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01-12-2017 | Bone and Soft Tissue Sarcomas

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

Authors: R. De Sanctis, MD, L. Giordano, MSc, C. Colombo, MD, A. De Paoli, MD, P. Navarria, MD, C. Sangalli, MD, A. Buonadonna, MD, R. Sanfilippo, MD, G. Bertola, MD, M. Fiore, MD, A. Marrari, MD, F. Navarria, MD, A. Bertuzzi, MD, P. G. Casali, MD, S. Basso, MD, A. Santoro, MD, V. Quagliuolo, MD, A. Gronchi, MD

Published in: Annals of Surgical Oncology | Issue 13/2017

Abstract

Background

This study was designed to assess patterns of recurrence and long-term outcomes of patients undergoing surgery for localized retroperitoneal sarcoma (RPS) after neoadjuvant high dose long-infusion ifosfamide (HLI) and radiotherapy (RT).

Methods

Patients received three cycles of HLI (14 g/m²). RT was started in combination with II cycle up to a total dose of 50.4 Gy. Surgery was scheduled 4–6 weeks after the end of RT. The primary endpoint was relapse-free survival (RFS) after surgery. Secondary endpoints were overall survival (OS), crude cumulative incidence of local recurrence (CCI-LR), and distant metastases (CCI-DM). For patients who relapsed, progression-free survival (PFS) and post-relapse OS were estimated. The trial was registered with ITASARC_*II_2004_003.

Results

Between 2003 and 2010, 83 patients were recruited. At a median follow-up of 91.7 months, 42 (56%) of 75 operated patients developed LR (n = 27) or DM (n = 10) or both LR and DM (n = 5) relapse. Seven-year RFS was 46.6% [95% confidence interval (CI) 29.6–52.4]. Thirty-two patients died. Seven-year OS rate was 63.2% (95% CI 42.7–66.0). The corresponding CCI of LR and DM were 37.4% [standard error (SE) 5.5%] and 20.0% (SE 12.6%), respectively. The only factor significantly associated with LR was FNCLCC grading, whereas histological subtype resulted associated with DM. At recurrence, 24 patients (57%) underwent surgery. Two-year post-relapse PFS and OS rates for patients developing LR or DM were 14.8, 41.0, 27.3, and 63.6%, respectively.

Conclusions

LR after neoadjuvant CT-RT for RPS were predominantly infield. While almost one half of relapsed patients underwent further surgery, prognosis was poor.

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Cormier JN, Gronchi A, Pollock RE. Soft tissue sarcomas. In: Brunicardi F, Andersen D, Billiar T, editors. Schwartz’s principles of surgery. New York: McGraw Hill; 2015:1465–1494.

Mussi C, Colombo P, Bertuzzi A, et al. Retroperitoneal sarcoma: is it time to change the surgical policy? Ann Surg Oncol. 2011;18:2136–42.CrossRefPubMed

Colombo C, Randall RL, Andtbacka RH, et al. Surgery in soft tissue sarcoma: more conservative in extremities, more extended in the retroperitoneum. Expert Rev Anticancer Ther. 2012;12:1079–87.CrossRefPubMed

Gronchi A, Miceli R, Colombo C, et al. Frontline extended surgery is associated with improved survival in retroperitoneal low- to intermediate-grade soft tissue sarcomas. Ann Oncol. 2012;23:1067–73.CrossRefPubMed

Bonvalot S, Miceli R, Causeret S, et al. Aggressive surgery in retroperitoneal sarcoma carried out at high-volume centers is safe and associated to an improved local control. Ann Surg Oncol. 2010;17:1507–14.CrossRefPubMed

Gronchi A, Lo Vullo S, Fiore M, et al. Aggressive surgical policies in a retrospectively reviewed single-institution case series of retroperitoneal soft-tissue sarcoma patients. J Clin Oncol. 2009;27:24–30.CrossRefPubMed

ESMO/European Sarcoma Network Working Group. Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25:102–12.CrossRef

Gronchi A, Miceli R, Shurell E, et al. Outcome prediction in primary resected retroperitoneal soft tissue sarcoma: histology-specific overall survival and disease-free survival nomograms built on major sarcoma center data sets. J Clin Oncol. 2013;31:1649–55.CrossRefPubMed

Gronchi A, De Paoli A, Dani C, et al. Preoperative chemo-radiation therapy for localized retroperitoneal sarcoma: a phase I–II study from the Italian Sarcoma Group. Eur J Cancer. 2014;50:784–92.CrossRefPubMed

10.

Lane WO, Cramer CK, Nussbaum DP, et al. Analysis of perioperative radiation therapy in the surgical treatment of primary and recurrent retroperitoneal sarcoma. J Surg Oncol. 2015;112:352–58.CrossRefPubMed

11.

