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Alessandro Gronchi - One of the best experts on this subject based on the ideXlab platform.
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strategies for care of patients with gastrointestinal stromal tumor or soft tissue Sarcoma during covid 19 pandemic a guide for surgical oncologists
Journal of Surgical Oncology, 2020Co-Authors: Dario Callegaro, Chandrajit P Raut, Alessandro Gronchi, Cecile Le Pechoux, Carol J Swallow, Emily Z Keung, Teresa Kim, Javier Martinbroto, Rebecca A GladdyAbstract:The coronavirus disease-2019 (COVID-19) pandemic is deeply impacting the accessibility of cancer patients to surgery. In resource-limited conditions, the standard of care might not be deliverable, but evidence to support alternative management strategies often exists. By revisiting available treatment options, this review provides surgical oncologists with an evidence-based framework for treating patients with gastrointestinal stromal tumor, extremity/truncal soft tissue Sarcoma, and Retroperitoneal Sarcoma to rapidly adapt their decision-making to the constant evolution of the COVID-19 pandemic.
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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 Oncology, 2020Co-Authors: Sylvie Bonvalot, Alessandro Gronchi, Cecile Le Pechoux, Carol Jane Swallow, Dirk C Strauss, P Meeus, Stephan Stoldt, Eberhard Stoeckle, Frits Van Coevorden, Piotr RutkowskiAbstract:Summary Background Unlike for extremity Sarcomas, the efficacy of radiotherapy for Retroperitoneal Sarcoma is not established. The aim of this study was to evaluate the impact of preoperative radiotherapy plus surgery versus surgery alone on abdominal recurrence-free survival. Methods EORTC-62092 is an open-label, randomised, phase 3 study done in 31 research institutions, hospitals, and cancer centres in 13 countries in Europe and North America. Adults (aged ≥18 years) with histologically documented, localised, primary Retroperitoneal Sarcoma that was operable and suitable for radiotherapy, who had not been previously treated and had a WHO performance status and American Society of Anesthesiologists score of 2 or lower, were centrally randomly assigned (1:1), using an interactive web response system and a minimisation algorithm, to receive either surgery alone or preoperative radiotherapy followed by surgery. Randomisation was stratified by hospital and performance status. Radiotherapy was delivered as 50·4 Gy (in 28 daily fractions of 1·8 Gy) in either 3D conformal radiotherapy or intensity modulated radiotherapy, and the objective of surgery was a macroscopically complete resection of the tumour mass with en-bloc organ resection as necessary. The primary endpoint was abdominal recurrence-free survival, as assessed by the investigator, and was analysed in the intention-to-treat population. Safety was analysed in all patients who started their allocated treatment. This trial is registered with ClinicalTrials.gov , NCT01344018 . Findings Between Jan 18, 2012 and April 10, 2017, 266 patients were enrolled, of whom 133 were randomly assigned to each group. The median follow-up was 43·1 months (IQR 28·8–59·2). 128 (96%) patients from the surgery alone group had surgery, and 119 (89%) patients in the radiotherapy and surgery group had both radiotherapy and surgery. Median abdominal recurrence-free survival was 4·5 years (95% CI 3·9 to not estimable) in the radiotherapy plus surgery group and 5·0 years (3·4 to not estimable) in the surgery only group (hazard ratio 1·01, 95% CI 0·71–1·44; log rank p=0·95). The most common grade 3–4 adverse events were lymphopenia (98 [77%] of 127 patients in the radiotherapy plus surgery group vs one [1%] of 128 patients in the surgery alone group), anaemia (15 [12%] vs ten [8%]), and hypoalbuminaemia (15 [12%] vs five [4%]). Serious adverse events were reported in 30 (24%) of 127 patients in the radiotherapy plus surgery group, and in 13 (10%) of 128 patients in the surgery alone group. One (1%) of 127 patients in the radiotherapy plus surgery group died due to treatment-related serious adverse events (gastropleural fistula), and no patients in the surgery alone group died due to treatment-related serious adverse events. Interpretation Preoperative radiotherapy should not be considered as standard of care treatment for Retroperitoneal Sarcoma. Funding European Organisation for Research and Treatment of Cancer, and European Clinical Trials in Rare Sarcomas.
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strass eortc 62092 a phase iii randomized study of preoperative radiotherapy plus surgery versus surgery alone for patients with Retroperitoneal Sarcoma
Journal of Clinical Oncology, 2019Co-Authors: Sylvie Bonvalot, Alessandro Gronchi, Cecile Le Pechoux, Carol Jane Swallow, Dirk C Strauss, P Meeus, Frits Van Coevorden, Stephan Stoldt, Eberhard Stoeckle, Piotr RutkowskiAbstract:11001Background: The predominant pattern of failure of Retroperitoneal Sarcoma (RPS), frequently associated with subsequent death, is locoregional recurrence. Unlike in limbs, the efficacy of radio...
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unsupervised versus supervised identification of prognostic factors in patients with localized Retroperitoneal Sarcoma a data clustering and mahalanobis distance approach
BioMed Research International, 2018Co-Authors: Vittorio Quagliuolo, Pierina Navarria, Armando Santoro, Alessandro Gronchi, Antonino De Paoli, Rita De Sanctis, Alessandro Vigano, Alessandro Giuliani, Alfredo ColosimoAbstract:The aim of this report is to unveil specific prognostic factors for Retroperitoneal Sarcoma (RPS) patients by univariate and multivariate statistical techniques. A phase I-II study on localized RPS treated with high-dose ifosfamide and radiotherapy followed by surgery (ISG-STS 0303 protocol) demonstrated that chemo/radiotherapy was safe and increased the 3-year relapse-free survival (RFS) with respect to historical controls. Of 70 patients, twenty-six developed local, 10 distant, and 5 combined relapse. Median disease-free interval (DFI) was 29.47 months. According to a discriminant function analysis, DFI, histology, relapse pattern, and the first treatment approach at relapse had a statistically significant prognostic impact. Based on scientific literature and clinical expertise, clinicopathological data were analyzed using both a supervised and an unsupervised classification method to predict the prognosis, with similar sample sizes (66 and 65, resp., in casewise approach and 70 in mean-substitution one). This is the first attempt to predict patients' prognosis by means of multivariate statistics, and in this light, it looks noticable that (i) some clinical data have a well-defined prognostic value, (ii) the unsupervised model produced comparable results with respect to the supervised one, and (iii) the appropriate combination of both models appears fruitful and easily extensible to different clinical contexts.
