Retrospective analysis of short-term efficacy and safety of preoperative radiotherapy for 33 cases of locally high-risk soft tissue sarcoma

Yan WANG; Yue SU; Tu HU; Qiying LIU; Weiqiang YAO; Yong CHEN; Wangjun YAN; Zhen ZHANG

doi:10.19401/j.cnki.1007-3639.2023.07.007

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Retrospective analysis of short-term efficacy and safety of preoperative radiotherapy for 33 cases of locally high-risk soft tissue sarcoma

Article | 更新时间：2025-12-31

- Retrospective analysis of short-term efficacy and safety of preoperative radiotherapy for 33 cases of locally high-risk soft tissue sarcoma
- China Oncology Vol. 33, Issue 7, Pages: 693-700(2023)
- 作者机构：
  
  1. 复旦大学附属肿瘤医院放射治疗中心，复旦大学上海医学院肿瘤学系，上海市放射肿瘤学重点实验室，上海市放射治疗临床医学研究中心，上海 200032
  2. 复旦大学附属肿瘤医院骨与软组织外科，复旦大学上海医学院肿瘤学系，上海 200032
  3. 复旦大学附属肿瘤医院病理科，复旦大学上海医学院肿瘤学系，复旦大学病理研究所，上海 200032
- 作者简介：
  
  ZHANG Zhen.
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2023.07.007
  CLC： R738.6
- Received：02 February 2023，
  
  Revised：2023-06-29，
  
  Published：30 July 2023
- 稿件说明：
移动端阅览
Yan WANG, Yue SU, Tu HU, et al. Retrospective analysis of short-term efficacy and safety of preoperative radiotherapy for 33 cases of locally high-risk soft tissue sarcoma[J]. China Oncology, 2023, 33(7): 693-700.
DOI：

Yan WANG, Yue SU, Tu HU, et al. Retrospective analysis of short-term efficacy and safety of preoperative radiotherapy for 33 cases of locally high-risk soft tissue sarcoma[J]. China Oncology, 2023, 33(7): 693-700. DOI： 10.19401/j.cnki.1007-3639.2023.07.007.

摘要

背景与目的：

对于局部高危软组织肉瘤，单纯手术治疗常常不能获得满意效果。本研究旨在评估术前放疗联合手术用于治疗局部高危软组织肉瘤患者的近期疗效和安全性。

方法：

回顾性分析2021年2月—2022年6月在复旦大学附属肿瘤医院接受术前放疗的连续性患者的临床资料，包括临床特征、放疗方案、影像学资料及病理学资料等。放疗的靶区勾画采用图像融合技术，将磁共振成像（magnetic resonance imaging，MRI）图像融合至模拟定位计算机体层成像（computed tomography，CT）图像上，勾画靶区时逐层参考。所有患者均接受调强适形放疗（intensity-modulated radiotherapy，IMRT）技术制订的放疗计划。计数资料采用百分数表示。分析影像学应答（完全缓解、部分缓解、疾病稳定、疾病进展、客观缓解及疾病控制）比例、病理学应答[接近病理学完全缓解（near-pathologic complete response，near-pCR），定义为≥90%的无活性肿瘤细胞

]

比例及毒性反应（急性皮肤损伤和术后120 d内伤口并发症）比例。

结果：

共41例患者在术前接受了放疗，其中33例患者符合纳入标准：31例可进行影像

学评估，28例可进行病理学评估。患者的中位年龄为53岁，30例（90.9%）患者的肿瘤组织学分级为3级。影像学分析提示，6例（19.4%）患者获得部分缓解，1例患者出现疾病进展，无人获得完全缓解，客观缓解率为19.4%，疾病控制率为96.8%。病理学分析提示，8例（28.6%）患者near-pCR；排除既往接受过化疗的患者，near-pCR率为34.8%（8/23）。33.3%（11/33）和3.0%（1/33）患者出现1和2级皮肤损伤，未发生3和4级皮肤损伤。1例（3.3%）患者出现术后120 d内的严重伤口并发症。

结论：

利用MRI图像融合技术和IMRT技术的术前放疗对于局部高危软组织肉瘤患者，近期疗效良好，急性毒性反应可接受。

Abstract

Background and purpose:

Surgery alone is not enough to get satisfied outcome for locally high-risk soft tissue sarcoma (STS). We retrospectively assessed the short-term efficacy and safety of preoperative radiotherapy followed by surgery in patients with locally high-risk STS.

