A Meta-Analysis of the Association Between Radiation Therapy and Survival for Surgically Resected Soft-Tissue Sarcoma

Qu, Xuanlu; Lubitz, Carrie C.; Rickard, Jennifer; Bergeron, Stephane G.; Wasif, Nabil

doi:10.1097/coc.0000000000000274

Cited by 9 publications

(8 citation statements)

References 48 publications

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“…To date, no differences were found in overall survival, progression free, or local disease control in case of radiotherapy in soft tissue sarcoma treatment. However, recently a meta-analysis suggested that radiotherapy is associated with lower long-term mortality [14]. In our patient population, 49% of all included patients were additionally treated with neoadjuvant RCT.…”

Section: Discussionmentioning

confidence: 99%

Patient’s quality of life after surgery and radiotherapy for extremity soft tissue sarcoma - a retrospective single-center study over ten years

Götzl

Sterzinger

Semrau

et al. 2019

Health Qual Life Outcomes

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Background and objectivesThe purpose of this study is to analyze major complication rates and different aspects of health-related quality of life (HRQoL) in extremity soft tissue sarcoma (STS) patients treated with or without radio (chemo) therapy and surgery.MethodsWe performed a retrospective analysis of all patients who underwent Extremity STS excision from 2004 to 2014 (182 patients included). Patients’ data were collected from patients’ records. HRQoL was assessed by using EORTC QLQ-C30.ResultsA total of 182 patients underwent sarcoma resection. After neoadjuvant radiochemotherapy (RCT), the major-complication rate amounted to 28% (vs. 7%, no radiotherapy, p < 0.001). Major-complication rates after adjuvant radiotherapy (RT) occurred in 8% (vs. 7%, no radiotherapy, p = 0.265). Comparison QoL scores between treating with neoadjuvant RCT or without RT revealed significant worse scores with neoadjuvant RCT. Further stratification of disease control of these patients showed significant reduced scores in the group of disease-free patients with neoadjuvant RCT compared to irradiated disease-free patients.DiscussionTo date, there have only been a few investigations of QoL in STS. Retrospective study on quality of life have limitations, like a lack of baseline evaluation of QoL. Patient candidated to radiation therapy could have had worse QoL baseline due to more advanced disease. Disease status of the patients who answered the questionnaires could have been an influence of QoL and we could show reduced scores in the group of disease-free patients with neoadjuvant RCT, but not for the patients with recurrence or metastasis, so it is very hard to discriminate whether radiation therapy could really have an impact or not.ConclusionThis study might assist in further improving the understanding of QoL in STS patients and may animate for prospective studies examining the oncological therapies impact on HRQoL.

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Section: Discussionmentioning

confidence: 99%

Patient’s quality of life after surgery and radiotherapy for extremity soft tissue sarcoma - a retrospective single-center study over ten years

Götzl

Sterzinger

Semrau

et al. 2019

Health Qual Life Outcomes

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“…A second explanation for why adherence to guidelines had a greater effect on overall survival is that they could actually reflect the direct impact of radiation therapy. Though phase III trials have not shown a survival benefit with radiation therapy, studies that use a larger sample size have shown a survival difference [ 12 , 17 – 20 ]. Review of the NCDB database reported that the utilization of radiation therapy in the treatment of large, deep, high-grade STS is underutilized and that its use was associated with improved overall survival [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Improving Long-Term Outcomes for Patients with Extra-Abdominal Soft Tissue Sarcoma Regionalization to High-Volume Centers, Improved Compliance with Guidelines or Both?

Bagaria

Chang

Gray

et al. 2018

Sarcoma

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Introduction Optimization of outcomes of extra-abdominal STS is not clearly understood. We sought to determine whether hospital surgical volume and adherence to NCCN guidelines, or both, are associated with outcomes in the treatment of extra-abdominal soft tissue sarcoma (STS). Methods The National Cancer Database (NCDB) was queried for patients undergoing surgery for extra-abdominal STS diagnosed from 2003 to 2007. Mean annual hospital volume for STS surgery was divided into volume terciles (1T ≤3, 2T 4–10, and 3T ≥11 cases/year). Adherence to NCCN guidelines was determined. Primary outcome was overall survival. Results Our study population consisted of 13,684 patients with a median age of 56 years. 3T hospitals were more likely to adhere to NCCN guidelines for stage III patients (63% versus 47%; p ≤ 0.001) than 1T hospitals. On multivariable analysis, adherence to NCCN guidelines was associated with improved survival (HR = 0.79, CI 0.73–0.87; p < 0.001), but hospital volume was not (3T versus 1T: HR = 0.92, CI 0.82–1.02; p=0.12). Five-year overall survival was comparable for compliant groups at 1T, 2T, and 3T hospitals (72%, 72.4%, and 72.6%, resp.). 3T hospitals were not associated with a lower risk of 30-day mortality (OR 0.70, 95% CI 0.44–1.11) compared to 1T hospitals but did have a higher R0 resection rate (OR 1.43, 95% CI 1.32–1.54). Conclusions Adherence to NCCN guidelines, irrespective of hospital volume, is associated with improved overall survival for patients with extra-abdominal STS. High-volume hospitals more often adhere to guidelines, but low-volume hospitals that follow national guidelines may achieve comparable outcomes.

