Sarcoma Flashcards
Epidemology of Sarcoma
- Rare<div>- 80% STS</div><div>- 20% bone</div><div>- Median age 45-55</div>
What did NCI limg sparing (Rosenburg, 1982) establish??
- Showed the limb sparing surgery with RT and chemo was effective strategy
“What was the patient population in ““NCI limb sparing”” trial”
N= 43, high grade extremity STS pts
“What was the treatment regimen and arms in ““NCI limb sparing”” trial for STS?”
WLE + PORT 50Gy +10-20Gy boost vs. amputation<div><br></br></div><div>both got adjuvant chemo</div>
“What were the results (OS, LR, 5 yr-DFS) of the ““NCI limb sparing”” trial?”
<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>
What trial(s) defined PORT for extermity STS?
<div>NCI adjuvant EBRT</div>
<div><br></br></div>
Yang. JCO, 1998<div>Beane, 2014 (this is the 20 year update)</div>
Who were the patients in the adjuvant EBRT STS trial?
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>
What was the treatmet regimen and arms of the adjuvant EBRT for STS?
Low grade: PORT 45Gy w/ boost to 63Gy vs. obs<div><br></br></div><div>High grade: PORT + doxo/cyclo vs. doxo/cyclo</div>
What was the local control rate on the adjuvant EBRT STS trial?
Low grade: LC 96% (PORT)vs. 67% (obs)<div>High grade: LC 100% (PORT+chemo) vs. 81% (chemo)</div><div><br></br></div>
What was the difference in OS and DMFS in the adjuvant EBRT STS trial?
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>
What study established the use of brachytherapy for STS?
MSKCC. Pisters. 1996
What was the patient population in the post-op brachytherapy study in STS?
Pisters, 1996. N= 160, extremity and superficical trunk STS s/p WLE<div>- R0= 85%</div><div>- R1= 15%</div><div><br></br></div>
What the intervention in the post op brachytherapy study
Pisters, 1996. Brachy Ir-192 (42-45Gy) + 2cm margin vs. observation
What is were the outcomes of the post op brachy paper?
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>
What study showed focused on surgery alone to treat STS?
MDACC, Pisters, 2007
What was the patient cohort in the surgery alone study for STS?
N= 58, STS T1 (<5cm) on trunk or extremity
What was the study design in the STS surgery alone study?
PRT. All got fuction sparing surgery. If R1 > adjuvant RT, if R0 >obs
What were the outcomes from the STS surgery alone study?
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>
Who are best cadidates for surgery alone for STS?
Pisters, 2007. Pts with low grade tumors (Gr 1-2) and <5cm with R0 resection
What are the seminal pre-op vs. post-op RT for STS?
NCIC. Davis, 2002, 2005<div>NCIC. O’Sullivan, 2004</div>
What was the cohort of patients in the pre-op vs. post op trials for STS?
N= 190, STS of extemities
What were the comparsion groups in the pre-op vs. post-op STS trials?
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>
What were the results of the preop vs. postop studies for STS?
“<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>”
What are the main takeaways from the preop vs. postop RT trial?
-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>
What was the trial that used hypofractionated regimen for pre-op STS?
Poland. Paterczyk, 2014.
What was the patient population for the hypofract STS trial?
N= 272, STS of extremity or trunk
What was the the design of the hypofrac STS trial?
PRT. Preop 25Gy/5fx, surgery immediately followed
What were the results of the hypofrac STS trial?
-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>
What study showed a benefit of pazopanib for STS?
ARST1321, 2020
What was patient population for the pazopanib study?
N=81, children >2 and adults, trunk or extremity STS, >5cm, grade 2-3
What was the study design for the pazopanib study?
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>
What were the results of pazopanib trial?
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>
What is the trial that compared preop vs. postop RT for RP sarcoma?
STRASS, 2020
What was the patient population in the preop vs. postop RP sarcoma trial?
N= 266, operable RP STS
What was the study desgin in the preop vs. no RT RP sarcoma trial?
PRT. Preop RT (50.4Gy) followed by en bloc resection vs. resection alone<div><br></br></div><div>Endpoint: Abdominal RFS</div>
What are the results of the preop RT vs. no RT trial?
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>
What is the dose escalation trial for spinal chordoma?
MGH, DeLaney, 2014
What was the patient population for the spine chordoma dose escalation study?
N=50, primary or locally recurrent thor, lumbar, sacral, paraspinal chordoma or sarcoma
What is the study design for the dose escalation spine chordoma trial?
Phase II. Dose escalation with photons or protons<div><72.0 Gy RBE vs. 76.6-77.4Gy RBE</div>
What were the outcomes of the spine chordoma dose escalation trial?
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>
