Does a less intensive surveillance protocol affect the survival of patients after treatment of a sarcoma of the limb? updated results of the randomized TOSS study
A single-centre prospective randomized trial was conducted to investigate whether a less intensive follow-up protocol would not be inferior to a conventional follow-up protocol, in terms of overall survival, in patients who have undergone surgery for sarcoma of the limb. Initial short-term results w...
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| Veröffentlicht in: | The bone & joint journal 2018-02, Vol.100-B (2), p.262-268 |
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| creator | Puri, A Ranganathan, P Gulia, A Crasto, S Hawaldar, R Badwe, R A |
| description | A single-centre prospective randomized trial was conducted to investigate whether a less intensive follow-up protocol would not be inferior to a conventional follow-up protocol, in terms of overall survival, in patients who have undergone surgery for sarcoma of the limb. Initial short-term results were published in 2014.
The primary objective was to show non-inferiority of a chest radiograph (CXR) group compared with a CT scan group, and of a less frequent (six-monthly) group than a more frequent (three-monthly) group, in two-by-two comparison. The primary outcome was overall survival and the secondary outcome was a recurrence-free survival. Five-year survival was compared between the CXR and CT scan groups and between the three-monthly and six-monthly groups. Of 500 patients who were enrolled, 476 were available for follow-up. Survival analyses were performed on a per-protocol basis (n = 412).
The updated results recorded 12 (2.4%) local recurrences, 182 (36.8%) metastases, and 56 (11.3%) combined (local + metastases) recurrence at a median follow-up of 81 months (60 to 118). Of 68 local recurrences, 60 (88%) were identified by the patients themselves. The six-monthly regime (overall survival (OS) 54%, recurrence-free survival (RFS) 46%) did not lead to a worse survival and was not inferior to the three-monthly regime (OS 55%, RFS 47%) in terms of detecting recurrence. Although CT scans (OS 53%, RFS 54%) detected pulmonary metastasis earlier, it did not lead to a better survival compared with CXR (OS 56%, RFS 59%).
The overall survival of patients who are treated for a sarcoma of the limb is not inferior to those followed up with a less intensive regimen than a more intensive protocol, in terms of frequency of visits and mode of imaging. CXR at six-monthly intervals and patient education about examination of the site of the surgery will detect most recurrences without deleterious effects on the eventual outcome. Cite this article:
2018;100-B:262-8. |
| doi_str_mv | 10.1302/0301-620X.100B2.BJJ-2017-0789.R1 |
| format | Article |
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The primary objective was to show non-inferiority of a chest radiograph (CXR) group compared with a CT scan group, and of a less frequent (six-monthly) group than a more frequent (three-monthly) group, in two-by-two comparison. The primary outcome was overall survival and the secondary outcome was a recurrence-free survival. Five-year survival was compared between the CXR and CT scan groups and between the three-monthly and six-monthly groups. Of 500 patients who were enrolled, 476 were available for follow-up. Survival analyses were performed on a per-protocol basis (n = 412).
The updated results recorded 12 (2.4%) local recurrences, 182 (36.8%) metastases, and 56 (11.3%) combined (local + metastases) recurrence at a median follow-up of 81 months (60 to 118). Of 68 local recurrences, 60 (88%) were identified by the patients themselves. The six-monthly regime (overall survival (OS) 54%, recurrence-free survival (RFS) 46%) did not lead to a worse survival and was not inferior to the three-monthly regime (OS 55%, RFS 47%) in terms of detecting recurrence. Although CT scans (OS 53%, RFS 54%) detected pulmonary metastasis earlier, it did not lead to a better survival compared with CXR (OS 56%, RFS 59%).
