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La radiologia medica

, Volume 124, Issue 4, pp 301–308 | Cite as

A matched cohort study of radio-chemotherapy versus radiotherapy alone in soft tissue sarcoma patients

  • Daniela GretoEmail author
  • Mauro Loi
  • Francesca Terziani
  • Luca Visani
  • Pietro Garlatti
  • Monica Lo Russo
  • Ausilia Teriaca
  • Cristina Muntoni
  • Camilla Delli Paoli
  • Juliana Topulli
  • Domenico Campanacci
  • Giovanni Beltrami
  • Guido Scoccianti
  • Pierluigi Bonomo
  • Isacco Desideri
  • Giulio Francolini
  • Lorenzo Livi
RADIOTHERAPY
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Purpose

Adjuvant radiotherapy is the standard postoperative treatment after conservative surgery in high risk soft tissue sarcoma. The role of adjuvant chemotherapy is still debated. Therefore, a matched cohort analysis was performed in high risk soft tissue patients to analyse differences in terms of clinical outcome and toxicity between patients treated with concomitant radio-chemotherapy (RTCT) and radiotherapy (RT) alone.

Materials and Methods

For each patient in RT group was selected a patient in the RTCT group matching for age, T stage and grading. Acute and late toxicity were recorded, overall survival, recurrence free survival and distant metastases free survival were analysed and compared between the two groups.

Results

Ninety patients were selected, half of patients underwent radio-chemotherapy and half received radiotherapy alone. During the treatment Grade 3 dermatitis was recorded in 15 (16.7%) patients, 6 (6.7%) patients associated chemotherapy and during follow up 12 (13.3%) patients developed grade 2 late fibrosis, 3 (3.3%) joint stiffness and 1 (1.1%) patient experienced a bone fracture. There were no differences in the rate of acute and late toxicity between RTCT and RT alone group. Nineteen (21.1%) patients developed local recurrence, overall 5-year local relapse free survival was 83%. There were no differences between the two groups. 29 patients developed distant metastases, 14 (15.6%) patients in the RTCT group and 15 (16.7%) patients in the RT group. The 5-year distant metastases free survival was 67%. Age > 65 years was the only independent factor affecting distant recurrence (HR = 5.7, 95% CI 2.7–11.9; p = 0.001). At the time of analysis 15 (16.7%) patients were dead, 6 (6.7%) patients in the RTCT group and 9 (10%) patients in the RT group. 5-years overall survival was: 88%. At multivariate analysis age > 65 years was an independent prognostic factor of overall survival (HR = 3.7, 95% CI 1.2–12.1, p = 0.037).

Conclusions

Prospective randomized studies with large size population and with subgroup analysis for histological subtypes are necessary to clarify the role of adjuvant chemotherapy in soft tissue sarcoma patients. Tailored treatment has to be considered in elderly soft tissue patients to guarantee a better outcome in this high risk and fragile population.

Keywords

Soft tissue sarcoma Radio-chemotherapy Radiotherapy Chemotherapy Toxicity 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Italian Society of Medical Radiology 2018

Authors and Affiliations

  • Daniela Greto
    • 1
    Email author
  • Mauro Loi
    • 1
  • Francesca Terziani
    • 1
  • Luca Visani
    • 1
  • Pietro Garlatti
    • 1
  • Monica Lo Russo
    • 1
  • Ausilia Teriaca
    • 1
  • Cristina Muntoni
    • 1
  • Camilla Delli Paoli
    • 1
  • Juliana Topulli
    • 1
  • Domenico Campanacci
    • 2
  • Giovanni Beltrami
    • 2
  • Guido Scoccianti
    • 2
  • Pierluigi Bonomo
    • 1
  • Isacco Desideri
    • 1
  • Giulio Francolini
    • 1
  • Lorenzo Livi
    • 1
  1. 1.Department of Radiation OncologyAzienda Ospedaliero Universitaria Careggi, University of FlorenceFlorenceItaly
  2. 2.Department of Orthopaedic Oncology and Reconstructive SurgeryAzienda Ospedaliero Universitaria Careggi, University of FlorenceFlorenceItaly

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