Should we be offering pre-op radiotherapy to our sarcoma patients?

Timothy Mitchell, Fiona Cowie, Ioanna Nixon

Research output: Contribution to conferenceAbstract


Aim: To evaluate measures of response to pre- operative radiotherapy (RT) for limb Soft Tissue Sarcoma (STS). Methods: Retrospective review of 20 sequential patients receiving limb RT for non- metastatic histologically proven STS from the local radiotherapy database. Response to preoperative RT was assessed using volume change on MRI and pathological percentage necrosis. Pathology retrospectively reviewed by 3 sarcoma pathologists for necrosis rate. All patients treated with standard dose and fractionation using either conventional or VMAT technique. Results: 11 myxoid liopsarcoma, 4 pleomorphic, 2 synovial, 2 spindle and 1 MPNST. Size range (longest dimension), 40 to 180mm. The range of change between pre and post-op MRI volumes was -665 mls to + 3213 mls. The pathological responses after RT ranged from 55 to 99%. Good inter-observer agreement for non myxoid liposarcoma, less agreement for myxoids. Conclusion: Pre operative RT did not consistently decrease tumour volume or induce significant pathological response. Differences between results from three pathologists reporting necrosis/ response warrant further investigation. Post operative complications after pre operative radiotherapy have been a local concern, however review of post operative complications has resulted in debate over scoring/ grading, rates of complications cannot be included until this is agreed locally. The overall benefit of pre operative RT has been questioned following a number of post operative complications. Pathology and radiology correlated fairly well as a marker of response, but less convincingly than expected. How can the risks and benefits for pre versus post operative radiotherapy be best evaluated to inform decision making?
Original languageEnglish
Publication statusPublished - 27 Feb 2018
EventBritish Sarcoma Group Annual Conference - The Repertory Theatre, Birmingham, United Kingdom
Duration: 27 Feb 201828 Feb 2018


ConferenceBritish Sarcoma Group Annual Conference
Country/TerritoryUnited Kingdom


  • radiotherapy
  • sarcomas
  • soft tissue sarcoma


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