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postoperative morbidity after radical resection of primary Retroperitoneal Sarcoma a report from the transatlantic rps working group
Annals of Surgery, 2017Co-Authors: Andrea Macneill, Dario Callegaro, Sylvie Bonvalot, Alessandro Gronchi, Piotr Rutkowski, Rosalba Miceli, Carol J Swallow, Frits Van Coevorden, P Hohenberger, Andrew J HayesAbstract:OBJECTIVE To investigate the safety of radical resection for Retroperitoneal Sarcoma (RPS). BACKGROUND The surgical management of RPS frequently involves complex multivisceral resection. Improved oncologic outcomes have been demonstrated with this approach compared to marginal excision, but the safety of radical resection has not been shown in a large study population. METHODS The Transatlantic Retroperitoneal Sarcoma Working Group (TARPSWG) is an international collaborative of Sarcoma centers. A combined experience of 1007 consecutive resections for primary RPS from January 2002 to December 2011 was studied retrospectively with respect to adverse events. A weighted organ score was devised to account for differences in surgical complexity. Univariate and multivariate logistic regression analyses were performed to investigate associations between adverse events and number and patterns of organs resected. Associations between adverse events and overall survival, local recurrence, and distant metastases were investigated. RESULTS Severe postoperative adverse events (Clavien-Dindo ≥3) occurred in 165 patients (16.4%) and 18 patients (1.8%) died within 30 days. Significant predictors of severe adverse events were age (P = 0.003), transfusion requirements (P 1.5). There was no impact of postoperative adverse events on overall survival, local recurrence, or distant metastases. CONCLUSIONS A radical surgical approach to RPS is safe when carried out at a specialist Sarcoma center. High-risk resections should be carefully considered on an individual basis and weighed against anticipated disease biology. There appears to be no association between surgical morbidity and long-term oncologic outcomes.
Piotr Rutkowski - One of the best experts on this subject based on the ideXlab platform.
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Management of Primary Retroperitoneal Sarcoma (RPS) in the Adult: An Updated Consensus Approach from the Transatlantic Australasian RPS Working Group
Annals of Surgical Oncology, 2021Co-Authors: Carol J Swallow, Mark Fairweather, Sylvie Bonvalot, Dirk C Strauss, Piotr Rutkowski, Anant Desai, Rebecca A Gladdy, David E Gyorki, Ricardo Gonzalez, Winan J. HoudtAbstract:Background Retroperitoneal soft tissue Sarcomas comprise a heterogeneous group of rare tumors of mesenchymal origin that include several well-defined histologic subtypes. In 2015, the Transatlantic Australasian RPS Working Group (TARPSWG) published consensus recommendations for the best management of primary Retroperitoneal Sarcoma (RPS). Since then, through international collaboration, new evidence and knowledge have been generated, creating the need for an updated consensus document. Methods The primary aim of this study was to critically evaluate the current evidence and develop an up-to-date consensus document on the approach to these difficult tumors. The resulting document applies to primary RPS that is non-visceral in origin, with exclusion criteria as previously described. The relevant literature was evaluated and an international group of experts consulted to formulate consensus statements regarding the best management of primary RPS. A level of evidence and grade of recommendation were attributed to each new/updated recommendation. Results Management of primary RPS was considered from diagnosis to follow-up. This rare and complex malignancy is best managed by an experienced multidisciplinary team in a specialized referral center. The best chance of cure is at the time of primary presentation, and an individualized management plan should be made based on the 29 consensus statements included in this article, which were agreed upon by all of the authors. Whenever possible, patients should be enrolled in prospective trials and studies. Conclusions Ongoing international collaboration is critical to expand upon current knowledge and further improve outcomes of patients with RPS. In addition, prospective data collection and participation in multi-institution trials are strongly encouraged.
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management of primary Retroperitoneal Sarcoma rps in the adult an updated consensus approach from the transatlantic australasian rps working group
Annals of Surgical Oncology, 2021Co-Authors: Sylvie Bonvalot, Dirk C Strauss, Piotr Rutkowski, Carol J Swallow, Ricardo J Gonzalez, Anant Desai, Rebecca A Gladdy, David E GyorkiAbstract:Retroperitoneal soft tissue Sarcomas comprise a heterogeneous group of rare tumors of mesenchymal origin that include several well-defined histologic subtypes. In 2015, the Transatlantic Australasian RPS Working Group (TARPSWG) published consensus recommendations for the best management of primary Retroperitoneal Sarcoma (RPS). Since then, through international collaboration, new evidence and knowledge have been generated, creating the need for an updated consensus document. The primary aim of this study was to critically evaluate the current evidence and develop an up-to-date consensus document on the approach to these difficult tumors. The resulting document applies to primary RPS that is non-visceral in origin, with exclusion criteria as previously described. The relevant literature was evaluated and an international group of experts consulted to formulate consensus statements regarding the best management of primary RPS. A level of evidence and grade of recommendation were attributed to each new/updated recommendation. Management of primary RPS was considered from diagnosis to follow-up. This rare and complex malignancy is best managed by an experienced multidisciplinary team in a specialized referral center. The best chance of cure is at the time of primary presentation, and an individualized management plan should be made based on the 29 consensus statements included in this article, which were agreed upon by all of the authors. Whenever possible, patients should be enrolled in prospective trials and studies. Ongoing international collaboration is critical to expand upon current knowledge and further improve outcomes of patients with RPS. In addition, prospective data collection and participation in multi-institution trials are strongly encouraged.
