Limb-sparing surgery (LSS) plus pre- or postoperative radiotherapy (RT) may lead to improved overall survival (OS) and sarcoma mortality (SM) among patients with high-grade, extremity soft-tissue sarcoma (E-STS), according to a study published in Cancer Medicine.1

A previous study demonstrated that LSS plus RT, now considered the standard of care, leads to improved outcomes among patients with E-STS. Subsequent studies however, produced conflicting results, did not include modern patient data, and were often underpowered.

For this study, researchers accessed the National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) Program to evaluate the cases of 7828 and 2937 patients with E-STS, respectively. Eligible patients had stage II to III, high-grade E-STS, and were diagnosed between 2004 and 2013. Investigators studied the outcomes of patients who underwent amputation alone, LSS alone, preoperative RT plus LSS, or LSS plus postoperative RT. Approximately 30% to 35% of patients underwent amputation or LSS alone.

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Multivariable analyses showed that patients who underwent amputation were associated with significantly inferior OS and SM compared with patients exposed to LSS alone (NCDB: hazard ratio [HR], 1.31; 95% CI, 1.13-1.51; SEER: HR, 1.59; 95% CI, 1.24-2.04).

Results from NCDB and SEER databases demonstrated that preoperative RT plus LSS (HR, 0.70; 95% CI, 0.62-0.78) and LSS plus postoperative RT (HR, 0.69; 95% CI, 0.63-0.75) prolonged OS and reduced SM compared with LSS alone.

Matched-pair analyses revealed that the median survival was 7.2 years among patients treated with LSS alone compared with 9.8 years among patients treated with LSS plus postoperative RT. Results were similar with preoperative RT plus LSS; patients who received LSS alone had a median survival of 6.6 years compared with 8.9 years among patients who underwent preoperative RT plus LSS.

The authors concluded that “LSS combined with RT is the optimal treatment option for most patients with high‐grade E‐STS.”


  1. Ramey SJ, Yechieli R, Zhao W, et al. Limb‐sparing surgery plus radiotherapy results in superior survival: an analysis of patients with high‐grade, extremity soft‐tissue sarcoma from the NCDB and SEER [published online July 20, 2018]. Cancer Med. doi: 10.1002/cam4.1625