A retrospective cohort study to assess adjuvant concurrent chemoradiation (CCRT) compared to adjuvant radiation therapy (RT) in the treatment of grade 2 and 3 extremity soft tissue sarcomas

Publication date: Available online 23 September 2017
Source:Radiotherapy and Oncology
Author(s): Jean Philippe Nesseler, Julia Salleron, Maria Rios, Philippe Nickers, Frederic Marchal, Fabien Brocard, Didier Peiffert, Guillaume Vogin
PurposeTo evaluate the efficacy and tolerance of adjuvant concurrent chemoradiation (CCRT) as treatment of grade 2 and 3 (G2-3) localized extremity soft tissue sarcomas (STS) by comparing CCRT with standard adjuvant radiation therapy (RT).Patients and methodsThis monocentric retrospective study included non-pediatric patients (>16years) treated by adjuvant RT with or without chemotherapy (CT) after conservative resection of non-recurrent G2-3 extremity STS.ResultsA total of 80 patients were treated between 1990 and 2012: 51 by RT and 29 by CCRT. Of the 29 CCRT patients, 25 received doxorubicin monotherapy (75mg/m²/3weeks). The CCRT group contained a greater proportion of grade 3 extremity STS (p<0.001). Median follow up was 68months (9–284). Multivariate analysis revealed greater local control in the CCRT group (1 local recurrence vs 8 in the RT group; HR=0.082, 95% CI 0.011–0.321) and incomplete resection as the major risk factor of local recurrence (HR=25.2, 95% CI 4.767–133.226). The two groups exhibited no differences in distant failure-free survival (HR=1.469, 95% CI 0.668–3.228), disease-free survival (HR=1.096, 95% CI 0.519–2.315) or overall survival (HR=1.378, 95% CI 0.498–3.814). Grade 3 was an adverse prognostic factor for overall survival (HR=3.11, 95% CI 1.04–9.32). Our analyses also revealed that CCRT tended to increase the risk of both grade ≥3 acute dermatitis (14 events vs 6 in the RT group; OR=6.99, 95% CI 2.28–21.47) and grade ≥2 late toxicity (6 events vs 3 in the RT group; p=0.0572).ConclusionCCRT could improve local control as part of a limb-preservation strategy. However, with a limited number of patients, CCRT showed no improvement in either distant control or survival and increased toxicity.



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