The overall survival of patients who are treated for a sarcoma of the limb is not inferior to those followed up with a less intensive regimen than a more intensive protocol, in terms of frequency of visits and mode of imaging. CXR at six-monthly intervals and patient education about examination of the site of the surgery will detect most recurrences without deleterious effects on the eventual outcome. Cite this article:
2018;100-B:262-8.</description><identifier>ISSN: 2049-4394</identifier><identifier>EISSN: 2049-4408</identifier><identifier>DOI: 10.1302/0301-620X.100B2.BJJ-2017-0789.R1</identifier><identifier>PMID: 29437071</identifier><language>eng</language><publisher>England</publisher><subject>Adolescent ; Adult ; Aged ; Arm Bones - pathology ; Arm Bones - surgery ; Bone Neoplasms - mortality ; Bone Neoplasms - pathology ; Bone Neoplasms - surgery ; Child ; Child, Preschool ; Female ; Humans ; India ; Leg Bones - pathology ; Leg Bones - surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local - pathology ; Population Surveillance ; Prospective Studies ; Sarcoma - mortality ; Sarcoma - surgery ; Survival Rate</subject><ispartof>The bone & joint journal, 2018-02, Vol.100-B (2), p.262-268</ispartof><rights>2018 The British Editorial Society of Bone & Joint Surgery.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c268t-2fbc3a9dfa6fbbb709c8b6628082cd589b9f18240cce6366f84d9ab9415edb883</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29437071$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Puri, A</creatorcontrib><creatorcontrib>Ranganathan, P</creatorcontrib><creatorcontrib>Gulia, A</creatorcontrib><creatorcontrib>Crasto, S</creatorcontrib><creatorcontrib>Hawaldar, R</creatorcontrib><creatorcontrib>Badwe, R A</creatorcontrib><title>Does a less intensive surveillance protocol affect the survival of patients after treatment of a sarcoma of the limb? updated results of the randomized TOSS study</title><title>The bone & joint journal</title><addtitle>Bone Joint J</addtitle><description>A single-centre prospective randomized trial was conducted to investigate whether a less intensive follow-up protocol would not be inferior to a conventional follow-up protocol, in terms of overall survival, in patients who have undergone surgery for sarcoma of the limb. Initial short-term results were published in 2014.
The primary objective was to show non-inferiority of a chest radiograph (CXR) group compared with a CT scan group, and of a less frequent (six-monthly) group than a more frequent (three-monthly) group, in two-by-two comparison. The primary outcome was overall survival and the secondary outcome was a recurrence-free survival. Five-year survival was compared between the CXR and CT scan groups and between the three-monthly and six-monthly groups. Of 500 patients who were enrolled, 476 were available for follow-up. Survival analyses were performed on a per-protocol basis (n = 412).
The updated results recorded 12 (2.4%) local recurrences, 182 (36.8%) metastases, and 56 (11.3%) combined (local + metastases) recurrence at a median follow-up of 81 months (60 to 118). Of 68 local recurrences, 60 (88%) were identified by the patients themselves. The six-monthly regime (overall survival (OS) 54%, recurrence-free survival (RFS) 46%) did not lead to a worse survival and was not inferior to the three-monthly regime (OS 55%, RFS 47%) in terms of detecting recurrence. Although CT scans (OS 53%, RFS 54%) detected pulmonary metastasis earlier, it did not lead to a better survival compared with CXR (OS 56%, RFS 59%).
The overall survival of patients who are treated for a sarcoma of the limb is not inferior to those followed up with a less intensive regimen than a more intensive protocol, in terms of frequency of visits and mode of imaging. CXR at six-monthly intervals and patient education about examination of the site of the surgery will detect most recurrences without deleterious effects on the eventual outcome. Cite this article:
2018;100-B:262-8.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Arm Bones - pathology</subject><subject>Arm Bones - surgery</subject><subject>Bone Neoplasms - mortality</subject><subject>Bone Neoplasms - pathology</subject><subject>Bone Neoplasms - surgery</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Humans</subject><subject>India</subject><subject>Leg Bones - pathology</subject><subject>Leg Bones - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Population Surveillance</subject><subject>Prospective Studies</subject><subject>Sarcoma - mortality</subject><subject>Sarcoma - surgery</subject><subject>Survival Rate</subject><issn>2049-4394</issn><issn>2049-4408</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kdFuFSEQhjdGY5vaVzBc9maPA0tZuFJbtdo0adLWxDsC7BDX7C5HYE9SH8cnLXhO5QaY_5-fDF_TnFHY0A7YO-iAtoLBjw0FuGCbi-vrlgHtW-il2tzRF80xA65azkG-fD53ih81pyn9grIkUMrp6-aIKd710NPj5u-ngIkYMmFKZFwyLmncIUlr3OE4TWZxSLYx5ODCRIz36DLJP_eGcWcmEjzZmjzikkuMzxhJjmjyXApVMySZ6MJs6qU2TuNs35N1O5iMA4mY1ql0HsRoliHM45-iPNze35OU1-HxTfPKmynh6WE_ab5_-fxw-bW9ub36dvnxpnVMyNwyb11n1OCN8NbaHpSTVggmQTI3nEtllaeScXAORSeEl3xQxipOz3GwUnYnzdk-t8z7e8WU9Twmh_UTMKxJMwCqKBWiK9YPe6uLIaWIXm_jOJv4qCnoCktXWLrC0v9g6QJLV1i6wtJ3tES8Pby22hmH_wHPaLonMOaU-w</recordid><startdate>201802</startdate><enddate>201802</enddate><creator>Puri, A</creator><creator>Ranganathan, P</creator><creator>Gulia, A</creator><creator>Crasto, S</creator><creator>Hawaldar, R</creator><creator>Badwe, R