Follow‐up after primary treatment of soft tissue sarcoma of extremities: Impact of frequency of follow‐up imaging on disease‐specific survival

Chou, Yi-Sheng; Liu, Chunyu; Chen, Wei-Ming; Chen, Tain-Hsiung; Chen, Paul Chih-Hsueh; Wu, Hung-Ta Hondar; Chiou, Hong‐Jen; Shiau, Chung‐Wai; Wu, Yu‐Chung; Liu, Chien-Lin; Chao, Ta‐Chung; Tzeng, Cheng‐Hwai; Yen, Ching‐Yu

doi:10.1002/jso.23060

Cited by 27 publications

(32 citation statements)

References 22 publications

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“…A retrospective analysis on a cohort of 80 relapsing patients after primary treatment for an extremity soft tissue sarcoma by Chou et al [4] showed no difference in time to detection and the median size of both pulmonary metastasis and local recurrences detected based on the frequency of followup visits. Although they did suggest that more frequent followup was associated with improved survival after treatment for relapse in patients with high-risk features, they failed to define objective followup intervals and patients in their study had varying followup intervals based on physicians' preferences.…”

Section: Discussionmentioning

confidence: 99%

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Does Intensity of Surveillance Affect Survival After Surgery for Sarcomas? Results of a Randomized Noninferiority Trial

Puri

Gulia

Hawaldar

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Whether current postoperative surveillance regimes result in improved overall survival (OS) of patients with extremity sarcomas is unknown. Questions/purposes We hypothesized that a less intensive followup protocol would not be inferior to the conventional followup protocol in terms of OS. We (1) assessed OS of patients to determine if less intensive followup regimens led to worsened survival and asked (2) whether chest radiograph followup group was inferior to CT scan followup group in detecting pulmonary metastasis; and (3) whether less frequent (6-monthly) followup interval was inferior to more frequent (3-monthly) followup in detecting pulmonary metastasis and local recurrence.Methods A prospective randomized single-center noninferiority trial was conducted between January 2006 and June 2010. On the basis of 3-year survival of 60% with intensive, more frequent followup, 500 nonmetastatic patients were randomized to demonstrate noninferiority by a margin (delta) of 10% (hazard ratio [HR], 1.36). The primary end point was OS at 3 years. The secondary objective was to compare disease-free survival (DFS) (time to recurrence) at 3 years. At minimum followup of 30 months (median, 42 months; range, 30-81 months), 178 deaths were documented. Results Three-year OS and DFS for all patients was 67% and 52%, respectively. Three-year OS was 67% and 66% in chest radiography and CT groups, respectively (HR, 0.9; upper 90% confidence interval [CI], 1.13). DFS rate was 54% and 49% in chest radiography and CT groups, respectively (HR, 0.82; upper 90% CI, 0.97). Three-year OS was 64% and 69% in 6-monthly and 3-monthly groups, respectively (HR, 1.2; upper 90% CI,

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Section: Discussionmentioning

confidence: 99%

“…Low-grade sarcomas have little metastatic potential [13] and tumor-related mortality; hence, retrospective studies suggest that surveillance is likely to have a positive impact only in highrisk cases [4]. TOSS included all sarcomas without risk assessment.…”

Section: Discussionmentioning

confidence: 99%

Does Intensity of Surveillance Affect Survival After Surgery for Sarcomas? Results of a Randomized Noninferiority Trial

Puri

Gulia

Hawaldar

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Prior work suggests that, if detected early, such disease may be more easily treatable and, in some cases, even curable with complete metastasectomy [1,2]. Some studies conclude that more aggressive pulmonary screening may facilitate earlier detection of lung metastases and improve survival for soft tissue sarcoma, particularly for higher risk patients [5,6]; others, however, either failed to confirm this advantage or demonstrated that less frequent scans are more appropriate for lower risk patients [13,17,20]. Although the optimal imaging frequency and modality to maximize survival remain unknown, it is generally agreed that patients with sarcoma require some form of surveillance that should be designed to maximize the number of recurrences detected per examination performed; therefore, understanding the frequency and timing of these events is necessary to determine optimal followup schedules.…”

Section: Discussionmentioning

confidence: 99%

Developing an Evidence-based Followup Schedule for Bone Sarcomas Based on Local Recurrence and Metastatic Progression

