Evaluation of the effect of neoadjuvant chemotherapy on the planned resectability of extremity soft-tissue sarcomas
Aims: In this study, we explore whether neoadjuvant chemotherapy influences the surgical resection strategy devised by surgeons for high-grade soft-tissue sarcoma. Methods: A total of 12 experienced soft-tissue sarcoma surgeons rated patients who underwent neoadjuvant chemotherapy for a soft-tissu...
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2025-05-01
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| Series: | Bone & Joint Open |
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| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.65.BJO-2025-0026.R1 |
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| author | Simon Tournemine Sylvie Bonvalot Jean-Yves Mary Dimosthenis Andreou David Biau |
| author_facet | Simon Tournemine Sylvie Bonvalot Jean-Yves Mary Dimosthenis Andreou David Biau |
| author_sort | Simon Tournemine |
| collection | DOAJ |
| description | Aims: In this study, we explore whether neoadjuvant chemotherapy influences the surgical resection strategy devised by surgeons for high-grade soft-tissue sarcoma. Methods: A total of 12 experienced soft-tissue sarcoma surgeons rated patients who underwent neoadjuvant chemotherapy for a soft-tissue sarcoma of the thigh. Cases were randomly assigned to surgeons, such that each surgeon rated three out of the 12 cases, and each case was rated by three out of 12 surgeons (n = 36 ratings before and after chemotherapy). Surgeons were asked which surgical technique they would use: amputation; and if not, resection or dissection of critical anatomical structures in close proximity to the tumour (sciatic nerve, femoral artery, and femur). Pre- and post-chemotherapy ratings were then compared to test if chemotherapy changed the surgery aggressiveness anticipated by the surgeons. Results: Tumour volume increased in 9/12 cases (75%). Ratings as amputation were discordant in 5/36 cases (14%) before and after chemotherapy. The surgical technique planned by surgeons before and after chemotherapy regarding critical anatomical structures were discordant in five (14%), eight (22%), and six of 36 ratings (17%) for the sciatic nerve, the femoral artery, and the femur, respectively. Overall, a similarly aggressive surgery was planned by surgeons in nine, six, and eight cases for the sciatic nerve, the femoral artery, and the femur, respectively, which is significantly more than that expected due to chance alone. A more aggressive surgery was anticipated in five of 36 cases (14%). Conclusion: Despite tumour growth being observed in 75% of cases, the surgical resection strategy devised after neoadjuvant chemotherapy remained notably similar to the one devised prior to neoadjuvant chemotherapy for critical anatomical structures. However, ‘switchers’, namely patients identified as being at risk of needing an amputation if the tumour experiences slight growth, should undergo conservative surgery initially, followed by chemotherapy. Cite this article: Bone Jt Open 2025;6(5):553–559. |
| format | Article |
| id | doaj-art-c248c729face4cce9d9207a96cf87528 |
| institution | DOAJ |
| issn | 2633-1462 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj-art-c248c729face4cce9d9207a96cf875282025-08-20T03:09:51ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622025-05-016555355910.1302/2633-1462.65.BJO-2025-0026.R1Evaluation of the effect of neoadjuvant chemotherapy on the planned resectability of extremity soft-tissue sarcomasSimon Tournemine0Sylvie Bonvalot1Jean-Yves Mary2Dimosthenis Andreou3David Biau4 Université Paris-Cité, INSERM U1153, AP-HP, Hôpital Cochin, Service de Chirurgie Orthopédique, Paris, France Department of Surgical Oncology, Institut Curie, Paris, France INSERM U1342, Team ECSTRRA, Université Paris Cité, Hôpital Saint-Louis, Paris, France Department of Orthopaedics and Trauma, Institute for Interdisciplinary Sarcoma Treatment and Research, Department of Orthopedic Oncology and Sarcoma Surgery, University Hospital Essen, Essen, Germany Université Paris-Cité, INSERM