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Adjuvant chemotherapy and postoperative radiotherapy in high-risk soft tissue sarcoma patients defined by biological risk factors—A Scandinavian Sarcoma Group study (SSG XX)

Sundby Hall, Kirsten; Bruland, Øyvind S.; Bjerkehagen, Bodil; Zaikova, Olga; Engellau, Jacob LU ; Hagberg, Oskar LU ; Hansson, Lina; Hagberg, Hans; Ahlström, Marie and Knobel, Heidi, et al. (2018) In European Journal of Cancer 99. p.78-85
Abstract

Purpose: To investigate the outcome following adjuvant doxorubicin and ifosfamide in a prospective non-randomised study based on a soft tissue sarcoma (STS) patient subgroup defined by specific morphological characteristics previously shown to be at a high-risk of metastatic relapse. The expected 5-year cumulative incidence of metastases in patients with this risk profile has previously been reported to be about 50% without adjuvant chemotherapy. Methods: High-risk STS was defined as high-grade morphology (according to the Fédération Nationale des Centres de Lutte Contre le Cancer [FNCLCC] grade II–III) and either vascular invasion or at least two of the following criteria: tumour size ≥8.0 cm, infiltrative growth and necrosis. Six... (More)

Purpose: To investigate the outcome following adjuvant doxorubicin and ifosfamide in a prospective non-randomised study based on a soft tissue sarcoma (STS) patient subgroup defined by specific morphological characteristics previously shown to be at a high-risk of metastatic relapse. The expected 5-year cumulative incidence of metastases in patients with this risk profile has previously been reported to be about 50% without adjuvant chemotherapy. Methods: High-risk STS was defined as high-grade morphology (according to the Fédération Nationale des Centres de Lutte Contre le Cancer [FNCLCC] grade II–III) and either vascular invasion or at least two of the following criteria: tumour size ≥8.0 cm, infiltrative growth and necrosis. Six cycles of doxorubicin (60 mg/m2) and ifosfamide (6 g/m2) were given. Postoperative accelerated radiotherapy was applied and scheduled between cycles 3 and 4. Results: For the 150 eligible patients, median follow-up time for metastases-free survival was 3.9 years (range 0.2–8.7). Five-year metastases-free survival (MFS) was 70.4% (95% confidence interval [CI]: 63.1–78.4) with a local recurrence rate of 14.0% (95% CI: 7.8–20.2). For overall survival (OS), the median follow-up time was 4.4 years (range: 0.2–8.7). The five-year OS was 76.1% (95% CI: 68.8–84.2). Tumour size, deep location and reduced dose intensity (<80%) had a negative impact on survival. Toxicity was moderate with no treatment-related death. Conclusions: A benefit of adjuvant chemotherapy, compared to similar historical control groups, was demonstrated in STS patients with defined poor prognostic factors. Vascular invasion, tumour size, growth pattern and necrosis may identify patients in need of adjuvant chemotherapy.

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published
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keywords
Adjuvant treatment, Growth pattern, Necrosis, Prognostic factors, Soft tissue sarcoma, Survival, Tumour size, Vascular invasion
in
European Journal of Cancer
volume
99
pages
8 pages
publisher
IFAC & Elsevier Ltd.
external identifiers
  • scopus:85048786554
ISSN
0959-8049
DOI
10.1016/j.ejca.2018.05.011
language
English
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yes
id
4c4eb951-eb77-4b3d-8e13-d9173093a3d0
date added to LUP
2018-07-04 12:10:22
date last changed
2019-10-08 03:32:16
@article{4c4eb951-eb77-4b3d-8e13-d9173093a3d0,
  abstract     = {<p>Purpose: To investigate the outcome following adjuvant doxorubicin and ifosfamide in a prospective non-randomised study based on a soft tissue sarcoma (STS) patient subgroup defined by specific morphological characteristics previously shown to be at a high-risk of metastatic relapse. The expected 5-year cumulative incidence of metastases in patients with this risk profile has previously been reported to be about 50% without adjuvant chemotherapy. Methods: High-risk STS was defined as high-grade morphology (according to the Fédération Nationale des Centres de Lutte Contre le Cancer [FNCLCC] grade II–III) and either vascular invasion or at least two of the following criteria: tumour size ≥8.0 cm, infiltrative growth and necrosis. Six cycles of doxorubicin (60 mg/m<sup>2</sup>) and ifosfamide (6 g/m<sup>2</sup>) were given. Postoperative accelerated radiotherapy was applied and scheduled between cycles 3 and 4. Results: For the 150 eligible patients, median follow-up time for metastases-free survival was 3.9 years (range 0.2–8.7). Five-year metastases-free survival (MFS) was 70.4% (95% confidence interval [CI]: 63.1–78.4) with a local recurrence rate of 14.0% (95% CI: 7.8–20.2). For overall survival (OS), the median follow-up time was 4.4 years (range: 0.2–8.7). The five-year OS was 76.1% (95% CI: 68.8–84.2). Tumour size, deep location and reduced dose intensity (&lt;80%) had a negative impact on survival. Toxicity was moderate with no treatment-related death. Conclusions: A benefit of adjuvant chemotherapy, compared to similar historical control groups, was demonstrated in STS patients with defined poor prognostic factors. Vascular invasion, tumour size, growth pattern and necrosis may identify patients in need of adjuvant chemotherapy.</p>},
  author       = {Sundby Hall, Kirsten and Bruland, Øyvind S. and Bjerkehagen, Bodil and Zaikova, Olga and Engellau, Jacob and Hagberg, Oskar and Hansson, Lina and Hagberg, Hans and Ahlström, Marie and Knobel, Heidi and Papworth, Karin and Zemmler, Maja and Goplen, Dorota and Bauer, Henrik C.F. and Eriksson, Mikael},
  issn         = {0959-8049},
  keyword      = {Adjuvant treatment,Growth pattern,Necrosis,Prognostic factors,Soft tissue sarcoma,Survival,Tumour size,Vascular invasion},
  language     = {eng},
  month        = {08},
  pages        = {78--85},
  publisher    = {IFAC & Elsevier Ltd.},
  series       = {European Journal of Cancer},
  title        = {Adjuvant chemotherapy and postoperative radiotherapy in high-risk soft tissue sarcoma patients defined by biological risk factors—A Scandinavian Sarcoma Group study (SSG XX)},
  url          = {http://dx.doi.org/10.1016/j.ejca.2018.05.011},
  volume       = {99},
  year         = {2018},
}