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Dammerer D, Neugebauer J, Braito M, Wagner M, Neubauer M, Moser L, Süß M, Liebensteiner M, Putzer D. Midterm Results of High-Dose-Rate Intraoperative Brachytherapy in the Treatment of Soft Tissue Sarcomas. Cancers (Basel) 2023; 15:2854. [PMID: 37345191 DOI: 10.3390/cancers15102854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/27/2023] [Accepted: 05/15/2023] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION According to the literature only sparse data are available on the use of high-dose-rate intraoperative brachytherapy (IOHDR-BT) as a boost to external-beam irradiation (EBRT) in combination with a wide resection in patients with high-grade soft tissue sarcomas (STS). MATERIALS AND METHODS Applying a retrospective study design, we investigated all patients who between 2010 and 2016 underwent marginal resection of a high-grade STS and intraoperative radiotherapy, followed by EBRT. We included only patients with a traceable follow-up time of at least two years. Of 89 patients, 35 met our inclusion criteria and showed an average follow-up of four years. RESULTS We found an overall 2-year local control rate of 94.3%. The local recurrence rate for R0 resections was 6%, whereas recurrences occurred in 13% of R1 resections and in 100% of R2 resections. One affected patient received only intraoperative radiotherapy. The recurrence rate by tumour entity was 36% for LPS, 11% for myxofibrosarcoma and 17% for undifferentiated pleomorphic sarcoma. CONCLUSION The treatment regimen consisting of limb-preserving surgery, IORT and pre- or postoperative radiotherapy consistently shows excellent local control rates.
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Affiliation(s)
- Dietmar Dammerer
- Department of Orthopaedics and Traumatology, University Hospital Krems, 3500 Krems, Austria
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Karl Landsteiner Private University for Health Sciences, 3500 Krems, Austria
| | - Johannes Neugebauer
- Department of Orthopaedics and Traumatology, University Hospital Krems, 3500 Krems, Austria
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Karl Landsteiner Private University for Health Sciences, 3500 Krems, Austria
| | - Matthias Braito
- Department of Orthopaedics and Traumatology, St. Johann in Tirol Hospital, 6380 St. Johann in Tirol, Austria
| | - Moritz Wagner
- Department of Orthopaedics and Traumatology, St. Johann in Tirol Hospital, 6380 St. Johann in Tirol, Austria
| | - Markus Neubauer
- Department of Orthopaedics and Traumatology, University Hospital Krems, 3500 Krems, Austria
| | - Lukas Moser
- Department of Orthopaedics and Traumatology, University Hospital Krems, 3500 Krems, Austria
| | - Markus Süß
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Michael Liebensteiner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - David Putzer
- Department of Experimental Orthopaedics, Medical University of Innsbruck, 6020 Innsbruck, Austria
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Brachytherapy in the Treatment of Soft-Tissue Sarcomas of the Extremities-A Current Concept and Systematic Review of the Literature. Cancers (Basel) 2023; 15:cancers15041133. [PMID: 36831476 PMCID: PMC9954233 DOI: 10.3390/cancers15041133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION Evidence on the use of brachytherapy in soft-tissue sarcoma (STS) is sparse. Therapy regimens are determined more by local interdisciplinary tumor conferences than by standardized protocols. Patient-specific factors complicate the standardized application of therapy protocols. The individuality of the treatment makes it difficult to compare results. MATERIALS AND METHODS A comprehensive literature search was conducted, whereby the literature from a period of almost 44 years (1977-2021) was graded and included in this systematic review. For this purpose, PubMed was used as the primary database. Search string included "soft-tissue sarcoma", "brachytherapy", and "extremity." Four independent researchers reviewed the literature. Only full-text articles written in English or German were included. RESULTS Of the 175 identified studies, 70 were eligible for analysis based on the inclusion and exclusion criteria. The key points to compare were local complications, recurrence rate and correlation with margins of resection, and the use of brachytherapy regarding tumor grading. CONCLUSION Brachytherapy represents an important subset of radiotherapy techniques used in STSs, whose indications and applications are constantly evolving, and for which a local control rate of 50% to 96% has been reported as monotherapy, depending on risk factors. However, the best benefit is seen in the combination of further resection and brachytherapy, and most authors at many other centers agree with this treatment strategy.
