Journal of plastic, reconstructive & aesthetic surgery : JPRAS | 2021
Preoperative versus Post-operative Radiotherapy for Extremity Soft tissue Sarcoma: a Systematic Review and Meta-analysis of Long-term Survival.
Abstract
BACKGROUND\nThe role of perioperative radiotherapy in the management of resectable extremity soft tissue sarcoma (ESTS) is widely recognised for local tumour control, wound complications (WC) and long-term function. However, debate continues regarding its implications on long-term survival. This study aimed to determine whether the timing of perioperative radiotherapy affects long-term survival outcomes in adults with ESTS.\n\n\nMETHODS\nA systematic literature search of MEDLINE, EMBASE, Web of Science and Cochrane was performed. The primary outcome measure was the pooled hazard ratio (HR) at 95% confidence intervals. Secondary outcomes and subgroup analyses were presented as cumulative odds ratios (OR). A random-effects, generic inverse variance method and sensitivity analysis were performed to minimise heterogeneity.\n\n\nRESULTS\nSix studies (n\u202f=\u202f4192 patients) were identified. Time-to-event analysis demonstrated a statistically significant advantage in post-operative radiotherapy for overall survival (HR 1.15 and p\u202f=\u202f0.05). Combined HRs for disease-free (1.25 and p\u202f=\u202f0.22) and disease-specific (1.06 and p\u202f=\u202f0.43) survival also favoured post-operative radiotherapy but did not achieve statistical significance. Post-operative radiotherapy was shown to confer an overall (OR 1.19 and p\u202f=\u202f0.01), disease-free (OR 1.19 and p\u202f=\u202f0.01) and disease-specific (OR 1.19 and p\u202f=\u202f0.01) survival advantage on subgroup analysis. This survival benefit was best observed at three years in the disease-free survival comparison (OR 1.55 and p\u202f=\u202f0.003). Preoperative radiotherapy was associated with more WC (OR 2.74 and p<0.00001).\n\n\nCONCLUSIONS\nPooled analysis of published literature suggests that post-operative radiotherapy confers a significant long-term survival advantage with fewer WC. Further large multicentre randomised controlled trials with long-term follow-up are required to determine the optimal perioperative radiotherapy regime in adult ESTS.