Long-term Oncologic Outcomes After Neoadjuvant Radiation Therapy for Retroperitoneal Sarcomas
OBJECTIVE:To evaluate long-term survival among patients undergoing radiation therapy (RT), followed by surgical resection of retroperitoneal sarcomas (RPS). BACKGROUND:Despite a lack of level 1 evidence supporting neoadjuvant RT for RPS, its use has increased substantially over the past decade. METH...
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Veröffentlicht in: | Annals of surgery 2015-07, Vol.262 (1), p.163-170 |
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creator | Nussbaum, Daniel P Speicher, Paul J Gulack, Brian C Ganapathi, Asvin M Englum, Brian R Kirsch, David G Tyler, Douglas S Blazer, Dan G |
description | OBJECTIVE:To evaluate long-term survival among patients undergoing radiation therapy (RT), followed by surgical resection of retroperitoneal sarcomas (RPS).
BACKGROUND:Despite a lack of level 1 evidence supporting neoadjuvant RT for RPS, its use has increased substantially over the past decade.
METHODS:The 1998–2011 National Cancer Data Base was queried to identify patients who underwent resection of RPS. Subjects were grouped by use of neoadjuvant RT. Perioperative variables and outcomes were compared. Multivariable logistic regression was performed to assess predictors of neoadjuvant RT. Groups were propensity matched using a 2:1 nearest neighbor algorithm and short-term outcomes were compared. Finally, long-term survival was evaluated using the Kaplan-Meier method, with comparisons based on the log-rank test.
RESULTS:A total of 11,324 patients were identified. Neoadjuvant RT was administered to 696 patients (6.1%). During the study period, preoperative RT use increased from 4% to nearly 15%. Male sex, tumor size larger than 5 cm, treatment at an academic/research program, and higher tumor grade all predicted neoadjuvant RT administration. After propensity matching, the only difference in baseline characteristics was the use of neoadjuvant chemotherapy. Although neoadjuvant RT was associated with a higher rate of negative margins (77.5% vs 73.0%; P = 0.014), there was no corresponding improvement in 5-year survival (53.2% vs 54.2%; P = 0.695).
CONCLUSIONS:Despite the increasing use of neoadjuvant RT for patients with RPS, the survival benefit associated with this treatment modality remains unclear. Continued investigation is needed to better define the role of RT among patients with RPS. |
doi_str_mv | 10.1097/SLA.0000000000000840 |
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BACKGROUND:Despite a lack of level 1 evidence supporting neoadjuvant RT for RPS, its use has increased substantially over the past decade.
METHODS:The 1998–2011 National Cancer Data Base was queried to identify patients who underwent resection of RPS. Subjects were grouped by use of neoadjuvant RT. Perioperative variables and outcomes were compared. Multivariable logistic regression was performed to assess predictors of neoadjuvant RT. Groups were propensity matched using a 2:1 nearest neighbor algorithm and short-term outcomes were compared. Finally, long-term survival was evaluated using the Kaplan-Meier method, with comparisons based on the log-rank test.
RESULTS:A total of 11,324 patients were identified. Neoadjuvant RT was administered to 696 patients (6.1%). During the study period, preoperative RT use increased from 4% to nearly 15%. Male sex, tumor size larger than 5 cm, treatment at an academic/research program, and higher tumor grade all predicted neoadjuvant RT administration. After propensity matching, the only difference in baseline characteristics was the use of neoadjuvant chemotherapy. Although neoadjuvant RT was associated with a higher rate of negative margins (77.5% vs 73.0%; P = 0.014), there was no corresponding improvement in 5-year survival (53.2% vs 54.2%; P = 0.695).
