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Defining the role of neoadjuvant systemic therapy in high‐risk retroperitoneal sarcoma: A multi‐institutional study from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group
Author(s) -
Tseng William W.,
Barretta Francesco,
Conti Lorenzo,
Grignani Giovanni,
Tolomeo Francesco,
Albertsmeier Markus,
Angele Martin K.,
Rutkowski Piotr,
Skoczylas Jacek,
De Paoli Antonino,
Navarria Federico,
Raut Chandrajit P.,
Fairweather Mark,
Farma Jeffrey M.,
Nessim Carolyn,
Goel Neha,
Grignol Valerie P.,
Ford Samuel J.,
Cardona Kenneth,
Subhawong Ty,
Tattersall Hannah L.,
Lee Rachel M.,
Hu James S.,
Mehren Margaret,
Sanfilippo Roberta,
Gronchi Alessandro
Publication year - 2021
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.33323
Subject(s) - medicine , interquartile range , sarcoma , neoadjuvant therapy , systemic therapy , leiomyosarcoma , anthracycline , retrospective cohort study , progressive disease , surgery , oncology , response evaluation criteria in solid tumors , cancer , disease , breast cancer , pathology
Background In patients with retroperitoneal sarcoma (RPS), the incidence of recurrence after surgery remains high. Novel treatment approaches are needed. This retrospective study evaluated patients with primary, high‐risk RPS who received neoadjuvant systemic therapy followed by surgery to 1) determine the frequency and potential predictors of radiologic tumor responses and 2) assess clinical outcomes. Methods Clinicopathologic data were collected for eligible patients treated at 13 sarcoma referral centers from 2008 to 2018. Univariable and multivariable logistic models were performed to assess the association between clinical predictors and response. Overall survival (OS) and crude cumulative incidences of local recurrence and distant metastasis were compared. Results Data on 158 patients were analyzed. A median of 3 cycles of neoadjuvant systemic therapy (interquartile range, 2‐4 cycles) were given. The regimens were mostly anthracycline based; however, there was significant heterogeneity. No patients demonstrated a complete response, 37 (23%) demonstrated a partial response (PR), 88 (56%) demonstrated stable disease, and 33 (21%) demonstrated progressive disease (PD) according to the Response Evaluation Criteria in Solid Tumors, version 1.1. Only a higher number of cycles given was positively associated with PR ( P = .005). All patients underwent complete resection, regardless of the tumor response. Overall, patients whose tumors demonstrated PD before surgery showed markedly worse OS ( P = .005). An indication of a better clinical outcome was seen in specific regimens given for grade 3 dedifferentiated liposarcoma and leiomyosarcoma. Conclusions In patients with high‐risk RPS, the response to neoadjuvant systemic therapy is fair overall. Disease progression on therapy may be used to predict survival after surgery. Subtype‐specific regimens should be further validated.