Abstract
PurposeThe role of adjuvant chemotherapy (ACT) for soft tissue sarcomas (STS) is not standard practice. We investigated effectiveness and tolerability of ACT in patients (pts) with operated high-risk STS in clinical practice.MethodsMedical records of pts with localized STS referred to Istituto Oncologico Veneto, Padova, from January 1, 2003 to July 07, 2012 were reviewed. Data were collected for pts with high-risk STS (size ≥5 cm, high grade and stage III). For those who received ACT, regimens used, drug doses, number of cycles, toxicity, and reasons for dose reduction or treatment interruption were recorded. Disease-free survival (DFS) and overall survival (OS) were calculated with the Kaplan–Meier method.ResultsOut of 96 eligible pts, median age 62 years, 36 received ACT after loco-regional treatment. Median DFS was 29.6 months (95 % CI 13.2–46.0) in pts receiving ACT and 7.8 months (95 % CI 3.9–11.7) in untreated pts (p < 0.0001); median OS was 67.0 months (95 % CI 25.4–108.6) in treated and 33.7 months (95 % CI 23.3–44.2) in untreated pts (p = 0.005). Among pts receiving ACT, a significant difference in DFS was observed between pts with limb/girdle disease (median DFS 82.4 months; 95 % CI 0.0–184.7) and pts with other primary sites (median DFS 18.3 months; 95 % CI 8.0–28.5) (p = 0.052). Grade ≥3 toxicities occurred in 20 pts (20.8 %), leading to dose reductions, delays, and treatment discontinuation in five cases. There was no treatment-related death.ConclusionOur data confirm benefit of ACT with regard to DFS and OS in pts with high-risk STS, greatest for limb/girdle STS.
Highlights
Soft tissue sarcomas (STS) are a heterogeneous group of malignancies which derive from mesenchymal tissue (Clark et al 2005)
Twenty-seven patients (75 %) had associated diseases, mostly low grade according to CIRS (Linn et al 1968), three grade 3 and no grade 4 (Table 1)
In our study 72 % of the patients in the ACT group received a Dose intensity (DI) ≥ 85 %, and this must be taken into account for the advantage we found from adjuvant chemotherapy
Summary
Soft tissue sarcomas (STS) are a heterogeneous group of malignancies which derive from mesenchymal tissue (Clark et al 2005). The prognosis may vary among different histotypes, with the most important prognostic factors being tumor size, grade, and depth (Coindre et al 1996). Some tools, such as the detection of sarcoma circulating tumor cells, are currently under investigation, and they may provide a way to monitor risk of relapse and metastatic spread, which might play a role in the future in clinical decision-making, if validated in large clinical studies (Satelli et al 2014)
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