Methods:

Data from consecutive patients treated with preoperative radiotherapy at Fudan University Shanghai Cancer Center from February 2021 to June 2022 were reviewed. The data included clinical characteristics

radiotherapy regimes

radiological images and pathology slides. The target volumes of radiotherapy were delineated on computed tomography (CT) simulation images with reference to fused magnetic resonance imaging (MRI) images slides by slides. All the patients received radiotherapy planned with intensity-modulated radiotherapy (IMRT). Counting data was presented as percentages. The rates of radiological response (complete response

partial response

stable disease

progressive disease

objective response and disease control)

pathological response [near-pathologic complete response (near-pCR)

defined as ≥90% non-viable tumor cells

]

and toxicities (acute skin toxicity and major wound complications occurring within 120 d of surgery) were analyzed.

Results:

Forty-one patients received radiotherapy before surgery

among them 33 patients were eligible: 31 for radiological assessment and 28 for pathological assessment. The median age was 53 years. Thirty (90.0%) cases were histologically classified as Grade 3. Six (19.4%) patients achieved partial response

and 1 patient had progressive

disease after radiotherapy. None got complete response. The objective response rate was 19.4%

and the disease control rate was 96.8%. Near-pCR was found in 8 (28.6%) patients. Excluding patients receiving chemotherapy previously

the near-pCR rate was 34.8% (8/23). Grade 1 and 2 skin injuries were found on 33.3% (11/33) and 3.0% (1/33) patients. No grade 3 and 4 skin injury occurred. Major wound complications within 120 d of surgery occured in 1 (3.3%) patient.

Conclusion:

Preoperative radiotherapy facilitated with fused MRI images and IMRT has good short-term efficacy and tolerable acute toxicities for locally high-risk STS.

关键词

Keywords

references

VON MEHREN M , KANE J M , AGULNIK M , et al . Soft tissue sarcoma, version 2.2022, NCCN clinical practice guidelines in oncology [J ] . J Natl Compr Canc Netw , 2022 , 20 ( 7 ): 815 - 833 . DOI: 10.6004/jnccn.2022.0035 http://doi.org/10.6004/jnccn.2022.0035 https://jnccn.org/view/journals/jnccn/20/7/article-p815.xml https://jnccn.org/view/journals/jnccn/20/7/article-p815.xml

KAINHOFER V , SMOLLE M A , SZKANDERA J , et al . The width of resection margins influences local recurrence in soft tissue sarcoma patients [J ] . Eur J Surg Oncol EJSO , 2016 , 42 ( 6 ): 899 - 906 .

DAVIS A M , O'SULLIVAN B , BELL R S , et al . Function and health status outcomes in a randomized trial comparing preoperative and postoperative radiotherapy in extremity soft tissue sarcoma [J ] . J Clin Oncol , 2002 , 20 ( 22 ): 4472 - 4477 . DOI: 10.1200/JCO.2002.03.084 http://doi.org/10.1200/JCO.2002.03.084

SAMPATH S , SCHULTHEISS T E , HITCHCOCK Y J , et al . Preoperative versus postoperative radiotherapy in soft-tissue sarcoma: multi-institutional analysis of 821 patients [J ] . Int J Radiat Oncol Biol Phys , 2011 , 81 ( 2 ): 498 - 505 . DOI: 10.1016/j.ijrobp.2010.06.034 http://doi.org/10.1016/j.ijrobp.2010.06.034 https://linkinghub.elsevier.com/retrieve/pii/S0360301610008850 https://linkinghub.elsevier.com/retrieve/pii/S0360301610008850

DAVIS A , OSULLIVAN B , TURCOTTE R , et al . Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma [J ] . Radiother Oncol , 2005 , 75 ( 1 ): 48 - 53 . DOI: 10.1016/j.radonc.2004.12.020 http://doi.org/10.1016/j.radonc.2004.12.020

O’SULLIVAN B , DAVIS A M , TURCOTTE R , et al . Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial [J ] . Lancet , 2002 , 359 ( 9325 ): 2235 - 2241 . DOI: 10.1016/S0140-6736(02)09292-9 http://doi.org/10.1016/S0140-6736(02)09292-9

FOLKERT M R , SINGER S , BRENNAN M F , et al . Comparison of local recurrence with conventional and intensity-modulated radiation therapy for primary soft-tissue sarcomas of the extremity [J ] . J Clin Oncol , 2014 , 32 ( 29 ): 3236 - 3241 . DOI: 10.1200/JCO.2013.53.9452 http://doi.org/10.1200/JCO.2013.53.9452

