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ANKI- Sarcoma > Sarcoma > Flashcards

Sarcoma Flashcards

1
Q

Epidemology of Sarcoma

A
  • Rare<div>- 80% STS</div><div>- 20% bone</div><div>- Median age 45-55</div>
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2
Q

What did NCI limg sparing (Rosenburg, 1982) establish??

A
  • Showed the limb sparing surgery with RT and chemo was effective strategy
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3
Q

“What was the patient population in ““NCI limb sparing”” trial”

A

N= 43, high grade extremity STS pts

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4
Q

“What was the treatment regimen and arms in ““NCI limb sparing”” trial for STS?”

A

WLE + PORT 50Gy +10-20Gy boost vs. amputation<div><br></br></div><div>both got adjuvant chemo</div>

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5
Q

“What were the results (OS, LR, 5 yr-DFS) of the ““NCI limb sparing”” trial?”

A

<div>LR: 15% vs. 0% amputation</div>

<div><br></br></div>

No difference in OS (83% vs 88% (amp)) or 5yr-DFS (71% vs. 78% (amp))<div><br></br></div>

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6
Q

What trial(s) defined PORT for extermity STS?

A

<div>NCI adjuvant EBRT</div>

<div><br></br></div>

Yang. JCO, 1998<div>Beane, 2014 (this is the 20 year update)</div>

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7
Q

Who were the patients in the adjuvant EBRT STS trial?

A

n= 141, extremity sarcoma s/p WLE<div><br></br></div><div>exclusion: gross residual tumor, widely positive margins</div><div><br></br></div><div>allowed desmoid and dermatofibrosarcoma protuberans</div>

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8
Q

What was the treatmet regimen and arms of the adjuvant EBRT for STS?

A

Low grade: PORT 45Gy w/ boost to 63Gy vs. obs<div><br></br></div><div>High grade: PORT + doxo/cyclo vs. doxo/cyclo</div>

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9
Q

What was the local control rate on the adjuvant EBRT STS trial?

A

Low grade: LC 96% (PORT)vs. 67% (obs)<div>High grade: LC 100% (PORT+chemo) vs. 81% (chemo)</div><div><br></br></div>

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10
Q

What was the difference in OS and DMFS in the adjuvant EBRT STS trial?

A

No difference in OS or DMFS<div><div>- 10-yr OS 82% (PORT) vs. 77% (p=0.22 for all grades)</div><div>- 20-yr OS 71% (PORT) vs. 64%</div></div>

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11
Q

What study established the use of brachytherapy for STS?

A

MSKCC. Pisters. 1996

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12
Q

What was the patient population in the post-op brachytherapy study in STS?

A

Pisters, 1996. N= 160, extremity and superficical trunk STS s/p WLE<div>- R0= 85%</div><div>- R1= 15%</div><div><br></br></div>

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13
Q

What the intervention in the post op brachytherapy study

A

Pisters, 1996. Brachy Ir-192 (42-45Gy) + 2cm margin vs. observation

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14
Q

What is were the outcomes of the post op brachy paper?

A

5yr LC improvement with brachy, 82 brachy vs. 69%obs<div>- High grade 5yr LC: 89 vs. 66%</div><div>- No difference with low grade tumors, DM, DFS<br></br></div>

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15
Q

What study showed focused on surgery alone to treat STS?

A

MDACC, Pisters, 2007

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16
Q

What was the patient cohort in the surgery alone study for STS?

A

N= 58, STS T1 (<5cm) on trunk or extremity

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17
Q

What was the study design in the STS surgery alone study?

A

PRT. All got fuction sparing surgery. If R1 > adjuvant RT, if R0 >obs

18
Q

What were the outcomes from the STS surgery alone study?

A

R0, obs: 5-yr LR 8%, 10-yr LR 10%. R1, radiation: LR 43%<div><br></br></div><div>Recurrences: 58% high grade</div><div><br></br></div><div><br></br></div>

19
Q

Who are best cadidates for surgery alone for STS?

A

Pisters, 2007. Pts with low grade tumors (Gr 1-2) and <5cm with R0 resection

20
Q

What are the seminal pre-op vs. post-op RT for STS?

A

NCIC. Davis, 2002, 2005<div>NCIC. O’Sullivan, 2004</div>

21
Q

What was the cohort of patients in the pre-op vs. post op trials for STS?

A

N= 190, STS of extemities

22
Q

What were the comparsion groups in the pre-op vs. post-op STS trials?

