Quality of surgery and neoadjuvant combined therapy in the ISG-GEIS trial on soft tissue sarcomas of limbs and trunk wall

A. Gronchi, P. Verderio, A. De Paoli, A. Ferraro, O. Tendero, J. Majó, J. Martin, A. Comandone, G. Grignani, S. Pizzamiglio, V. Quagliuolo, P. Picci, S. Frustaci, A. P. Dei Tos, E. Palassini, S. Stacchiotti, S. Ferrari, M. Fiore, P. G. Casali

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    Abstract

    Background: To explore correlation between the quality of surgery and outcome in high-risk soft tissue sarcoma (STS) patients treated within a phase III randomized trial. Patients and Methods: In the trial, all patients received three cycles of preoperative chemotherapy (CT) with epirubicin 120 mg/m2 and ifosfamide 9 g/m2 and were randomly assigned to receive two further postoperative cycles. Radiotherapy (RT) could be delivered in the preoperative or postoperative setting. The association between surgical margins andoverall survival (OS) was studied in a univariate and multivariate fashion. Results: Two hundred and fifty-two patients completed the whole treatment and were operated conservatively. At a median follow-up of 60 months (IQR, 45-74 months), the 5-year OS was 0.73,even in patients with positive and negative margins. The 5-year cumulative incidence (CI) of local recurrence (LR) in patients with positive and negative microscopic margins was 0.17 (standard error, SE, 0.08) and 0.03 (SE, 0.01), respectively. In the subgroup of patients receiving combined preoperative CT-RT and with positive surgical margins, the CI of LR was 0. Conclusions: In this setting of high-risk STS treated by preoperative CT or CT-RT, the negative impact of positive margins on the outcome was limited. When close margins can be anticipated preoperative CT-RT may be a reasonable option to maximize the chance of cure. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. Published by Oxford University Press on behalf of the European Society for Medical Oncology.
    Original languageEnglish
    Article numbermds501
    Pages (from-to)817-823
    JournalAnnals of Oncology
    Volume24
    Issue number3
    DOIs
    Publication statusPublished - 1 Mar 2013

    Keywords

    • Chemotherapy
    • Local recurrence
    • Radiation therapy
    • Sarcoma
    • Surgical margins
    • Survival

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