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Conti L, Buriro F, Baia M, Pasquali S, Miceli R, De Rosa L, Gronchi A, Fiore M. Contemporary role of amputation for patients with extremity soft tissue sarcoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 49:934-940. [PMID: 36517316 DOI: 10.1016/j.ejso.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION limb-sparing surgery is the mainstream treatment for primary extremity soft tissue sarcoma (ESTS) at referral centers, following advances in surgical reconstructions and multimodal management. However, amputation is still needed in selected patients and has not yet been described for a ESTS cohort in a contemporary scenario. MATERIAL AND METHODS consecutive patients who underwent surgery for primary ESTS from 2006 to 2018 were extracted from a prospectively collected database at our reference center. Patients receiving amputation for either primary tumor or local recurrence (LR) after limb-sparing surgery were selected for analysis. RESULTS Among 1628 primary ESTS, 29 patients underwent primary amputation (1.8%), 22/1159 (1.9%) for upper limb and 7/469 (1.5%) for lower limb ESTS. Patients were mainly affected by grade III FNCLCC (89.6%) of notable dimension (median size 16 cm, IQR 10-24). 65.5% of patients received preoperative treatments (systemic or regional chemotherapy, radiotherapy or chemo-radiation). Secondary amputation for LR was performed after a median of 23 months in 16/1599 patients (1%). Median survival time was 16.2 and 29.6 months after primary or secondary amputation respectively. Factors prompting the need for a primary amputation were most often a combination of multifocal disease, bone invasion and pain or neurovascular bundle involvement and relevant comorbidities, mainly for grade III tumors in elderly patients. CONCLUSION Contemporary rate of amputation for ESTS at a reference center is extremely low. Still, amputation is required in selected cases with advanced presentations, especially in elderly, frail patients.
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Siew CCH, Apte SS, Baia M, Gyorki DE, Ford S, van Houdt WJ. Retroperitoneal and Mesenteric Liposarcomas. Surg Oncol Clin N Am 2022; 31:399-417. [PMID: 35715141 DOI: 10.1016/j.soc.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Retroperitoneal liposarcomas are a rare entity and are comprised mostly of the well-differentiated and dedifferentiated subtypes. Eight-year survival ranges from 30% to 80% depending on histologic subtype and grade. Surgery is the cornerstone of treatment and compartment resection is the current standard. Mesenteric liposarcomas are extremely rare and comprise more high-grade lesions, with poorer prognosis of 50% 5-year overall survival. They are managed with a similar aggressive surgical approach. This review presents the current management of retroperitoneal and mesenteric liposarcomas.
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Affiliation(s)
- Caroline C H Siew
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam 1066 CX, the Netherlands; Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433 Singapore
| | - Sameer S Apte
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000 Australia
| | - Marco Baia
- The Sarcoma Unit, Queen Elizabeth Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, UK
| | - David E Gyorki
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000 Australia
| | - Samuel Ford
- The Sarcoma Unit, Queen Elizabeth Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, UK
| | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam 1066 CX, the Netherlands.
