Main Session
Sep
27
PQA 02 - Pediatric Cancer, Sarcoma and Cutaneous Tumors, Medical Education & Professional Development, and Health Services Research
Presenter(s)
Dianna Liakos, BS - Medical College of Wisconsin, Milwaukee, WI
D. Liakos1, A. C. Istl1, M. V. Boxtel1, M. Bedi2, and C. M. Ellison1; 1Medical College of Wisconsin, Milwaukee, WI, 2Cleveland Clinic Florida, Weston, FL
Purpose/Objective(s):
Inguinofemoral soft tissue sarcomas (STS) are rare and often diagnosed incidentally after non-oncologic resection. Their proximity to critical vascular structures and frequent incomplete resections pose diagnostic and therapeutic challenges. While radiation therapy (RT) is well established in retroperitoneal and extremity STS, its role in inguinofemoral STS, particularly after non-oncologic resection, remains unclear. This study evaluates the impact of perioperative RT on local control after definitive resection. We hypothesize that perioperative RT reduces local recurrence in inguinofemoral STS, irrespective of initial resection type.Materials/Methods:
We conducted a retrospective cohort study of patients with biopsy-proven inguinofemoral STS treated at a single tertiary referral high-volume sarcoma center between 2000-2025. Demographic and pathologic data were abstracted from electronic medical records. Treatment variables including type of surgery (incidental non-oncologic versus planned oncologic resection) and timing of RT (neoadjuvant or adjuvant) were collected. Our primary outcome was crude LR rate, calculated from the index operation to radiographic or clinical evidence of recurrence. Secondary outcomes included rate of distant metastasis.Results:
We identified 49 patients who met inclusion criteria. Mean age was 55.9 years (SD ± 17.75) and 65% were male. The majority had favorable baseline performance status (ECOG 0-1, 67%). Tumor histology was heterogeneous, with liposarcoma and leiomyosarcoma being the most common subtypes. At presentation, 55.1% of patients had T2 disease, 14.3% had T1, 6.1% had T3, and 10.2% had T4 tumors. Ten percent had distant metastases at diagnosis. All patients underwent surgical resection of their primary tumor: 22 (44.9%) non-oncologic and 27 (55.1%) oncologic at time of index operation. Sixteen patients (32.7%) received chemotherapy. Median duration of follow-up was 53.6 months (IQR 15-115 months). Distant metastases were observed in 14 patients during follow-up (28.6%). The 2-year crude incidence of LR was 10% and the 5-year crude incidence of LR was 16%. Thirty-three patients (67.3%) received perioperative RT which was delivered predominantly in the neoadjuvant setting to a median dose of 50 Gy in 25 fractions. Five (15.1%) patients who received RT developed LR during the course of follow-up compared to 3 patients (18.8%) who did not undergo RT. Median time to LR was 8.5 months for the entire cohort, 18 months for patients receiving RT, and 5 months for those who did not.Conclusion:
Inguinofemoral sarcomas represent a rare and challenging subset of STS. Perioperative RT may improve LR, as in extremity sarcomas, underscoring the need for accurate diagnosis and upfront multidisciplinary care. Larger, multi-institutional studies are needed to further elucidate the timing and benefit of perioperative RT to guide future recommendations for this rare group of tumors.