Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity.

TLDR

This randomized, prospective study evaluates whether postoperative external‑beam radiation therapy reduces local recurrence, overall survival, and impacts quality of life after limb‑sparing resection of extremity soft‑tissue sarcomas. Patients with extremity sarcomas were randomized to receive or omit adjuvant external‑beam radiotherapy after limb‑sparing surgery, with high‑grade tumors also receiving chemotherapy and low‑grade or locally aggressive non‑malignant tumors randomized after surgery alone. Over a median 9.6‑year follow‑up, radiotherapy significantly lowered local recurrence rates in both high‑ and low‑grade lesions without improving overall survival, and while it caused transient deficits in limb strength, edema, and range of motion, it had minimal impact on overall quality of life.

Abstract

PURPOSE This randomized, prospective study assesses the impact of postoperative external-beam radiation therapy on local recurrence (LR), overall survival (OS), and quality of life after limb-sparing resection of extremity sarcomas. PATIENTS AND METHODS Patients with extremity tumors and a limb-sparing surgical option were randomized to receive or not receive postoperative adjuvant external-beam radiotherapy. Patients with high-grade sarcomas received postoperative adjuvant chemotherapy whereas patients with low-grade sarcomas or locally aggressive nonmalignant tumors were randomized after surgery alone. RESULTS Ninety-one patients with high-grade lesions were randomized; 47 to receive radiotherapy (XRT) and 44 to not receive XRT. With a median follow-up of 9.6 years, a highly significant decrease (P2 = .0028) in the probability of LR was seen with radiation, but no difference in OS was shown. Of 50 patients with low-grade lesions (24 randomized to resection alone and 26 to resection and postoperative XRT), there was also a lower probability of LR (P2 = .016) in patients receiving XRT, again, without a difference in OS. A concurrent quality-of-life study showed that extremity radiotherapy resulted in significantly worse limb strength, edema, and range of motion, but these deficits were often transient and had few measurable effects on activities of daily life or global quality of life. CONCLUSION This study indicates that although postoperative external-beam radiotherapy is highly effective in preventing LRs, selected patients with extremity soft tissue sarcoma who have a low risk of LR may not require adjuvant XRT after limb-sparing surgery (LSS).