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Hall KS, Bruland ØS, Bjerkehagen B, Lidbrink E, Jebsen N, Hagberg H, Papworth K, Hagberg O, Trovik C, Bauer H, Eriksson M. Preoperative accelerated radiotherapy combined with chemotherapy in a defined cohort of patients with high risk soft tissue sarcoma: a Scandinavian Sarcoma Group study. Clin Sarcoma Res 2020; 10:22. [PMID: 33292545 PMCID: PMC7672981 DOI: 10.1186/s13569-020-00145-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/06/2020] [Indexed: 12/01/2022] Open
Abstract
Background We recently reported outcomes from a Scandinavian Sarcoma Group adjuvant study (SSG XX group A) conducted on localized and operable high risk soft tissue sarcoma (STS) of the extremities and trunk wall. SSG XX, group B, comprised of patients in a defined cohort with locally advanced STS considered at high risk for intralesional surgery. These patients received preoperative accelerated radiotherapy, together with neoadjuvant and adjuvant chemotherapy. Herein we report the results of this group B. Methods Twenty patients with high-grade, locally advanced and deep STS located in lower extremities (n = 12), upper extremities (5) or trunk wall (3) were included. The median age was 59 years and 14 patients were males. The treatment regimen consisted of 6 cycles of doxorubicin (60 mg/m2) and ifosfamide (6 g/m2), with three cycles given neoadjuvantly, and preoperative radiotherapy (1, 8 Gyx2/daily to 36 Gy) between cycles 2 and 3. After a repeated MRI surgery was then conducted, and the remaining 3 chemotherapy cycles were given postoperatively at 3 weeks intervals. Survival data, local control, toxicity of chemotherapy and postoperative complications are presented. Results Median follow-up time for metastasis-free survival (MFS) was 2.8 years (range 0.3–10.4). The 5-year MFS was 49.5% (95% confidence interval [CI] 31.7–77.4). The median follow-up time was 5.4 years (range 0.3–10.4) for overall survival (OS). The 5-year OS was 64.0% (95% CI 45.8–89.4). The median tumour size was 13 cm, with undifferentiated pleomorphic sarcoma (n = 10) and synovial sarcoma (n = 6) diagnosed most frequently. All patients completed surgery. Resection margins were R0 in 19 patients and R1 in 1 patient. No patients had evidence of disease progression preoperatively. Three patients experienced a local recurrence, in 2 after lung metastases had already been diagnosed. Eleven patients (55%) had postoperative wound problems (temporary in 8 and persistent in 3). Conclusions Preoperative chemotherapy and radiotherapy were associated with temporary wound-healing problems. Survival outcomes, local control and toxicities were deemed satisfactory when considering the locally advanced sarcoma disease status at primary diagnosis. Trial registration This study was registered at ClinicalTrials.gov Identifier NCT00790244 and with European Union Drug Regulating Authorities Clinical Trials No. EUDRACT 2007-001152-39
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Affiliation(s)
- Kirsten Sundby Hall
- Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
| | - Øyvind S Bruland
- Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bodil Bjerkehagen
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,Institute for Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Elisabet Lidbrink
- Department of Medical Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Nina Jebsen
- Departments of Oncology and Orthopedics, Haukeland University Hospital and Centre for Cancer Biomarkers (CCBIO), University of Bergen, Bergen, Norway
| | - Hans Hagberg
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Karin Papworth
- Department of Oncology, Norrlands University Hospital, Umeå, Sweden
| | - Oskar Hagberg
- Institution of Translation Medicine, Lund University, Malmö, Sweden
| | - Clement Trovik
- Department Musculo-Skeletal Tumor Service/Orthopedics, Haukeland University Hospital, Bergen, Norway
| | - Henrik Bauer
- Musculo-Skeletal Tumor Service, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Eriksson
- Department of Oncology, Skåne University Hospital, and Lund University, Lund, Sweden