U1153, AP-HP, Hôpital Cochin, Service de Chirurgie Orthopédique, Paris, France Aims: In this study, we explore whether neoadjuvant chemotherapy influences the surgical resection strategy devised by surgeons for high-grade soft-tissue sarcoma. Methods: A total of 12 experienced soft-tissue sarcoma surgeons rated patients who underwent neoadjuvant chemotherapy for a soft-tissue sarcoma of the thigh. Cases were randomly assigned to surgeons, such that each surgeon rated three out of the 12 cases, and each case was rated by three out of 12 surgeons (n = 36 ratings before and after chemotherapy). Surgeons were asked which surgical technique they would use: amputation; and if not, resection or dissection of critical anatomical structures in close proximity to the tumour (sciatic nerve, femoral artery, and femur). Pre- and post-chemotherapy ratings were then compared to test if chemotherapy changed the surgery aggressiveness anticipated by the surgeons. Results: Tumour volume increased in 9/12 cases (75%). Ratings as amputation were discordant in 5/36 cases (14%) before and after chemotherapy. The surgical technique planned by surgeons before and after chemotherapy regarding critical anatomical structures were discordant in five (14%), eight (22%), and six of 36 ratings (17%) for the sciatic nerve, the femoral artery, and the femur, respectively. Overall, a similarly aggressive surgery was planned by surgeons in nine, six, and eight cases for the sciatic nerve, the femoral artery, and the femur, respectively, which is significantly more than that expected due to chance alone. A more aggressive surgery was anticipated in five of 36 cases (14%). Conclusion: Despite tumour growth being observed in 75% of cases, the surgical resection strategy devised after neoadjuvant chemotherapy remained notably similar to the one devised prior to neoadjuvant chemotherapy for critical anatomical structures. However, ‘switchers’, namely patients identified as being at risk of needing an amputation if the tumour experiences slight growth, should undergo conservative surgery initially, followed by chemotherapy. Cite this article: Bone Jt Open 2025;6(5):553–559.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.65.BJO-2025-0026.R1soft-tissue sarcomaimagingchemotherapysurgical techniqueneoadjuvant chemotherapyextremity soft-tissue sarcomaschemotherapysoft-tissue sarcomasamputationsanatomical structuressurgical resectionfemoral arterysciatic nervefemur |
| spellingShingle | Simon Tournemine Sylvie Bonvalot Jean-Yves Mary Dimosthenis Andreou David Biau Evaluation of the effect of neoadjuvant chemotherapy on the planned resectability of extremity soft-tissue sarcomas Bone & Joint Open soft-tissue sarcoma imaging chemotherapy surgical technique neoadjuvant chemotherapy extremity soft-tissue sarcomas chemotherapy soft-tissue sarcomas amputations anatomical structures surgical resection femoral artery sciatic nerve femur |
| title | Evaluation of the effect of neoadjuvant chemotherapy on the planned resectability of extremity soft-tissue sarcomas |
| title_full | Evaluation of the effect of neoadjuvant chemotherapy on the planned resectability of extremity soft-tissue sarcomas |
| title_fullStr | Evaluation of the effect of neoadjuvant chemotherapy on the planned resectability of extremity soft-tissue sarcomas |
| title_full_unstemmed | Evaluation of the effect of neoadjuvant chemotherapy on the planned resectability of extremity soft-tissue sarcomas |
| title_short | Evaluation of the effect of neoadjuvant chemotherapy on the planned resectability of extremity soft-tissue sarcomas |
| title_sort | evaluation of the effect of neoadjuvant chemotherapy on the planned resectability of extremity soft tissue sarcomas |
| topic | soft-tissue sarcoma imaging chemotherapy surgical technique neoadjuvant chemotherapy extremity soft-tissue sarcomas chemotherapy soft-tissue sarcomas amputations anatomical structures surgical resection femoral artery sciatic nerve femur |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.65.BJO-2025-0026.R1 |
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