S1049
Clinical – Sarcoma, skin cancer, malignant melanoma
ESTRO 2026
Digital Poster 4424 Clinical Outcomes and the Impact of Radiotherapy in Myxofibrosarcoma: Insights from a Retrospective Cohort Daniela Greto 1 , Mauro Loi 1 , Silvia Ruggeri 1 , Olga Ruggieri 1 , Roberto Scanferla 2 , Domenico Andrea Campanacci 2 , Guido Scoccianti 2 , Giuliana Roselli 3 , Annarita Palomba 4 , Lorenzo Livi 1 1 Radiation Oncology Department - Careggi Hospital, University of Florence, Florence, Italy. 2 Orthopaedic Oncology Department, University of Florence, Florence, Italy. 3 Radiology Department, University of Florence, Florence, Italy. 4 Pathology department, University of Florence, Florence, Italy Purpose/Objective: Myxofibrosarcoma (MFS) is a locally aggressive soft tissue sarcoma characterized by an infiltrative growth pattern and a high rate of local recurrence. Local failure is frequently followed by distant dissemination, suggesting a biological association between inadequate local control and systemic progression. The role of perioperative radiotherapy (RT) in improving these outcomes remains debated. This study assessed the impact of RT, surgical margins, and pathological features on local recurrence (LR), distant metastasis (DM), and overall survival (OS) in a single- institution cohort of patients undergoing surgery for MFS. Material/Methods: We retrospectively reviewed consecutive patients with histologically confirmed MFS of the extremities or superficial trunk treated surgically between 2010 and 2024. Radiotherapy was delivered preoperatively (50 Gy in 25 fractions) or postoperatively (60 Gy in 30 fractions). High-risk patients received adjuvant epirubicin–ifosfamide chemotherapy (three cycles, every 21 days). Data collected included demographics, tumor size (T-stage), depth, FNCLCC grade, margin status, RT modality (none, neoadjuvant, adjuvant), and neurovascular or satellite involvement. Outcomes were local recurrence-free survival (LRFS), metastasis- free survival (MFS), and overall survival (OS). Results: Ninety-nine patients were identified, median age was 70 years (range 35–95). Most tumors were located in the extremities (83%) and deep-seated (63%) with a grade 3 disease in 44% patients. R0 resection was achieved in 64%, and 49% received perioperative RT, predominantly adjuvant (32%). Eight patients received adjuvant chemotherapy. At a median follow-up of 4.8 years (range 0.5–14.6), 2 and 5-year OS rates were 91% and 76%; DMFS rates were 58% and 41%; and LRFS rates were 64% and 48%, respectively. Adjuvant RT significantly prolonged LRFS compared with neoadjuvant or no RT (median 3.3 vs 1.3 and 0.36
A total of 200 patients were included (median age 63 years [IQR 51-74], 51% male). Median biopsy-to- surgery interval was 156 days [IQR 133-183] and the median follow-up was 71 months; 81 DFS events occurred. The biopsy-to-surgery interval was not significantly associated with DFS (HR 1.06; 95% CI 0.95- 1.19; p=0.30). Kaplan-Meier analyses by quartiles of delay confirmed no significant difference (log-rank p=0.56). Among covariables, ECOG 1 versus 0 was independently associated with worse DFS (HR 2.25; 95% CI 1.23-4.10; p=0.008). No other variables reached statistical significance. Conclusion: In this homogeneous cohort of patients with limb or trunk STS treated with neoadjuvant radiotherapy, the biopsy-to-surgery interval was not associated with disease-free survival. Performance status remains a key independent prognostic factor. References: Blay J-Y, Honoré C, Stoeckle E, Meeus P, Jafari M, Gouin F, et al. Surgery in reference centers improves survival of sarcoma patients: a nationwide study. Ann Oncol 2019;30:1143–53. https://doi.org/10.1093/annonc/mdz124O’Sullivan B, Davis AM, Turcotte R, Bell R, Catton C, Chabot P, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. The Lancet 2002;359:2235–41. https://doi.org/10.1016/S0140-6736(02)09292-9Davis AM, O’Sullivan B, Turcotte R, Bell R, Catton C, Chabot P, et al. Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma. Radiother Oncol 2005;75:48–53. https://doi.org/10.1016/j.radonc.2004.12.020 Keywords: neoadjuvant radiotherapy, surgery timing
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