Does the addition of chemotherapy to neoadjuvant radiotherapy impact survival in high‐risk extremity/trunk soft‐tissue sarcoma?

Abstract

BACKGROUND:The role of chemotherapy in extremity/trunk soft-tissue sarcoma (ET-STS) is controversial, even for patients at high risk for distant recurrence and death (those with high-grade tumors ≥5 cm in size). This study examines the impact of integrating chemotherapy with neoadjuvant radiotherapy (RT) on overall survival (OS) for patients with high-risk ET-STS. METHODS: The National Cancer Data Base was queried for adult patients with high-risk ET-STS who received neoadjuvant RT and limb salvage surgery between 2006 and 2014. Patients were stratified into RT and chemoradiotherapy (CRT) cohorts. OS for the RT and CRT cohorts was analyzed with the Kaplan-Meier method, log-rank tests, and Cox proportional hazards models. Propensity score matching (PSM) analysis was used to account for a potential treatment selection bias between the cohorts. RESULTS: A total of 884 patients were identified: 639 (72.3%) in the RT cohort and 245 (27.7%) in the CRT cohort. The unadjusted 5-year Kaplan-Meier OS rate was significantly higher in the CRT cohort: 72.0% versus 56.1% (P < .001). Neoadjuvant chemotherapy was associated with improved OS in univariate and multivariable analyses (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.41-0.78; P < .001). PSM identified 2 evenly matched cohorts of 212 patients each. The 5-year matched Kaplan-Meier OS rates were 69.8% and 55.4% for the CRT and RT cohorts, respectively (P = .002). The addition of neoadjuvant chemotherapy remained prognostic for OS on PSM (HR, 0.56; 95% CI, 0.39-0.83; P = .003). CONCLUSIONS: The addition of chemotherapy to neoadjuvant RT was associated with improved OS for patients with high-risk ET-STS. In the absence of randomized data evaluating CRT versus RT, these findings warrant further investigation. Cancer 2019;125:3801-3809.

Chemotherapy and Survival in Patients with Primary High-Grade Extremity and Trunk Soft Tissue Sarcoma

“…While radiation therapy does not impact survival [24], our results suggest that the effect of chemotherapy on survival may be pronounced in patients with optimal local control. This is supported by an analysis of "high-risk" STS patients, defined by criteria including size ≥5 cm and high-grade, that identified an OS benefit with the addition of neoadjuvant chemotherapy to radiation [25]. A recent randomized trial compared standard anthracycline plus ifosfamide (AIM) neoadjuvant chemotherapy to histology-tailored (HT) neoadjuvant chemotherapy for localized extremity or trunk STS in the five histologic subtypes included in our analysis [26].…”

The prognostic role of the preoperative systemic immune-inflammation index and high-sensitivity modified Glasgow prognostic score in patients after radical operation for soft tissue sarcoma

“…Despite the advances in multimodal treatment, the prognosis of STSs, especially high-grade tumours, remains poor. Approximately 35% of patients with extremity and trunk STS tumours suffer from disease relapse after surgery, and the 5-year survival rate is approximately 55%e70% [2,3]. Therefore, a prognosis model is needed to assist in patient stratification and treatment optimization.…”

Time to Local Recurrence as a Predictor of Survival in Patients With Soft Tissue Sarcoma of the Extremity and Abdominothoracic Wall

“…The anatomic sites and pathologic subtypes of these tumors are crucial for their treatments and outcomes. Despite the established role of radical or wide surgical resection as a standard of treatment, 15%-40% of patients with localized STS tumors develop recurrence and have a dismal 5year survival rate ranging between 55% and 70% (2,3). Thus, tumor local relapse remains one of the major problems in managing STS, and can be defined as early or late recurrence.…”