Overall survival advantage of chemotherapy and radiotherapy in the perioperative management of large extremity and trunk soft tissue sarcoma; a large database analysis

Mahmoud, Omar; Tunceroglu, Ahmet; Benevenia, Joseph; Beebe, Kathleen S.; Patterson, Francis; DeLaney, Thomas F.

doi:10.1016/j.radonc.2017.07.021

Cited by 33 publications

(28 citation statements)

References 32 publications

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“…The first, by Movva et al, 30 showed an OS advantage with the addition of neoadjuvant or adjuvant chemotherapy Cancer November 1, 2019 31 showed an OS benefit with any neoadjuvant or adjunct therapy (RT, CRT, or chemotherapy alone) versus surgery alone. The first, by Movva et al, 30 showed an OS advantage with the addition of neoadjuvant or adjuvant chemotherapy Cancer November 1, 2019 31 showed an OS benefit with any neoadjuvant or adjunct therapy (RT, CRT, or chemotherapy alone) versus surgery alone.…”

Section: Discussionmentioning

confidence: 99%

“…The first, by Movva et al, 30 showed an OS advantage with the addition of neoadjuvant or adjuvant chemotherapy Cancer November 1, 2019 Cancer November 1, 2019 to surgery. The second, by Mahmoud et al, 31 showed an OS benefit with any neoadjuvant or adjunct therapy (RT, CRT, or chemotherapy alone) versus surgery alone. Neither study directly evaluated neoadjuvant CRT versus RT.…”

Section: Bothmentioning

confidence: 99%

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

Chowdhary

Sen

et al. 2019

Cancer

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Bothmentioning

confidence: 99%

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

Chowdhary

Sen

et al. 2019

Cancer

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“…Key studies have demonstrated that the addition of RT improves margin‐negative resection rates and local control for this disease 5,7,12 . Although these improvements have not translated to a survival benefit in most studies, the benefit of radiation in the treatment of extremity sarcomas is well‐established 13,14 . The timing of delivery remains a significant area of study.…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant radiation improves margin‐negative resection rates in extremity sarcoma but not survival

Shelby

Suarez‐Kelly

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: Radiation improves limb salvage in extremity sarcomas.Timing of radiation therapy remains under investigation. We sought to evaluate the effects of neoadjuvant radiation (NAR) on surgery and survival of patients with extremity sarcomas. Materials and Methods:A multi-institutional database was used to identify patients with extremity sarcomas undergoing surgical resection from 2000-2016. Patients were categorized by treatment strategy: surgery alone, adjuvant radiation (AR), or NAR. Survival, recurrence, limb salvage, and surgical margin status was analyzed.Results: A total of 1483 patients were identified. Most patients receiving radiotherapy had high-grade tumors (82% NAR vs 81% AR vs 60% surgery; P < .001). The radiotherapy groups had more limb-sparing operations (98% AR vs 94% NAR vs 87% surgery; P < .001). NAR resulted in negative margin resections (90% NAR vs 79% surgery vs 75% AR; P < .0001). There were fewer local recurrences in the radiation groups (14% NAR vs 17% AR vs 27% surgery; P = .001). There was no difference in overall or recurrence-free survival between the three groups (OS, P = .132; RFS, P = .227). Conclusion:In this large study, radiotherapy improved limb salvage rates and decreased local recurrences. Receipt of NAR achieves more margin-negative resections however this did not improve local recurrence or survival rates over. K E Y W O R D S extremity, margins, radiation therapy, sarcoma, survival 1250 | SHELBY ET AL.

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“…Treatment recommendations for head and neck sarcomas tend to emerge from data collected from trials involving sarcomas of the extremities, despite the anatomical differences . One analysis of the National Cancer Database by Mahmoud found a reduction in hazard ratio by 37% with adjuvant radiation therapy for extremity and trunk soft tissue sarcoma; another by Gingrich found that both neoadjuvant and adjuvant radiation therapy for extremity soft tissue sarcoma increased overall survival . Ideally, these tumors would be managed with complete surgical resection .…”

Section: Introductionmentioning

confidence: 99%

“…16 One analysis of the National Cancer Database by Mahmoud found a reduction in hazard ratio by 37% with adjuvant radiation therapy for extremity and trunk soft tissue sarcoma; another by Gingrich found that both neoadjuvant and adjuvant radiation therapy for extremity soft tissue sarcoma increased overall survival. 17,18 Ideally, these tumors would be managed with complete surgical resection. [19][20][21] Nevertheless, head and neck anatomy, with its many complexities involving vital structures, cannot be treated as equal with an extremity where margins are concerned.…”

Section: Introductionmentioning

confidence: 99%

Adjuvant radiation for positive margins in adult head and neck sarcomas is associated with improved survival: Analysis of the National Cancer Database

et al. 2019

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Background Adult head and neck (H&N) sarcomas are a rare malignancy with limited data delineating the role of postoperative radiotherapy (PORT), particularly for a positive surgical margin. There are no randomized trials supporting the use of PORT, therefore treatment trends vary between institutions. A positive margin predicts recurrence and poor survival outcomes. This study uses the National Cancer Database (NCDB) to investigate whether PORT improves overall survival (OS) in adult H&N sarcomas with a positive margin and how utilization has changed. Methods Patients (n = 1142) in the NCDB from 2004‐2013 with adult H&N sarcomas who underwent resection and had a positive margin. Results Factors significantly associated with increased utilization of PORT were: having insurance, salivary gland primary site, high‐risk histology, poor differentiation, and a macroscopic positive margin. Treatment with PORT was associated with improved 5‐year OS for all patients with a positive margin (57% vs 48%; P = .002), both microscopic (57% vs 49%; P = .010) and macroscopic (57% vs 41%; P = .036). Improved OS was significant after controlling for other known covariates on multivariate analysis (HR: 0.76; [0.64‐0.90]; P = .002). Treatment at a community‐based facility was an independent predictor for reduced OS (HR: 1.37; [1.15‐1.64]; P < .001). The percentage utilization (53%) of PORT for these patients did not change significantly over time. Conclusion PORT provides a significant survival benefit for adult H&N sarcoma patients with either a microscopic or macroscopic positive margin; however, PORT is underutilized. Treatment at academic/research cancer programs was associated with increased utilization of PORT and improved survival outcomes.

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Overall survival advantage of chemotherapy and radiotherapy in the perioperative management of large extremity and trunk soft tissue sarcoma; a large database analysis

Cited by 33 publications

References 32 publications

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

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

Neoadjuvant radiation improves margin‐negative resection rates in extremity sarcoma but not survival

Adjuvant radiation for positive margins in adult head and neck sarcomas is associated with improved survival: Analysis of the National Cancer Database

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