Improved survival using specialized multidisciplinary board in sarcoma patients

Blay, Jean‐Yves; Soibinet, Pauline; Penel, Nicolas; Bompas, Emmanuelle; Duffaud, Florence; Stoeckle, Eberhard; Mir, Olivier; Adam, Julien; Chevreau, Christine; Bonvalot, Sylvie; Rios, María; Kerbrat, Pierre; Cupissol, Didier; Anract, Philippe; Gouin, F.; Kurtz, Jean‐Emmanuel; Lebbe, Célèste; Isambert, Nicolás; Bertucci, François; Toumonde, M.; Thyss, A.; Piperno‐Neumann, Sophie; Dubray‐Longeras, Pascale; Méeus, Pierre; Ducimetière, Françoise; Giraud, Antoine; Coindre, Jean Michél; Ray‐Coquard, Isabelle; Italiano, Antoîne; Cesne, Axel Le

doi:10.1093/annonc/mdx484

Cited by 289 publications

(195 citation statements)

References 25 publications

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“…Adjuvant RT and PP were also associated with a better outcome. This finding is consistent with the nationwide French NetSarc reference work that observed a twofold increased R2 surgery outside the NetSarc center and threefold more secondary resection after primary surgery performed without multidisciplinary tumor board in other sarcoma types 18. In the present study, local surgery had a favorable impact on survival even for patients with metastatic RMS which is consistent with the MSKCC and French pediatric experience.…”

Section: Discussionsupporting

confidence: 92%

“…But in our study, patients older than 25 years received significantly less chemotherapy and numerous treatments. Surgical results were consistent with those previously reported 11, 12, 13, 15, 16, 17, 18, 19. The absence of surgery and incomplete resection were deleterious for OS.…”

Section: Discussionsupporting

confidence: 90%

“…For localized RMS, OS is similar to that reported by the MDA and MSKCC experience 14, 15. Importantly, the outcome of patients initially treated in the reference center in the retrospective cohort (Conticabase series) is superior to that of the nationwide and more recent series, possibly explaining the excellence of the reference center compared with other centers 18. The relapse rate is consistent with that reported in the literature: 33–57% local relapses 11, 12, 13, 14, 19 and up to 48–68% metastatic relapse 14, 16, 19.…”

Section: Discussionsupporting

confidence: 75%

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Outcome of 449 adult patients with rhabdomyosarcoma: an observational ambispective nationwide study

et al. 2018

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Five‐year overall survival (OS) of localized RMS exceeds 70% in children (<18) but is very poor in adult patients. We analyzed the outcome and prognostic factors (PF) of a national series of adult patients with RMS in a large study. The study population consisted of two different cohorts: a retrospective cohort (157 adult patients treated in 13 reference centers between 05/1981 and 02/2010) and the prospective cohort (292 patients with RMS diagnosed and treated between 01/2010 and 12/2014 in France) included in the NetSarc database. A descriptive analysis of patients’ characteristics and prognostic factors was conducted on both series which were compared. In the retrospective series, histological subtypes were embryonal (E‐RMS) for 21% of patients, alveolar (A‐RMS) for 35% of patients, and “adult‐type” P‐RMS (pleomorphic, spindle cell RMS, not otherwise specified) (P) for 44% patients. This distribution significantly differed in the prospective cohort: A‐RMS: 18%; E‐RMS: 17%; and P‐RMS 65%. With a median follow‐up of 8.5 years, 5‐year OS for localized RMS and advanced RMS (with nodes and/or metastases) was 43% and 5%, respectively, (P < 0.0001), and median OS was 51, 33, and 16 months for E‐RMS, A‐RMS, and P‐RMS, respectively, in the retrospective cohort. The median OS was less than 40 months for the prospective nationwide cohort for the entire population. In a multivariate analysis of the retrospective study, independent prognostic factors for OS were A‐RMS, R0 resection, and adjuvant radiotherapy (RT). For localized RMS, age and use of pediatric chemotherapy (CT) regimen are independent prognostic factors. Adult patients with RMS have a poorer overall survival than pediatric patients, and survival varies considerably across histological subtypes.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 75%

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Outcome of 449 adult patients with rhabdomyosarcoma: an observational ambispective nationwide study

et al. 2018

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“…This observation has also been reported by Blay et al 7 suggesting significantly more R0 and less R2 resections, less reoperations, and higher relapse-free survival (RFS) and local RFS in reference centers.…”

Section: What Are the Remarkable Findings?supporting

confidence: 84%

Managing Extremity Soft Tissue Sarcoma Patients: Surgery Alone or in Combination with Radiotherapy? An Editorial on the Paper by Fiore et al.

Haas

2018

Ann Surg Oncol

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Dr Fiore and colleagues are to be congratulated on their analysis of local control probability after surgery alone in high-risk extremity soft tissue sarcomas (ESTSs). 1Although both national comprehensive cancer network (NCCN) 2 and European society for medical oncology (ESMO) 3 guidelines suggest combining limb salvage surgery with radiotherapy (RT), and although no data are currently available from randomized studies suggesting to refrain from RT, the results from the study by Dr Fiore et al. are remarkable in several ways, but also need to be considered in the right perspective. WHAT ARE THE REMARKABLE FINDINGS?There were less R0 resections (69.4% vs. 78.9%; p = 0.182) in patients in group B (without RT) compared with those in group A, yet local control in both groups was comparable. What one would expect is that, specifically in a subgroup with R1 resections, perioperative RT would compensate for these microscopically positive margins with respect to local control, which it did not-66.3% vs. 72.1%.The local failure rate without RT in R1 resections was 27.9%. As found by Alektiar (manuscript reference #24) and many others, radiation would decrease the local failure rate with a factor of 2-3, mounting to a failure rate of 9-14%, and therefore a local control estimate of 86-91%.This rate is comparable with the literature; however, in the study by Fiore et al., it is unexpectedly lower at 66.3%.The local failure rate without RT in R0 resections was fairly low at 14.8%. If, again, the risk on local relapse was reduced with a factor of 2-3, a local failure rate of 5-8% would be expected, leading to a local control estimate of 92-

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“…2 In fact, recent data have demonstrated that sarcoma patients undergoing evaluation in a specialized multidisciplinary tumor board had better local relapse-free and relapse-free survival compared with patients who did not. 3 There is a growing body of evidence regarding the better outcome, specifically among RPS patients initially treated in specialized centers. [4][5][6][7] This disease, or in reality, family of diseases, is complex.…”

mentioning

confidence: 99%

Minimally Invasive Surgery for Retroperitoneal Sarcoma: Just Because We Can Does Not Mean We Should

2018

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Improved survival using specialized multidisciplinary board in sarcoma patients

Abstract: The compliance to clinical practice guidelines and relapse-free survival of sarcoma patients are significantly better when the initial treatment is guided by a pre-therapeutic specialized MDTB.

Cited by 289 publications

References 25 publications

Outcome of 449 adult patients with rhabdomyosarcoma: an observational ambispective nationwide study

Outcome of 449 adult patients with rhabdomyosarcoma: an observational ambispective nationwide study

Managing Extremity Soft Tissue Sarcoma Patients: Surgery Alone or in Combination with Radiotherapy? An Editorial on the Paper by Fiore et al.

Minimally Invasive Surgery for Retroperitoneal Sarcoma: Just Because We Can Does Not Mean We Should

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