William W Tseng1, Francesco Barretta2, Lorenzo Conti3, Giovanni Grignani4, Francesco Tolomeo4, Markus Albertsmeier5, Martin K Angele5, Piotr Rutkowski6, Jacek Skoczylas6, Antonino De Paoli7, Federico Navarria7, Chandrajit P Raut8,9, Mark Fairweather8,9, Jeffrey M Farma10,11, Carolyn Nessim12, Neha Goel13,14, Valerie P Grignol15, Samuel J Ford16, Kenneth Cardona17, Ty Subhawong13,14, Hannah L Tattersall16, Rachel M Lee17, James S Hu18, Margaret von Mehren10,11, Roberta Sanfilippo3, Alessandro Gronchi3. 1. Division of Breast, Endocrine, and Soft Tissue Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California. 2. Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 3. Sarcoma Service, Departments of Surgery and Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 4. Division of Medical Oncology, Candiolo Cancer Institute, Fondazione del Piemonte per l'Oncologia-IRCCS, Candiolo, Italy. 5. Department of General, Visceral, and Transplantation Surgery, University Hospital Großhadern, Ludwig Maximilian University of Munich, Munich, Germany. 6. Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska Curie National Research Institute of Oncology, Warsaw, Poland. 7. Radiation Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy. 8. Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts. 9. Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts. 10. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania. 11. Department of Hematology/Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania. 12. Department of Surgery, University of Ottawa-Ottawa General Hospital, Ottawa, Ontario, Canada. 13. Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida. 14. Department of Radiology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida. 15. Division of Surgical Oncology, Department of Surgery, James Comprehensive Cancer Center, Ohio State University, Columbus, Ohio. 16. Department of Sarcoma Surgery, University Hospitals Birmingham, Birmingham, United Kingdom. 17. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia. 18. Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California.
Abstract
BACKGROUND: In patients with retroperitoneal sarcoma (RPS), the incidence of recurrence after surgery remains high. Novel treatment approaches are needed. This retrospective study evaluated patients with primary, high-risk RPS who received neoadjuvant systemic therapy followed by surgery to 1) determine the frequency and potential predictors of radiologic tumor responses and 2) assess clinical outcomes. METHODS: Clinicopathologic data were collected for eligible patients treated at 13 sarcoma referral centers from 2008 to 2018. Univariable and multivariable logistic models were performed to assess the association between clinical predictors and response. Overall survival (OS) and crude cumulative incidences of local recurrence and distant metastasis were compared. RESULTS: Data on 158 patients were analyzed. A median of 3 cycles of neoadjuvant systemic therapy (interquartile range, 2-4 cycles) were given. The regimens were mostly anthracycline based; however, there was significant heterogeneity. No patients demonstrated a complete response, 37 (23%) demonstrated a partial response (PR), 88 (56%) demonstrated stable disease, and 33 (21%) demonstrated progressive disease (PD) according to the Response Evaluation Criteria in Solid Tumors, version 1.1. Only a higher number of cycles given was positively associated with PR (P = .005). All patients underwent complete resection, regardless of the tumor response. Overall, patients whose tumors demonstrated PD before surgery showed markedly worse OS (P = .005). An indication of a better clinical outcome was seen in specific regimens given for grade 3 dedifferentiated liposarcoma and leiomyosarcoma. CONCLUSIONS: In patients with high-risk RPS, the response to neoadjuvant systemic therapy is fair overall. Disease progression on therapy may be used to predict survival after surgery. Subtype-specific regimens should be further validated.
BACKGROUND: In patients with retroperitoneal sarcoma (RPS), the incidence of recurrence after surgery remains high. Novel treatment approaches are needed. This retrospective study evaluated patients with primary, high-risk RPS who received neoadjuvant systemic therapy followed by surgery to 1) determine the frequency and potential predictors of radiologic tumor responses and 2) assess clinical outcomes. METHODS: Clinicopathologic data were collected for eligible patients treated at 13 sarcoma referral centers from 2008 to 2018. Univariable and multivariable logistic models were performed to assess the association between clinical predictors and response. Overall survival (OS) and crude cumulative incidences of local recurrence and distant metastasis were compared. RESULTS: Data on 158 patients were analyzed. A median of 3 cycles of neoadjuvant systemic therapy (interquartile range, 2-4 cycles) were given. The regimens were mostly anthracycline based; however, there was significant heterogeneity. No patients demonstrated a complete response, 37 (23%) demonstrated a partial response (PR), 88 (56%) demonstrated stable disease, and 33 (21%) demonstrated progressive disease (PD) according to the Response Evaluation Criteria in Solid Tumors, version 1.1. Only a higher number of cycles given was positively associated with PR (P = .005). All patients underwent complete resection, regardless of the tumor response. Overall, patients whose tumors demonstrated PD before surgery showed markedly worse OS (P = .005). An indication of a better clinical outcome was seen in specific regimens given for grade 3 dedifferentiated liposarcoma and leiomyosarcoma. CONCLUSIONS: In patients with high-risk RPS, the response to neoadjuvant systemic therapy is fair overall. Disease progression on therapy may be used to predict survival after surgery. Subtype-specific regimens should be further validated.
Authors: Anthony M Villano; Roberto J Vidri; Elaine T Vo; Stephanie H Greco; Krisha J Howell; Margaret von Mehren; Jeffrey M Farma Journal: Ann Surg Oncol Date: 2021-10-11 Impact factor: 5.344
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
Authors: Haoyu Ren; Alexandr V Bazhin; Elise Pretzsch; Sven Jacob; Haochen Yu; Jiang Zhu; Markus Albertsmeier; Lars H Lindner; Thomas Knösel; Jens Werner; Martin K Angele; Florian Bösch Journal: Mol Ther Oncolytics Date: 2021-12-09 Impact factor: 7.200