title: Tumour volume changes following pre-operative radiotherapy in borderline resectable limb and trunk soft tissue sarcoma.
abstract: OBJECTIVE
  To evaluate tumour volume changes after preoperative radiotherapy (PRT) for borderline operable soft tissue sarcomas (STS).
  
  
  METHODS
  A retrospective review was performed of 68 patients who received PRT between December 2004 and July 2011. Endpoints were radiological response, surgical margins, local control and survival.
  
  
  RESULTS
  Median tumour size was 12.5 cm. Tumour location was extremity (87%), trunk (12%), and neck (1%). Commonest histological subtypes were myxoid liposarcoma (32%) and myxofibrosarcoma (16%). The majority of patients (88%) received 50 Gy in 25 fractions. Post-radiotherapy imaging was available in 55 cases. By RECIST there was stable disease in 89%, partial response in 7% and progressive disease in 4%. Tumour volumes reduced in 80%. Median change in maximal tumour dimension was -13.6%; median change in volume was greater, at -33.3%. Tumour volumes increased in 11 cases (20%). However, surgical margins were clear in all 11 cases, with no local recurrences in this group. For the entire group, surgical margins were clear in 93%, and microscopically positive in 7%. Eight patients (12%) had local relapse at 2-24.8 months after surgery. Two year local relapse free survival was 87.5%; 2 year overall survival was 74.7%.
  
  
  CONCLUSIONS
  The majority of tumours showed reduction in volume. A small number of tumours increased in volume, but there was no definite relationship between volume increase and poor surgical outcomes or lower local control rates. Local control was equivalent to published series' of PRT. PRT is a reasonable approach in patients with borderline resectable tumours.
authors.affiliation: University College London Hospitals NHS Foundation Trust, Department of Oncology, 1st Floor Central, 250 Euston Road, London NW1 2PG, UK. Electronic address: franel.legrange@uclh.nhs.uk.
authors.forename: F
authors.initials: F
authors.lastname: le Grange
authors.affiliation: University College London Hospitals NHS Foundation Trust, Department of Oncology, 1st Floor Central, 250 Euston Road, London NW1 2PG, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Cassoni
authors.affiliation: University College London Hospitals NHS Foundation Trust, Department of Oncology, 1st Floor Central, 250 Euston Road, London NW1 2PG, UK; NIHR University College London Hospitals Biomedical Research Centre, 1st Floor Maple House, Suite A, 149 Tottenham Court Road, London W1T 7DN, UK.
authors.forename: B M
authors.initials: BM
authors.lastname: Seddon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019583:Dose Fractionation, Radiation; D005121:Extremities; D005260:Female; D006801:Humans; D018208:Liposarcoma, Myxoid / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D018365:Neoplasm, Residual / Q000532:radiotherapy / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012509:Sarcoma / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D060726:Torso; D016896:Treatment Outcome
keywords: Local control; Pre-operative; Radiotherapy; Soft tissue sarcoma; Surgical margins