Winan J van Houdt1, Marco Fiore2, Francesco Barretta3, Piotr Rutkowski4, Jean-Yves Blay5, Guy Lahat6, Dirk Strauss7, Ricardo J Gonzalez8, Nita Ahuja9, Giovanni Grignani10, Vittorio Quagliuolo11, Eberhard Stoeckle12, Antonino De Paoli13, Yvonne Schrage14, Kenneth Cardona15, Elisabetta Pennacchioli16, Venu G Pillarisetty17, Carolyn Nessim18, Carol J Swallow19, Sanjay P Bagaria20, Robert Canter21, John T Mullen22, Dario Callegaro2, Mark Fairweather23, Rosalba Miceli3, Chandrajit P Raut22, Alessandro Gronchi2, Rebecca A Gladdy19. 1. Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 2. Department of Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 3. Medical Statistics, Biometry and Bioinformatics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 4. Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland. 5. Department of Medical Oncology, Leon Berard Center, Claude Bernard Lyon 1 University, Lyon, France. 6. Department of General Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 7. Sarcoma Unit, Department of Surgery, Royal Marsden Hospital, London, United Kingdom. 8. Sarcoma Department, Moffitt Cancer Center, Tampa, Florida. 9. Department of Surgery, Yale School of Medicine, New Haven, Connecticut. 10. Sarcoma Unit, Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy. 11. Surgical Oncology Unit, Humanitas Clinical Institute IRCCS, Milan, Italy. 12. Department of Surgery, Bergonie Institute, Regional Cancer Centre, Bordeaux Cedex, France. 13. Department of Radiation Oncology, Oncology Reference Center (CRO), CRO-IRCCS, Aviano, Italy. 14. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. 15. Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia. 16. Division of Melanoma and Sarcoma, European Institute of Oncology IRCCS, Milan, Italy. 17. Department of Surgery, Seattle Cancer Care Alliance, University of Washington School of Medicine, Seattle, Washington. 18. Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada. 19. Division of General Surgery, Mount Sinai Hospital, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada. 20. Section of Surgical Oncology, Department of Surgery, Mayo Clinic Jacksonville, Jacksonville, Florida. 21. Department of Surgery, University of California at Davis School of Medicine, Davis, California. 22. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 23. Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
Abstract
BACKGROUND: In this series from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG), the authors examined longitudinal outcomes of patients with a second recurrence of retroperitoneal sarcoma (RPS) after complete resection of a first local recurrence (LR). METHODS: Data from patients undergoing resection of a first LR from January 2002 to December 2011were collected from 22 sarcoma centers. The primary outcome was overall survival (OS) after second recurrence. RESULTS: Second recurrences occurred in 400 of 567 patients (70.5%) after an R0/R1 resection of a first locally recurrent RPS. Patterns of disease recurrence were LR in 323 patients (80.75%), distant metastases (DM) in 55 patients (13.75%), and both LR and DM in 22 patients (5.5%). The main subtype among the LR group was liposarcoma (77%), whereas DM mainly were leiomyosarcomas (43.6%). In patients with a second LR only, a total of 200 patients underwent re-resection (61.9%). The 5-year OS rate varied significantly based on the pattern of failure (P < .001): 45.6% for the LR group, 25.5% for the DM group, and 0% for the group with LR and DM. The only factors found to be associated with improved OS on multivariable analysis were both time between second surgery and the development of the second recurrence (32 months vs 8 months: hazard ratio, 0.44 [P < .001]) and surgery for second recurrence (yes vs no: hazard ratio, 3.25 [P < .001]). The 5-year OS rate for patients undergoing surgery for a second LR was 59% versus 18% in the patients not deemed suitable for surgical resection. CONCLUSIONS: Survival rates after second recurrence of RPS varied based on patterns of disease recurrence and treatment. Durable disease-free survivors were identified after surgery for second LR in patients selected for this intervention.
BACKGROUND: In this series from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG), the authors examined longitudinal outcomes of patients with a second recurrence of retroperitoneal sarcoma (RPS) after complete resection of a first local recurrence (LR). METHODS: Data from patients undergoing resection of a first LR from January 2002 to December 2011were collected from 22 sarcoma centers. The primary outcome was overall survival (OS) after second recurrence. RESULTS: Second recurrences occurred in 400 of 567 patients (70.5%) after an R0/R1 resection of a first locally recurrent RPS. Patterns of disease recurrence were LR in 323 patients (80.75%), distant metastases (DM) in 55 patients (13.75%), and both LR and DM in 22 patients (5.5%). The main subtype among the LR group was liposarcoma (77%), whereas DM mainly were leiomyosarcomas (43.6%). In patients with a second LR only, a total of 200 patients underwent re-resection (61.9%). The 5-year OS rate varied significantly based on the pattern of failure (P < .001): 45.6% for the LR group, 25.5% for the DM group, and 0% for the group with LR and DM. The only factors found to be associated with improved OS on multivariable analysis were both time between second surgery and the development of the second recurrence (32 months vs 8 months: hazard ratio, 0.44 [P < .001]) and surgery for second recurrence (yes vs no: hazard ratio, 3.25 [P < .001]). The 5-year OS rate for patients undergoing surgery for a second LR was 59% versus 18% in the patients not deemed suitable for surgical resection. CONCLUSIONS: Survival rates after second recurrence of RPS varied based on patterns of disease recurrence and treatment. Durable disease-free survivors were identified after surgery for second LR in patients selected for this intervention.
Authors: William W Tseng; Carol J Swallow; Dirk C Strauss; Sylvie Bonvalot; Piotr Rutkowski; Samuel J Ford; Ricardo J Gonzalez; Rebecca A Gladdy; David E Gyorki; Mark Fairweather; Kyo Won Lee; Markus Albertsmeier; Winan J van Houdt; Magalie Fau; Carolyn Nessim; Giovanni Grignani; Kenneth Cardona; Vittorio Quagliuolo; Valerie Grignol; Jeffrey M Farma; Elisabetta Pennacchioli; Marco Fiore; Andrew Hayes; Dimitri Tzanis; Jacek Skoczylas; Max L Almond; John E Mullinax; Wendy Johnston; Hayden Snow; Rick L Haas; Dario Callegaro; Myles J Smith; Toufik Bouhadiba; Anant Desai; Rachel Voss; Roberta Sanfilippo; Robin L Jones; Elizabeth H Baldini; Andrew J Wagner; Charles N Catton; Silvia Stacchiotti; Khin Thway; Christina L Roland; Chandrajit P Raut; Alessandro Gronchi Journal: Ann Surg Oncol Date: 2022-06-29 Impact factor: 4.339