A</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201802</creationdate><title>Does a less intensive surveillance protocol affect the survival of patients after treatment of a sarcoma of the limb? updated results of the randomized TOSS study</title><author>Puri, A ; Ranganathan, P ; Gulia, A ; Crasto, S ; Hawaldar, R ; Badwe, R A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c268t-2fbc3a9dfa6fbbb709c8b6628082cd589b9f18240cce6366f84d9ab9415edb883</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Arm Bones - pathology</topic><topic>Arm Bones - surgery</topic><topic>Bone Neoplasms - mortality</topic><topic>Bone Neoplasms - pathology</topic><topic>Bone Neoplasms - surgery</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>Humans</topic><topic>India</topic><topic>Leg Bones - pathology</topic><topic>Leg Bones - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Population Surveillance</topic><topic>Prospective Studies</topic><topic>Sarcoma - mortality</topic><topic>Sarcoma - surgery</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Puri, A</creatorcontrib><creatorcontrib>Ranganathan, P</creatorcontrib><creatorcontrib>Gulia, A</creatorcontrib><creatorcontrib>Crasto, S</creatorcontrib><creatorcontrib>Hawaldar, R</creatorcontrib><creatorcontrib>Badwe, R A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The bone & joint journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Puri, A</au><au>Ranganathan, P</au><au>Gulia, A</au><au>Crasto, S</au><au>Hawaldar, R</au><au>Badwe, R A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does a less intensive surveillance protocol affect the survival of patients after treatment of a sarcoma of the limb? updated results of the randomized TOSS study</atitle><jtitle>The bone & joint journal</jtitle><addtitle>Bone Joint J</addtitle><date>2018-02</date><risdate>2018</risdate><volume>100-B</volume><issue>2</issue><spage>262</spage><epage>268</epage><pages>262-268</pages><issn>2049-4394</issn><eissn>2049-4408</eissn><abstract>A single-centre prospective randomized trial was conducted to investigate whether a less intensive follow-up protocol would not be inferior to a conventional follow-up protocol, in terms of overall survival, in patients who have undergone surgery for sarcoma of the limb. Initial short-term results were published in 2014.
The primary objective was to show non-inferiority of a chest radiograph (CXR) group compared with a CT scan group, and of a less frequent (six-monthly) group than a more frequent (three-monthly) group, in two-by-two comparison. The primary outcome was overall survival and the secondary outcome was a recurrence-free survival. Five-year survival was compared between the CXR and CT scan groups and between the three-monthly and six-monthly groups. Of 500 patients who were enrolled, 476 were available for follow-up. Survival analyses were performed on a per-protocol basis (n = 412).
The updated results recorded 12 (2.4%) local recurrences, 182 (36.8%) metastases, and 56 (11.3%) combined (local + metastases) recurrence at a median follow-up of 81 months (60 to 118). Of 68 local recurrences, 60 (88%) were identified by the patients themselves. The six-monthly regime (overall survival (OS) 54%, recurrence-free survival (RFS) 46%) did not lead to a worse survival and was not inferior to the three-monthly regime (OS 55%, RFS 47%) in terms of detecting recurrence. Although CT scans (OS 53%, RFS 54%) detected pulmonary metastasis earlier, it did not lead to a better survival compared with CXR (OS 56%, RFS 59%).
The overall survival of patients who are treated for a sarcoma of the limb is not inferior to those followed up with a less intensive regimen than a more intensive protocol, in terms of frequency of visits and mode of imaging. CXR at six-monthly intervals and patient education about examination of the site of the surgery will detect most recurrences without deleterious effects on the eventual outcome. Cite this article:
2018;100-B:262-8.</abstract><cop>England</cop><pmid>29437071</pmid><doi>10.1302/0301-620X.100B2.BJJ-2017-0789.R1</doi><tpages>7</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Arm Bones - pathology Arm Bones - surgery Bone Neoplasms - mortality Bone Neoplasms - pathology Bone Neoplasms - surgery Child Child, Preschool Female Humans India Leg Bones - pathology Leg Bones - surgery Male Middle Aged Neoplasm Recurrence, Local - pathology Population Surveillance Prospective Studies Sarcoma - mortality Sarcoma - surgery Survival Rate |
| title | Does a less intensive surveillance protocol affect the survival of patients after treatment of a sarcoma of the limb? updated results of the randomized TOSS study |
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