Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Woelfel, J.
Assessing the impact of radiotherapy on local recurrence, distant metastasis, and overall survival in a multicentre cohort of extremity soft tissue sarcoma patients
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2023. pp. 98
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Smolle Maria Anna
- Szkandera Joanna
- Altmetrics:
- Abstract:
- Background: Radiotherapy (RTX) is an important part of the treatment of extremity soft tissue sarcomas (eSTS), along with surgery and chemotherapy (CTX). While its positive effect on local recurrence (LR) has been clearly demonstrated in previous studies, the effect on distant metastasis (DM) and overall survival (OS) has not been conclusively shown. The aim of this study was to investigate the independent effect of neoadjuvant and adjuvant radiotherapy (NRTX and ARTX) on LR-risk, DM-risk and OS. Methods: The multicentre retrospective study included 1200 patients with localised high-grade eSTS treated in ten different tertiary tumour centres with curative intent. Mean age of the patients was 60.7±16.8 years and 44.4% were female. 216 (18.0%) had received no RTX, 194 (16.2%) had received NRTX and 790 (65.8%) had received ARTX. The median follow-up was 70.5 months (interquartile range [IQR]: 41.8 - 106.4 months). For statistical analysis, the total dataset was divided into three separate sets: 1. NRTX vs. no RTX, (n=410); 2. ARTX vs. no RTX, (n=1006); 3. NRTX vs. ARTX, (n=984). Differences between treatment pairs were adjusted for using propensity score (PS) and inverse-probability of treatment-weight (IPTW). Fine&Gray models were used to assess the impact of prognostic variables on LR and DM, and Cox-regression models to analyse the effect of prognostic factors on OS. Results: In the univariate IPTW-weighted models, both NRTX and ARTX were significantly associated with a reduced LR-risk (NRTX: subhazard ratio [SHR] 0.236, p<0.001; ARTX: SHR 0.479, p<0.001) compared to no RTX. Neither NRTX nor ARTX showed a significant impact on DM-risk (NRTX: SHR 1.329, p=0.192; ARTX: SHR 1.294, p=0.121) or OS (NRTX: hazard ratio [HR] 1.294, p=0.121; ARTX: HR 0.829, p=0.178)compared to no RTX. There was a significantly lower LR-risk for patients receiving NRTX compared to those administered ARTX (SHR 3.433; p<0.001), but no significant difference in DM-risk (SHR 0.985; p=0.936) or OS (HR 1.312; p=0.213). Conclusion: Both NRTX and ARTX have a significant positive effect on LR risk-reduction, but do not appear to significantly affect DM-risk or OS. The superiority of NRTX over ARTX in local control is a reason to prefer NRTX when possible.