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Comparison of preoperative chemoradiation with radiation or chemotherapy alone in patients with non-metastatic, resectable retroperitoneal sarcoma

Published online by Cambridge University Press:  09 December 2021

Sung Jun Ma ,
Brian Yu ,
Lucas M. Serra ,
Austin J. Bartl ,
Oluwadamilola T. Oladeru ,
Mark Farrugia ,
Rohil Shekher ,
Austin J. Iovoli ,
Fatemeh Fekrmandi  and
Han Yu
...Show all authors
Sung Jun Ma
Affiliation:
Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA
Brian Yu
Affiliation:
Jacobs School of Medicine and Biomedical Sciences University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203, USA
Lucas M. Serra
Affiliation:
Jacobs School of Medicine and Biomedical Sciences University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203, USA
Austin J. Bartl
Affiliation:
Jacobs School of Medicine and Biomedical Sciences University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203, USA
Oluwadamilola T. Oladeru
Affiliation:
Department of Radiation Oncology, University of Florida, 2000 SW Archer Road, Gainesville, FL 32610, USA
Mark Farrugia
Affiliation:
Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA
Rohil Shekher
Affiliation:
Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA
Austin J. Iovoli
Affiliation:
Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA
Fatemeh Fekrmandi
Affiliation:
Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA
Han Yu
Affiliation:
Department of Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA
Anurag K. Singh*
Affiliation:
Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA
*
Author for correspondence: Anurag K. Singh, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA. Tel: 716-845-5715. Fax: 716-845-7616. E-mail: Anurag.Singh@RoswellPark.org
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Abstract

Aim:

Optimal preoperative therapy regimen in the treatment of resectable retroperitoneal sarcoma (RPS) remains unclear. This study compares the impact of preoperative radiation, chemoradiation and chemotherapy on overall survival (OS) in RPS patients.

Materials and Methods:

The National Cancer Database (NCDB) was queried for patients with non-metastatic, resectable RPS (2006–15). The primary endpoint was OS, evaluated by Kaplan–Meier method, log-rank test, Cox multivariable analysis and propensity score matching.

Results:

A total of 1,253 patients met the inclusion criteria, with 210 patients (17%) receiving chemoradiation, 850 patients (68%) receiving radiation and 193 patients (15%) receiving chemotherapy. On Cox multivariable analysis, when compared to preoperative chemoradiation, preoperative radiation was not associated with improved OS (hazards ratio [HR] 0·98, 95% CI 0·76–1·25, p = 0·84), while preoperative chemotherapy was associated with worse OS (HR 1·64, 95% CI 1·24–2·18, p < 0·001). Similar findings were observed in 199 and 128 matched pairs for preoperative radiation and chemotherapy, respectively, when compared to preoperative chemoradiation.

Findings:

Our study suggested an OS benefit in using preoperative chemoradiation compared to chemotherapy alone, but OS outcomes were comparable between preoperative chemoradiation and radiation alone.

Keywords

sarcomachemoradiationradiotherapyNational Cancer Databaseoverall survival
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 22 , 2023 , e12
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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References

