Postoperative radiotherapy in patients with R0 resection of soft tissue sarcoma: results from the European sarcoma CONTICABASE analysis

Marie Pierre Sunyach; Amélie Lusque; Cécile Le Péchoux; Antonin Levy; Paul Sargos; Sylvie Helfre; Juliette Thariat; Laurence Moureau Zabotto; Delphine Lerouge; Carmen Llacer; Augustin Mervoyer; Guillaume Vogin; Christine Chevreau; Françoise Ducimetière; Jean Yves Blay; Martine Delannes; Anne Ducassou

doi:10.1093/bjr/tqaf068

Postoperative radiotherapy in patients with R0 resection of soft tissue sarcoma: results from the European sarcoma CONTICABASE analysis

Marie Pierre Sunyach^*
, Amélie Lusque
, Cécile Le Péchoux
, Antonin Levy
, Paul Sargos
, Sylvie Helfre
, Juliette Thariat
, Laurence Moureau Zabotto
, Delphine Lerouge
, Carmen Llacer
, Augustin Mervoyer
, Guillaume Vogin
, Christine Chevreau
, Françoise Ducimetière
, Jean Yves Blay
, Martine Delannes
, Anne Ducassou

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

1 Citation (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	1409-1418
Number of pages	10
Journal	British Journal of Radiology
Volume	98
Issue number	1173
DOIs	https://doi.org/10.1093/bjr/tqaf068
Publication status	Published - 1 Sept 2025
Externally published	Yes

Keywords

disease-free survival
local control
overall survival
reference center
soft tissue sarcoma
surgery
tumour margin size
Sarcoma/diagnostic imaging
Humans
Middle Aged
Male
Young Adult
Postoperative Care
Aged, 80 and over
Female
Adult
Retrospective Studies
Databases, Factual
Europe
Treatment Outcome
Radiotherapy
Databases as Topic
Disease-Free Survival
Adolescent
Aged

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10.1093/bjr/tqaf068

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Sunyach, M. P., Lusque, A., Le Péchoux, C., Levy, A., Sargos, P., Helfre, S., Thariat, J., Zabotto, L. M., Lerouge, D., Llacer, C., Mervoyer, A., Vogin, G., Chevreau, C., Ducimetière, F., Blay, J. Y., Delannes, M., & Ducassou, A. (2025). Postoperative radiotherapy in patients with R0 resection of soft tissue sarcoma: results from the European sarcoma CONTICABASE analysis. British Journal of Radiology, 98(1173), 1409-1418. https://doi.org/10.1093/bjr/tqaf068

@article{6826e8c3634f43189fff300f93400aca,

title = "Postoperative radiotherapy in patients with R0 resection of soft tissue sarcoma: results from the European sarcoma CONTICABASE analysis",

abstract = "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.",

keywords = "disease-free survival, local control, overall survival, reference center, soft tissue sarcoma, surgery, tumour margin size, Sarcoma/diagnostic imaging, Humans, Middle Aged, Male, Young Adult, Postoperative Care, Aged, 80 and over, Female, Adult, Retrospective Studies, Databases, Factual, Europe, Treatment Outcome, Radiotherapy, Databases as Topic, Disease-Free Survival, Adolescent, Aged",

author = "Sunyach, \{Marie Pierre\} and Am{\'e}lie Lusque and \{Le P{\'e}choux\}, C{\'e}cile and Antonin Levy and Paul Sargos and Sylvie Helfre and Juliette Thariat and Zabotto, \{Laurence Moureau\} and Delphine Lerouge and Carmen Llacer and Augustin Mervoyer and Guillaume Vogin and Christine Chevreau and Fran{\c c}oise Ducimeti{\`e}re and Blay, \{Jean Yves\} and Martine Delannes and Anne Ducassou",

note = "{\textcopyright} The Author(s) 2025. Published by Oxford University Press on behalf of the British Institute of Radiology.",

year = "2025",

month = sep,

day = "1",

doi = "10.1093/bjr/tqaf068",

language = "English",

volume = "98",

pages = "1409--1418",

journal = "British Journal of Radiology",

issn = "0007-1285",

publisher = "Oxford University Press",

number = "1173",

}

Sunyach, MP, Lusque, A, Le Péchoux, C, Levy, A, Sargos, P, Helfre, S, Thariat, J, Zabotto, LM, Lerouge, D, Llacer, C, Mervoyer, A, Vogin, G, Chevreau, C, Ducimetière, F, Blay, JY, Delannes, M & Ducassou, A 2025, 'Postoperative radiotherapy in patients with R0 resection of soft tissue sarcoma: results from the European sarcoma CONTICABASE analysis', British Journal of Radiology, vol. 98, no. 1173, pp. 1409-1418. https://doi.org/10.1093/bjr/tqaf068

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 -

Postoperative radiotherapy in patients with R0 resection of soft tissue sarcoma: results from the European sarcoma CONTICABASE analysis

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