CONCLUSIONS:Despite the increasing use of neoadjuvant RT for patients with RPS, the survival benefit associated with this treatment modality remains unclear. Continued investigation is needed to better define the role of RT among patients with RPS.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/SLA.0000000000000840</identifier><identifier>PMID: 25185464</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Aged ; Female ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Radiotherapy, Adjuvant ; Retroperitoneal Neoplasms - radiotherapy ; Retroperitoneal Neoplasms - surgery ; Sarcoma - radiotherapy ; Sarcoma - surgery ; Survival Analysis ; Treatment Outcome</subject><ispartof>Annals of surgery, 2015-07, Vol.262 (1), p.163-170</ispartof><rights>Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.</rights><rights>Copyright © 2014 by Lippincott Williams & Wilkins 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5270-f1b82a87a241777aa984101ea6b360a49f44d5ecaf89f8a35d1fc88da8f3293b3</citedby><cites>FETCH-LOGICAL-c5270-f1b82a87a241777aa984101ea6b360a49f44d5ecaf89f8a35d1fc88da8f3293b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345136/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345136/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25185464$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nussbaum, Daniel P</creatorcontrib><creatorcontrib>Speicher, Paul J</creatorcontrib><creatorcontrib>Gulack, Brian C</creatorcontrib><creatorcontrib>Ganapathi, Asvin M</creatorcontrib><creatorcontrib>Englum, Brian R</creatorcontrib><creatorcontrib>Kirsch, David G</creatorcontrib><creatorcontrib>Tyler, Douglas S</creatorcontrib><creatorcontrib>Blazer, Dan G</creatorcontrib><title>Long-term Oncologic Outcomes After Neoadjuvant Radiation Therapy for Retroperitoneal Sarcomas</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>OBJECTIVE:To evaluate long-term survival among patients undergoing radiation therapy (RT), followed by surgical resection of retroperitoneal sarcomas (RPS).
BACKGROUND:Despite a lack of level 1 evidence supporting neoadjuvant RT for RPS, its use has increased substantially over the past decade.
METHODS:The 1998–2011 National Cancer Data Base was queried to identify patients who underwent resection of RPS. Subjects were grouped by use of neoadjuvant RT. Perioperative variables and outcomes were compared. Multivariable logistic regression was performed to assess predictors of neoadjuvant RT. Groups were propensity matched using a 2:1 nearest neighbor algorithm and short-term outcomes were compared. Finally, long-term survival was evaluated using the Kaplan-Meier method, with comparisons based on the log-rank test.
RESULTS:A total of 11,324 patients were identified. Neoadjuvant RT was administered to 696 patients (6.1%). During the study period, preoperative RT use increased from 4% to nearly 15%. Male sex, tumor size larger than 5 cm, treatment at an academic/research program, and higher tumor grade all predicted neoadjuvant RT administration. After propensity matching, the only difference in baseline characteristics was the use of neoadjuvant chemotherapy. Although neoadjuvant RT was associated with a higher rate of negative margins (77.5% vs 73.0%; P = 0.014), there was no corresponding improvement in 5-year survival (53.2% vs 54.2%; P = 0.695).
CONCLUSIONS:Despite the increasing use of neoadjuvant RT for patients with RPS, the survival benefit associated with this treatment modality remains unclear. Continued investigation is needed to better define the role of RT among patients with RPS.</description><subject>Aged</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoadjuvant Therapy</subject><subject>Radiotherapy, Adjuvant</subject><subject>Retroperitoneal Neoplasms - radiotherapy</subject><subject>Retroperitoneal Neoplasms - surgery</subject><subject>Sarcoma - radiotherapy</subject><subject>Sarcoma - surgery</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><issn>0003-4932</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kF1LwzAUhoMobn78A5H8gc6kSdv0RhjDLygOtnkp4bRN1s62GWm7sX9vZDqmF56bA-ec9znwIHRDyYiSOLqbJ-MROS7ByQka0sAXHqWcnKKhGzKPx8wfoIu2XRFCuSDRORr4ARUBD_kQvSemWXqdsjWeNpmpzLLM8LTvMlOrFo-12-BXZSBf9RtoOjyDvISuNA1eFMrCeoe1sXimOmvWypadaRRUeA7WAaC9QmcaqlZdf_dL9Pb4sJg8e8n06WUyTrws8CPiaZoKH0QEPqdRFAHEglNCFYQpCwnwWHOeByoDLWItgAU51ZkQOQjN_Jil7BLd77nrPq1Vnqmms1DJtS1rsDtpoJS_N01ZyKXZSM54QFnoAHwPyKxpW6v0IUuJ_NItnW75V7eL3R7_PYR-_LoDsT_YmsqpbD-qfqusLJykrvif_QkY9o7G</recordid><startdate>201507</startdate><enddate>201507</enddate><creator>Nussbaum, Daniel