O’SULLIVAN B , GRIFFIN A M , DICKIE C I , et al . Phase 2 study of preoperative image-guided intensity-modulated radiation therapy to reduce wound and combined modality morbidities in lower extremity soft tissue sarcoma [J ] . Cancer , 2013 , 119 ( 10 ): 1878 - 1884 . DOI: 10.1002/cncr.27951 http://doi.org/10.1002/cncr.27951

LI X A , CHEN X J , ZHANG Q , et al . Margin reduction from image guided radiation therapy for soft tissue sarcoma: secondary analysis of Radiation Therapy Oncology Group 0630 results [J ] . Pract Radiat Oncol , 2016 , 6 ( 4 ): e135 - e140 . DOI: 10.1016/j.prro.2015.11.012 http://doi.org/10.1016/j.prro.2015.11.012

WANG D , BOSCH W , ROBERGE D , et al . RTOG sarcoma radiation oncologists reach consensus on gross tumor volume and clinical target volume on computed tomographic images for preoperative radiotherapy of primary soft tissue sarcoma of extremity in Radiation Therapy Oncology Group studies [J ] . Int J Radiat Oncol Biol Phys , 2011 , 81 ( 4 ): e525 - e528 . DOI: 10.1016/j.ijrobp.2011.04.038 http://doi.org/10.1016/j.ijrobp.2011.04.038 https://linkinghub.elsevier.com/retrieve/pii/S0360301611005591 https://linkinghub.elsevier.com/retrieve/pii/S0360301611005591

EISENHAUER E A , THERASSE P , BOGAERTS J , et al . New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1) [J ] . Eur J Cancer , 2009 , 45 ( 2 ): 228 - 247 . DOI: 10.1016/j.ejca.2008.10.026 http://doi.org/10.1016/j.ejca.2008.10.026

WEISS A R , CHEN Y L , SCHARSCHMIDT T J , et al . Pathological response in children and adults with large unresected intermediate-grade or high-grade soft tissue sarcoma receiving preoperative chemoradiotherapy with or without pazopanib (ARST1321): a multicentre, randomised, open-label, phase 2 trial [J ] . Lancet Oncol , 2020 , 21 ( 8 ): 1110 - 1122 . DOI: S1470-2045(20)30325-9 http://doi.org/S1470-2045(20)30325-9

ASHLEIGH GUADAGNOLO B , BASSETT R L , MITRA D , et al . Hypofractionated, 3-week, preoperative radiotherapy for patients with soft tissue sarcomas (HYPORT-STS): a single-centre, open-label, single-arm, phase 2 trial [J ] . Lancet Oncol , 2022 , 23 ( 12 ): 1547 - 1557 . DOI: 10.1016/S1470-2045(22)00638-6 http://doi.org/10.1016/S1470-2045(22)00638-6

National Cancer Institute . Protocol development cancer therapy evaluation program [EB/OL ] . ( 2017-11-27 )[ 2023-04-28 ] . https://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm https://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm https://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm.

COINDRE J M . Recommendations for anatamo-pathologic management of soft tissue sarcomas in the adult. Pathologists of the FNCLCC Sarcoma Group (Fédération Nationale des Centres de Lutte Contre le Cancer) [J ] . Ann Pathol , 1998 , 18 ( 6 ): 505 - 511 .

SBARAGLIA M , BELLAN E , DEI TOS A P . The 2020 WHO Classification of Soft Tissue Tumours: news and perspectives [J ] . Pathologica , 2021 , 113 ( 2 ): 70 - 84 . DOI: 10.32074/1591-951X-213 http://doi.org/10.32074/1591-951X-213

FENG X Y , LI J , LI A M , et al . Stereotactic body radiotherapy for recurrent and oligometastatic soft tissue sarcoma [J ] . World J Surg Oncol , 2022 , 20 ( 1 ): 322 . DOI: 10.1186/s12957-022-02781-1 http://doi.org/10.1186/s12957-022-02781-1

HUANG Z , LI N , TANG Y , et al . Neoadjuvant radiotherapy for soft tissue sarcoma in China: a preliminary result [J ] . Ann Transl Med , 2022 , 10 ( 8 ): 452 . DOI: 10.21037/atm-22-98 http://doi.org/10.21037/atm-22-98

