Radiotherapy associated with improved survival for high‐grade sarcoma of the extremity

Kachare, Swapnil D.; Brinkley, Jason; Vohra, Nasreen A.; Zervos, Emmanuel E.; Wong, Jan H.; Fitzgerald, Timothy L.

doi:10.1002/jso.23989

Cited by 45 publications

(38 citation statements)

References 31 publications

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“…The NCDB analysis also showed that treatment at a high‐volume center was associated with improved survival, consistent with previous analyses . Others have also found that postoperative RT, malignant fibrous histiocytoma, and liposarcoma histologies were predictors of improved OS . While at least one SEER study found that black patients had worse SM and OS compared to white patients, our study did not find a similar difference based on race although this was not the primary variable evaluated in the current study.…”

Section: Discussionsupporting

confidence: 90%

“…Several studies have compared outcomes between preoperative and postoperative RT combined with LSS, and at least one has assessed the effect of amputation on survival. No significant difference in OS was seen between pre‐RT vs post‐RT in two SEER studies . An NCDB study showed improved rates of negative surgical margins in patients receiving preoperative RT compared to postoperative RT; however, survival between these two treatment strategies was not directly compared .…”

Section: Discussionmentioning

confidence: 98%

“…Importantly, most of these studies did not contain data from the last decade, and all except two excluded patients treated with amputation or did not specify type of resection . Several SEER or smaller retrospective studies found no difference in survival or LC between preoperative and postoperative RT. In contrast, a study from the National Oncology Database found significantly greater OS and cause‐specific survival with preoperative RT …”

Section: Introductionmentioning

confidence: 99%

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Limb‐sparing surgery plus radiotherapy results in superior survival: an analysis of patients with high‐grade, extremity soft‐tissue sarcoma from the NCDB and SEER

et al. 2018

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Small randomized trials have not shown an overall survival (OS) difference among local treatment modalities for patients with extremity soft‐tissue sarcomas (E‐STS) but were underpowered for OS. We examine the impact of local treatment modalities on OS and sarcoma mortality (SM) using two national registries. The National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) Program were analyzed separately to identify patients with stage II‐III, high‐grade E‐STS diagnosed between 2004 and 2013 and treated with (1) amputation alone, (2) limb‐sparing surgery (LSS) alone, (3) preoperative radiation therapy (RT) and LSS, or (4) LSS and postoperative RT. Multivariable analyses (MVAs) and 1:1 matched pair analyses (MPAs) examined treatment impacts on OS (both databases) and SM (SEER only). From the NCDB and SEER, 7828 and 2937 patients were included. On MVAs, amputation was associated with inferior OS and SM. Relative to LSS alone, both preoperative RT and LSS (HR, 0.70; 95% CI: 0.62‐0.78) and LSS and postoperative RT (HR, 0.69; 95% CI: 0.63‐0.75) improved OS in NCDB analyses with confirmation by SEER. Estimated median survivals from MPA utilizing NCDB data were 7.2 years with LSS alone (95% CI: 6.5‐8.9 years) vs 9.8 years (95% CI: 9.0‐11.2 years) with LSS and postoperative RT. A MPA comparing preoperative RT and LSS to LSS alone found median survivals of 8.9 years (95% CI: 7.9‐not estimable) and 6.6 years (95% CI: 5.4‐7.8 years). Optimal high‐grade E‐STS management includes LSS with preoperative or postoperative RT as evidenced by superior OS and SM.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Limb‐sparing surgery plus radiotherapy results in superior survival: an analysis of patients with high‐grade, extremity soft‐tissue sarcoma from the NCDB and SEER

et al. 2018

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“…At least four studies analyzing SEER data have reported an OS benefit in patients with high-grade or advanced-stage sarcoma receiving RT. 3,6,7,22 An additional report from the NCDB supports the link between RT and survival. 5 Internationally, registry data from 922 patients in Denmark also showed that RT was associated with ∼5% improved disease-specific survival.…”