Miah AB, Hannay J, Benson C, et al. Optimal management of primary retroperitoneal sarcoma: an update. Expert Rev Anticancer Ther. 2014;14:565–79.CrossRefPubMed

12.

Sindelar WF, Kinsella TJ, Chen PW, et al. Intraoperative radiotherapy in retroperitoneal sarcomas. Final results of a prospective, randomized, clinical trial. Arch Surg. 1993;128:402–10.CrossRefPubMed

13.

Alektiar KM, Hu K, Anderson L, et al. High-dose-rate intraoperative radiation therapy (HDR-IORT) for retroperitoneal sarcomas. Int J Radiat Oncol Biol Phys. 2000;47:157–63.CrossRefPubMed

14.

Gieschen HL, Spiro IJ, Suit HD, et al. Long-term results of intraoperative electron beam radiotherapy for primary and recurrent retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys. 2001;50(1):127–31.CrossRefPubMed

15.

Petersen IA, Haddock MG, Donohue JH, et al. Use of intraoperative electron beam radiotherapy in the management of retroperitoneal soft tissue sarcomas. Int J Radiat Oncol Biol Phys. 2002;52:469–75.CrossRefPubMed

16.

Gilbeau L, Kantor G, Stoeckle E, et al. Surgical resection and radiotherapy for primary retroperitoneal soft tissue sarcoma. Radiother Oncol. 2002;65:137–43.CrossRefPubMed

17.

Trovik LH, Ovrebo K, Almquist M, et al. Adjuvant radiotherapy in retroperitoneal sarcomas. A Scandinavian Sarcoma Group study of 97 patients. Acta Oncol. 2014;53:1165–72.CrossRefPubMed

18.

Pawlik TM, Pisters PW, Mikula L, et al. Long-term results of two prospective trials of preoperative external beam radiotherapy for localized intermediate- or high-grade retroperitoneal soft tissue sarcoma. Ann Surg Oncol. 2006;13:508–17.CrossRefPubMed

19.

Smith MJ, Ridgway PF, Catton CN, et al. Combined management of retroperitoneal sarcoma with dose intensification radiotherapy and resection: long-term results of a prospective trial. Radiother Oncol. 2014;110:165–71.CrossRefPubMed

20.

Nussbaum DP, Speicher PJ, Gulack BC, et al. Long-term oncologic outcomes after neoadjuvant radiation therapy for retroperitoneal sarcomas. Ann Surg. 2015;262:163–70.CrossRefPubMedPubMedCentral

21.

Nussbaum DP, Rushing CN, Lane WO, et al. Preoperative or postoperative radiotherapy versus surgery alone for retroperitoneal sarcoma: a case-control, propensity score-matched analysis of a nationwide clinical oncology database. Lancet Oncol. 2016;17:966–75.CrossRefPubMed

22.

Sanfilippo R, Bertulli R, Marrari A, et al. High-dose continuous-infusion ifosfamide in advanced well-differentiated/dedifferentiated liposarcoma. Clin Sarcoma Res. 2014;4(1):16.CrossRefPubMedPubMedCentral

23.

Martin-Liberal J, Alam S, Constantinidou A, et al. Clinical activity and tolerability of a 14-day infusional Ifosfamide schedule in soft-tissue sarcoma. Sarcoma. 2013;2013:868973.CrossRefPubMedPubMedCentral

24.

Grobmyer SR, Wilson JP, Apel B, et al. Recurrent retroperitoneal sarcoma: impact of biology and therapy on outcomes. J Am Coll Surg. 2010;210:602–10.CrossRefPubMed

25.

Lochan R, French JJ, Manas DM. Surgery for retroperitoneal soft tissue sarcomas: aggressive re-resection of recurrent disease is possible. Ann R Coll Surg Engl. 2011;93:39–43.CrossRefPubMed

26.

van Dalen T, Hoekstra HJ, van Geel AN, et al. Locoregional recurrence of retroperitoneal soft tissue sarcoma: second chance of cure for selected patients. Eur J Surg. Oncol 2001;27:564–68.CrossRefPubMed

27.

Gronchi A, Strauss DC, Miceli R, et al. Variability in patterns of recurrence after resection of primary retroperitoneal sarcoma (RPS): a report on 1007 patients from the multi-institutional collaborative RPS Working Group. Ann Surg 2016;263:1002–9.CrossRefPubMed

Title: 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
Authors: R. De Sanctis, MD
L. Giordano, MSc
C. Colombo, MD
A. De Paoli, MD
P. Navarria, MD
C. Sangalli, MD
A. Buonadonna, MD
R. Sanfilippo, MD
G. Bertola, MD
M. Fiore, MD
A. Marrari, MD
F. Navarria, MD
A. Bertuzzi, MD
P. G. Casali, MD
S. Basso, MD
A. Santoro, MD
V. Quagliuolo, MD
A. Gronchi, MD
Publication date: 01-12-2017
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 13/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-017-6105-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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