Assessing Functional Outcomes and Health-Related Quality of Life After Radiation Therapy in Extremity Soft Tissue Sarcoma

AIMS: Extremity soft-tissue sarcomas (ESTS) are rare neoplasms treated with limb-sparing surgery and radiation therapy (RT). While RT improves local control, it can be associated with late functional impairments that may affect health-related quality of life (HR-QOL). As survivorship care gains importance, understanding the relationship between functional outcomes (FO) and HR-QOL is crucial. This study evaluates the relationship between FO, measured by the Toronto Extremity Salvage Score (TESS), and HR-QOL, assessed with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30).

MATERIALS AND METHOD: A cohort study including ESTS patients treated with RT (January 2009 to October 2024) was conducted. Eligible patients completed the TESS and QLQ-C30 questionnaires. Correlation analyses, receiver operating characteristic (ROC) curve analysis, and statistical comparisons were performed to assess the association between FO and HR-QOL and to determine a clinically relevant TESS threshold for impairment.

RESULTS: Of 255 identified patients, 123 were eligible, and 61 (response rate: 52%) completed the questionnaires. TESS lower-limb scores showed strong correlations with QLQ-C30 physical (r = 0.74), role (r = 0.63), and social functioning (r = 0.62). Notably, ROC analysis identified a clinically meaningful TESS threshold of ≥80, demonstrating high sensitivity (88%) and specificity (100%) for detecting significant functional impairments. Most patients reported good FO and HR-QOL, but a subset experienced severe impairments.

CONCLUSION: ESTS survivors generally maintain good function and HR-QOL, but functional impairments significantly affect some patients. The identified TESS threshold of ≥80 may help clinicians monitor at-risk patients and guide early interventions. Future studies should validate this threshold and explore interventions for patients with severe impairments.