September 15, 2026The Lancet
Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial
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Discussion
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Implication
Randomized trial reveals higher acute wound complications after preoperative radiotherapy in limb soft-tissue sarcoma, suggesting trade-offs against long-term tissue fibrosis.
Key Points
- To determine whether preoperative radiotherapy reduces morbidity compared to postoperative radiotherapy in patients undergoing surgery for extremity soft-tissue sarcoma.
- Multicenter randomized trial enrolling 190 patients with operable extremity soft-tissue sarcoma.
- Patients were randomly allocated to receive either preoperative radiotherapy (50 Gy in 25 fractions) or postoperative radiotherapy (66 Gy in 33 fractions) alongside limb-sparing resection.
- The primary endpoint was the rate of acute wound complications documented within 120 days of surgical resection.
- Acute wound complications developed in 35% of patients (31 of 88) receiving preoperative radiotherapy compared with 17% of patients (16 of 94) receiving postoperative radiotherapy (absolute difference 18%, 95% CI 5%–30%, p=0.01).
- Overall survival and local recurrence rates did not differ significantly between the preoperative and postoperative treatment groups.
Cite This Study
O’Sullivan et al. (2002) studied this question.