Clark, MA, Fisher, C, Judson, I, Thomas, JM. Soft-tissue sarcomas in adults. N Engl J Med 2005; 353 (7): 701–711.CrossRefGoogle ScholarPubMed
Brennan, MF, Antonescu, CR, Moraco, N, Singer, S. Lessons learned from the study of 10,000 patients with soft tissue sarcoma. Ann Surg 2014; 260 (3): 416–421; discussion 21–22.CrossRefGoogle Scholar
Chouliaras, K, Senehi, R, Ethun, CG, et al. Recurrence patterns after resection of retroperitoneal sarcomas: an eight-institution study from the US Sarcoma Collaborative. J Surg Oncol 2019; 120 (3): 340–347.CrossRefGoogle ScholarPubMed
MacNeill, AJ, Miceli, R, Strauss, DC, et al. Post-relapse outcomes after primary extended resection of retroperitoneal sarcoma: a report from the Trans-Atlantic RPS Working Group. Cancer 2017; 123 (11): 1971–1978.CrossRefGoogle ScholarPubMed
Singer, S, Antonescu, CR, Riedel, E, Brennan, MF. Histologic subtype and margin of resection predict pattern of recurrence and survival for retroperitoneal liposarcoma. Ann Surg 2003; 238 (3): 358–370; discussion 70–71.CrossRefGoogle ScholarPubMed
Bonvalot, S, Gronchi, A, Le Pechoux, C, et al. Preoperative radiotherapy plus surgery versus surgery alone for patients with primary retroperitoneal sarcoma (EORTC-62092: STRASS): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol 2020; 21 (10): 1366–1377.CrossRefGoogle ScholarPubMed
Ma, SJ, Oladeru, OT, Farrugia, MK, Shekher, R, Iovoli, AJ, Singh, AK. Evaluation of Preoperative Chemotherapy or Radiation and Overall Survival in Patients With Nonmetastatic, Resectable Retroperitoneal Sarcoma. J Am Med Assoc Netw Open 2020; 3 (11): e2025529.Google ScholarPubMed
Nussbaum, DP, Speicher, PJ, Gulack, BC, Ganapathi, AM, Englum, BR, Kirsch, DG, et al. Long-term Oncologic Outcomes After Neoadjuvant Radiation Therapy for Retroperitoneal Sarcomas. Ann Surg 2015; 262 (1): 163–170.CrossRefGoogle ScholarPubMed
National Comprehensive Cancer Network. Soft Tissue Sarcoma (Version 1.2021). Available from: https://www.nccn.org/professionals/physician_gls/pdf/sarcoma.pdf.Google Scholar
von Elm, E, Altman, DG, Egger, M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370 (9596): 1453–1457.CrossRefGoogle ScholarPubMed
Bilimoria, KY, Stewart, AK, Winchester, DP, Ko, CY. The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol 2008; 15 (3): 683–690.CrossRefGoogle ScholarPubMed
Penumarthy, NL, Goldsby, RE, Shiboski, SC, Wustrack, R, Murphy, P, Winestone, LE. Insurance impacts survival for children, adolescents, and young adults with bone and soft tissue sarcomas. Cancer Med 2020; 9 (3): 951–958.CrossRefGoogle Scholar
Barraclough, H, Govindan, R. Biostatistics primer: what a clinician ought to know: subgroup analyses. J Thorac Oncol 2010; 5 (5): 741–746.CrossRefGoogle ScholarPubMed
Austin, PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat 2011; 10 (2): 150–161.CrossRefGoogle ScholarPubMed
Haukoos, JS, Lewis, RJ. The propensity score. J Am Med Assoc. 2015; 314 (15): 1637–1638.CrossRefGoogle ScholarPubMed
Gronchi, A, De Paoli, A, Dani, C, et al. Preoperative chemo-radiation therapy for localised retroperitoneal sarcoma: a phase I-II study from the Italian Sarcoma Group. Eur J Cancer. 2014; 50 (4): 784–792.CrossRefGoogle ScholarPubMed
Pisters, PW, Ballo, MT, Fenstermacher, MJ, et al. Phase I trial of preoperative concurrent doxorubicin and radiation therapy, surgical resection, and intraoperative electron-beam radiation therapy for patients with localized retroperitoneal sarcoma. J Clin Oncol 2003; 21 (16): 3092–3097.CrossRefGoogle ScholarPubMed
De Sanctis, R, Giordano, L, Colombo, C, et al. Long-term Follow-up and post-relapse outcome of patients with localized retroperitoneal sarcoma treated in the Italian Sarcoma Group-Soft Tissue Sarcoma (ISG-STS) protocol 0303. Ann Surg Oncol. 2017; 24 (13): 3872–3879.CrossRefGoogle ScholarPubMed
