Localized myxofibrosarcomas: roles of surgical margins and adjuvant radiotherapy

Publication date: Available online 2 June 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Raoudha Boughzala-Bennadji, Eberhard Stoeckle, Cécile Le Péchoux, Pierre Méeus, Charles Honoré, Justine Attal, Florence Duffaud, Gonzague De Pinieux, Emmanuelle Bompas, Juliette Thariat, Agnès Leroux, François Bertucci, Nicolas Isambert, Corinne Delcambre, Jean-Yves Blay, Marie-Pierre Sunyach, Jean-Michel Coindre, Paul Sargos, Nicolas Penel, Sylvie Bonvalot
BackgroundThe objective of this study was to describe the outcome and prognostic factors of adults treated for localized myxofibrosarcoma.MethodsWe conducted a retrospective multicenter study of 425 non-metastatic patients (pts) operated between January 1996 and December 2015 in X national Group and were enrolled in the "Conticabase." Pathological diagnosis was systematically reviewed by expert pathologists. The endpoints were relapse-free and metastasis-free survival. Log-rank tests and Cox models have been used to identified prognostic factors.ResultsMedian age was 66, 53% were males, 85% of cases occurred in limbs or superficial trunk, median size was 60 mm, 47%/39% had grade 2/3, 66% R0 resection and 34% R1 resection. Adjuvant radiotherapy was given to 65% of patients, neoadjuvant radiotherapy in 3%, neoadjuvant chemotherapy in 7% and adjuvant chemotherapy in 13%. The median follow-up was 51 months. The 5-year local relapse free-survival was 67%; independent prognostic factors for local relapse were R1 resection (HR=1.26; p=0.001) and adjuvant radiotherapy (HR= 0.35; p=0.0001) [i.e. R1 resection and no adjuvant radiotherapy increase the hazard ratio]. In stratified analysis, adjuvant radiotherapy was beneficial after R0 resection (p=0.0020) as well as after R1 resection (p=0.0001). The 5-year overall survival was 80%. The 5-year metastasis-free survival was 83%. Independent prognostic factors for metastatic relapse were: grade 3 (HR=1.975; p=0.0001) and size (HR=1.006; p=0.001).ConclusionsThis large series of myxofibrosarcoma confirms the high rate of local relapse. Combination of R0 resection and adjuvant radiotherapy provided the best local control. In parallel with increasing rate of R0 resection and adjuvant radiotherapy, during the study we have observed a constant improvement of both metastatic and local relapse free survivals.

Teaser

After R0 or R1 resection of limb or superificial trunk myxofibrosarcoma, the 5-year local relapse free survival was only 67%.Three independent prognostic factors influenced the local control: age, R0 resection and adjuvant radiotherapy


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