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Weiss AR, Chen YL, Scharschmidt TJ, Chi YY, Tian J, Black JO, Davis JL, Fanburg-Smith JC, Zambrano E, Anderson J, Arens R, Binitie O, Choy E, Davis JW, Hayes-Jordan A, Kao SC, Kayton ML, Kessel S, Lim R, Meyer WH, Million L, Okuno SH, Ostrenga A, Parisi MT, Pryma DA, Randall RL, Rosen MA, Schlapkohl M, Shulkin BL, Smith EA, Sorger JI, Terezakis S, Hawkins DS, Spunt SL, Wang D. Pathological response in children and adults with large unresected intermediate-grade or high-grade soft tissue sarcoma receiving preoperative chemoradiotherapy with or without pazopanib (ARST1321): a multicentre, randomised, open-label, phase 2 trial. Lancet Oncol 2020; 21:1110-1122. [PMID: 32702309 DOI: 10.1016/s1470-2045(20)30325-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Outcomes for children and adults with advanced soft tissue sarcoma are poor with traditional therapy. We investigated whether the addition of pazopanib to preoperative chemoradiotherapy would improve pathological near complete response rate compared with chemoradiotherapy alone. METHODS In this joint Children's Oncology Group and NRG Oncology multicentre, randomised, open-label, phase 2 trial, we enrolled eligible adults (aged ≥18 years) and children (aged between 2 and <18 years) from 57 hospitals in the USA and Canada with unresected, newly diagnosed trunk or extremity chemotherapy-sensitive soft tissue sarcoma, which were larger than 5 cm in diameter and of intermediate or high grade. Eligible patients had Lansky (if aged ≤16 years) or Karnofsky (if aged >16 years) performance status score of at least 70. Patients received ifosfamide (2·5 g/m2 per dose intravenously on days 1-3 with mesna) and doxorubicin (37·5 mg/m2 per dose intravenously on days 1-2) with 45 Gy preoperative radiotherapy, followed by surgical resection at week 13. Patients were randomly assigned (1:1) using a web-based system, in an unmasked manner, to receive oral pazopanib (if patients <18 years 350 mg/m2 once daily; if patients ≥18 years 600 mg once daily) or not (control group), with pazopanib not given immediately before or after surgery at week 13. The study projected 100 randomly assigned patients were needed to show an improvement in the number of participants with a 90% or higher pathological response at week 13 from 40% to 60%. Analysis was done per protocol. This study has completed accrual and is registered with ClinicalTrials.gov, NCT02180867. FINDINGS Between July 7, 2014, and Oct 1, 2018, 81 eligible patients were enrolled and randomly assigned to the pazopanib group (n=42) or the control group (n=39). At the planned second interim analysis with 42 evaluable patients and a median follow-up of 0·8 years (IQR 0·3-1·6) in the pazopanib group and 1 year (0·3-1·6) in the control group, the number of patients with a 90% pathological response or higher was 14 (58%) of 24 patients in the pazopanib group and four (22%) of 18 patients in the control group, with a between-group difference in the number of 90% or higher pathological response of 36·1% (83·8% CI 16·5-55·8). On the basis of an interim analysis significance level of 0·081 (overall one-sided significance level of 0·20, power of 0·80, and O'Brien-Fleming-type cumulative error spending function), the 83·8% CI for response difference was between 16·5% and 55·8% and thus excluded 0. The improvement in pathological response rate with the addition of pazopanib crossed the predetermined boundary and enrolment was stopped. The most common grade 3-4 adverse events were leukopenia (16 [43%] of 37 patients), neutropenia (15 [41%]), and febrile neutropenia (15 [41%]) in the pazopanib group, and neutropenia (three [9%] of 35 patients) and febrile neutropenia (three [9%]) in the control group. 22 (59%) of 37 patients in the pazopanib group had a pazopanib-related serious adverse event. Paediatric and adult patients had a similar number of grade 3 and 4 toxicity. There were seven deaths (three in the pazopanib group and four in the control group), none of which were treatment related. INTERPRETATION In this presumed first prospective trial of soft tissue sarcoma spanning nearly the entire age spectrum, adding pazopanib to neoadjuvant chemoradiotherapy improved the rate of pathological near complete response, suggesting that this is a highly active and feasible combination in children and adults with advanced soft tissue sarcoma. The comparison of survival outcomes requires longer follow-up. FUNDING National Institutes of Health, St Baldrick's Foundation, Seattle Children's Foundation.
