Critical impact of radiotherapy protocol compliance and quality in the treatment of retroperitoneal sarcomas: Results from the EORTC 62092-22092 STRASS trial.

Tytuł:: Critical impact of radiotherapy protocol compliance and quality in the treatment of retroperitoneal sarcomas: Results from the EORTC 62092-22092 STRASS trial.
Autorzy:: Haas R; Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.; Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands.
Stelmes JJ; Ente Ospedliero Cantonale, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
Zaffaroni F; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium.
Sauvé N; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium.
Clementel E; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium.
Bar-Deroma R; Department of Oncology, Rambam Medical Center, Haifa, Israel.
Le Péchoux C; Department of Radiation Oncology, Gustave Roussy Institute, Paris, France.
Litière S; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium.
Marreaud S; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium.
Alyamani N; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium.
Andratschke NHJ; Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
Sangalli C; Department of Radiation Oncology, IRCCS Foundation, National Cancer Institute, Milan, Italy.
Chung PW; Department of Radiation Oncology, Mount Sinai Hospital, Toronto, Ontario, Canada.
Miah A; Department of Radiation Oncology, The Royal Marsden National Health Service Foundation Trust and The Institute of Cancer Research, London, United Kingdom.
Hurkmans C; Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands.
Gronchi A; Department of Surgery, IRCCS Foundation, National Cancer Institute, Milan, Italy.
Bovée JVMG; Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands.
Gelderblom H; Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
Kasper B; Sarcoma Unit of the Interdisciplinary Tumor Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany.
Weber DC; Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland.; Radiation Oncology Department, University Hospital of Bern, Bern, Switzerland.; Radiation Oncology Department, University Hospital of Zurich, Zurich, Switzerland.
Bonvalot S; Department of Surgery, Curie Institute, University of Paris, Paris, France.
Źródło:: Cancer [Cancer] 2022 Jul 15; Vol. 128 (14), pp. 2796-2805. Date of Electronic Publication: 2022 May 10.
Typ publikacji:: Journal Article; Research Support, Non-U.S. Gov't
Język:: English
Imprint Name(s):: Publication: <2005- >: Hoboken, NJ : Wiley
Original Publication: New York [etc.] Published for the American Cancer Society by J. Wiley [etc.]
MeSH Terms:: Guideline Adherence*
Retroperitoneal Neoplasms*/radiotherapy
Retroperitoneal Neoplasms*/surgery
Sarcoma*/radiotherapy
Sarcoma*/surgery
Soft Tissue Neoplasms*/radiotherapy
Soft Tissue Neoplasms*/surgery
Disease-Free Survival ; Humans ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local/pathology ; Proportional Hazards Models ; Randomized Controlled Trials as Topic ; Survival Rate
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Bonvalot S, Gronchi A, Le Pechoux C, et al. Preoperative radiotherapy plus surgery versus surgery alone for patients with primary retroperitoneal sarcoma (EORTC-62092: STRASS): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2020;21:1366-1377. doi:10.1016/S1470-2045(20)30446-0.
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Contributed Indexing:: Keywords: protocol compliance; quality assurance; radiotherapy; retroperitoneal sarcomas; soft tissue sarcomas
Entry Date(s):: Date Created: 20220510 Date Completed: 20220623 Latest Revision: 20220708
Update Code:: 20240105
DOI:: 10.1002/cncr.34239
PMID:: 35536104
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Background: The European Organization for Research and Treatment of Cancer 22092-62092 STRASS trial failed to demonstrate the superiority of neoadjuvant radiotherapy (RT) over surgery alone in patients with retroperitoneal sarcoma. Therefore, an RT quality-assurance program was added to the study protocol to detect and correct RT deviations. The authors report results from the trial RT quality-assurance program and its potential effect on patient outcomes.
Methods: To evaluate the effect of RT compliance on survival outcomes, a composite end point was created. It combined the information related to planning target volume coverage, target delineation, total dose received, and overall treatment time into 2 groups: non-RT-compliant (NRC) for patients who had unacceptable deviation(s) in any of the previous categories and RT-compliant (RC) otherwise. Abdominal recurrence-free survival (ARFS) and overall survival were compared between the 2 groups using a Cox proportional hazard model adjusted for known prognostic factors.
Results: Thirty-six of 125 patients (28.8%) were classified as NRC, and the remaining 89 patients (71.2%) were classified as RC. The 3-year ARFS rate was 66.8% (95% confidence interval [CI], 55.8%-75.7%) and 49.8% (95% CI, 32.7%-64.8%) for the RC and NRC groups, respectively (adjusted hazard ratio, 2.32; 95% CI, 1.25-4.32; P = .008). Local recurrence after macroscopic complete resection occurred in 13 of 89 patients (14.6%) versus 2 of 36 patients (5.6%) in the RC and NRC groups, respectively.
Conclusions: The current analysis suggests a significant benefit in terms of ARFS in favor of the RC group. This association did not translate into less local relapses after complete resection in the RC group. Multidisciplinary collaboration and review of cases are critical to avoid geographic misses, especially for rare tumors like retroperitoneal sarcoma.
(© 2022 American Cancer Society.)

Comment in: Cancer. 2022 Jul 15;128(14):2701-2703. (PMID: 35536110)

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