P</creator><creator>Speicher, Paul J</creator><creator>Gulack, Brian C</creator><creator>Ganapathi, Asvin M</creator><creator>Englum, Brian R</creator><creator>Kirsch, David G</creator><creator>Tyler, Douglas S</creator><creator>Blazer, Dan G</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><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>5PM</scope></search><sort><creationdate>201507</creationdate><title>Long-term Oncologic Outcomes After Neoadjuvant Radiation Therapy for Retroperitoneal Sarcomas</title><author>Nussbaum, Daniel P ; Speicher, Paul J ; Gulack, Brian C ; Ganapathi, Asvin M ; Englum, Brian R ; Kirsch, David G ; Tyler, Douglas S ; Blazer, Dan G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5270-f1b82a87a241777aa984101ea6b360a49f44d5ecaf89f8a35d1fc88da8f3293b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoadjuvant Therapy</topic><topic>Radiotherapy, Adjuvant</topic><topic>Retroperitoneal Neoplasms - radiotherapy</topic><topic>Retroperitoneal Neoplasms - surgery</topic><topic>Sarcoma - radiotherapy</topic><topic>Sarcoma - surgery</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nussbaum, Daniel P</creatorcontrib><creatorcontrib>Speicher, Paul J</creatorcontrib><creatorcontrib>Gulack, Brian C</creatorcontrib><creatorcontrib>Ganapathi, Asvin M</creatorcontrib><creatorcontrib>Englum, Brian R</creatorcontrib><creatorcontrib>Kirsch, David G</creatorcontrib><creatorcontrib>Tyler, Douglas S</creatorcontrib><creatorcontrib>Blazer, Dan G</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nussbaum, Daniel P</au><au>Speicher, Paul J</au><au>Gulack, Brian C</au><au>Ganapathi, Asvin M</au><au>Englum, Brian R</au><au>Kirsch, David G</au><au>Tyler, Douglas S</au><au>Blazer, Dan G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term Oncologic Outcomes After Neoadjuvant Radiation Therapy for Retroperitoneal Sarcomas</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>2015-07</date><risdate>2015</risdate><volume>262</volume><issue>1</issue><spage>163</spage><epage>170</epage><pages>163-170</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><abstract>OBJECTIVE:To evaluate long-term survival among patients undergoing radiation therapy (RT), followed by surgical resection of retroperitoneal sarcomas (RPS).
BACKGROUND:Despite a lack of level 1 evidence supporting neoadjuvant RT for RPS, its use has increased substantially over the past decade.
METHODS:The 1998–2011 National Cancer Data Base was queried to identify patients who underwent resection of RPS. Subjects were grouped by use of neoadjuvant RT. Perioperative variables and outcomes were compared. Multivariable logistic regression was performed to assess predictors of neoadjuvant RT. Groups were propensity matched using a 2:1 nearest neighbor algorithm and short-term outcomes were compared. Finally, long-term survival was evaluated using the Kaplan-Meier method, with comparisons based on the log-rank test.
RESULTS:A total of 11,324 patients were identified. Neoadjuvant RT was administered to 696 patients (6.1%). During the study period, preoperative RT use increased from 4% to nearly 15%. Male sex, tumor size larger than 5 cm, treatment at an academic/research program, and higher tumor grade all predicted neoadjuvant RT administration. After propensity matching, the only difference in baseline characteristics was the use of neoadjuvant chemotherapy. Although neoadjuvant RT was associated with a higher rate of negative margins (77.5% vs 73.0%; P = 0.014), there was no corresponding improvement in 5-year survival (53.2% vs 54.2%; P = 0.695).
CONCLUSIONS:Despite the increasing use of neoadjuvant RT for patients with RPS, the survival benefit associated with this treatment modality remains unclear. Continued investigation is needed to better define the role of RT among patients with RPS.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>25185464</pmid><doi>10.1097/SLA.0000000000000840</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Aged Female Humans Male Middle Aged Neoadjuvant Therapy Radiotherapy, Adjuvant Retroperitoneal Neoplasms - radiotherapy Retroperitoneal Neoplasms - surgery Sarcoma - radiotherapy Sarcoma - surgery Survival Analysis Treatment Outcome |
title | Long-term Oncologic Outcomes After Neoadjuvant Radiation Therapy for Retroperitoneal Sarcomas |
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