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Sarcoma

Plenary Session 1

82: Neoadjuvant Radiation Therapy (RT) for Primary Retroperitoneal Well-Differentiated Liposarcoma (RP WDLPS): A Transatlantic Australasian Retroperitoneal Working Group (TARPSWG) Study

Friday, March 22, 2024
2:14pm – 2:26pm ET
Location: Georgia Ballroom

    Abstract Presenter(s)

  • Mark Fairweather, MD

    Surgical Oncologist
    Brigham and Women's Hospital/Harvard Medical School
    Boston, Massachusetts, United States

    • Submitter(s)

  • Mark Fairweather, MD

    Surgical Oncologist
    Brigham and Women's Hospital/Harvard Medical School
    Boston, Massachusetts, United States

    • Author(s)

  • Megan L. Sulciner, MD

    Resident
    Brigham and Women's Hospital
    Boston, Massachusetts, United States

  • JJ

    Joshua S. Jolissaint, MD, MSc

    Complex General Surgical Oncology Fellow
    Memorial Sloan Kettering Cancer Center, United States

  • Marco Fiore, MD, FACS, FEBSh

    Surgical Oncologist
    Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
    Milan, Lombardia, Italy

  • Dorian Yarih Garcia Ortega, MD, MSc

    Surgical Oncologist
    Skin and Soft Tumors Department, National Cancer Institute (Mexico)
    Tlalpan, Distrito Federal, United States

  • CS

    Carol Swallow, MD, PhD (she/her/hers)

    Surgical Oncologist
    Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre
    Toronto, Ontario, Canada

  • SF

    Samuel Ford, MD, PhD

    Surgical Oncologist
    Department of Surgery, University Hospitals Birmingham, United States

  • SI

    Shintaro Iwata, MD

    Surgical Oncologist
    Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Japan, United States

  • Eran Nizri, n/a

    Chairman, Department of Surgery B
    Tel-Aviv Sourasky Medical Center
    Jerusalem, Tel Aviv, Israel

  • VQ

    Vittorio Quagliuolo, MD

    Surgical Oncologist
    Department of Surgery, Istituto Clinico Humanitas, United States

  • DA

    Dagmar A. Adamkova, MD, PhD

    Attending physician
    Department of Cancer Comprehensive Care, Masaryk Memorial Cancer Institute, United States

  • Carolyn Nessim, MD, MSc, FRCSC, FACS (she/her/hers)

    Surgical Oncologist, Associate Professor, Clinician Investigator, CGSO Program Director
    The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute
    Ottawa, Ontario, Canada

  • PR

    Piotr Rutkowski, MD, PhD

    Surgical Oncologist
    Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, United States

  • Kenneth Cardona, MD

    Patricia R. Reynolds Professor of Sarcoma Lead, Winship Sarcoma Disease Team Chair, NCI ECOG-ACRIN Sarcoma Working Group
    Winship Cancer Institute, Emory University, Georgia, United States

  • EK

    Edward Kim, MD

    Radiation Oncologist
    Department of Radiation Oncology, University of Washington, United States

  • AP

    Andrea S. Porpiglia, MD, Mac

    Surgical Oncologist
    Department of Surgical Oncology, Fox Chase Cancer Center, United States

  • Fabian M. Johnston, MD, MHS

    Associate Professor of Surgery
    Division of Gastrointestinal Surgical Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
    Baltimore, Maryland, United States

  • EB

    Elizabeth Baldini, MD, MPH

    Radiation Oncologist
    Department of Radiation Oncology, Brigham and Women’s Hospital, United States

  • Alessandro Gronchi, MD, FSSO

    Chief of Surgical Department
    Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
    Milano, Italy

  • Chandrajit P. Raut, MD, MSc (he/him/his)

    Chief, Division of Surgical Oncology
    Brigham and Women's Hospital
    Boston, Massachusetts, United States

Disclosure(s):
Mark Fairweather, MD: No financial relationships to disclose
Carol Swallow, MD, PhD: No financial relationships to disclose
Alessandro Gronchi, MD, FSSO: Boehringer-Ingelheim: Consultant (Ongoing)
Chandrajit P. Raut, MD, MSc: No financial relationships to disclose
Introduction: With negligible risk of distant metastasis, the primary treatment focus in patients (pts) with primary RP WDLPS is local control. Both an ad hoc analysis from the recently completed phase 3 STRASS trial, (N=88 of 266 STRASS pts), and the multicenter retrospective STREXIT analysis (N=161 of 727 STREXIT pts) suggested a potential benefit of neoadjuvant RT in optimizing local control in these pts.  This study investigates outcomes associated with neoadjuvant RT in a larger cohort of pts undergoing surgery for primary RP WDLPS.


Methods:

In this TARPSWG study from 24 participating sites, we retrospectively identified all pts with primary RP WDLPS who underwent curative-intent resection between January 1, 2002 and December 31, 2017. Patient and tumor characteristics, local recurrence (LR), and overall survival (OS) were analyzed.



Results: Of 584 pts who underwent surgery for RP WDLPS, 72 (12%) of pts received neoadjuvant RT. Primary tumor resection was performed at the participating site in 496 patients (85%), outside referring center in 80 patients (14%), and unknown location in 8 patients (1%).  There were no statistically significant differences in demographics or tumor characteristics including age, gender, tumor multifocality, tumor size, or R0/R1 resection rate between pts treated with neoadjuvant RT and surgery vs. surgery alone. Median tumor size for pts who received RT was 22.7 cm (range 17.0-30.0 cm) and 25.9 cm (range 17.2-34.0 cm) for pts treated with surgery alone (P=0.174).  With median follow up of 73 months, 5-year crude cumulative incidence of LR was significantly lower for neoadjuvant RT vs. surgery alone (5.8% vs. 37%, P< 0.001, Fig 1A).  On multivariate analysis, neoadjuvant RT was an independent predictor of decreased LR (OR 0.22, P< 0.001). Pts who received neoadjuvant RT had longer OS compared to surgery alone at 5 years (90% vs. 86%, P =0.02, Fig. 1B); however, neoadjuvant RT was not a statistically significant independent predictor of OS (P=0.06).


Conclusions:

To the best of our knowledge, this is the largest study to report outcomes of neoadjuvant RT for primary RP WDLPS. Neoadjuvant RT was associated with a significant decrease in LR when compared to surgery alone in two naturally equivalent cohorts of pts. This substantiates the results from the non-preplanned analysis of a smaller cohort of WDLPS pts from both the STRASS trial.

Learning Objectives:

  • Upon completion, participants will be able to describe the impact of neoadjuvant radiation on local recurrence in the management of primary retroperitoneal well-differentiated liposarcoma.
  • Upon completion, participants will be able to describe factors that are predictive of decreased local recurrence in the management of primary retroperitoneal well-differentiated liposarcoma.
  • Upon completion, participants will be able to describe the impact of neoadjuvant radiation on overall survival in the management of primary retroperitoneal well-differentiated liposarcoma.