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Preoperative Radiotherapy in Patients With Primary Retroperitoneal Sarcoma: EORTC-62092 Trial (STRASS) Versus Off-trial (STREXIT) Results.
Callegaro, Dario; Raut, Chandrajit P; Ajayi, Taiwo; Strauss, Dirk; Bonvalot, Sylvie; Ng, Deanna; Stoeckle, Eberhard; Fairweather, Mark; Rutkowski, Piotr; van Houdt, Winan J; Gelderblom, Hans; Sangalli, Claudia; Hayes, Andrew; Honoré, Charles; Gladdy, Rebecca A; Fau, Magali; Haas, Rick; Tzanis, Dimitri; Miah, Aisha B; Chung, Peter; Baldini, Elizabeth H; Marreaud, Sandrine; Litiere, Saskia; Swallow, Carol J; Gronchi, Alessandro.
Affiliation
  • Callegaro D; Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
  • Raut CP; Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
  • Ajayi T; Department of Statistics, European Organisation for Research and Treatment of Cancer, Brussels, Belgium.
  • Strauss D; Department of General Surgery, Royal Marsden NHS Foundation Trust, London, UK.
  • Bonvalot S; Department of Surgery, Institute Curie, University of Paris, Paris, France.
  • Ng D; Department of Surgical Oncology, Princess Margaret Cancer Center/Mount Sinai Hospital, Toronto, ON, Canada.
  • Stoeckle E; Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Fairweather M; Department of Surgery, Institut Bergonie, Bordeaux, France.
  • Rutkowski P; Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
  • van Houdt WJ; Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
  • Gelderblom H; Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
  • Sangalli C; Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
  • Hayes A; Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
  • Honoré C; Department of General Surgery, Royal Marsden NHS Foundation Trust, London, UK.
  • Gladdy RA; Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France.
  • Fau M; Department of Surgical Oncology, Princess Margaret Cancer Center/Mount Sinai Hospital, Toronto, ON, Canada.
  • Haas R; Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Tzanis D; Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
  • Miah AB; Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands.
  • Chung P; Department of Surgery, Institute Curie, University of Paris, Paris, France.
  • Baldini EH; Department of Radiation Oncology, Royal Marsden NHS Foundation Trust, and The Institute of Cancer Research, London, UK.
  • Marreaud S; Department of Radiation Oncology, Princess Margaret Cancer Center/Mount Sinai Hospital, Toronto, ON, Canada.
  • Litiere S; Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Swallow CJ; Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
  • Gronchi A; European Organisation for Research and Treatment of Cancer, Brussels, Belgium.
Ann Surg ; 278(1): 127-134, 2023 Jul 01.
Article in En | MEDLINE | ID: mdl-35833413
ABSTRACT

OBJECTIVE:

The aim of the present study was to compare the effect of radiotherapy (RT) on abdominal recurrence-free survival (ARFS) in patients with primary retroperitoneal sarcoma treated in the EORTC-STBSG-62092 (STRASS) phase 3 randomized controlled trial (STRASS cohort) and off-trial (STREXIT cohort) and to pool STRASS and STREXIT data to test the hypothesis that RT improves ARFS in patients with liposarcoma.

BACKGROUND:

The STRASS trial did not show any difference in ARFS between patients treated with preoperative radiotherapy+surgery (RT+S) versus surgery alone (S).

METHODS:

All consecutive adult patients not enrolled in STRASS and underwent curative-intent surgery for a primary retroperitoneal sarcoma with or without preoperative RT between 2012 and 2017 (STRASS recruiting period) among ten STRASS-recruiting centres formed the STREXIT cohort. The effect of RT in STREXIT was explored with a propensity score (PS)-matching analysis. Primary endpoint was ARFS defined as macroscopically incomplete resection or abdominal recurrence or death of any cause, whichever occurred first.

RESULTS:

STRASS included 266 patients, STREXIT included 831 patients (727 after excluding patients who received preoperative chemotherapy, 202 after 11 PS-matching). The effect of RT on ARFS in STRASS and 11 PS-matched STREXIT cohorts, overall and in patients with liposarcoma, was similar. In the pooled cohort analysis, RT administration was associated with better ARFS in patients with liposarcoma [N=321, hazard ratio (HR), 0.61; 95% confidence interval (CI), 0.42-0.89]. In particular, patients with well-differentiated liposarcoma and G1-2 dedifferentiated liposarcoma (G1-2 DDLPS, n=266) treated with RT+S had better ARFS (HR, 0.63; 95% CI, 0.40-0.97) while patients with G3 DDLPS and leiomyosarcoma had not. At the current follow-up, there was no association between RT and overall survival or distant metastases-free survival.

CONCLUSIONS:

In this study, preoperative RT was associated with better ARFS in patients with primary well-differentiated liposarcoma and G1-2 DDLPS.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Retroperitoneal Neoplasms / Sarcoma / Liposarcoma Type of study: Clinical_trials / Observational_studies Limits: Adult / Humans Language: En Journal: Ann Surg Year: 2023 Document type: Article Affiliation country: Italy
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Retroperitoneal Neoplasms / Sarcoma / Liposarcoma Type of study: Clinical_trials / Observational_studies Limits: Adult / Humans Language: En Journal: Ann Surg Year: 2023 Document type: Article Affiliation country: Italy