Pre- and Postoperative Chemotherapy in Localized Extremity Soft Tissue Sarcoma: A European Organization for Research and Treatment of Cancer Expert Survey

Rothermundt, Christian; Fischer, Galina Farina; Bauer, Sebastian; Blay, Jean‐Yves; Grünwald, Viktor; Italiano, Antoîne; Kasper, Bernd; Kollár, Attila; Линднер, Ларс; Miah, Aisha; Sleijfer, Stefan; Stacchiotti, Silvia; Putora, Paul Martin

doi:10.1634/theoncologist.2017-0391

Cited by 30 publications

(16 citation statements)

References 35 publications

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“…Some authors have highlighted the feasibility of CT in addition to RT in this indication. There is no evidence that adjuvant or neoadjuvant chemotherapy is beneficial in localized STS, the majority European experts recommended neoadjuvant chemotherapy for mildly resectable grade 2-3 tumors [25]. The whole issue is to identify which patient could benefit from this treatment and when.…”

Section: Discussionmentioning

confidence: 99%

Histologic Response Following Pre-Operative Radiotherapy for Soft Tissue Sarcoma (STS) in a French Reference Center and Review

Prapan¹,

Bertaut²,

Karanian³

et al. 2020

COR

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Background and Purpose: Limb sparing surgery and radiotherapy is the main treatment of patients harboring soft tissue sarcoma of the extremity. There is limited data regarding the prognostic impact of histologic response after pre-operative radiotherapy. Patients and Methods: Between 2010 and 2018, 123 patients were treated with a pre-operative radiotherapy for soft tissue sarcoma at Leon Berard Centre (Lyon, France) and were retrospectively reviewed. All patients received a dose of 50 Gy in 25 fractions. The histologic response has been analysed by considering the following factors: necrosis ≥ 90%, percentage of viable tumor cells ≤ 10% and fibrosis ≥ 10%. Overall survival (OS), local recurrence-free survival (LRFS), distant recurrence-free survival (DRFS) and event-free survival (EFS) were evaluated. Results: Median follow up was 33.2 months (range 2.3-128.1 months). Local recurrence occurred in 9 patients (7.5%) and 40 patients (33%) presented a distant recurrence. The 2 and 5-year OS was 84% and 63%. Histologic response factors (necrosis ≥ 90%, viable tumor cells ≤ 10% and fibrosis ≥ 10%) were not predictive in DRFS and EFS. In multivariate analysis, grade was the only significant prognostic factor for EFS P=0.0087. Among the 14 patients with ≤ 10% viable cells after irradiation 13 presented a metastatic evolution within 6 months. Conclusion: This study showed that current histological response evaluation based on necrosis, fibrosis and viable cells could not predict clinical outcomes after radiotherapy for extremity soft tissue sarcoma. A significant proportion of patients with a good response after pre-operative radiotherapy present a metastatic recurrence.

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Section: Discussionmentioning

confidence: 99%

Histologic Response Following Pre-Operative Radiotherapy for Soft Tissue Sarcoma (STS) in a French Reference Center and Review

Prapan¹,

Bertaut²,

Karanian³

et al. 2020

COR

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“…2) [7]. For various cancer forms and settings, even among highly specialized medical centers or experts, the use of decision criteria varies considerably [7,40,[78][79][80].…”

Section: Process Of Decision Makingmentioning

confidence: 99%

Decision Making Criteria in Oncology

et al. 2018

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Decision making is one of the most complex skills required of an oncologist and is affected by a broad range of parameters. For example, the wide variety of treatment options, with various outcomes, side-effects and costs present challenges in selecting the most appropriate treatment. Many treatment choices are affected by limited scientific evidence, availability of therapies or patient-specific factors. In the decision making process, standardized approaches can be useful, but a multitude of criteria are relevant to this process. Thus, the aim of this review is to summarize common types of decision criteria used in oncology by focusing on 3 main categories: criteria associated with the decision maker (both patient and doctor), decision specific criteria, and the often-overlooked contextual factors. Our review aims to highlight the broad range of decision criteria in use, as well as variations in their interpretation.

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“…We performed a survey among EORTC STBSG members in 2017: Experts from 12 centres and seven countries were polled regarding their criteria used for decision-making and their use of preand postoperative chemotherapy. Substantial heterogeneity in practice patterns was revealed and no recommendations could be provided for general use [37].…”

Section: Why Neo/adjuvant Chemotherapy Should Be a Standard In High-rmentioning

confidence: 99%

Perioperative treatment of soft-tissue sarcoma

Rothermundt

2020

memo

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The standard treatment of high-risk localized extremity and trunk soft-tissue sarcoma is wide local excision and radiation therapy, which can be delivered pre-or postoperatively. Improved care for sarcoma patients at expert centres with multidisciplinary tumour boards, specialized pathologists, surgeons, radio-oncologists, and medical oncologists, according to national or international guidelines, has improved outcomes. Yet, a substantial number of patients will experience disease recurrence with metastatic spread and ultimately die from their disease. In many solid tumours neo/adjuvant chemotherapy has become an accepted standard treatment, whereas in softtissue sarcoma discussions on the use of cytotoxic therapy in localized and resectable disease are ongoing. Some centres demonstrated the feasibility and now treat with concomitant neoadjuvant chemoradiotherapy as standard. Others argue that treatments should be given in the order of the accompanying evidence (surgery → radiotherapy → chemotherapy), which does not take biology of the disease into account and probably attempts to simplify complex decision making processes. It is important to enhance our ability to identify patients at highest risk of recurrence, and to generate data and develop tools to predict which patients will benefit from neo/adjuvant systemic therapy most.

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Pre- and Postoperative Chemotherapy in Localized Extremity Soft Tissue Sarcoma: A European Organization for Research and Treatment of Cancer Expert Survey

Cited by 30 publications

References 35 publications

Histologic Response Following Pre-Operative Radiotherapy for Soft Tissue Sarcoma (STS) in a French Reference Center and Review

Histologic Response Following Pre-Operative Radiotherapy for Soft Tissue Sarcoma (STS) in a French Reference Center and Review

Decision Making Criteria in Oncology

Perioperative treatment of soft-tissue sarcoma

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