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Affiliation(s)
- Aaron R Weiss
- Department of Pediatrics, Maine Medical Center, Portland, ME, USA.
| | - Yen-Lin Chen
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas J Scharschmidt
- Department of Orthopaedics, James Cancer Hospital and Nationwide Children's Hospital, Columbus, OH, USA
| | - Yueh-Yun Chi
- Department of Pediatrics and Preventative Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jing Tian
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Jennifer O Black
- Department of Pathology, Children's Hospital Colorado, Aurora, CO, USA
| | - Jessica L Davis
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | | | - Eduardo Zambrano
- Department of Pathology, Rocky Mountain Hospital for Children, Presbyterian St Luke Medical Centre, Denver, CO, USA
| | - James Anderson
- Department of Biostatistics and Research Decision Sciences, Merck and Co, North Wales, PA, USA
| | - Robin Arens
- Department of Clinical Trials, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Odion Binitie
- Department of Sarcoma, Moffitt Cancer Center, Tampa, FL, USA
| | - Edwin Choy
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Andrea Hayes-Jordan
- Department of Surgery, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Simon C Kao
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Mark L Kayton
- Department of Surgery, Palm Beach Children's Hospital, St Mary's Medical Center, Florida Atlantic University, West Palm Beach, FL, USA
| | - Sandy Kessel
- Imaging and Radiation Oncology Core Rhode Island, Lincoln, RI, USA
| | - Ruth Lim
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - William H Meyer
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Lynn Million
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Scott H Okuno
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Andrew Ostrenga
- Department of Pharmacy, University of Mississippi Medical Center, Jackson, MS, USA
| | - Marguerite T Parisi
- Department of Radiology and Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA
| | - Daniel A Pryma
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - R Lor Randall
- Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA, USA
| | - Mark A Rosen
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary Schlapkohl
- Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Ethan A Smith
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joel I Sorger
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stephanie Terezakis
- Department of Radiation Oncology, University of Minnesota, Masonic Cancer Center, Minneapolis, MN, USA
| | - Douglas S Hawkins
- Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA
| | - Sheri L Spunt
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Dian Wang
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, USA
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Rizk VT, Naghavi AO, Brohl AS, Joyce DM, Binitie O, Kim Y, Hanna JP, Swank J, Gonzalez RJ, Reed DR, Druta M. Chemotherapy improves distant control in localized high-grade soft tissue sarcoma of the extremity/trunk. Clin Sarcoma Res 2020; 10:11. [PMID: 32670544 PMCID: PMC7350709 DOI: 10.1186/s13569-020-00132-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 06/29/2020] [Indexed: 02/01/2023] Open
Abstract
Background Soft tissue sarcomas (STS) are rare and heterogeneous tumors making chemotherapy use controversial. Our goal was to identify a subset of patients with primary STS that benefit with the addition of chemotherapy. Methods A retrospective chart review included intermediate to high-grade localized primary STS of the extremity/trunk, and tumor size > 5 cm. The effect of chemotherapy was evaluated for local control (LC), distant control (DC), progression free survival (PFS), and overall survival (OS). Results In this cohort (n = 273), patients were treated with surgery (98%), radiation (81%), and chemotherapy (24.5%). With a median follow-up of 51 months, the entire cohort’s 5-year LC, DC, PFS, and OS are 79.1%, 59.9%, 43.8%, and 68.7%, respectively. The addition of chemotherapy did not provide a DC benefit (p = 0.238) for the entire cohort. High-grade disease (n = 210) experienced a 5-year benefit in DC (68% vs. 54.4%, p = 0.04), which was more pronounced with MAI (Mesna, Adriamycin, Ifosfamide) based regimens (74.2%, p = 0.016), and a 5-year PFS (50.8% vs 45%, p = 0.025) and OS benefit (76.2% vs 70%, p = 0.067) vs. no chemotherapy. On multivariate analysis of the high-grade subset, chemotherapy independently predicted for a DC benefit (HR 0.48 95% CI 0.26–89, p = 0.019). The benefit of chemotherapy was more pronounced with MAI, showing a significant benefit in DC (HR 0.333 95% CI 0.145–0.767, p = 0.01) and PFS (HR 0.52 95% CI 0.28–0.99, p = 0.047). Conclusion In patients with localized STS > 5 cm, the high-grade subset had a distant control benefit with the addition of chemotherapy, leading to improved progression free survival. This is more pronounced with the use of MAI and should be considered in patients eligible for this regimen.
