2325 - Oncologic Outcomes and Prognostic Determinants Following Neoadjuvant Radiotherapy and Surgical Resection in Myxoid Liposarcoma
Presenter(s)
D. Greto1, M. Loi1, G. Simontacchi1, S. Ruggeri2, N. Bertini2, D. A. Campanacci3, G. Scoccianti3, G. Roselli4, A. Palomba5, F. Nozzoli5, I. Meattini2, G. Francolini1, and L. Livi1; 1Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy, 2Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy, 3Department of Health Sciences, Orthopedic Oncology and Reconstructive Surgery Unit, Careggi University Hospital, University of Florence, Florence, Italy, 4Department of Radiology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy, 5Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
Purpose/Objective(s): Myxoid liposarcoma (MLPS) is a distinct and radiosensitive subtype of soft tissue sarcoma. Preoperative radiotherapy (RT), with or without chemotherapy, may enhance local control and facilitate optimal surgical resection. We evaluated oncologic outcomes, treatment tolerance, and prognostic factors in patients with myxoid liposarcoma treated with neoadjuvant RT-based strategies followed by surgery.
Materials/Methods: We retrospectively analyzed 52 consecutive patients with MLPS treated between 2002 and 2024 with preoperative RT (50 Gy in 25 fractions), with or without concurrent chemotherapy (epirubicin–ifosfamide), followed by surgical resection. Survival outcomes—including local control (LC), disease-free survival (DFS), distant metastasis–free survival (DMFS), and overall survival (OS)—were estimated using the Kaplan–Meier method. Prognostic factors were assessed by univariate analysis.
Results: With a median follow-up of 55 months (range, 4–148), 33% of tumors were grade 3 and 35% of patients received combined radiochemotherapy. An R0 resection was achieved in 89% of cases, while 11% had marginal (R1) resections. The amputation rate was 4%.Treatment was well tolerated: wound complications occurred in 15% of patients and fractures in 8%.Oncologic outcomes were favorable. The 3- and 5-year LC rates were 97% and 94%, respectively. Corresponding 3- and 5-year DFS rates were 74% and 68%, DMFS rates were 79% and 69%, and OS rates were 88% and 86%. On univariate analysis, R1 resection significantly impaired local control (p = 0.002). Grade 3 disease was associated with worse DFS (p = 0.04), DMFS (p = 0.018), and OS (p = 0.016).
Conclusion: Neoadjuvant RT, with or without chemotherapy, followed by surgery provides excellent local control and favorable long-term survival in patients with myxoid liposarcoma. High-grade disease remains the principal adverse prognostic factor, while incomplete resection compromises local control. Treatment-related toxicity is acceptable, supporting the safety and effectiveness of preoperative RT-based approaches in this radiosensitive sarcoma subtype.