Cipriano

Griffin

Ferguson

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background The potential for local recurrence and pulmonary metastasis after treatment of primary bone sarcomas necessitates careful patient followup; however, minimal data exist regarding the incidence and timing of these events, and therefore an evidence-based surveillance protocol has not been developed. Questions/purposes The purposes of this study were to (1) describe the frequency and timing of local recurrence by histologic grade over time; (2) describe the frequency and timing of metastasis by histologic grade and diagnosis over time; and (3) use these data to either justify current surveillance schedules and/or propose modifications that may improve the rate of new pulmonary metastatic events detected per examination. Methods A retrospective review was performed of all patients who underwent resection of a primary, nonmetastatic bone sarcoma (excluding chordoma) at a single tertiary oncology center from 1989 to 2010. Of the 680 patients identified, 15 were excluded for loss of followup in the first 2 years, leaving 665 eligible for study. Of these, 437 patients were alive with no evidence of disease at the conclusion of the study (mean followup, 136 months; range, 25-321 months). Cox regression analysis was performed to evaluate and control for patient age, tumor size, tumor location, and surgical margins. With patients stratified by sarcoma grade, Kaplan-Meier survival curves were constructed for the endpoints of local recurrence and metastasis, and log-rank tests were used to compare the rates of these events between grades and diagnoses. The number of new pulmonary metastatic events per patientyear was calculated for each sarcoma grade over the time intervals used in current surveillance protocols (0-2, 2-5, 5-10, and [ 10 years) to facilitate development of a surveillance schedule that would maximize events detected per imaging study performed. In addition, to determine the effect of disease type, subset analysis was performed for osteosarcoma (OSA) and chondrosarcoma because these were the only diagnoses with sufficient numbers to support individual statistical analysis. Results With the numbers available for study, the overall local recurrence-free survival did not differ between sarcoma grades at any time points (p = 0.864). Metastasis-free survival curves differed between sarcoma grades (p \ 0.001), and the pattern of Grade 2 OSA metastasis was more consistent with other Grade 3 sarcomas, so it was

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“…It is estimated that after treatment of primary STS the disease recurs in approximately 40–60 % of patients [1–4], depending on histological grade and subtype of sarcoma, tumor size, and type of local treatment. The majority of recurrences (approximately 80 %) occur within the first 3 years of observation.…”

Section: Pattern Of Recurrence In Soft Tissue Sarcomas (Sts)mentioning

confidence: 99%

“…Regular H&P (history and physical examination) with a chest X-ray permit detection of more than half of cases with asymptomatic lung metastases [1, 4, 7]. It is also estimated that lung metastasectomies enable long-term survival in 30–40 % of cases [6, 8, 9].…”

Section: Benefits Of Follow-upmentioning

confidence: 99%

Follow-up in soft tissue sarcomas

Rutkowski

Ługowska

2014

memo

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The strategy for the follow-up of soft tissue sarcomas (STS) after therapy is tailored to the individual risk of recurrence and based on efficient rather than sophisticated methods of observation. Along with advances in the treatment of sarcomas, earlier detection of a less advanced and resectable recurrent disease (local or metastasis—especially to the lungs) can prolong patient survival. Since the majority of STS relapses occur within 5 years after treatment (approximately 80 % of metastases to the lung and close to 70 % of local recurrences within the first 2–3 years), in the period between 2 and 3 years after treatment, it is mandatory to follow-up patients every 3 months and perform careful history and physical examination (especially scars after surgery of the primary site) and a chest X-ray. There is no reason to perform other studies in asymptomatic patients (unless the patient reports symptoms). In case of retroperitoneal or intraperitoneal STS (including gastrointestinal stromal tumor), contrast-enhanced computed tomography of the abdomen and pelvis is recommended as the follow-up modality of choice. In this paper we outline the current recommendations for the follow-up strategy.

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Follow‐up after primary treatment of soft tissue sarcoma of extremities: Impact of frequency of follow‐up imaging on disease‐specific survival

Abstract: More frequent follow-up were associated with improved survival in high-risk relapsing patients with extremity STS by providing greater opportunities for adequate reoperation.

Cited by 27 publications

References 22 publications

Does Intensity of Surveillance Affect Survival After Surgery for Sarcomas? Results of a Randomized Noninferiority Trial

Does Intensity of Surveillance Affect Survival After Surgery for Sarcomas? Results of a Randomized Noninferiority Trial

Developing an Evidence-based Followup Schedule for Bone Sarcomas Based on Local Recurrence and Metastatic Progression

Follow-up in soft tissue sarcomas

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