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Soft Tissue Sarcoma: Perhaps OK to Delay Surgery?

Elizabeth Hofheinz, M.P.H., M.Ed.

Using the National Cancer Database, a team of researchers from Case Western Reserve University undertook a study on patients with soft tissue sarcoma, specifically examining what factors are associated with the preoperative radiation therapy-surgery interval. They also aimed to determine if the preoperative radiation therapy-surgery interval was associated with overall survival.

Their study, “The Interval Between Preoperative Radiation and Surgery Is Not Associated with Overall Survival for Soft-tissue Sarcomas: An Analysis of the National Cancer Database,” appears in the March 1, 2021 edition of Clinical Orthopaedics and Related Research.

Excluded patients included those who: had lymphatic or metastatic disease at diagnosis, underwent neoadjuvant chemotherapy, had missing vital status, had chemosensitive histologies, had undergone radiation other than external beam, were missing preoperative radiation therapy-surgery interval, or had a preoperative radiation therapy-surgery interval greater than 120 days. A total of 2176 patients were included for analysis, with a mean preoperative radiation therapy-surgery interval of 35 ± 16 days.

Christopher D. Collier, M.D., an orthopedic surgeon at Case Western, told OSN: “After the diagnosis of sarcoma is made, patients often express anxiety about waiting for surgical resection after preoperative radiation therapy where surgery is generally delayed to allow soft tissue recovery after radiation. We therefore performed this study to address those concerns and asked if the waiting time between radiation and surgery affected survival.”

Asked about the timing of this study, Dr. Collier commented to OSN: “When we started this project, we certainly did not anticipate a worldwide pandemic. However, in the context of the COVID-era, this study has greater importance since it provides further evidence to suggest that a delay in surgery does not impact survival in soft tissue sarcoma.”

The authors wrote: “A longer preRT-surgery [preoperative radiation therapy] interval was associated with higher age, tumor location in the pelvis, and malignant peripheral nerve sheath tumor subtype. A shorter preRT-surgery interval was associated with higher facility volume and higher tumor stage. The 5-year overall survival rates were similar across all preRT-surgery interval groups: less than 3 weeks, 3 to 4 weeks, 4 to 5 weeks, 5 to 6 weeks, 6 to 7 weeks, 7 to 9 weeks, and more than 9 weeks. Over 10 years, no difference in overall survival was observed when stratified by the preRT-surgery interval.”

“A delay in surgery up to 90 days after preoperative radiation is not associated with survival,” said Dr. Collier to OSN. “Therefore, it appears safe and perhaps prudent to delay surgery to allow soft tissue recovery after radiation and minimize wound complications.”

Looking forward, stated Dr. Collier, “The ideal interval between preoperative radiation and surgery has yet to be defined. Our study suggests that it would be safe to conduct a prospective randomized trial comparing margin status, wound complication rates, and survival at various preoperative radiation-surgery intervals.”


Josh Sandberg

Josh Sandberg is the President and CEO of Ortho Spine Partners and sits on several company and industry related Boards. He also is the Creator and Editor of OrthoSpineNews.

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