CASALI P G , ABECASSIS N , ARO H T , et al . Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up [J ] . Ann Oncol , 2018 , 29 ( Suppl 4 ): iv51 - iv67 . DOI: 10.1093/annonc/mdy096 http://doi.org/10.1093/annonc/mdy096 https://linkinghub.elsevier.com/retrieve/pii/S0923753419316928 https://linkinghub.elsevier.com/retrieve/pii/S0923753419316928

GORTZAK E , AZZARELLI A , BUESA J , et al . A randomised phase Ⅱ study on neo-adjuvant chemotherapy for ‘high-risk’ adult soft-tissue sarcoma [J ] . Eur J Cancer , 2001 , 37 ( 9 ): 1096 - 1103 . DOI: 10.1016/S0959-8049(01)00083-1 http://doi.org/10.1016/S0959-8049(01)00083-1 https://linkinghub.elsevier.com/retrieve/pii/S0959804901000831 https://linkinghub.elsevier.com/retrieve/pii/S0959804901000831

VOSS R K , CHIANG Y J , TORRES K E , et al . Adherence to national comprehensive cancer network guidelines is associated with improved survival for patients with stage 2A and stages 2B and 3 extremity and superficial trunk soft tissue sarcoma [J ] . Ann Surg Oncol , 2017 , 24 ( 11 ): 3271 - 3278 . DOI: 10.1245/s10434-017-6015-z http://doi.org/10.1245/s10434-017-6015-z

SCHAEFER I M , HORNICK J L , BARYSAUSKAS C M , et al . Histologic appearance after preoperative radiation therapy for soft tissue sarcoma: assessment of the European organization for research and treatment of cancer-soft tissue and bone sarcoma group response score [J ] . Int J Radiat Oncol Biol Phys , 2017 , 98 ( 2 ): 375 - 383 . DOI: 10.1016/j.ijrobp.2017.02.087 http://doi.org/10.1016/j.ijrobp.2017.02.087 https://linkinghub.elsevier.com/retrieve/pii/S0360301617304704 https://linkinghub.elsevier.com/retrieve/pii/S0360301617304704

TANAKA K , OGAWA G , MIZUSAWA J , et al . Prospective comparison of various radiological response criteria and pathological response to preoperative chemotherapy and survival in operable high-grade soft tissue sarcomas in the Japan Clinical Oncology Group study JCOG0304 [J ] . World J Surg Oncol , 2018 , 16 ( 1 ): 162 . DOI: 10.1186/s12957-018-1462-y http://doi.org/10.1186/s12957-018-1462-y

WAHL R L , JACENE H , KASAMON Y , et al . From RECIST to PERCIST: evolving Considerations for PET response criteria in solid tumors [J ] . J Nucl Med , 2009 , 50 ( Suppl 1 ): 122S - 150S . DOI: 10.2967/jnumed.108.057307 http://doi.org/10.2967/jnumed.108.057307 http://jnm.snmjournals.org/lookup/doi/10.2967/jnumed.108.057307 http://jnm.snmjournals.org/lookup/doi/10.2967/jnumed.108.057307

YANG X , ZHANG L , YANG X , et al . Oncologic outcomes of pre- versus post-operative radiation in Resectable soft tissue sarcoma: a systematic review and meta-analysis [J ] . Radiat Oncol , 2020 , 15 ( 1 ): 158 . DOI: 10.1186/s13014-020-01600-9 http://doi.org/10.1186/s13014-020-01600-9

KALBASI A , KAMRAVA M , CHU F I , et al . A phase Ⅱ trial of 5-day neoadjuvant radiotherapy for patients with high-risk primary soft tissue sarcoma [J ] . Clin Cancer Res , 2020 , 26 ( 8 ): 1829 - 1836 . DOI: 10.1158/1078-0432.CCR-19-3524 http://doi.org/10.1158/1078-0432.CCR-19-3524 https://aacrjournals.org/clincancerres/article/26/8/1829/83248/A-Phase-II-Trial-of-5-Day-Neoadjuvant-Radiotherapy https://aacrjournals.org/clincancerres/article/26/8/1829/83248/A-Phase-II-Trial-of-5-Day-Neoadjuvant-Radiotherapy

ALBERTSMEIER M , RAUCH A , ROEDER F , et al . External beam radiation therapy for resectable soft tissue sarcoma: A systematic review and meta-analysis [J ] . Ann Surg Oncol , 2018 , 25 ( 3 ): 754 - 767 . DOI: 10.1245/s10434-017-6081-2 http://doi.org/10.1245/s10434-017-6081-2

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