Section: Discussionmentioning

confidence: 88%

Adherence to National Comprehensive Cancer Network Guidelines is Associated with Improved Survival for Patients with Stage 2A and Stages 2B and 3 Extremity and Superficial Trunk Soft Tissue Sarcoma

et al. 2017

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Purpose The National Comprehensive Cancer Network (NCCN) has instituted treatment guidelines for stage IIA and stage IIB/III extremity and superficial trunk soft tissue sarcomas (ETSTS). We examined adherence to NCCN guidelines and factors associated with nonadherent treatment and survival outcomes. Methods Patients with stage IIA and IIB/III ETSTS (n = 15,957) were categorized as adherent or nonadherent treatment groups based on 2014 NCCN guidelines. Multivariate logistic regression models were used to determine factors associated with nonadherent treatment. Overall survival (OS) and disease-specific survival (DSS) were calculated and Cox models were used to generate adjusted survival curves and hazard ratios (HR). Results We found that 87.2% of patients with stage IIA disease and 58.3% of patients with stage IIB/III disease received adherent treatment. Community treatment facilities and uninsured or unknown insurance status were associated with nonadherent treatment for both stage groups. Adherent treatment was associated with higher 5-year adjusted OS and DSS in stage IIA and IIB/III patients. In Cox models, nonadherent treatment was associated with worse survival both for stage IIA (HR = 2.31, 95% confidence interval [CI] = 2.02-2.63) and stage IIB/III disease (HR = 1.63, 95% CI = 1.53-1.73). Increasing age and non-private insurance were associated with poorer outcomes. For stage IIB/III, treatment at a community center and African American race were associated with worse survival. Conclusions Adherence to NCCN guidelines is excellent for stage IIA and poor for stage IIB/III ETSTS. Adherent treatment was associated with improved survival outcomes, highlighting the importance of adherence to NCCN guidelines.

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“…The application of new evidence is often delayed and inconsistently adapted into clinical care [1–3]. The genesis of ERAS is associated with the colonic surgeries of the 1990s and is often attributed to Professor Henrik Kehlet of Copenhagen [4].…”

Section: Introductionmentioning

confidence: 99%

Enhanced Recovery after Surgery in a Single High-Volume Surgical Oncology Unit: Details Matter

Fitzgerald

Mosquera

Koutlas

et al. 2016

Surgery Research and Practice

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Benefits of ERAS protocol have been well documented; however, it is unclear whether the improvement stems from the protocol or shifts in expectations. Interdisciplinary educational seminars were conducted for all health professionals. However, one test surgeon adopted the protocol. 394 patients undergoing elective abdominal surgery from June 2013 to April 2015 with a median age of 63 years were included. The implementation of ERAS protocol resulted in a decrease in the length of stay (LOS) and mortality, whereas the difference in cost was found to be insignificant. For the test surgeon, ERAS was associated with decreased LOS, cost, and mortality. For the control providers, the LOS, cost, mortality, readmission rates, and complications remained similar both before and after the implementation of ERAS. An ERAS protocol on the single high-volume surgical unit decreased the cost, LOS, and mortality.

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Radiotherapy associated with improved survival for high‐grade sarcoma of the extremity

Abstract: Radiotherapy, regardless of the timing, is associated with improved survival in high-risk sarcoma.

Cited by 45 publications

References 31 publications

Limb‐sparing surgery plus radiotherapy results in superior survival: an analysis of patients with high‐grade, extremity soft‐tissue sarcoma from the NCDB and SEER

Limb‐sparing surgery plus radiotherapy results in superior survival: an analysis of patients with high‐grade, extremity soft‐tissue sarcoma from the NCDB and SEER

Adherence to National Comprehensive Cancer Network Guidelines is Associated with Improved Survival for Patients with Stage 2A and Stages 2B and 3 Extremity and Superficial Trunk Soft Tissue Sarcoma

Enhanced Recovery after Surgery in a Single High-Volume Surgical Oncology Unit: Details Matter

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