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defining the role of neoadjuvant systemic therapy in high risk Retroperitoneal Sarcoma a multi institutional study from the transatlantic australasian Retroperitoneal Sarcoma working group
Cancer, 2021Co-Authors: William W Tseng, Giovanni Grignani, Piotr Rutkowski, Francesco Barretta, Lorenzo Conti, Francesco Tolomeo, Markus Albertsmeier, Martin K Angele, Jacek Skoczylas, Antonino De PaoliAbstract:Background In patients with Retroperitoneal Sarcoma (RPS), the incidence of recurrence after surgery remains high. Novel treatment approaches are needed. This retrospective study evaluated patients with primary, high-risk RPS who received neoadjuvant systemic therapy followed by surgery to 1) determine the frequency and potential predictors of radiologic tumor responses and 2) assess clinical outcomes. Methods Clinicopathologic data were collected for eligible patients treated at 13 Sarcoma referral centers from 2008 to 2018. Univariable and multivariable logistic models were performed to assess the association between clinical predictors and response. Overall survival (OS) and crude cumulative incidences of local recurrence and distant metastasis were compared. Results Data on 158 patients were analyzed. A median of 3 cycles of neoadjuvant systemic therapy (interquartile range, 2-4 cycles) were given. The regimens were mostly anthracycline based; however, there was significant heterogeneity. No patients demonstrated a complete response, 37 (23%) demonstrated a partial response (PR), 88 (56%) demonstrated stable disease, and 33 (21%) demonstrated progressive disease (PD) according to the Response Evaluation Criteria in Solid Tumors, version 1.1. Only a higher number of cycles given was positively associated with PR (P = .005). All patients underwent complete resection, regardless of the tumor response. Overall, patients whose tumors demonstrated PD before surgery showed markedly worse OS (P = .005). An indication of a better clinical outcome was seen in specific regimens given for grade 3 dedifferentiated lipoSarcoma and leiomyoSarcoma. Conclusions In patients with high-risk RPS, the response to neoadjuvant systemic therapy is fair overall. Disease progression on therapy may be used to predict survival after surgery. Subtype-specific regimens should be further validated.
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postoperative morbidity after resection of recurrent Retroperitoneal Sarcoma a report from the transatlantic australasian rps working group tarpswg
Annals of Surgical Oncology, 2021Co-Authors: Carolyn Nessim, Chandrajit P Raut, Mark Fairweather, Dario Callegaro, Dirk C Strauss, Piotr Rutkowski, Rosalba Miceli, Francesco Barretta, Jeanyves Blay, Ricardo J GonzalezAbstract:This study aimed to evaluate perioperative morbidity after surgery for first locally recurrent (LR1) Retroperitoneal Sarcoma (RPS). Data concerning the safety of resecting recurrent RPS are lacking. Data were collected on all patients undergoing resection of RPS-LR1 at 22 Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) centers from 2002 to 2011. Uni- and multivariable logistic models were fitted to study the association between major (Clavien-Dindo grade ≥ 3) complications and patient/surgery characteristics as well as outcome. The resected organ score, a method of standardizing the number of organs resected, as previously described by the TARPSWG, was used. The 681 patients in this study had a median age of 59 years, and 51.8% were female. The most common histologic subtype was de-differentiated lipoSarcoma (43%), the median resected organ score was 1, and 83.3% of the patients achieved an R0 or R1 resection. Major complications occurred for 16% of the patients, and the 90-day mortality rate was 0.4%. In the multivariable analysis, a transfusion requirement was found to be a significant predictor of major complications (p < 0.001) and worse overall survival (OS) (p = 0.010). However, having a major complication was not associated with a worse OS or a higher incidence of local recurrence or distant metastasis. A surgical approach to recurrent RPS is relatively safe and comparable with primary RPS in terms of complications and postoperative mortality when performed at specialized Sarcoma centers. Because alternative effective therapies still are lacking, when indicated, resection of a recurrent RPS is a reasonable option. Every effort should be made to minimize the need for blood transfusions.
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patterns of recurrence and survival probability after second recurrence of Retroperitoneal Sarcoma a study from tarpswg
Cancer, 2020Co-Authors: Winan J Van Houdt, Nita Ahuja, Dirk C Strauss, Piotr Rutkowski, Marco Fiore, Francesco Barretta, Jeanyves Blay, Guy Lahat, Ricardo J Gonzalez, Giovanni GrignaniAbstract:BACKGROUND In this series from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG), the authors examined longitudinal outcomes of patients with a second recurrence of Retroperitoneal Sarcoma (RPS) after complete resection of a first local recurrence (LR). METHODS Data from patients undergoing resection of a first LR from January 2002 to December 2011were collected from 22 Sarcoma centers. The primary outcome was overall survival (OS) after second recurrence. RESULTS Second recurrences occurred in 400 of 567 patients (70.5%) after an R0/R1 resection of a first locally recurrent RPS. Patterns of disease recurrence were LR in 323 patients (80.75%), distant metastases (DM) in 55 patients (13.75%), and both LR and DM in 22 patients (5.5%). The main subtype among the LR group was lipoSarcoma (77%), whereas DM mainly were leiomyoSarcomas (43.6%). In patients with a second LR only, a total of 200 patients underwent re-resection (61.9%). The 5-year OS rate varied significantly based on the pattern of failure (P < .001): 45.6% for the LR group, 25.5% for the DM group, and 0% for the group with LR and DM. The only factors found to be associated with improved OS on multivariable analysis were both time between second surgery and the development of the second recurrence (32 months vs 8 months: hazard ratio, 0.44 [P < .001]) and surgery for second recurrence (yes vs no: hazard ratio, 3.25 [P < .001]). The 5-year OS rate for patients undergoing surgery for a second LR was 59% versus 18% in the patients not deemed suitable for surgical resection. CONCLUSIONS Survival rates after second recurrence of RPS varied based on patterns of disease recurrence and treatment. Durable disease-free survivors were identified after surgery for second LR in patients selected for this intervention.
