TY - JOUR
T1 - Postoperative radiotherapy in patients with R0 resection of soft tissue sarcoma
T2 - results from the European sarcoma CONTICABASE analysis
AU - Sunyach, Marie Pierre
AU - Lusque, Amélie
AU - Le Péchoux, Cécile
AU - Levy, Antonin
AU - Sargos, Paul
AU - Helfre, Sylvie
AU - Thariat, Juliette
AU - Zabotto, Laurence Moureau
AU - Lerouge, Delphine
AU - Llacer, Carmen
AU - Mervoyer, Augustin
AU - Vogin, Guillaume
AU - Chevreau, Christine
AU - Ducimetière, Françoise
AU - Blay, Jean Yves
AU - Delannes, Martine
AU - Ducassou, Anne
N1 - © The Author(s) 2025. Published by Oxford University Press on behalf of the British Institute of Radiology.
PY - 2025/9/1
Y1 - 2025/9/1
N2 - OBJECTIVES: We aim to report the outcomes of soft tissue sarcoma (STS) patients with surgical R0 margin size (large: ≥5 mm or close: ≥1 to <5 mm) tumour, treated or not with postoperative radiotherapy (RT).METHODS: The Connective Tissue Cancer Network database CONTICABASE collected data from adult patients diagnosed from 1999 to 2016 for histologically-proven locally advanced STS of trunk or limbs, with surgical R0 margin size (large: ≥5 mm; close: ≥1 to <5 mm), who did not receive neoadjuvant/adjuvant chemotherapy. A propensity score matching analysis was performed to account for potential treatment selection biases. We reported local control (LC), disease-free survival (DFS), overall survival (OS), RT impact in subgroup analyses, and performed multivariable analyses adjusted for classical prognostic factors.RESULTS: Among 738 patients with STS eligible from 11 sites, 524 patients had R0 surgical margins, either treated with postoperative RT (N = 374, 71.4%), or not (N = 150). Besides similar characteristics regarding sex, age, margin size, and preoperative MRI assessment, more tumour localizations in lower limbs (62.8% vs 46%), larger tumours (≥5 cm) (68.4% vs 46%), deeper tumours (75.9% vs 56%), and more grade ≥3 tumours (50.4% vs 32.7%) were reported in patients having received adjuvant RT. The median follow-up was 74.7 [95% CI 71.8-83.0] months, 10-year-LC, -DFS, and -OS were 77.5% [95% CI 71.2-82.6], 51.0% [45.1-56.7], and 69.6% [63.7-74.6], respectively. The multivariable analysis showed that patients with older age and larger tumours are more at risk in terms of LC, DFS, and OS. Preoperative MRI assessment (HR 0.43, 95% CI 0.22-0.83; P = .012) and RT (HR 0.27, 95% CI 0.15-0.49; P < .001) were significantly associated with better LC. However, RT did not impact OS. Subgroup analyses showed that RT also benefit to grade 1 and 2 tumours.CONCLUSION: This series shows that adjuvant RT improved LC in all patients with STS with surgical R0 resection.ADVANCES IN KNOWLEDGE: This series did not identify subgroups in whom RT can be deleted.
AB - OBJECTIVES: We aim to report the outcomes of soft tissue sarcoma (STS) patients with surgical R0 margin size (large: ≥5 mm or close: ≥1 to <5 mm) tumour, treated or not with postoperative radiotherapy (RT).METHODS: The Connective Tissue Cancer Network database CONTICABASE collected data from adult patients diagnosed from 1999 to 2016 for histologically-proven locally advanced STS of trunk or limbs, with surgical R0 margin size (large: ≥5 mm; close: ≥1 to <5 mm), who did not receive neoadjuvant/adjuvant chemotherapy. A propensity score matching analysis was performed to account for potential treatment selection biases. We reported local control (LC), disease-free survival (DFS), overall survival (OS), RT impact in subgroup analyses, and performed multivariable analyses adjusted for classical prognostic factors.RESULTS: Among 738 patients with STS eligible from 11 sites, 524 patients had R0 surgical margins, either treated with postoperative RT (N = 374, 71.4%), or not (N = 150). Besides similar characteristics regarding sex, age, margin size, and preoperative MRI assessment, more tumour localizations in lower limbs (62.8% vs 46%), larger tumours (≥5 cm) (68.4% vs 46%), deeper tumours (75.9% vs 56%), and more grade ≥3 tumours (50.4% vs 32.7%) were reported in patients having received adjuvant RT. The median follow-up was 74.7 [95% CI 71.8-83.0] months, 10-year-LC, -DFS, and -OS were 77.5% [95% CI 71.2-82.6], 51.0% [45.1-56.7], and 69.6% [63.7-74.6], respectively. The multivariable analysis showed that patients with older age and larger tumours are more at risk in terms of LC, DFS, and OS. Preoperative MRI assessment (HR 0.43, 95% CI 0.22-0.83; P = .012) and RT (HR 0.27, 95% CI 0.15-0.49; P < .001) were significantly associated with better LC. However, RT did not impact OS. Subgroup analyses showed that RT also benefit to grade 1 and 2 tumours.CONCLUSION: This series shows that adjuvant RT improved LC in all patients with STS with surgical R0 resection.ADVANCES IN KNOWLEDGE: This series did not identify subgroups in whom RT can be deleted.
KW - disease-free survival
KW - local control
KW - overall survival
KW - reference center
KW - soft tissue sarcoma
KW - surgery
KW - tumour margin size
KW - Sarcoma/diagnostic imaging
KW - Humans
KW - Middle Aged
KW - Male
KW - Young Adult
KW - Postoperative Care
KW - Aged, 80 and over
KW - Female
KW - Adult
KW - Retrospective Studies
KW - Databases, Factual
KW - Europe
KW - Treatment Outcome
KW - Radiotherapy
KW - Databases as Topic
KW - Disease-Free Survival
KW - Adolescent
KW - Aged
UR - https://www.scopus.com/pages/publications/105014087945
U2 - 10.1093/bjr/tqaf068
DO - 10.1093/bjr/tqaf068
M3 - Article
C2 - 40609017
AN - SCOPUS:105014087945
SN - 0007-1285
VL - 98
SP - 1409
EP - 1418
JO - British Journal of Radiology
JF - British Journal of Radiology
IS - 1173
ER -