

Abstract

Purpose: Patients with large, high-grade soft tissue sarcomas are commonly treated with aggressive limb preservation regimens. This study aimed to assess cancer control outcomes of patients treated with neoadjuvant chemoradiation (CRT) compared with radiation therapy (RT) alone.

Methods: We reviewed records of patients with high-grade extremity or trunk soft tissue sarcomas ≥5 cm who were treated with neoadjuvant radiation with or without chemotherapy. Patient and disease characteristics were compared using t test and χ² tests. Standardized mortality ratio weighted method was used to compare overall survival (OS), local control, and disease-free (DFS) survival. Acute radiation and surgical toxicity were reported.

Results: In the study, 64 patients (34 CRT and 30 RT) treated between 1997 and 2015 were analyzed. In the RT group compared with the CRT group, the patient population was older, with a median age of 65 versus 50 years (P < .001), and more likely to have cardiovascular disease (CVD; 30% vs 0%, P < .001). At a median follow-up of 41 months, after adjusting for propensity score of receiving RT, the 3-year LC was 87.3% versus 86.1%, DFS was 58.5% versus 56.6%, and OS was 75.6% versus 69.0% for the CRT and RT groups, respectively (P > .05). Acute dermatitis occurred in 18% versus 3% and surgical complications occurred in 32% versus 17% of CRT and RT patients, respectively.

Conclusions: In this study, patients receiving RT alone were more likely to be older and have comorbid cardiovascular disease. When controlling for baseline differences, neoadjuvant CRT and RT provided similar rates of LC, DFS, and OS.