Dirk C Strauss - One of the best experts on this subject based on the ideXlab platform.
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management of primary Retroperitoneal Sarcoma rps in the adult an updated consensus approach from the transatlantic australasian rps working group
Annals of Surgical Oncology, 2021Co-Authors: Sylvie Bonvalot, Dirk C Strauss, Piotr Rutkowski, Carol J Swallow, Ricardo J Gonzalez, Anant Desai, Rebecca A Gladdy, David E GyorkiAbstract:Retroperitoneal soft tissue Sarcomas comprise a heterogeneous group of rare tumors of mesenchymal origin that include several well-defined histologic subtypes. In 2015, the Transatlantic Australasian RPS Working Group (TARPSWG) published consensus recommendations for the best management of primary Retroperitoneal Sarcoma (RPS). Since then, through international collaboration, new evidence and knowledge have been generated, creating the need for an updated consensus document. The primary aim of this study was to critically evaluate the current evidence and develop an up-to-date consensus document on the approach to these difficult tumors. The resulting document applies to primary RPS that is non-visceral in origin, with exclusion criteria as previously described. The relevant literature was evaluated and an international group of experts consulted to formulate consensus statements regarding the best management of primary RPS. A level of evidence and grade of recommendation were attributed to each new/updated recommendation. Management of primary RPS was considered from diagnosis to follow-up. This rare and complex malignancy is best managed by an experienced multidisciplinary team in a specialized referral center. The best chance of cure is at the time of primary presentation, and an individualized management plan should be made based on the 29 consensus statements included in this article, which were agreed upon by all of the authors. Whenever possible, patients should be enrolled in prospective trials and studies. Ongoing international collaboration is critical to expand upon current knowledge and further improve outcomes of patients with RPS. In addition, prospective data collection and participation in multi-institution trials are strongly encouraged.
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Management of Primary Retroperitoneal Sarcoma (RPS) in the Adult: An Updated Consensus Approach from the Transatlantic Australasian RPS Working Group
Annals of Surgical Oncology, 2021Co-Authors: Carol J Swallow, Mark Fairweather, Sylvie Bonvalot, Dirk C Strauss, Piotr Rutkowski, Anant Desai, Rebecca A Gladdy, David E Gyorki, Ricardo Gonzalez, Winan J. HoudtAbstract:Background Retroperitoneal soft tissue Sarcomas comprise a heterogeneous group of rare tumors of mesenchymal origin that include several well-defined histologic subtypes. In 2015, the Transatlantic Australasian RPS Working Group (TARPSWG) published consensus recommendations for the best management of primary Retroperitoneal Sarcoma (RPS). Since then, through international collaboration, new evidence and knowledge have been generated, creating the need for an updated consensus document. Methods The primary aim of this study was to critically evaluate the current evidence and develop an up-to-date consensus document on the approach to these difficult tumors. The resulting document applies to primary RPS that is non-visceral in origin, with exclusion criteria as previously described. The relevant literature was evaluated and an international group of experts consulted to formulate consensus statements regarding the best management of primary RPS. A level of evidence and grade of recommendation were attributed to each new/updated recommendation. Results Management of primary RPS was considered from diagnosis to follow-up. This rare and complex malignancy is best managed by an experienced multidisciplinary team in a specialized referral center. The best chance of cure is at the time of primary presentation, and an individualized management plan should be made based on the 29 consensus statements included in this article, which were agreed upon by all of the authors. Whenever possible, patients should be enrolled in prospective trials and studies. Conclusions Ongoing international collaboration is critical to expand upon current knowledge and further improve outcomes of patients with RPS. In addition, prospective data collection and participation in multi-institution trials are strongly encouraged.
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postoperative morbidity after resection of recurrent Retroperitoneal Sarcoma a report from the transatlantic australasian rps working group tarpswg
Annals of Surgical Oncology, 2021Co-Authors: Carolyn Nessim, Chandrajit P Raut, Mark Fairweather, Dario Callegaro, Dirk C Strauss, Piotr Rutkowski, Rosalba Miceli, Francesco Barretta, Jeanyves Blay, Ricardo J GonzalezAbstract:This study aimed to evaluate perioperative morbidity after surgery for first locally recurrent (LR1) Retroperitoneal Sarcoma (RPS). Data concerning the safety of resecting recurrent RPS are lacking. Data were collected on all patients undergoing resection of RPS-LR1 at 22 Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) centers from 2002 to 2011. Uni- and multivariable logistic models were fitted to study the association between major (Clavien-Dindo grade ≥ 3) complications and patient/surgery characteristics as well as outcome. The resected organ score, a method of standardizing the number of organs resected, as previously described by the TARPSWG, was used. The 681 patients in this study had a median age of 59 years, and 51.8% were female. The most common histologic subtype was de-differentiated lipoSarcoma (43%), the median resected organ score was 1, and 83.3% of the patients achieved an R0 or R1 resection. Major complications occurred for 16% of the patients, and the 90-day mortality rate was 0.4%. In the multivariable analysis, a transfusion requirement was found to be a significant predictor of major complications (p < 0.001) and worse overall survival (OS) (p = 0.010). However, having a major complication was not associated with a worse OS or a higher incidence of local recurrence or distant metastasis. A surgical approach to recurrent RPS is relatively safe and comparable with primary RPS in terms of complications and postoperative mortality when performed at specialized Sarcoma centers. Because alternative effective therapies still are lacking, when indicated, resection of a recurrent RPS is a reasonable option. Every effort should be made to minimize the need for blood transfusions.
