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Prognostic factors and uutcomes for post-radiation sarcoma: a systematic review and meta-analysis : systematic review

Background/Objectives: Post-radiation sarcomas (PRS) are secondary malignancies occurring years after radiotherapy. Due to low incidence, evidence on prognostic factors and management is limited. Methods: MEDLINE, Embase, and the Cochrane Library were searched from January 1960 to January 2026. Elig...

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Main Authors: Harbrücker, Melissa (Author) , Möller, Maximilian (Author) , Krug, Carla (Author) , Hetjens, Svetlana (Author) , Hettler, Madelaine (Author) , Seyfried, Steffen (Author) , Reißfelder, Christoph (Author) , Kasper, Bernd (Author) , Brochhausen, Christoph (Author) , Fröhling, Stefan (Author) , Teleanu, Veronica (Author) , Ströbel, Philipp (Author) , Kneser, Ulrich (Author) , Hohenberger, Peter (Author) , Jakob, Jens (Author)
Format: Article (Journal)
Language:English
Published: 27 July 2026
In: Cancers
Year: 2026, Volume: 18, Issue: 15, Pages: 1-21
ISSN:2072-6694
DOI:10.3390/cancers18152414
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.3390/cancers18152414
Verlag, kostenfrei, Volltext: https://www.mdpi.com/2072-6694/18/15/2414
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Author Notes:Melissa Harbrücker, Maximilian Moeller, Carla Krug, Svetlana Hetjens, Madelaine Hettler, Steffen Seyfried, Christoph Reissfelder, Bernd Kasper, Christoph Brochhausen, Stefan Fröhling, Veronica Teleanu, Philipp Ströbel, Ulrich Kneser, Peter Hohenberger and Jens Jakob
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Summary:Background/Objectives: Post-radiation sarcomas (PRS) are secondary malignancies occurring years after radiotherapy. Due to low incidence, evidence on prognostic factors and management is limited. Methods: MEDLINE, Embase, and the Cochrane Library were searched from January 1960 to January 2026. Eligible studies included observational cohorts reporting outcomes of histologically confirmed PRS. We excluded case reports, case series with fewer than ten patients, reviews, editorials, and studies without survival or recurrence outcomes. Two authors independently screened studies, extracted data, and assessed risk of bias. Hazard ratios (HRs) and 95% confidence intervals were extracted or calculated. The primary outcome was overall survival. Heterogeneity was assessed using the I2 statistic. This study was registered with PROSPERO (CRD42023457401). Results: The search identified 4222 records, of which 28 studies comprising 2438 patients were eligible for analysis. Most patients were female (2008, 83.3%), reflecting a predominance of breast radiation-associated angiosarcoma. Older age, larger tumor size, higher histological grade, and positive surgical margins were consistently associated with worse overall survival. Complete (R0) resection was associated with improved survival (pooled HR < 1.0), as was treatment in specialized sarcoma centers. Chemotherapy and additional radiotherapy were not associated with improved overall survival. Substantial heterogeneity was observed (I2 > 50% for several analyses). Overall risk of bias was moderate. Conclusions: PRS share key prognostic determinants with sporadic sarcomas. Complete surgical resection and management in specialized sarcoma centers are the most important factors associated with improved outcomes. These findings support centralized care and highlight the need for prospective research to improve risk stratification and management of PRS.
Item Description:Gesehen am 14.09.2026
Physical Description:Online Resource
ISSN:2072-6694
DOI:10.3390/cancers18152414

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