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Affiliation(s)
- Victoria T Rizk
- Department of Hematology and Oncology, Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612 USA
| | - Arash O Naghavi
- Department of Radiation Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Andrew S Brohl
- Department of Sarcoma, Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - David M Joyce
- Department of Sarcoma, Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Odion Binitie
- Department of Sarcoma, Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - John P Hanna
- Department of Surgery, University of South Florida, Tampa, FL USA
| | - Jennifer Swank
- Department of Pharmacy, Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Ricardo J Gonzalez
- Department of Sarcoma, Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Damon R Reed
- Department of Sarcoma, Moffitt Cancer Center and Research Institute, Tampa, FL USA
| | - Mihaela Druta
- Department of Sarcoma, Moffitt Cancer Center and Research Institute, Tampa, FL USA
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Larsen F, Terlizzi M, Linacre V, Sargos P, Suarez F, Kirova Y, Van Houtte P, Lerouge D, Zilli T, Sole CV. Radiation Therapy in Resectable Intrathoracic Sarcomas. A Rare Cancer Network Study. Int J Radiat Oncol Biol Phys 2019; 103:1175-1181. [PMID: 30578911 DOI: 10.1016/j.ijrobp.2018.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/05/2018] [Accepted: 12/11/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Intrathoracic sarcomas (ITS) are considered rare tumors and have a dismal prognosis. We investigated outcomes and risk factors for local control (LC), disease-free survival (DFS), and overall survival (OS) in patients with resected nonmetastatic ITS treated with or without adjuvant radiation therapy (RT) and/or chemotherapy. METHODS AND MATERIALS Patients from the Rare Cancer Network database were studied. A Kaplan-Meier estimate was used to assess survival curves, and Cox proportional hazards regression was used to assess risk factors for LC, DFS, and OS. RESULTS Between 2000 and 2017, 121 patients met inclusion criteria. The primary site was lung in 30%, mediastinum in 34%, and pleura in 36%. Thirty-nine percent and 32% received RT and chemotherapy. Median follow-up was 34 months (range, 2-141). LC, DFS, and OS at 10 years were 52%, 18.7%, and 7.2%, respectively. In multivariate analysis, RT (P = .003) and R1 margin status (P = .041) retained a significant association with LC. Only R1 resection (P = .002) remained associated with an increased risk of death in multivariate analysis. Overall, 7 patients (6%) developed grade 3 treatment-related chronic toxicity events. CONCLUSIONS This joint analysis revealed that OS remains modest in this group of patients, mainly given by the high risk of local and distant failure. Our results suggest that resected ITS can benefit from adjuvant RT.
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Affiliation(s)
- Francisco Larsen
- Department of Radiation Oncology, Clinica IRAM, Santiago, Chile; Faculty of Medicine, Universidad Diego Portales, Santiago, Chile
| | - Mario Terlizzi
- Department of Radiation Oncology, Institut Bergonie, Bordeaux, France
| | - Virginia Linacre
- Department of Thoracic Surgery, Instituto Nacional del Torax, Santiago, Chile
| | - Paul Sargos
- Department of Radiation Oncology, Institut Bergonie, Bordeaux, France
| | - Francisco Suarez
- Department of Thoracic Surgery, Clinica Santa Maria, Santiago, Chile
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Paul Van Houtte
- Department of Radiation Oncology, Institut Bordet, Bruxelles, Belgium
| | - Delphine Lerouge
- Department of Radiation Oncology, Institut Bordet, Bruxelles, Belgium
| | - Thomas Zilli
- Department of Radiation Oncology, Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | - Claudio V Sole
- Department of Radiation Oncology, Clinica IRAM, Santiago, Chile; Faculty of Medicine, Universidad Diego Portales, Santiago, Chile.
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