The health-related quality of life of sarcoma patients treated with neoadjuvant versus adjuvant radiotherapy – Results of a multi-center observational study

Research output: Contribution to journalResearch articleContributedpeer-review


  • Susanne Singer - , Johannes Gutenberg University Mainz, German Cancer Research Center (DKFZ) (Author)
  • Sabine Semrau - , Friedrich-Alexander University Erlangen-Nürnberg (Author)
  • Henriette Golcher - , Friedrich-Alexander University Erlangen-Nürnberg (Author)
  • Katja Fechner - , Friedrich-Alexander University Erlangen-Nürnberg (Author)
  • Annett Kallies - , Friedrich-Alexander University Erlangen-Nürnberg (Author)
  • Sergio Zapata Bonilla - , Johannes Gutenberg University Mainz (Author)
  • Robert Grützmann - , Friedrich-Alexander University Erlangen-Nürnberg (Author)
  • Rainer Fietkau - , Friedrich-Alexander University Erlangen-Nürnberg (Author)
  • Torsten Kluba - , Communal Hospital (Author)
  • Christina Jentsch - , Dresden University of Technology, University Cancer Center (UCC) (Author)
  • Dimosthenis Andreou - , University of Münster, Medical University of Graz (Author)
  • Martin Bornhäuser - , University Cancer Centre, Department of internal Medicine I (Author)
  • Jochen Schmitt - , Center for Evidence-Based Healthcare, National Center for Tumor Diseases (Partners: UKD, MFD, HZDR, DKFZ), Dresden University of Technology (Author)
  • Markus K. Schuler - , Dresden University of Technology (Author)
  • Martin Eichler - , University Cancer Centre (Author)


Aim: The sequence of radiotherapy and resection in patients with soft tissue sarcomas is usually discussed on an individual basis. Better understanding of potential differences of health-related quality of life (QoL) between patients undergoing adjuvant (ART) versus neoadjuvant radiotherapy (NART) is therefore helpful for clinical decision making. Methods: Adult sarcoma patients from 39 hospitals completed the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30). Differences in global QoL, physical functioning, role functioning, fatigue, pain, and insomnia between ART versus NART were investigated with multivariate regression, adjusting for age, gender, chemotherapy, grading, stage, tumor location, recurrence/distant metastasis, sarcoma type, time since last treatment, and treatment status using validated thresholds. Results: A total of 1110 patients participated. Of them, 340 had received radiotherapy (NART: n = 95, 28%; ART: n = 245, 72%). Global QoL was 59.3 on average after NART and 60.5 after ART (Badj = 1.0, p = 0.74). Physical functioning was 65.9 compared to 70.5 (Badj = 4.2; p = 0.16), role function 48.8 vs. 56.7 (Badj = 7.0, p = 0.08), fatigue 47.5 vs. 45.4 (Badj = -1.2; p = 0.71), pain 40.2 vs. 34.1 (Badj = -6.8; p = 0.08), and insomnia 33.7 vs. 41.6 (Badj = 5.5, p = 0.16). Among patients with NART, clinically relevant QoL impairments were less frequent 2 years after treatment compared to < 2 years thereafter (n = 6 vs. n = 4 on average). Conclusion: There is little evidence for QoL differences in most domains and overall QoL between the two irradiation groups. However, patients after NART might experience worse role functioning and pain but fewer problems with insomnia compared to patients after ART.


Original languageEnglish
Article number109913
Number of pages9
JournalRadiotherapy and oncology
Publication statusPublished - Dec 2023

External IDs

PubMed 37739319
ORCID /0000-0001-9654-2207/work/146646073


Research priority areas of TU Dresden

Sustainable Development Goals


  • Leiomyosarcoma, Liposarcoma, Neoadjuvant Therapy, Neoplasms, Connective and Soft Tissue, Patient Reported Outcome Measures, Radiotherapy, Adjuvant, Humans, Radiotherapy, Adjuvant/adverse effects, Neoadjuvant Therapy/adverse effects, Male, Pain/etiology, Sarcoma/radiotherapy, Quality of Life, Adult, Female, Sleep Initiation and Maintenance Disorders/etiology