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patterns of recurrence and survival probability after second recurrence of Retroperitoneal Sarcoma a study from tarpswg
Cancer, 2020Co-Authors: Winan J Van Houdt, Nita Ahuja, Dirk C Strauss, Piotr Rutkowski, Marco Fiore, Francesco Barretta, Jeanyves Blay, Guy Lahat, Ricardo J Gonzalez, Giovanni GrignaniAbstract:BACKGROUND In this series from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG), the authors examined longitudinal outcomes of patients with a second recurrence of Retroperitoneal Sarcoma (RPS) after complete resection of a first local recurrence (LR). METHODS Data from patients undergoing resection of a first LR from January 2002 to December 2011were collected from 22 Sarcoma centers. The primary outcome was overall survival (OS) after second recurrence. RESULTS Second recurrences occurred in 400 of 567 patients (70.5%) after an R0/R1 resection of a first locally recurrent RPS. Patterns of disease recurrence were LR in 323 patients (80.75%), distant metastases (DM) in 55 patients (13.75%), and both LR and DM in 22 patients (5.5%). The main subtype among the LR group was lipoSarcoma (77%), whereas DM mainly were leiomyoSarcomas (43.6%). In patients with a second LR only, a total of 200 patients underwent re-resection (61.9%). The 5-year OS rate varied significantly based on the pattern of failure (P < .001): 45.6% for the LR group, 25.5% for the DM group, and 0% for the group with LR and DM. The only factors found to be associated with improved OS on multivariable analysis were both time between second surgery and the development of the second recurrence (32 months vs 8 months: hazard ratio, 0.44 [P < .001]) and surgery for second recurrence (yes vs no: hazard ratio, 3.25 [P < .001]). The 5-year OS rate for patients undergoing surgery for a second LR was 59% versus 18% in the patients not deemed suitable for surgical resection. CONCLUSIONS Survival rates after second recurrence of RPS varied based on patterns of disease recurrence and treatment. Durable disease-free survivors were identified after surgery for second LR in patients selected for this intervention.
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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 Oncology, 2020Co-Authors: Sylvie Bonvalot, Alessandro Gronchi, Cecile Le Pechoux, Carol Jane Swallow, Dirk C Strauss, P Meeus, Stephan Stoldt, Eberhard Stoeckle, Frits Van Coevorden, Piotr RutkowskiAbstract:Summary Background Unlike for extremity Sarcomas, the efficacy of radiotherapy for Retroperitoneal Sarcoma is not established. The aim of this study was to evaluate the impact of preoperative radiotherapy plus surgery versus surgery alone on abdominal recurrence-free survival. Methods EORTC-62092 is an open-label, randomised, phase 3 study done in 31 research institutions, hospitals, and cancer centres in 13 countries in Europe and North America. Adults (aged ≥18 years) with histologically documented, localised, primary Retroperitoneal Sarcoma that was operable and suitable for radiotherapy, who had not been previously treated and had a WHO performance status and American Society of Anesthesiologists score of 2 or lower, were centrally randomly assigned (1:1), using an interactive web response system and a minimisation algorithm, to receive either surgery alone or preoperative radiotherapy followed by surgery. Randomisation was stratified by hospital and performance status. Radiotherapy was delivered as 50·4 Gy (in 28 daily fractions of 1·8 Gy) in either 3D conformal radiotherapy or intensity modulated radiotherapy, and the objective of surgery was a macroscopically complete resection of the tumour mass with en-bloc organ resection as necessary. The primary endpoint was abdominal recurrence-free survival, as assessed by the investigator, and was analysed in the intention-to-treat population. Safety was analysed in all patients who started their allocated treatment. This trial is registered with ClinicalTrials.gov , NCT01344018 . Findings Between Jan 18, 2012 and April 10, 2017, 266 patients were enrolled, of whom 133 were randomly assigned to each group. The median follow-up was 43·1 months (IQR 28·8–59·2). 128 (96%) patients from the surgery alone group had surgery, and 119 (89%) patients in the radiotherapy and surgery group had both radiotherapy and surgery. Median abdominal recurrence-free survival was 4·5 years (95% CI 3·9 to not estimable) in the radiotherapy plus surgery group and 5·0 years (3·4 to not estimable) in the surgery only group (hazard ratio 1·01, 95% CI 0·71–1·44; log rank p=0·95). The most common grade 3–4 adverse events were lymphopenia (98 [77%] of 127 patients in the radiotherapy plus surgery group vs one [1%] of 128 patients in the surgery alone group), anaemia (15 [12%] vs ten [8%]), and hypoalbuminaemia (15 [12%] vs five [4%]). Serious adverse events were reported in 30 (24%) of 127 patients in the radiotherapy plus surgery group, and in 13 (10%) of 128 patients in the surgery alone group. One (1%) of 127 patients in the radiotherapy plus surgery group died due to treatment-related serious adverse events (gastropleural fistula), and no patients in the surgery alone group died due to treatment-related serious adverse events. Interpretation Preoperative radiotherapy should not be considered as standard of care treatment for Retroperitoneal Sarcoma. Funding European Organisation for Research and Treatment of Cancer, and European Clinical Trials in Rare Sarcomas.
