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Journal Article Ppublish 92 citations

PubMed: 35833413 DOI: 10.1097/SLA.0000000000005492

Preoperative Radiotherapy in Patients With Primary Retroperitoneal Sarcoma: EORTC-62092 Trial (STRASS) Versus Off-trial (STREXIT) Results.

Ann Surg 278(1):127-134

Authors: Dario Callegaro, Chandrajit P Raut, Taiwo Ajayi, Dirk Strauss, Sylvie Bonvalot, Deanna Ng, Eberhard Stoeckle, Mark Fairweather, Piotr Rutkowski, Winan J van Houdt, Hans Gelderblom, Claudia Sangalli, Andrew Hayes, Charles Honoré, Rebecca A Gladdy, Magali Fau, Rick Haas, Dimitri Tzanis, Aisha B Miah, Peter Chung, Elizabeth H Baldini, Sandrine Marreaud, Saskia Litiere, Carol J Swallow, Alessandro Gronchi

Affiliations

  • Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
  • Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
  • Department of Statistics, European Organisation for Research and Treatment of Cancer, Brussels, Belgium.
  • Department of General Surgery, Royal Marsden NHS Foundation Trust, London, UK.
  • Department of Surgery, Institute Curie, University of Paris, Paris, France.
  • Department of Surgical Oncology, Princess Margaret Cancer Center/Mount Sinai Hospital, Toronto, ON, Canada.
  • Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Department of Surgery, Institut Bergonie, Bordeaux, France.
  • Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
  • Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
  • Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
  • Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
  • Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France.
  • Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
  • Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands.
  • Department of Radiation Oncology, Royal Marsden NHS Foundation Trust, and The Institute of Cancer Research, London, UK.
  • Department of Radiation Oncology, Princess Margaret Cancer Center/Mount Sinai Hospital, Toronto, ON, Canada.
  • Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
  • European Organisation for Research and Treatment of Cancer, Brussels, Belgium.

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 1:1 PS-matching). The effect of RT on ARFS in STRASS and 1:1 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.

MeSH

Sarcoma, General Surgery, Liposarcoma, Radiotherapy

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