Dario Callegaro1, Rosalba Miceli2, Sylvie Bonvalot3, Peter Ferguson4, Dirk C Strauss5, Antonin Levy6, Anthony Griffin4, Andrew J Hayes5, Silvia Stacchiotti7, Cecile Le Pèchoux6, Myles J Smith5, Marco Fiore1, Angelo Paolo Dei Tos8, Henry G Smith5, Charles Catton9, Paolo G Casali10, Jay S Wunder4, Alessandro Gronchi11. 1. Department of Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy. 2. Department of Clinical Epidemiology and Trial Organisation, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy. 3. Department of Surgery, Institut Curie, PSL Research University, Paris, France. 4. University Musculoskeletal Oncology Unit, Department of Surgery, Mount Sinai and Princess Margaret Hospitals, University of Toronto, Toronto, ON, Canada. 5. Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK. 6. Department of Radiation Oncology, Gustave Roussy Cancer Campus, Paris Sud University, Villejuif, France. 7. Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy. 8. Department of Pathology, General Hospital of Treviso, Treviso, Italy. 9. Department of Radiation Oncology, Mount Sinai and Princess Margaret Hospitals, University of Toronto, Toronto, ON, Canada. 10. Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy; Oncology and Hemato-Oncology Department, University of Milan, Milan Italy. 11. Department of Surgery, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy. Electronic address: alessandro.gronchi@istitutotumori.mi.it.
Abstract
BACKGROUND: The role of radiotherapy (RTx) and chemotherapy (CTx) in primary extremity soft tissue sarcoma (eSTS) patients is not precisely defined. METHODS: All consecutive primary eSTS patients treated within three European and one North American reference centres in a 20-year time span were included. The tendency to perform chemotherapy/radiotherapy (CTx/RTx) was explored using multivariable binary logistic models. Five and 10-year overall survival (OS) and crude cumulative incidence (CCI) of local recurrence (LR) and distant metastasis (DM) were estimated. Multivariable analyses of OS, CCI of LR and CCI of DM were performed. The effect of CTx administration was explored with a propensity score matching analysis. RESULTS: Overall, 3752 patients were included. Median follow-up was 79 months (interquartile range 44-119). Ten-year OS, CCI of LR and CCI of DM were 66.3% (64.3-68.2%), 8.2% (7.2-9.2%) and 28.2% (26.6-30.0%), respectively. Centre and histology significantly influenced administration of RTx/CTx. RTx was associated with a better local outcome, especially in myxoid liposarcoma, vascular sarcoma and myxofibrosarcoma, without being associated with survival. Chemotherapy was not an independent prognostic factor for OS in all patients (p = 0.73). In a propensity score-matched analysis, patients treated with CTx had longer survival although this difference did not reach statistical significance (p = 0.054). The use of perioperative CTx in patients with primary localised eSTS was not associated with worse survival after occurrence of DM. CONCLUSION: Some histologies gain a greater benefit from perioperative RTx in terms of LR risk reduction. The trend towards a 5% survival benefit associated with CTx administration is consistent with the published literature, but definitive conclusions are awaited from ongoing randomised controlled trials. Perioperative CTx for primary eSTS does not hamper post-DM survival.
BACKGROUND: The role of radiotherapy (RTx) and chemotherapy (CTx) in primary extremity soft tissue sarcoma (eSTS) patients is not precisely defined. METHODS: All consecutive primary eSTS patients treated within three European and one North American reference centres in a 20-year time span were included. The tendency to perform chemotherapy/radiotherapy (CTx/RTx) was explored using multivariable binary logistic models. Five and 10-year overall survival (OS) and crude cumulative incidence (CCI) of local recurrence (LR) and distant metastasis (DM) were estimated. Multivariable analyses of OS, CCI of LR and CCI of DM were performed. The effect of CTx administration was explored with a propensity score matching analysis. RESULTS: Overall, 3752 patients were included. Median follow-up was 79 months (interquartile range 44-119). Ten-year OS, CCI of LR and CCI of DM were 66.3% (64.3-68.2%), 8.2% (7.2-9.2%) and 28.2% (26.6-30.0%), respectively. Centre and histology significantly influenced administration of RTx/CTx. RTx was associated with a better local outcome, especially in myxoid liposarcoma, vascular sarcoma and myxofibrosarcoma, without being associated with survival. Chemotherapy was not an independent prognostic factor for OS in all patients (p = 0.73). In a propensity score-matched analysis, patients treated with CTx had longer survival although this difference did not reach statistical significance (p = 0.054). The use of perioperative CTx in patients with primary localised eSTS was not associated with worse survival after occurrence of DM. CONCLUSION: Some histologies gain a greater benefit from perioperative RTx in terms of LR risk reduction. The trend towards a 5% survival benefit associated with CTx administration is consistent with the published literature, but definitive conclusions are awaited from ongoing randomised controlled trials. Perioperative CTx for primary eSTS does not hamper post-DM survival.
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Authors: Dario Callegaro; Rosalba Miceli; Sylvie Bonvalot; Peter C Ferguson; Dirk C Strauss; Veroniek V M van Praag; Antonin Levy; Anthony M Griffin; Andrew J Hayes; Silvia Stacchiotti; Cecile Le Pèchoux; Myles J Smith; Marco Fiore; Angelo Paolo Dei Tos; Henry G Smith; Charles Catton; Joanna Szkandera; Andreas Leithner; Michiel A J van de Sande; Paolo G Casali; Jay S Wunder; Alessandro Gronchi Journal: EClinicalMedicine Date: 2019-11-22