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Background <p>Marginal excision following preoperative radiotherapy (RT), particularly for tumours near critical structures, is a strategy that is gaining acceptance in treating Myxoid Liposarcoma (MLS). This study evaluates the oncological results of this approach by assessing the correlation between surgical margins and the risk of local recurrence (LR) and distant metastasis in patients undergoing limb salvage surgery following preoperative RT.</p> Materials and Methods <p>A retrospective study was conducted based on a prospectively maintained database of patients with non-metastatic MLS of the extremities who underwent limb salvage surgery following preoperative RT between 2012 and 2022, with at least one-year follow-up. Patient data were retrieved and analysed, including treatment characteristics, radiological and histological responses to neoadjuvant treatment, and clinical and oncological outcomes. Surgical margins were categorized based on final histopathological assessment after specimen processing as involved (R1), close (&lt;1 mm), or wide (≥1 mm).</p> Results <p>Sixty-three patients were included in the study. Of these, 6 patients (9.5%) had involved margins, 31 (49.2%) had close margins (&lt;1 mm) and 26 (41.3%) had wide margins (≥1 mm). The mean pre-RT tumour size was 12.6 cm, and the mean post-RT size was 10.2 cm, representing a statistically significant reduction following RT (p &lt; 0.001). The LR rate was 4.8% (3/63), with no significant association between margin status, tumour depth, or RT response (all p &gt; 0.05). The post-operative metastasis rate was 17.5% (11/63), with a mean time to metastasis of 3 ± 2 years. Metastasis was significantly more common in patients with involved or close margins (27%) compared to those with wide margins (3.8%) (p = 0.045). The 5-year LR-free survival rate was 95.2%, and metastasis-free survival was 84.1%.</p> Conclusion <p>In our cohort, marginal excision following preoperative radiotherapy was not associated with a higher incidence of local recurrence. However, in patients with close or involved margins, a significantly higher incidence of distant metastasis was observed. This finding suggests a careful risk-benefit discussion regarding the extent of surgery and underscores the need for stringent surveillance in these patients. This requires validation in a larger, multi-institutional cohort.</p>

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Is Marginal Excision Following Preoperative Radiotherapy for Extremity Myxoid Liposarcoma Acceptable?

  • 期刊论文

  • 发表日期：

    2026年2月28日

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  • Bhim Bahadur Shreemal,
  • Giuseppe Francesco Papalia,
  • Guy Morris,
  • Lee Jeys,
  • Sumathi Vaiyapuri,
  • Scott Evans,
  • Vineet Kurisunkal

摘要

Background

Marginal excision following preoperative radiotherapy (RT), particularly for tumours near critical structures, is a strategy that is gaining acceptance in treating Myxoid Liposarcoma (MLS). This study evaluates the oncological results of this approach by assessing the correlation between surgical margins and the risk of local recurrence (LR) and distant metastasis in patients undergoing limb salvage surgery following preoperative RT.

Materials and Methods

A retrospective study was conducted based on a prospectively maintained database of patients with non-metastatic MLS of the extremities who underwent limb salvage surgery following preoperative RT between 2012 and 2022, with at least one-year follow-up. Patient data were retrieved and analysed, including treatment characteristics, radiological and histological responses to neoadjuvant treatment, and clinical and oncological outcomes. Surgical margins were categorized based on final histopathological assessment after specimen processing as involved (R1), close (<1 mm), or wide (≥1 mm).

Results

Sixty-three patients were included in the study. Of these, 6 patients (9.5%) had involved margins, 31 (49.2%) had close margins (<1 mm) and 26 (41.3%) had wide margins (≥1 mm). The mean pre-RT tumour size was 12.6 cm, and the mean post-RT size was 10.2 cm, representing a statistically significant reduction following RT (p < 0.001). The LR rate was 4.8% (3/63), with no significant association between margin status, tumour depth, or RT response (all p > 0.05). The post-operative metastasis rate was 17.5% (11/63), with a mean time to metastasis of 3 ± 2 years. Metastasis was significantly more common in patients with involved or close margins (27%) compared to those with wide margins (3.8%) (p = 0.045). The 5-year LR-free survival rate was 95.2%, and metastasis-free survival was 84.1%.

Conclusion

In our cohort, marginal excision following preoperative radiotherapy was not associated with a higher incidence of local recurrence. However, in patients with close or involved margins, a significantly higher incidence of distant metastasis was observed. This finding suggests a careful risk-benefit discussion regarding the extent of surgery and underscores the need for stringent surveillance in these patients. This requires validation in a larger, multi-institutional cohort.