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    Local Control For High-Grade Nonrhabdomyosarcoma Soft Tissue Sarcoma Assigned to Radiation Therapy on ARST0332: A Report From the Childrens Oncology Group

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    Authors
    Million, Lynn
    Laurie, Frances
    Morano, Karen
    FitzGerald, Thomas J.
    UMass Chan Affiliations
    Imaging and Radiation Oncology Core (IROC)
    Department of Radiation Oncology
    Document Type
    Journal Article
    Publication Date
    2021-02-03
    Keywords
    Biological and Chemical Physics
    Neoplasms
    Oncology
    Pediatrics
    Radiation Medicine
    
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    Link to Full Text
    https://doi.org/10.1016/j.ijrobp.2021.01.051
    Abstract
    PURPOSE: The ARST0332 trial for pediatric and young adults with nonrhabdomyosarcoma soft tissue sarcoma (NRSTS) used risk-based treatment including primary resection with lower-than-standard radiation doses to optimize local control (LC) while minimizing long-term toxicity in those requiring radiation therapy (RT). RT for high-grade NRSTS was based on extent of resection (R0: negative margins, R1: microscopic margins, R2/U: gross disease/unresectable); those with > 5 cm tumors received chemotherapy (CT; ifosfamide/doxorubicin). This analysis evaluates LC for patients assigned to RT and prognostic factors associated with local recurrence (LR). METHODS AND MATERIALS: Patients aged < 30 years with high-grade NRSTS received RT (55.8 Gy) for R1 < /=5 cm tumor (arm B); RT (55.8 Gy)/CT for R0/R1 > 5 cm tumor (arm C); or neoadjuvant RT (45 Gy)/CT plus delayed surgery, CT, and postoperative boost to 10.8 Gy R0 < 5 mm margins/R1 or 19.8 Gy for R2/unresected tumors (arm D). RESULTS: One hundred ninety-three eligible patients had 24 LRs (arm B 1/15 [6.7%], arm C 7/65 [10.8%], arm D 16/113 [14.2%]) at median time to LR of 1.1 years (range, 0.11-5.27). Of 95 eligible for delayed surgery after neoadjuvant therapy, 89 (93.7%) achieved R0/R1 margins. Overall LC after RT were as follows: R0, 106 of 109 (97%); R1, 51 of 60 (85%); and R2/unresectable, 2 of 6 (33%). LR predictors include extent of delayed resection (P < .001), imaging response before delayed surgery (P < .001), histologic subtype (P < .001), and no RT (P = .046). The 5-year event-free survival was significantly lower (P = .0003) for patients unable to undergo R0/R1 resection. CONCLUSIONS: Risk-based treatment for young patients with high-grade NRSTS treated on ARST0332 produced very high LC, particularly after R0 resection (97%), despite lower-than-standard RT doses. Neoadjuvant CT/RT enabled delayed R0/R1 resection in most patients and is preferred over adjuvant therapy due to the lower RT dose delivered.
    Source

    Million L, Hayes-Jordan A, Chi YY, Donaldson SS, Wolden S, Morris C, Terezakis S, Laurie F, Morano K, Fitzgerald TJ, Yock TI, Rodeberg DA, Anderson JR, Speights RA, Black JO, Coffin C, McCarville MB, Kao SC, Hawkins DS, Spunt SL, Randall RL. Local Control For High-Grade Nonrhabdomyosarcoma Soft Tissue Sarcoma Assigned to Radiation Therapy on ARST0332: A Report From the Childrens Oncology Group. Int J Radiat Oncol Biol Phys. 2021 Feb 3:S0360-3016(21)00125-5. doi: 10.1016/j.ijrobp.2021.01.051. Epub ahead of print. PMID: 33548339. Link to article on publisher's site

    DOI
    10.1016/j.ijrobp.2021.01.051
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/29753
    PubMed ID
    33548339
    Notes

    Full author list omitted for brevity. For the full list of authors, see article.

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    Link to Article in PubMed

    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ijrobp.2021.01.051
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