TY - JOUR
T1 - Patterns of Perioperative Treatment and Survival of Localized, Resected, Intermediate- or High-Grade Soft Tissue Sarcoma
T2 - A 2000-2017 Netherlands Cancer Registry Database Analysis
AU - Van Meekeren, Milan
AU - Fiocco, Marta
AU - Ho, Vincent K.Y.
AU - Bovée, Judith V.M.G.
AU - Gelderblom, Hans
AU - Haas, Rick L.
N1 - Publisher Copyright:
© 2021 Milan Van Meekeren et al.
PY - 2021
Y1 - 2021
N2 - Background. Standard therapy for localized soft tissue sarcoma (STS) is wide, limb-sparing resection. For intermediate- or high-grade tumors, (neo)adjuvant therapies are frequently added to the treatment plan. In this study, data from a Dutch nationwide database are used to (1) assess whether perioperative management of STS follows ESMO guidelines, (2) characterize prognostic factors for overall survival (OS), and (3) assess the association between perioperative treatment and survival. Methods. All intermediate- or high-grade, localized STS cases, who have undergone surgery and diagnosed between 2000 and 2017, were identified in the Netherlands Cancer Registry (NCR) database. Variables with demographic, treatment, and survival data were obtained. Survival curves were estimated by Kaplan-Meier's method, and the effect of prognostic factors on OS was assessed in a multivariable Cox regression analysis. Results. A total of 4957 patients were identified. There were slightly more males (54.7%). Median age at diagnosis was 64 years, and 53.6% of the tumors were located in the extremities. Radiotherapy (RT) was administered to 2481 (50.1%) patients, and 252 (5.1%) patients were treated with perioperative systemic chemotherapy. The total use of perioperative RT did not significantly change in the last 20 years, but the timing followed clinical guidelines: preoperative RT increased significantly (2000-2008: 3.7%, 2009-2017: 22.3%; p<0.001), whereas the use of postoperative RT diminished (2000-2008: 45.9%, 2009-2017: 26.1%; p<0.001). The use of perioperative chemotherapy slightly decreased (2000-2008: 5.9%, 2009-2017: 4.4%; p = 0.015). 5-year OS was 59.6% (95% CI: 58.2-61.0). Sex, age, year of diagnosis, tumor location, tumor size, histological grade, depth, histological subtype, surgical margins, and the use of perioperative RT were identified as independent predictors for OS. Conclusion. Preoperative RT is gradually replacing postoperative RT for localized STS in the Netherlands. The use of perioperative chemotherapy is rare and has slightly decreased in recent years. Identified baseline characteristics and treatment factors predicting OS may aid in future treatment decisions.
AB - Background. Standard therapy for localized soft tissue sarcoma (STS) is wide, limb-sparing resection. For intermediate- or high-grade tumors, (neo)adjuvant therapies are frequently added to the treatment plan. In this study, data from a Dutch nationwide database are used to (1) assess whether perioperative management of STS follows ESMO guidelines, (2) characterize prognostic factors for overall survival (OS), and (3) assess the association between perioperative treatment and survival. Methods. All intermediate- or high-grade, localized STS cases, who have undergone surgery and diagnosed between 2000 and 2017, were identified in the Netherlands Cancer Registry (NCR) database. Variables with demographic, treatment, and survival data were obtained. Survival curves were estimated by Kaplan-Meier's method, and the effect of prognostic factors on OS was assessed in a multivariable Cox regression analysis. Results. A total of 4957 patients were identified. There were slightly more males (54.7%). Median age at diagnosis was 64 years, and 53.6% of the tumors were located in the extremities. Radiotherapy (RT) was administered to 2481 (50.1%) patients, and 252 (5.1%) patients were treated with perioperative systemic chemotherapy. The total use of perioperative RT did not significantly change in the last 20 years, but the timing followed clinical guidelines: preoperative RT increased significantly (2000-2008: 3.7%, 2009-2017: 22.3%; p<0.001), whereas the use of postoperative RT diminished (2000-2008: 45.9%, 2009-2017: 26.1%; p<0.001). The use of perioperative chemotherapy slightly decreased (2000-2008: 5.9%, 2009-2017: 4.4%; p = 0.015). 5-year OS was 59.6% (95% CI: 58.2-61.0). Sex, age, year of diagnosis, tumor location, tumor size, histological grade, depth, histological subtype, surgical margins, and the use of perioperative RT were identified as independent predictors for OS. Conclusion. Preoperative RT is gradually replacing postoperative RT for localized STS in the Netherlands. The use of perioperative chemotherapy is rare and has slightly decreased in recent years. Identified baseline characteristics and treatment factors predicting OS may aid in future treatment decisions.
UR - http://www.scopus.com/inward/record.url?scp=85112001802&partnerID=8YFLogxK
U2 - 10.1155/2021/9976122
DO - 10.1155/2021/9976122
M3 - Review article
AN - SCOPUS:85112001802
SN - 1357-714X
VL - 2021
JO - Sarcoma
JF - Sarcoma
M1 - 9976122
ER -