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“…According to the evaluated treatment, 13 SRs appraised chemotherapy therapies [15, 18, 21, 25-27, 30-32, 37-39]; 5 SRs evaluated radiotherapy interventions [19,22,23,33,36]; 2 SRs assessed surgical interventions [24,34]; 1 SR assessed a combination of surgery (cytoreduction) plus intraperitoneal chemotherapy [28]; and finally 3 SRs assessed a therapy at the forefront named isolated limb perfusion (ILP) [20,29,35].…”

Section: Characteristics and Quality Of Systematic Reviewsmentioning

confidence: 99%

“…SRs [19,32,33,40] were identified with a total of 27 RCTs and 32 observational studies, which addressed three different therapeutic options within this scenario. Two SRs compared different regimens of adjuvant chemotherapy [32,40] mainly based in doxorubicin or doxorubicin plus ifosfamide with surgery.…”

Section: Patients With Localised Resectable Sts (First Line): Fourmentioning

confidence: 99%

“…Two SRs compared different regimens of adjuvant chemotherapy [32,40] mainly based in doxorubicin or doxorubicin plus ifosfamide with surgery. Adjuvant chemotherapy was considered by the authors as "probably beneficial" in one SR and as "inconclusive" in another SR. One SR compared adjuvant radiotherapy [33] with surgery and its authors qualified this intervention as "probably beneficial". Another SR compared neoadjuvant radiotherapy [19] with surgery, and as stated in the conclusion, the authors considered this intervention as "probably beneficial".…”

Section: Patients With Localised Resectable Sts (First Line): Fourmentioning

confidence: 99%

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Evidence mapping based on systematic reviews of therapeutic interventions for soft tissue sarcomas

Ballesteros¹,

Montero

López‐Pousa

et al. 2019

Clin Transl Oncol

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Purpose Soft tissue sarcomas are a heterogeneous group of rare tumours of mesenchymal origin. Evidence mapping is one of the most didactic and friendly approaches to organise and summarise the range of research activity in broad topic fields. The objective of this evidence mapping is to identify, describe and organise the current available evidence about therapeutic interventions on soft tissues sarcomas. Methods We followed the methodology of global evidence mapping. We performed a search of the PubMed, EMBASE, The Cochrane Library and Epistemonikos to identify systematic reviews (SRs) with or without meta-analyses published between 1990 and March 2016. Two independent literature reviewers assessed eligibility and extracted data. Methodological quality of the included systematic reviews was assessed using AMSTAR. We organised the results according to identified PICO questions and used tables and a bubble plot to display the results. Results The map is based on 24 SRs that met eligibility criteria and included 66 individual studies. Three-quarters were either observational or uncontrolled clinical trials. The quality of the included SRs was in general moderate or high. We identified 64 PICO questions from them. The corresponding results mostly favoured the intervention arm. Conclusions This evidence mapping was built on the basis of SRs, which mostly included non-experimental studies and were qualified by the AMSTAR tool as of moderate quality. The evidence mapping created from PICO questions is a useful approach to describe complex and huge clinical topics through graphical media and orientate further research to fulfil the existing gaps. However, it is important to delimitate the steps of the evidence mapping in a pre-established protocol.

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A Meta-Analysis of the Association Between Radiation Therapy and Survival for Surgically Resected Soft-Tissue Sarcoma

Cited by 9 publications

References 48 publications

Patient’s quality of life after surgery and radiotherapy for extremity soft tissue sarcoma - a retrospective single-center study over ten years

Patient’s quality of life after surgery and radiotherapy for extremity soft tissue sarcoma - a retrospective single-center study over ten years

Improving Long-Term Outcomes for Patients with Extra-Abdominal Soft Tissue Sarcoma Regionalization to High-Volume Centers, Improved Compliance with Guidelines or Both?

Evidence mapping based on systematic reviews of therapeutic interventions for soft tissue sarcomas

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