Chandrajit P Raut - One of the best experts on this subject based on the ideXlab platform.
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Morbidity and Outcomes After Distal Pancreatectomy for Primary Retroperitoneal Sarcoma: An Analysis by the Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group
Annals of Surgical Oncology, 2021Co-Authors: Sanjay P Bagaria, Chandrajit P Raut, Mark Fairweather, Carol Swallow, Harini Suraweera, Ferdinando Cananzi, Vittorio Quagliuolo, Giovanni Grignani, Daphne Hompes, Samuel J. FordAbstract:Background Multi-visceral resection often is used in the treatment of Retroperitoneal Sarcoma (RPS). The morbidity after distal pancreatectomy for primary pancreatic cancer is well-documented, but the outcomes after distal pancreatectomy for primary RPS are not. This study aimed to evaluate morbidity and oncologic outcomes after distal pancreatectomy for primary RPS. Methods In this study, 26 Sarcoma centers that are members of the Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) retrospectively identified consecutive patients who underwent distal pancreatectomy for primary RPS from 2008 to 2017. The outcomes measured were 90-day severe complications (Clavien-Dindo ≥ 3), postoperative pancreatic fistula (POPF) rate, and oncologic outcomes. Results Between 2008 and 2017, 280 patients underwent distal pancreatectomy for primary RPS. The median tumor size was 25 cm, and the median number of organs resected, including the pancreas, was three. In 96% of the operations, R0/R1 resection was achieved. The 90-day severe complication rate was 40 %. The grades B and C POPF complication rates were respectively 19% and 5% and not associated with worse overall survival. Administration of preoperative radiation and factors to mitigate POPF did not have an impact on the risk for the development of a POPF. The RPS invaded the pancreas in 38% of the patients, and local recurrence was doubled for the patients who had a microscopic, positive pancreas margin (hazard ratio, 2.0; p = 0.042). Conclusion Distal pancreatectomy for primary RPS has acceptable morbidity and oncologic outcomes and is a reasonable approach to facilitate complete tumor resection.
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postoperative morbidity after resection of recurrent Retroperitoneal Sarcoma a report from the transatlantic australasian rps working group tarpswg
Annals of Surgical Oncology, 2021Co-Authors: Carolyn Nessim, Chandrajit P Raut, Mark Fairweather, Dario Callegaro, Dirk C Strauss, Piotr Rutkowski, Rosalba Miceli, Francesco Barretta, Jeanyves Blay, Ricardo J GonzalezAbstract:This study aimed to evaluate perioperative morbidity after surgery for first locally recurrent (LR1) Retroperitoneal Sarcoma (RPS). Data concerning the safety of resecting recurrent RPS are lacking. Data were collected on all patients undergoing resection of RPS-LR1 at 22 Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) centers from 2002 to 2011. Uni- and multivariable logistic models were fitted to study the association between major (Clavien-Dindo grade ≥ 3) complications and patient/surgery characteristics as well as outcome. The resected organ score, a method of standardizing the number of organs resected, as previously described by the TARPSWG, was used. The 681 patients in this study had a median age of 59 years, and 51.8% were female. The most common histologic subtype was de-differentiated lipoSarcoma (43%), the median resected organ score was 1, and 83.3% of the patients achieved an R0 or R1 resection. Major complications occurred for 16% of the patients, and the 90-day mortality rate was 0.4%. In the multivariable analysis, a transfusion requirement was found to be a significant predictor of major complications (p < 0.001) and worse overall survival (OS) (p = 0.010). However, having a major complication was not associated with a worse OS or a higher incidence of local recurrence or distant metastasis. A surgical approach to recurrent RPS is relatively safe and comparable with primary RPS in terms of complications and postoperative mortality when performed at specialized Sarcoma centers. Because alternative effective therapies still are lacking, when indicated, resection of a recurrent RPS is a reasonable option. Every effort should be made to minimize the need for blood transfusions.
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strategies for care of patients with gastrointestinal stromal tumor or soft tissue Sarcoma during covid 19 pandemic a guide for surgical oncologists
Journal of Surgical Oncology, 2020Co-Authors: Dario Callegaro, Chandrajit P Raut, Alessandro Gronchi, Cecile Le Pechoux, Carol J Swallow, Emily Z Keung, Teresa Kim, Javier Martinbroto, Rebecca A GladdyAbstract:The coronavirus disease-2019 (COVID-19) pandemic is deeply impacting the accessibility of cancer patients to surgery. In resource-limited conditions, the standard of care might not be deliverable, but evidence to support alternative management strategies often exists. By revisiting available treatment options, this review provides surgical oncologists with an evidence-based framework for treating patients with gastrointestinal stromal tumor, extremity/truncal soft tissue Sarcoma, and Retroperitoneal Sarcoma to rapidly adapt their decision-making to the constant evolution of the COVID-19 pandemic.
