Preoperative versus Postoperative Radiotherapy in Localized Soft Tissue Sarcoma: Nationwide Patterns of Care and Trends in Utilization

Publication date: Available online 18 April 2017
Source:Practical Radiation Oncology
Author(s): Stanislav Lazarev, Heather McGee, Erin Moshier, Meng Ru, Elizabeth G. Demicco, Vishal Gupta
PurposeThe timing of perioperative radiotherapy (RT) in the treatment of soft tissue sarcoma (STS) varies among institutions. This study examines patterns of care, trends in utilization, and survival with preoperative (preop) versus postoperative (postop) RT for primary STS.MethodsUsing the National Cancer Data Base, we identified patients with stage I-III STS who underwent definitive surgery with either preop or postop RT between 2004 and 2012. Univariate, bivariate, and multivariate analyses were performed to identify factors predicting receipt of preop versus postop RT. Overall survival (OS) was analyzed using the log-rank test, Kaplan–Meier method, and Cox proportional-hazards model.ResultsThis study included 9604 patients: 7246 (75.4%) received postop and 2358 (24.6%) - preop RT. Chemotherapy was administered to 27.0% patients in the preop and 13.0% in the postop cohort. Use of preop RT increased over time, from 16.8% in 2004 to 29.7% in 2012. Multivariate analysis revealed that preop RT utilization increased with the following factors: higher educational attainment, treatment at an academic facility, further distance from facility (>60miles), receipt of chemotherapy, tumor originating in lower extremities, >10cm tumors, myxoid liposarcoma. OS analysis revealed no difference between the two treatment cohorts.ConclusionsPostop RT is utilized much more commonly than preop RT in localized STS. However, preop RT use has increased in recent years. Multiple demographic and clinicopathologic factors were predictive of preop RT use. Consistent with randomized phase 3 data, there was no difference in OS.



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