Miura, JT, Charlson, J, Gamblin, TC, et al. Impact of chemotherapy on survival in surgically resected retroperitoneal sarcoma. Eur J Surg Oncol. 2015; 41 (10): 1386–1392.CrossRefGoogle ScholarPubMed
Linehan, DC, Lewis, JJ, Leung, D, Brennan, MF. Influence of biologic factors and anatomic site in completely resected liposarcoma. J Clin Oncol 2000; 18 (8): 1637–1643.CrossRefGoogle ScholarPubMed
Park, JO, Qin, LX, Prete, FP, Antonescu, C, Brennan, MF, Singer, S. Predicting outcome by growth rate of locally recurrent retroperitoneal liposarcoma: the one centimeter per month rule. Ann Surg 2009; 250 (6): 977–982.CrossRefGoogle ScholarPubMed
Stojadinovic, A, Yeh, A, Brennan, MF. Completely resected recurrent soft tissue sarcoma: primary anatomic site governs outcomes. J Am Coll Surg. 2002; 194 (4): 436–447.CrossRefGoogle ScholarPubMed
Issels, RD, Lindner, LH, Verweij, J, et al. Effect of neoadjuvant chemotherapy plus regional hyperthermia on long-term outcomes among patients with localized high-risk soft tissue sarcoma: the EORTC 62961-ESHO 95 randomized clinical trial. J Am Med Assoc Oncol 2018; 4 (4): 483–492.Google ScholarPubMed
Wendtner, CM, Abdel-Rahman, S, Krych, M, et al. Response to neoadjuvant chemotherapy combined with regional hyperthermia predicts long-term survival for adult patients with retroperitoneal and visceral high-risk soft tissue sarcomas. J Clin Oncol 2002; 20 (14): 3156–3164.CrossRefGoogle ScholarPubMed
Chowdhry, V, Goldberg, S, DeLaney, TF, et al. Myxoid liposarcoma: treatment outcomes from chemotherapy and radiation therapy. Sarcoma 2018; 2018: 8029157.CrossRefGoogle ScholarPubMed
Engstrom, K, Bergh, P, Cederlund, CG, et al. Irradiation of myxoid/round cell liposarcoma induces volume reduction and lipoma-like morphology. Acta Oncol 2007; 46 (6): 838–845.CrossRefGoogle ScholarPubMed
Jones, RL, Fisher, C, Al-Muderis, O, Judson, IR. Differential sensitivity of liposarcoma subtypes to chemotherapy. Eur J Cancer. 2005; 41 (18): 2853–2860.CrossRefGoogle ScholarPubMed
Pitson, G, Robinson, P, Wilke, D, et al. Radiation response: an additional unique signature of myxoid liposarcoma. Int J Radiat Oncol Biol Phys. 2004; 60 (2): 522–526.CrossRefGoogle ScholarPubMed
Stitzenberg, KB, Chang, Y, Smith, AB, Nielsen, ME. Exploring the burden of inpatient readmissions after major cancer surgery. J Clin Oncol. 2015; 33 (5): 455–464.CrossRefGoogle ScholarPubMed
DeLaney, TF, Chen, YL, Baldini, EH, et al. Phase 1 trial of preoperative image guided intensity modulated proton radiation therapy with simultaneously integrated boost to the high risk margin for retroperitoneal sarcomas. Adv Radiat Oncol 2017; 2 (1): 85–93.CrossRefGoogle Scholar
Alektiar, KM, Hu, K, Anderson, L, Brennan, MF, Harrison, LB. High-dose-rate intraoperative radiation therapy (HDR-IORT) for retroperitoneal sarcomas. Int J Radiat Oncol Biol Phys 2000; 47 (1): 157–163.CrossRefGoogle ScholarPubMed
Yoon, SS, Chen, YL, Kirsch, DG, et al. Proton-beam, intensity-modulated, and/or intraoperative electron radiation therapy combined with aggressive anterior surgical resection for retroperitoneal sarcomas. Ann Surg Oncol. 2010; 17 (6): 1515–1529.CrossRefGoogle Scholar
Roeder, F, Morillo, V, Saleh-Ebrahimi, L, Calvo, FA, Poortmans, P, Ferrer Albiach, C. Intraoperative radiation therapy (IORT) for soft tissue sarcoma - ESTRO IORT Task Force/ACROP recommendations. Radiother Oncol J Euro Soc Therap Radiol Oncol 2020; 150: 293–302.CrossRefGoogle ScholarPubMed
Blay, JY, Soibinet, P, Penel, N, et al. Improved survival using specialized multidisciplinary board in sarcoma patients. Ann Oncol 2017; 28 (11): 2852–2859.CrossRefGoogle ScholarPubMed