A

Pts stratified < 10cm vs. >10 cm. Randomized preop RT (50 Gy/25fx) vs. post op RT (66Gy/33fx)<div><br></br></div><div>*longditudinal borders: 5cm, 2cm boost to scar<br></br><div><br></br></div><div>Primary endpoint: wound healing, not powered for survivial</div></div>

23
Q

What were the results of the preop vs. postop studies for STS?

A

“<div>Preop had increased acute wound complications (35% vs. 17%)</div><div>*mostly in lower extremity</div><div><br></br></div><div>Post-op trended towards worse fibrosis, edema, joint stiffness at 2 yrs (NS)</div><div><br></br></div>- No diff in LC, OS, RFS<div><div>-<span>Tumor size and grade predicted for OS</span></div><div><span>- Grade predicted for RFS</span></div></div>”

24
Q

What are the main takeaways from the preop vs. postop RT trial?

A

-LC and OS are equally effective<div>- Consider each technique for anatomic site as toxicities differ</div><div><br></br></div><div>-Most prefer preop because toxicities are more reversible than late fibrosis</div><div><br></br></div><div>- Typically much bigger fields for post op</div>

25
Q

What was the trial that used hypofractionated regimen for pre-op STS?

A

Poland. Paterczyk, 2014.

26
Q

What was the patient population for the hypofract STS trial?

A

N= 272, STS of extremity or trunk

27
Q

What was the the design of the hypofrac STS trial?

A

PRT. Preop 25Gy/5fx, surgery immediately followed

28
Q

What were the results of the hypofrac STS trial?

A

-3yr LR- 19%, 3yr OS- 72%<div>-Toxicity -42%</div><div>-Surgical complications- 7%</div><div>-Tumor >10cm- 42%</div><div><br></br></div><div>* hypofrac has favorable LC and acceptable toxicity</div>

29
Q

What study showed a benefit of pazopanib for STS?

A

ARST1321, 2020

30
Q

What was patient population for the pazopanib study?

A

N=81, children >2 and adults, trunk or extremity STS, >5cm, grade 2-3

31
Q

What was the study design for the pazopanib study?

A

Phase II PRT.<div><br></br></div><div>Preop 45Gy chemoRT with ifos/doxo +/- pazopanib, followed by surgery</div><div><br></br></div><div>*Endpoint: 90% path response<br></br><div><br></br></div></div>

32
Q

What were the results of pazopanib trial?

A

90% path reseponse rate: 58% (pazo) vs. 22% (placebo)<div><br></br></div><div>More gr 3-4</div><div><br></br></div><div>*Pazo with preop RT and chemo for STS improves path near CR rates</div>

33
Q

What is the trial that compared preop vs. postop RT for RP sarcoma?

A

STRASS, 2020

34
Q

What was the patient population in the preop vs. postop RP sarcoma trial?

A

N= 266, operable RP STS

35
Q

What was the study desgin in the preop vs. no RT RP sarcoma trial?

A

PRT. Preop RT (50.4Gy) followed by en bloc resection vs. resection alone<div><br></br></div><div>Endpoint: Abdominal RFS</div>

36
Q

What are the results of the preop RT vs. no RT trial?

A

No difference in abdominal RFS, OS, or DM<div><br></br></div><div>-3yr abdominal RFS- 60%</div><div>- sub analysis of liposarcoma showed CI cross to 1.02, curves seperating</div><div>-not powered to evaluate sub-endpoints</div><div><br></br></div><div>LR- 13% (R0) vs. 29% (R1)</div>

37
Q

What is the dose escalation trial for spinal chordoma?

A

MGH, DeLaney, 2014

38
Q

What was the patient population for the spine chordoma dose escalation study?

A

N=50, primary or locally recurrent thor, lumbar, sacral, paraspinal chordoma or sarcoma

39
Q

What is the study design for the dose escalation spine chordoma trial?

A

Phase II. Dose escalation with photons or protons<div><72.0 Gy RBE vs. 76.6-77.4Gy RBE</div>

40
Q

What were the outcomes of the spine chordoma dose escalation trial?

A

Primary tumors. 5yr-LC: 94%, 8yr-LC 85%<div>All tumors. 5yr- LC 81%, 8yr- LC 74%</div><div><br></br></div><div>8yr grade 3-4 toxicities- 13%</div><div><br></br></div><div><br></br></div>

ANKI- Sarcoma (1 decks)

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