Treatment and Outcomes of Radiation-Induced Soft Tissue Sarcomas of the Extremities and Trunk-A Systematic Review of the Literature

Abstract

Introduction: Radiation-induced soft tissue sarcomas (RISs) are rare secondary malignancies with a dire prognosis. The literature on the management of these tumors remains scarce due to their low incidence. Our systematic review sought to assess the treatment alternatives and outcomes of patients with RIS.

Methods: A systematic review was conducted following the PRISMA guidelines. Our study was registered in PROSPERO (ID: CRD42023438415). Quality assessment was performed using the STROBE checklist. Weighted means for both continuous and categorical values were calculated.

Results: Twenty-one studies comprising 1371 patients with RIS were included. The mean latency period from radiation to RIS diagnosis was 14 years, and the mean radiation dose delivered to the primary malignancy was 29.2 Gy. The most common histological type was undifferentiated pleomorphic sarcoma (42.2%), and 64% of all tumors were high-grade. The trunk was the most common location (59%), followed by extremities (21%) and pelvis (11%). Surgery was performed in 68% of patients and, among those with an appendicular tumor, the majority (74%) underwent limb-salvage surgery. Negative margins were attained in 58% of patients. Chemotherapy and radiotherapy were administered in 29% and 15% of patients, respectively. The mean 5-year overall survival was 45%, and the local recurrence and metastasis rates were 39% and 27%, respectively.

Conclusions: In our study, the most common treatment was surgical resection, with RT and chemotherapy being administered in less than one third of patients. Patients with RIS exhibited poor oncologic outcomes. Future studies should compare RIS with de novo STS while controlling for confounders.

Keywords: radiation-associated sarcoma; soft tissue sarcoma; surgery; survival.

Figure 1

PRISMA flowchart for our literature search and selection of relevant articles.

Figure 2

Pie chart of the histology distribution of the included RISs. UPS: undifferentiated pleomorphic sarcoma; AS: angiosarcoma; LMS: leiomyosarcoma; FS: fibrosarcoma; OS: osteosarcoma; EOS: extraskeletal osteosarcoma; others: malignant peripheral nerve sheath tumor, pleomorphic leiomyosarcoma, myxofibrosarcoma, Ewing sarcoma, malignant schwannoma, rhabdomyosarcoma, hemangiosarcoma, lymphangiosarcoma.