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predicting survival in patients undergoing resection for locally recurrent Retroperitoneal Sarcoma a study and novel nomogram from tarpswg
Clinical Cancer Research, 2019Co-Authors: Chandrajit P Raut, Dario Callegaro, Dirk C Strauss, Piotr Rutkowski, Rosalba Miceli, Francesco Barretta, Jeanyves Blay, Guy Lahat, Ricardo J Gonzalez, Nita AhujaAbstract:Purpose The role of surgery for first relapse locally recurrent Retroperitoneal Sarcoma (RPS-LR1) is uncertain. We report outcomes of the largest RPS-LR1 series and propose a new prognostic nomogram. Experimental design Patients with consecutive RPS-LR1 without distant metastases who underwent resection at 22 centers (2002-2011) were included. Endpoints were disease-free and overall survival (DFS, OS) and crude-cumulative-incidence (CCI) of local/distant recurrence from second surgery. Nomograms predicting DFS and OS from second surgery were developed and validated (calibration plots); discrimination was assessed (Harrell C index). Results Of 684 patients identified, full prognostic variable data were available for 602. Initial surgery for primary RPS was performed at our institutions in 188 patients (31%) and elsewhere in 414 (69%). At a median follow-up of 119 months [Interquartile range (IQR), 80-169] from initial surgery and 75 months (IQR 50-105) from second surgery, 6-year DFS and OS were 19.2% [95% confidence interval (CI), 16.0-23.0%] and 54.1% (95% CI, 49.8-58.8%), respectively. Recurrence patterns and survival probability were histology-specific, with lipoSarcoma subtypes having the highest 6-year CCI of second local recurrence (LR, 60.2%-70.9%) and leiomyoSarcoma (LMS) having higher 6-year CCI of distant metastasis (DM, 36.3%). Nomograms included age at second surgery, multifocality, grade, completeness of second surgery, histology, chemotherapy/radiotherapy at first surgery, and number of organs resected at first surgery. OS and DFS nomograms showed good calibration and discriminative ability (C index 0.70 and 0.67, respectively). Conclusions We developed nomograms to predict DFS and OS for patients undergoing RPS-LR1 resection. Nomograms provide individualized, disease-relevant estimations of survival for RPS-LR1 patients and assist in clinical decisions.
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incidence and adverse prognostic implications of histopathologic organ invasion in primary Retroperitoneal Sarcoma
Journal of The American College of Surgeons, 2017Co-Authors: Chandrajit P Raut, Elizabeth H. Baldini, Mark Fairweather, Monica M Bertagnolli, Jiping WangAbstract:Background The incidence of histopathologic organ invasion (HOI) in Retroperitoneal Sarcoma (RPS) is not well described. We reviewed our experience to investigate the rate and prognostic implications of HOI. Study Design Patients with primary RPS who underwent surgery at our institution were reviewed. Histopathologic organ invasion was defined as microscopic organ invasion confirmed by re-review of pathology slides by an expert Sarcoma pathologist. Impact of HOI on the crude cumulative incidence of locoregional recurrence, distant recurrence, and overall survival rates was analyzed. Results Between 2002 and 2011, one hundred and eighteen patients underwent resection for primary RPS; 99 had at least 1 organ resected and, among those, HOI was present in 58% (57 of 99). Among the 77 patients with the 3 most common histologies, rates of HOI were 61% for dedifferentiated lipoSarcoma, 56% for leiomyoSarcoma, and 40% for well-differentiated lipoSarcoma. In this subset, HOI was associated with no difference in 2-year crude cumulative incidence of locoregional recurrence (48% vs 47%; p = 0.55) or distant recurrence (46% vs 22%; p = 0.2). With a median follow-up of 33.6 months, HOI was an independent predictor of worse 5-year overall survival (34% vs 62%; p = 0.04; hazard ratio = 2.3; 95% CI 1.2 to 4.4; p = 0.02). Conclusions The likelihood of organ invasion can be predicted by histologic subtype of primary RPS. To the best of our knowledge, this is the first study to demonstrate that HOI is associated with worse overall survival. These data can help guide the minimal extent of surgical resection required for RPS.
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management of primary Retroperitoneal Sarcoma rps in the adult an updated consensus approach from the transatlantic australasian rps working group
Annals of Surgical Oncology, 2021Co-Authors: Sylvie Bonvalot, Dirk C Strauss, Piotr Rutkowski, Carol J Swallow, Ricardo J Gonzalez, Anant Desai, Rebecca A Gladdy, David E GyorkiAbstract:Retroperitoneal soft tissue Sarcomas comprise a heterogeneous group of rare tumors of mesenchymal origin that include several well-defined histologic subtypes. In 2015, the Transatlantic Australasian RPS Working Group (TARPSWG) published consensus recommendations for the best management of primary Retroperitoneal Sarcoma (RPS). Since then, through international collaboration, new evidence and knowledge have been generated, creating the need for an updated consensus document. The primary aim of this study was to critically evaluate the current evidence and develop an up-to-date consensus document on the approach to these difficult tumors. The resulting document applies to primary RPS that is non-visceral in origin, with exclusion criteria as previously described. The relevant literature was evaluated and an international group of experts consulted to formulate consensus statements regarding the best management of primary RPS. A level of evidence and grade of recommendation were attributed to each new/updated recommendation. Management of primary RPS was considered from diagnosis to follow-up. This rare and complex malignancy is best managed by an experienced multidisciplinary team in a specialized referral center. The best chance of cure is at the time of primary presentation, and an individualized management plan should be made based on the 29 consensus statements included in this article, which were agreed upon by all of the authors. Whenever possible, patients should be enrolled in prospective trials and studies. Ongoing international collaboration is critical to expand upon current knowledge and further improve outcomes of patients with RPS. In addition, prospective data collection and participation in multi-institution trials are strongly encouraged.
