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Long-term Follow-up and Post-relapse Outcome of Patients with Localized Retroperitoneal Sarcoma Treated in the Italian Sarcoma Group-Soft Tissue Sarcoma (ISG-STS) Protocol 0303

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study was designed to assess patterns of recurrence and long-term outcomes of patients undergoing surgery for localized retroperitoneal sarcoma (RPS) after neoadjuvant high dose long-infusion ifosfamide (HLI) and radiotherapy (RT).

Methods

Patients received three cycles of HLI (14 g/m2). RT was started in combination with II cycle up to a total dose of 50.4 Gy. Surgery was scheduled 4–6 weeks after the end of RT. The primary endpoint was relapse-free survival (RFS) after surgery. Secondary endpoints were overall survival (OS), crude cumulative incidence of local recurrence (CCI-LR), and distant metastases (CCI-DM). For patients who relapsed, progression-free survival (PFS) and post-relapse OS were estimated. The trial was registered with ITASARC_*II_2004_003.

Results

Between 2003 and 2010, 83 patients were recruited. At a median follow-up of 91.7 months, 42 (56%) of 75 operated patients developed LR (n = 27) or DM (n = 10) or both LR and DM (n = 5) relapse. Seven-year RFS was 46.6% [95% confidence interval (CI) 29.6–52.4]. Thirty-two patients died. Seven-year OS rate was 63.2% (95% CI 42.7–66.0). The corresponding CCI of LR and DM were 37.4% [standard error (SE) 5.5%] and 20.0% (SE 12.6%), respectively. The only factor significantly associated with LR was FNCLCC grading, whereas histological subtype resulted associated with DM. At recurrence, 24 patients (57%) underwent surgery. Two-year post-relapse PFS and OS rates for patients developing LR or DM were 14.8, 41.0, 27.3, and 63.6%, respectively.

Conclusions

LR after neoadjuvant CT-RT for RPS were predominantly infield. While almost one half of relapsed patients underwent further surgery, prognosis was poor.

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Acknowledgements

Editorial assistance was provided by Luca Giacomelli, PhD. This assistance was supported by internal funds. No further funding to declare.

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Authors and Affiliations

  1. Department of Medical Oncology and Hematology, Humanitas Cancer Center and Research Hospital, IRCCS, Rozzano, Milan, Italy

    R. De Sanctis MD, A. Marrari MD, A. Bertuzzi MD & A. Santoro MD

  2. Molecular and Cellular Networks Lab, Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, “Sapienza” University, Rome, Italy

    R. De Sanctis MD

  3. Biostatistics Unit, Humanitas Cancer Center and Research Hospital, IRCCS, Rozzano, Milan, Italy

    L. Giordano MSc

  4. Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    C. Colombo MD, M. Fiore MD & A. Gronchi MD

  5. Department of Radiation Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy

    A. De Paoli MD & F. Navarria MD

  6. Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, IRCCS, Rozzano, Milan, Italy

    P. Navarria MD

  7. Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    C. Sangalli MD

  8. Department of Medical Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy

    A. Buonadonna MD

  9. Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    R. Sanfilippo MD & P. G. Casali MD

  10. Department of Surgical Oncology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy

    G. Bertola MD & S. Basso MD

  11. Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy

    A. Santoro MD

  12. Department of Surgery, Humanitas Cancer Center and Research Hospital, IRCCS, Rozzano, Milan, Italy

    V. Quagliuolo MD

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  1. R. De Sanctis MD
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  2. L. Giordano MSc
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  3. C. Colombo MD
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  9. G. Bertola MD
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  15. S. Basso MD
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  17. V. Quagliuolo MD
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  18. A. Gronchi MD
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Corresponding author

Correspondence to R. De Sanctis MD.

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De Sanctis, R., Giordano, L., Colombo, C. et al. Long-term Follow-up and Post-relapse Outcome of Patients with Localized Retroperitoneal Sarcoma Treated in the Italian Sarcoma Group-Soft Tissue Sarcoma (ISG-STS) Protocol 0303. Ann Surg Oncol 24, 3872–3879 (2017). https://doi.org/10.1245/s10434-017-6105-y

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  • DOI: https://doi.org/10.1245/s10434-017-6105-y

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