title: Is preoperative radiotherapy suitable for all patients with primary soft tissue sarcoma of the limbs?
abstract: OBJECTIVE
  To evaluate the indications and results of preoperative radiotherapy (RT) on a series of selected patients treated at our institution with curative intent for a limb sarcoma (STS).
  
  
  METHODS
  From 05/1993 to 12/2011, 64 STS patients received preoperative RT.
  
  
  RESULTS
  RT was delivered as a "limb salvage treatment" prior to surgery for the following reasons: as the preferential induction treatment in 53 patients (83%) or as a second intent (17%) after the failure of neoadjuvant systemic chemotherapy/isolated limb perfusion. Surgery was performed after RT in 54 (84%) patients and final limb salvage was performed in 98%. Musculo-cutaneous flap reconstruction was planned upfront in 44% patients, and 19% had a skin graft. Seven patients (13%) had a postoperative RT boost. Thirteen (20%) patients had grade (G) 3/4 adverse events, one after RT and 12 after surgery. At a median follow-up of 3.5 years, the 3-year actuarial overall survival (OS) and distant relapse (DR) rates were 83% and 31%, respectively. Two patients developed a local relapse and two a local progression (non-operated patients). In the multivariate analysis (MVA), histological subtype (leiomyosarcoma) and grade 3 were predictive of poorer survival. Patients with >3 month delay between the start of RT and surgery at our institution had an increased risk of DR in the MVA.
  
  
  CONCLUSIONS
  Induction RT should be personalised according to histological subtype, tumour site and risks-benefit ratio of preoperative radiotherapy and is best managed by a multidisciplinary surgical and oncology team in a specialist sarcoma centre.
authors.affiliation: Department of Radiation Oncology, Gustave Roussy, Université Paris Sud, Villejuif, France; Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France.
authors.forename: A
authors.initials: A
authors.lastname: Levy
authors.affiliation: Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France; Department of Surgery, Gustave-Roussy, Villejuif, France.
authors.forename: S
authors.initials: S
authors.lastname: Bonvalot
authors.affiliation: Department of Radiation Oncology, Gustave Roussy, Université Paris Sud, Villejuif, France; Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France.
authors.forename: S
authors.initials: S
authors.lastname: Bellefqih
authors.affiliation: Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France; Department of Radiology, Gustave-Roussy, Villejuif, France.
authors.forename: L
authors.initials: L
authors.lastname: Vilcot
authors.affiliation: Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France; Department of Surgery, Gustave-Roussy, Villejuif, France; Plastic Surgery Unit, Gustave-Roussy, Villejuif, France.
authors.forename: F
authors.initials: F
authors.lastname: Rimareix
authors.affiliation: Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France; Department of Pathology, Gustave-Roussy, Villejuif, France.
authors.forename: P
authors.initials: P
authors.lastname: Terrier
authors.affiliation: Department of Radiation Oncology, Gustave Roussy, Université Paris Sud, Villejuif, France; Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France.
authors.forename: D
authors.initials: D
authors.lastname: Belemsagha
authors.affiliation: Department of Radiation Oncology, Gustave Roussy, Université Paris Sud, Villejuif, France; Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France.
authors.forename: A
authors.initials: A
authors.lastname: Cascales
authors.affiliation: Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France; Department of Medical Oncology, Gustave-Roussy, Villejuif, France.
authors.forename: J
authors.initials: J
authors.lastname: Domont
authors.affiliation: Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France; Department of Medical Oncology, Gustave-Roussy, Villejuif, France.
authors.forename: O
authors.initials: O
authors.lastname: Mir
authors.affiliation: Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France; Department of Surgery, Gustave-Roussy, Villejuif, France.
authors.forename: C
authors.initials: C
authors.lastname: Honoré
authors.affiliation: Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France; Department of Medical Oncology, Gustave-Roussy, Villejuif, France.
authors.forename: A
authors.initials: A
authors.lastname: Le Cesne
authors.affiliation: Department of Radiation Oncology, Gustave Roussy, Université Paris Sud, Villejuif, France; Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Gustave-Roussy, Villejuif, France. Electronic address: cecile.lepechoux@gustaveroussy.fr.
authors.forename: C
authors.initials: C
authors.lastname: Le Péchoux
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005121:Extremities; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D060787:Neoplasm Grading; D018579:Patient Selection; D057285:Precision Medicine; D011379:Prognosis; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D012307:Risk Factors; D012509:Sarcoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D055815:Young Adult
keywords: Chemotherapy; Extremities; Limb sarcomas; Preoperative radiotherapy; Prognosis; Surgery