Surgery, neoadjuvant chemotherapy emerge as crucial in radiation-induced sarcoma management

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Surgery should be a standard treatment modality in the management of radiation-induced sarcomas (RIS), according to a study that suggests that neoadjuvant chemotherapy (NACT) could be particularly beneficial in downsizing large lesions, especially in patients with breast angiosarcoma (BAS).

The study identified 107 tumors meeting the criteria for RIS, categorized into 3 subgroups: BAS, osteosarcoma (OST), and other soft-tissue sarcomas (STS). Most patients were female, and primarily treated initially for breast carcinomas. Notably, 86% of cases were diagnosed as high-grade tumors, with no evidence of synchronous metastasis.

Patients with osteosarcoma were found to be younger, in comparison to the other subgroups. Breast angiosarcoma cases exhibited the shortest latency interval, highlighting the importance of vigilant monitoring after radiation therapy.

Surgery emerged as the standard treatment, with 76% of patients undergoing successful R0 resection. In addition, 24% of patients received radiation therapy, predominantly in the neoadjuvant setting. Among those receiving chemotherapy, NACT was administered to 75% of patients, and a remarkable 68% showed a positive response.

The study reported a median overall survival of 53 months, with a 5-year survival rate of 47.6%. Larger tumor size, high histologic grade, and older age were identified as independent prognostic factors associated with worse overall survival.

Ribeiro MF, Peretz Soroka H, Bhura Z, et al. Clinico-demographic characteristics and outcomes of radiation-induced sarcomas (RIS): a CanSaRCC study. Ther Adv Med Oncol. 2023;15:17588359231198943. doi: 10.1177/17588359231198943. PMID: 37781501; PMCID: PMC10540571.