Neoadjuvant Chemoradiation Compared With Neoadjuvant Radiation Alone in the Management of High-Grade Soft Tissue Extremity Sarcomas

Sarah Z. Hazell; Chen Hu; Sara R. Alcorn; Kingsley O. Asiedu; Gillian Pulido; Deborah A. Frassica; Christian Meyer; Adam S. Levin; Carol D. Morris; Stephanie A. Terezakis

doi:10.1016/j.adro.2019.08.015

Neoadjuvant Chemoradiation Compared With Neoadjuvant Radiation Alone in the Management of High-Grade Soft Tissue Extremity Sarcomas

Sarah Z. Hazell, Chen Hu, Sara R. Alcorn, Kingsley O. Asiedu, Gillian Pulido, Deborah A. Frassica, Christian Meyer, Adam S. Levin, Carol D. Morris, Stephanie A. Terezakis

Radiation Oncology

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Abstract

Purpose: Patients with large, high-grade soft tissue sarcomas are commonly treated with aggressive limb preservation regimens. This study aimed to assess cancer control outcomes of patients treated with neoadjuvant chemoradiation (CRT) compared with radiation therapy (RT) alone. Methods: We reviewed records of patients with high-grade extremity or trunk soft tissue sarcomas ≥5 cm who were treated with neoadjuvant radiation with or without chemotherapy. Patient and disease characteristics were compared using t test and χ² tests. Standardized mortality ratio weighted method was used to compare overall survival (OS), local control, and disease-free (DFS) survival. Acute radiation and surgical toxicity were reported. Results: In the study, 64 patients (34 CRT and 30 RT) treated between 1997 and 2015 were analyzed. In the RT group compared with the CRT group, the patient population was older, with a median age of 65 versus 50 years (P < .001), and more likely to have cardiovascular disease (CVD; 30% vs 0%, P < .001). At a median follow-up of 41 months, after adjusting for propensity score of receiving RT, the 3-year LC was 87.3% versus 86.1%, DFS was 58.5% versus 56.6%, and OS was 75.6% versus 69.0% for the CRT and RT groups, respectively (P >. 05). Acute dermatitis occurred in 18% versus 3% and surgical complications occurred in 32% versus 17% of CRT and RT patients, respectively. Conclusions: In this study, patients receiving RT alone were more likely to be older and have comorbid cardiovascular disease. When controlling for baseline differences, neoadjuvant CRT and RT provided similar rates of LC, DFS, and OS.

Original language	English (US)
Pages (from-to)	231-237
Number of pages	7
Journal	Advances in Radiation Oncology
Volume	5
Issue number	2
DOIs	https://doi.org/10.1016/j.adro.2019.08.015
State	Published - Mar 1 2020

Bibliographical note

Funding Information:
Disclosures: Dr Alcorn reports grants from Elekta AB during the conduct of the study; others from Johns Hopkins Hospital, grants from NIH KL2 Mentored Career Development Grant, personal fees from Allegheny Health Network, outside the submitted work; and member of ASTRO Subcommittee on Research Grants and ASTRO Committee on Health, Equity, Diversity, and Inclusion. Dr Hu reports grants from National Cancer Institute during the conduct of the study; personal fees from Merck & Co., outside the submitted work. The remaining authors have no conflicts of interest related to this manuscript.

Publisher Copyright:
© 2019 The Authors

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Hazell, S. Z., Hu, C., Alcorn, S. R., Asiedu, K. O., Pulido, G., Frassica, D. A., Meyer, C., Levin, A. S., Morris, C. D., & Terezakis, S. A. (2020). Neoadjuvant Chemoradiation Compared With Neoadjuvant Radiation Alone in the Management of High-Grade Soft Tissue Extremity Sarcomas. Advances in Radiation Oncology, 5(2), 231-237. https://doi.org/10.1016/j.adro.2019.08.015

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title = "Neoadjuvant Chemoradiation Compared With Neoadjuvant Radiation Alone in the Management of High-Grade Soft Tissue Extremity Sarcomas",

abstract = "Purpose: Patients with large, high-grade soft tissue sarcomas are commonly treated with aggressive limb preservation regimens. This study aimed to assess cancer control outcomes of patients treated with neoadjuvant chemoradiation (CRT) compared with radiation therapy (RT) alone. Methods: We reviewed records of patients with high-grade extremity or trunk soft tissue sarcomas ≥5 cm who were treated with neoadjuvant radiation with or without chemotherapy. Patient and disease characteristics were compared using t test and χ2 tests. Standardized mortality ratio weighted method was used to compare overall survival (OS), local control, and disease-free (DFS) survival. Acute radiation and surgical toxicity were reported. Results: In the study, 64 patients (34 CRT and 30 RT) treated between 1997 and 2015 were analyzed. In the RT group compared with the CRT group, the patient population was older, with a median age of 65 versus 50 years (P < .001), and more likely to have cardiovascular disease (CVD; 30% vs 0%, P < .001). At a median follow-up of 41 months, after adjusting for propensity score of receiving RT, the 3-year LC was 87.3% versus 86.1%, DFS was 58.5% versus 56.6%, and OS was 75.6% versus 69.0% for the CRT and RT groups, respectively (P >. 05). Acute dermatitis occurred in 18% versus 3% and surgical complications occurred in 32% versus 17% of CRT and RT patients, respectively. Conclusions: In this study, patients receiving RT alone were more likely to be older and have comorbid cardiovascular disease. When controlling for baseline differences, neoadjuvant CRT and RT provided similar rates of LC, DFS, and OS.",