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Management of Primary Retroperitoneal Sarcoma (RPS) in the Adult: An Updated Consensus Approach from the Transatlantic Australasian RPS Working Group
Annals of Surgical Oncology, 2021Co-Authors: Carol J Swallow, Mark Fairweather, Sylvie Bonvalot, Dirk C Strauss, Piotr Rutkowski, Anant Desai, Rebecca A Gladdy, David E Gyorki, Ricardo Gonzalez, Winan J. HoudtAbstract:Background Retroperitoneal soft tissue Sarcomas comprise a heterogeneous group of rare tumors of mesenchymal origin that include several well-defined histologic subtypes. In 2015, the Transatlantic Australasian RPS Working Group (TARPSWG) published consensus recommendations for the best management of primary Retroperitoneal Sarcoma (RPS). Since then, through international collaboration, new evidence and knowledge have been generated, creating the need for an updated consensus document. Methods The primary aim of this study was to critically evaluate the current evidence and develop an up-to-date consensus document on the approach to these difficult tumors. The resulting document applies to primary RPS that is non-visceral in origin, with exclusion criteria as previously described. The relevant literature was evaluated and an international group of experts consulted to formulate consensus statements regarding the best management of primary RPS. A level of evidence and grade of recommendation were attributed to each new/updated recommendation. Results Management of primary RPS was considered from diagnosis to follow-up. This rare and complex malignancy is best managed by an experienced multidisciplinary team in a specialized referral center. The best chance of cure is at the time of primary presentation, and an individualized management plan should be made based on the 29 consensus statements included in this article, which were agreed upon by all of the authors. Whenever possible, patients should be enrolled in prospective trials and studies. Conclusions Ongoing international collaboration is critical to expand upon current knowledge and further improve outcomes of patients with RPS. In addition, prospective data collection and participation in multi-institution trials are strongly encouraged.
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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 Oncology, 2020Co-Authors: Sylvie Bonvalot, Alessandro Gronchi, Cecile Le Pechoux, Carol Jane Swallow, Dirk C Strauss, P Meeus, Stephan Stoldt, Eberhard Stoeckle, Frits Van Coevorden, Piotr RutkowskiAbstract:Summary Background Unlike for extremity Sarcomas, the efficacy of radiotherapy for Retroperitoneal Sarcoma is not established. The aim of this study was to evaluate the impact of preoperative radiotherapy plus surgery versus surgery alone on abdominal recurrence-free survival. Methods EORTC-62092 is an open-label, randomised, phase 3 study done in 31 research institutions, hospitals, and cancer centres in 13 countries in Europe and North America. Adults (aged ≥18 years) with histologically documented, localised, primary Retroperitoneal Sarcoma that was operable and suitable for radiotherapy, who had not been previously treated and had a WHO performance status and American Society of Anesthesiologists score of 2 or lower, were centrally randomly assigned (1:1), using an interactive web response system and a minimisation algorithm, to receive either surgery alone or preoperative radiotherapy followed by surgery. Randomisation was stratified by hospital and performance status. Radiotherapy was delivered as 50·4 Gy (in 28 daily fractions of 1·8 Gy) in either 3D conformal radiotherapy or intensity modulated radiotherapy, and the objective of surgery was a macroscopically complete resection of the tumour mass with en-bloc organ resection as necessary. The primary endpoint was abdominal recurrence-free survival, as assessed by the investigator, and was analysed in the intention-to-treat population. Safety was analysed in all patients who started their allocated treatment. This trial is registered with ClinicalTrials.gov , NCT01344018 . Findings Between Jan 18, 2012 and April 10, 2017, 266 patients were enrolled, of whom 133 were randomly assigned to each group. The median follow-up was 43·1 months (IQR 28·8–59·2). 128 (96%) patients from the surgery alone group had surgery, and 119 (89%) patients in the radiotherapy and surgery group had both radiotherapy and surgery. Median abdominal recurrence-free survival was 4·5 years (95% CI 3·9 to not estimable) in the radiotherapy plus surgery group and 5·0 years (3·4 to not estimable) in the surgery only group (hazard ratio 1·01, 95% CI 0·71–1·44; log rank p=0·95). The most common grade 3–4 adverse events were lymphopenia (98 [77%] of 127 patients in the radiotherapy plus surgery group vs one [1%] of 128 patients in the surgery alone group), anaemia (15 [12%] vs ten [8%]), and hypoalbuminaemia (15 [12%] vs five [4%]). Serious adverse events were reported in 30 (24%) of 127 patients in the radiotherapy plus surgery group, and in 13 (10%) of 128 patients in the surgery alone group. One (1%) of 127 patients in the radiotherapy plus surgery group died due to treatment-related serious adverse events (gastropleural fistula), and no patients in the surgery alone group died due to treatment-related serious adverse events. Interpretation Preoperative radiotherapy should not be considered as standard of care treatment for Retroperitoneal Sarcoma. Funding European Organisation for Research and Treatment of Cancer, and European Clinical Trials in Rare Sarcomas.
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strass eortc 62092 a phase iii randomized study of preoperative radiotherapy plus surgery versus surgery alone for patients with Retroperitoneal Sarcoma
Journal of Clinical Oncology, 2019Co-Authors: Sylvie Bonvalot, Alessandro Gronchi, Cecile Le Pechoux, Carol Jane Swallow, Dirk C Strauss, P Meeus, Frits Van Coevorden, Stephan Stoldt, Eberhard Stoeckle, Piotr RutkowskiAbstract:11001Background: The predominant pattern of failure of Retroperitoneal Sarcoma (RPS), frequently associated with subsequent death, is locoregional recurrence. Unlike in limbs, the efficacy of radio...
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radiotherapy for Retroperitoneal lipoSarcoma a report from the transatlantic Retroperitoneal Sarcoma working group
Cancer, 2019Co-Authors: Sylvie Bonvalot, Dirk C Strauss, Frits Van Coevorden, Rosalba Miceli, Carol J Swallow, P Hohenberger, Rick L.m. Haas, Piotr RutkowskiAbstract:Background The current study investigated the role of radiotherapy (RT) in patients with primary nonmetastatic Retroperitoneal lipoSarcomas.