Preop vs postop RT in STS (NCIC SR2)

Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial.

O'Sullivan B, Davis AM, Turcotte R, et al. Lancet (London, England) 2002 · PMID 12103287 · doi:10.1016/s0140-6736(02)09292-9

Question

Does giving radiotherapy before rather than after surgery for limb soft tissue sarcoma alter wound complications and outcome?

Design

Multicentre Canadian RCT (NCIC Clinical Trials Group).

Patients

Adults with extremity soft tissue sarcoma suitable for limb-sparing surgery.

Intervention

Preoperative radiotherapy (50 Gy)

Comparison

Postoperative radiotherapy (66 Gy)

Primary outcome

Major wound complications within 120 days of surgery

Key result

Preoperative radiotherapy roughly doubled wound complications (35% versus 17%, significant); tumour size and site were also risk factors, and overall survival was marginally better with preoperative treatment.

Limitations

Not powered for local control or survival; later follow-up showed more late fibrosis and joint stiffness with the higher postoperative dose.

Impact on practice

Informs the UK sarcoma MDT choice of radiotherapy timing, trading early wound problems (preop) against late fibrosis and oedema (postop), with plastic surgical input often planned.