author = "Hazell, {Sarah Z.} and Chen Hu and Alcorn, {Sara R.} and Asiedu, {Kingsley O.} and Gillian Pulido and Frassica, {Deborah A.} and Christian Meyer and Levin, {Adam S.} and Morris, {Carol D.} and Terezakis, {Stephanie A.}",

note = "Funding Information: Disclosures: Dr Alcorn reports grants from Elekta AB during the conduct of the study; others from Johns Hopkins Hospital, grants from NIH KL2 Mentored Career Development Grant, personal fees from Allegheny Health Network, outside the submitted work; and member of ASTRO Subcommittee on Research Grants and ASTRO Committee on Health, Equity, Diversity, and Inclusion. Dr Hu reports grants from National Cancer Institute during the conduct of the study; personal fees from Merck & Co., outside the submitted work. The remaining authors have no conflicts of interest related to this manuscript. Publisher Copyright: {\textcopyright} 2019 The Authors",

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doi = "10.1016/j.adro.2019.08.015",

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T1 - Neoadjuvant Chemoradiation Compared With Neoadjuvant Radiation Alone in the Management of High-Grade Soft Tissue Extremity Sarcomas

AU - Hazell, Sarah Z.

AU - Hu, Chen

AU - Alcorn, Sara R.

AU - Asiedu, Kingsley O.

AU - Pulido, Gillian

AU - Frassica, Deborah A.

AU - Meyer, Christian

AU - Levin, Adam S.

AU - Morris, Carol D.

AU - Terezakis, Stephanie A.

N1 - Funding Information: Disclosures: Dr Alcorn reports grants from Elekta AB during the conduct of the study; others from Johns Hopkins Hospital, grants from NIH KL2 Mentored Career Development Grant, personal fees from Allegheny Health Network, outside the submitted work; and member of ASTRO Subcommittee on Research Grants and ASTRO Committee on Health, Equity, Diversity, and Inclusion. Dr Hu reports grants from National Cancer Institute during the conduct of the study; personal fees from Merck & Co., outside the submitted work. The remaining authors have no conflicts of interest related to this manuscript. Publisher Copyright: © 2019 The Authors

PY - 2020/3/1

Y1 - 2020/3/1

N2 - Purpose: Patients with large, high-grade soft tissue sarcomas are commonly treated with aggressive limb preservation regimens. This study aimed to assess cancer control outcomes of patients treated with neoadjuvant chemoradiation (CRT) compared with radiation therapy (RT) alone. Methods: We reviewed records of patients with high-grade extremity or trunk soft tissue sarcomas ≥5 cm who were treated with neoadjuvant radiation with or without chemotherapy. Patient and disease characteristics were compared using t test and χ2 tests. Standardized mortality ratio weighted method was used to compare overall survival (OS), local control, and disease-free (DFS) survival. Acute radiation and surgical toxicity were reported. Results: In the study, 64 patients (34 CRT and 30 RT) treated between 1997 and 2015 were analyzed. In the RT group compared with the CRT group, the patient population was older, with a median age of 65 versus 50 years (P < .001), and more likely to have cardiovascular disease (CVD; 30% vs 0%, P < .001). At a median follow-up of 41 months, after adjusting for propensity score of receiving RT, the 3-year LC was 87.3% versus 86.1%, DFS was 58.5% versus 56.6%, and OS was 75.6% versus 69.0% for the CRT and RT groups, respectively (P >. 05). Acute dermatitis occurred in 18% versus 3% and surgical complications occurred in 32% versus 17% of CRT and RT patients, respectively. Conclusions: In this study, patients receiving RT alone were more likely to be older and have comorbid cardiovascular disease. When controlling for baseline differences, neoadjuvant CRT and RT provided similar rates of LC, DFS, and OS.

AB - Purpose: Patients with large, high-grade soft tissue sarcomas are commonly treated with aggressive limb preservation regimens. This study aimed to assess cancer control outcomes of patients treated with neoadjuvant chemoradiation (CRT) compared with radiation therapy (RT) alone. Methods: We reviewed records of patients with high-grade extremity or trunk soft tissue sarcomas ≥5 cm who were treated with neoadjuvant radiation with or without chemotherapy. Patient and disease characteristics were compared using t test and χ2 tests. Standardized mortality ratio weighted method was used to compare overall survival (OS), local control, and disease-free (DFS) survival. Acute radiation and surgical toxicity were reported. Results: In the study, 64 patients (34 CRT and 30 RT) treated between 1997 and 2015 were analyzed. In the RT group compared with the CRT group, the patient population was older, with a median age of 65 versus 50 years (P < .001), and more likely to have cardiovascular disease (CVD; 30% vs 0%, P < .001). At a median follow-up of 41 months, after adjusting for propensity score of receiving RT, the 3-year LC was 87.3% versus 86.1%, DFS was 58.5% versus 56.6%, and OS was 75.6% versus 69.0% for the CRT and RT groups, respectively (P >. 05). Acute dermatitis occurred in 18% versus 3% and surgical complications occurred in 32% versus 17% of CRT and RT patients, respectively. Conclusions: In this study, patients receiving RT alone were more likely to be older and have comorbid cardiovascular disease. When controlling for baseline differences, neoadjuvant CRT and RT provided similar rates of LC, DFS, and OS.

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Neoadjuvant Chemoradiation Compared With Neoadjuvant Radiation Alone in the Management of High-Grade Soft Tissue Extremity Sarcomas

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