S1050
Clinical – Sarcoma, skin cancer, malignant melanoma
ESTRO 2026
study aimed to evaluate clinical outcomes, treatment tolerance, and prognostic factors in patients with STS treated with neoadjuvant RT alone or concurrent radiochemotherapy (RTCT) followed by surgery. Material/Methods: Clinical and treatment data were retrospectively collected from consecutive patients with STS treated with preoperative RT or RTCT followed by surgery between 2002 and 2024 at a single Institution. RT was delivered to a total dose of 50 Gy in 25 fractions. Chemotherapy consisted of three cycles of epirubicin– ifosfamide administered every 21 days. Overall survival (OS), distant metastasis–free survival (DMFS), and local control (LC) were estimated using the Kaplan–Meier method. Results: A total of 158 patients were analyzed. The mean age was 56 years (range, 16–91), and most tumors were located in the limbs (91%). The most common histological subtypes were liposarcoma (35%), undifferentiated pleomorphic sarcoma (29%), and synovial sarcoma (9%). High-grade disease was present in 77% of patients, and 47% received RTCT.All patients underwent surgery: wide excision in 87%, marginal resection in 8%, and amputation in seven cases. Major wound complications occurred in 23% of patients, with only two requiring a second surgical procedure for scar revision.After a median follow-up of 30 months (range, 3–175), the 2- and 5-year OS rates were 80% and 63%, DMFS rates were 61% and 46%, and LC rates were 97% and 88%, respectively. On multivariate analysis, R1 resection was significantly associated with poorer LC (p = 0.0057), while grade 3 disease correlated with inferior DMFS (p = 0.0004) and OS (p = 0.0012). No other clinical or treatment variables showed significant correlations with outcomes. Conclusion: Neoadjuvant RT followed by surgery provides excellent local control and favorable overall survival in patients with STS. High-grade tumors remain the strongest predictors of distant relapse and reduced survival, while incomplete (R1) resection compromises local control. Importantly, treatment-related toxicity is acceptable: wound complications are relatively low and largely manageable, supporting the safety and feasibility of preoperative RT-based approaches in the multidisciplinary management of STS. References: O'Sullivan B, Davis AM, Turcotte R, Bell R, Catton C, Chabot P, Wunder J, Kandel R, Goddard K, Sadura A, Pater J, Zee B. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002 Jun 29;359(9325):2235- 41. doi: 10.1016/S0140-6736(02)09292-9. PMID: 12103287. Keywords: neoadjuvant radiotherapy, soft tissue
years; p = 0.048). Local recurrence strongly predicted metastasis (53% with LR vs 17% without; p = 0.004), with 82% of metastases occurring after LR. Deep location and positive margins correlated with poorer outcomes, though not significantly. Neurovascular and satellite involvement showed no prognostic impact. Conclusion: Adjuvant RT significantly improved local control and delayed recurrence in MFS. Local recurrence was the strongest predictor of metastasis and reduced survival, underscoring the importance of optimal local
treatment. Achieving negative margins and administering adjuvant RT appear critical for
preventing systemic spread. These results align with recent multicenter evidence supporting adjuvant RT in curative MFS management and highlight the need for prospective studies comparing neoadjuvant and adjuvant approaches References: Fahad S, Grothe A, An Q, Miller BJ. Is Perioperative Radiotherapy Effective in Preventing Local Recurrence in Myxofibrosarcoma? Iowa Orthop J. 2024;44(1):85-92. PMID: 38919357; PMCID: PMC11195901.Look Hong NJ, Hornicek FJ, Raskin KA, Yoon SS, Szymonifka J, Yeap B, Chen YL, DeLaney TF, Nielsen GP, Mullen JT. Prognostic factors and outcomes of patients with myxofibrosarcoma. Ann Surg Oncol. 2013 Jan;20(1):80- 6. doi: 10.1245/s10434-012-2572-3. Epub 2012 Aug 14. PMID: 22890594; PMCID: PMC3837421. Keywords: myxofibrosarcoma, margins, radiotherapy Digital Poster 4432 Preoperative Radiotherapy in Soft Tissue Sarcoma: Outcomes, Toxicities and Clinical Implications Daniela Greto 1 , Mauro Loi 1 , Silvia Ruggeri 1 , Olga Ruggieri 1 , Marco Banini 1 , Niccolò Bertini 1 , 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: Surgical excision remains the cornerstone of curative- intent therapy for soft tissue sarcoma (STS). However, high-grade tumors, large size, deep location, and proximity to critical structures may limit the ability to achieve optimal resection. Neoadjuvant radiotherapy (RT) has become an integral part of multimodal management, aiming to improve local control (LC), enable limb- or function-sparing surgery, and potentially reduce the risk of distant metastasis. This
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