Gauthier Decanter1,2, Eberhard Stoeckle3, Charles Honore4, Pierre Meeus5, Jean Camille Mattei6, Pascale Dubray-Longeras7, Gwenael Ferron8, Sébastien Carrere9, Sylvain Causeret10, Jean-Marc Guilloit11, Magali Fau12, Philippe Rosset13, Jean-Christophe Machiavello14, Jean Baptiste Delhorme15, Nicolas Regenet16, François Gouin17, Jean-Yves Blay18, Jean-Michel Coindre19, Nicolas Penel20, Sylvie Bonvalot21. 1. Department of Medical Oncology, Oscar Lambret Center, Lille, France. g-decanter@o-lambret.fr. 2. General Oncology Department, Oscar Lambret Cancer Center, Lille, France. g-decanter@o-lambret.fr. 3. Department of Surgery, Bergonie Institute, Bordeaux, France. 4. Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France. 5. Department of Surgical Oncology, Centre Léon Bérard, Lyon, France. 6. Department of Orthopedic Surgery, Hôpital Nord, Marseille, France. 7. Department of Medical Oncology, Centre Jean Perrin, Clermont-Ferrand, France. 8. Department of Surgical Oncology, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France. 9. Department of Surgical Oncology, Montpellier Cancer Centre, Montpellier, France. 10. Department of Surgery, Centre Georges François Leclerc, Dijon, France. 11. Department of Medical Oncology, Regional Cancer Centre, Caen, France. 12. Department of Medical Surgery, Centre Alexis Vautrin, Vandœuvre-lès-Nancy, France. 13. Department of Orthopedic Surgery, University Hospital of Tours, Tours, France. 14. Breast Cancer and Reconstructive Surgery Unit, Centre Antoine Lacassagne, Nice, France. 15. Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France. 16. Department of Digestive Surgery, Nantes Hospital, Nantes, France. 17. Department of Orthopedic Surgery, Leon Berard Center, Lyon, France. 18. Department of Medical Oncology, Leon Berard Center, Lyon, France. 19. Department of Pathology, Bergonié Cancer Institute, Bordeaux, France. 20. Medical Oncology Department, Centre Oscar Lambret and Lille University Hospital, Lille, France. 21. Department of Medical Oncology and Surgery, Gustave Roussy Institute, Villejuif, France.
Abstract
BACKGROUND: The benefits of systematic re-excision (RE) after initial unplanned excision (UE) of soft tissue sarcoma (STS) are unknown. OBJECTIVE: The aim of this study was to evaluate the impact of delayed RE versus systematic RE after UE on overall survival (OS), metastatic relapse-free survival (MRFS), local relapse-free survival (LRFS), and rate of amputation. METHODS: Patients who underwent complete UE, without metastasis or residual disease, for primary extremity or superficial STS between 2007 and 2013 were analyzed. The amputation rate, LRFS, MRFS, and OS were assessed in cases of systematic RE in sarcoma referral centers (Group A), systematic RE outside of community centers (Group B), or without RE (Group C). RESULTS: Groups A, B, and C included 300 (48.2%), 71 (11.4%), and 251 (40.4%) patients, respectively. Median follow-up was 61 months and 5-year OS was 88.4%, 87.3%, and 88% in Groups A, B, and C, respectively (p = 0.22), while 5-year MFRS was 85.4%, 86.2%, and 84.9%, respectively (p = 0.938); RE (p = 0.55) did not influence MRFS. The 5-year LRFS was 83%, 73.5%, and 63.8% in Groups A, B and C, respectively (p = 0.00001). Of the 123 local recurrences observed, 0/28, 1/15, and 5/80 patients in Groups A, B, and C, respectively, required amputation (p = 0.41). Factors influencing LRFS were adjuvant radiotherapy [hazard ratio (HR) 0.21; p = 0.0001], initial R0 resection (HR 0.24, p = 0.0001), and Group A (HR 0.44; p = 0.01). CONCLUSION: Systematic RE in sarcoma centers offers best local control but does not impact OS. Delayed RE at the time of local relapse, if any, could be an option.
BACKGROUND: The benefits of systematic re-excision (RE) after initial unplanned excision (UE) of soft tissue sarcoma (STS) are unknown. OBJECTIVE: The aim of this study was to evaluate the impact of delayed RE versus systematic RE after UE on overall survival (OS), metastatic relapse-free survival (MRFS), local relapse-free survival (LRFS), and rate of amputation. METHODS:Patients who underwent complete UE, without metastasis or residual disease, for primary extremity or superficial STS between 2007 and 2013 were analyzed. The amputation rate, LRFS, MRFS, and OS were assessed in cases of systematic RE in sarcoma referral centers (Group A), systematic RE outside of community centers (Group B), or without RE (Group C). RESULTS: Groups A, B, and C included 300 (48.2%), 71 (11.4%), and 251 (40.4%) patients, respectively. Median follow-up was 61 months and 5-year OS was 88.4%, 87.3%, and 88% in Groups A, B, and C, respectively (p = 0.22), while 5-year MFRS was 85.4%, 86.2%, and 84.9%, respectively (p = 0.938); RE (p = 0.55) did not influence MRFS. The 5-year LRFS was 83%, 73.5%, and 63.8% in Groups A, B and C, respectively (p = 0.00001). Of the 123 local recurrences observed, 0/28, 1/15, and 5/80 patients in Groups A, B, and C, respectively, required amputation (p = 0.41). Factors influencing LRFS were adjuvant radiotherapy [hazard ratio (HR) 0.21; p = 0.0001], initial R0 resection (HR 0.24, p = 0.0001), and Group A (HR 0.44; p = 0.01). CONCLUSION: Systematic RE in sarcoma centers offers best local control but does not impact OS. Delayed RE at the time of local relapse, if any, could be an option.