Advanced soft-tissue sarcoma: a disease that is potentially curable for a subset of patients treated with chemotherapy☆
Introduction
The prognosis of patients with irresectable or advanced metastatic soft-tissue sarcoma (ASTS) remains poor with response rates to chemotherapy ranging from 20–35% in most series and a median survival of at best 12 months 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11. The treatment of ASTS is therefore generally considered as palliative. However, long-term survival can be achieved in patients with metastatic sarcoma in whom complete remission is achieved after complete resection of all metastases 12, 13, as well as in patients with locally advanced disease when adequate surgery is rendered possible by preoperative chemotherapy [14]. However, whether long-term survival can be achieved in patients with irresectable metastatic or advanced sarcoma treated with chemotherapy has seldom been addressed in a large prospective series of ASTS [15]. If long-term survival can be achieved in some patients with ASTS treated with chemotherapy, the therapeutic strategy may be significantly modified for subsets of patients.
The objectives of this study were to evaluate the frequency and the clinical characteristics of long-term survivors in patients with ASTS. With this aim, we performed a retrospective study of long-term survivors in a database of 2187 patients treated with a doxorubicin-containing regimen between 1976 and 1990 in trials carried out by the European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group (EORTC STBSG) 2, 3, 4, 5, 6, 7, 8.
Section snippets
Database
This study was performed retrospectively using a database involving 2187 patients ASTS, treated with a doxorubicin-containing regimen as first-line chemotherapy, within 7 prospective EORTC STBSG studies between 1976 and 1990 1, 2, 3, 4, 5, 6, 7, 8 (Table 1). Of these 2187 patients, 1888 (86%) had a minimum follow-up of 5 years since the initiation of chemotherapy: 66 were alive at 5 years, and 1822 had died within the first 5 years. The chemotherapy regimens used in these studies were:
Results
The median overall survival of the series of 2187 patients was 354 days (11.7 months). 355 patients were still alive in October 2000. The survival estimate was 8% at 5 years, 7.6% at 6 years, 6.8% at 7 years and 5.6% at 8 years (standard error <1%). No deaths were recorded beyond 8 years; 9- and 10-year survival estimates were therefore also 5.6%. Among the 66 patients alive at 5 years, 10 died beyond 5 years after inclusion. The 6-, 7- and 8-year survival estimates for 5-year survivors were
Discussion
These results show that ASTS is not an incurable disease: 8% of these patients are alive 5 years after initial diagnosis, and the majority of them experience long-term survival afterwards. Several clinical parameters, such as gender, PS, tumour grade and liver metastasis were found to be correlated to 5-year survival in univariate and multivariate analysis, and independent prognostic factors for 5-year survival were actually similar to those correlated to overall survival since the inclusion in
Acknowledgements
This work was supported by the Prix Pierre Bardoux.
References (25)
- et al.
Adriamycin versus epirubicin in advanced soft tissue sarcomas. A randomized phase II/phase III study of the EORTC Soft Tissue and Bone Sarcoma Group
Eur. J. Cancer Clin. Oncol.
(1987) - et al.
Ifosfamide plus doxorubicin in previously untreated patients with advanced soft tissue sarcoma. The EORTC Soft Tissue and Bone Sarcoma Group
Eur. J. Cancer
(1990) - et al.
The outcome of advanced soft tissue sarcoma patients with complete tumour regression after either chemotherapy alone or chemotherapy plus surgery. The Scandinavian Sarcoma Group experience
Eur. J. Cancer
(1997) - et al.
Pronostic factors in advanced soft tissue sarcoma (STS)analysis of 2187 patients treated with doxorubicin containing first line regimens—a European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group study
J. Clin. Oncol.
(1999) - et al.
Cyvadic in advanced soft tissue sarcomaa randomized study comparing two schedules. A study of the EORTC Soft Tissue and Bone Sarcoma Group
Cancer
(1984) - et al.
Doxorubicin versus CyVADic versus ifosfamide plus doxorubicin in first line treatment of advanced soft tissue sarcomas. A randomized study of the EORTC Soft tissue and bone sarcoma group
J. Clin. Oncol.
(1995) - et al.
GM-CSF allows safe escalation of dose intensity in metastatic adult soft tissue sarcomasa study of the European organisation for Research and treatment of Cancer Soft tissue and Bone sarcoma Group
J. Clin. Oncol.
(1993) - et al.
A phase III trial comparing adriamycin versus two schedule of high dose epirubicin in advanced soft tissue sarcomas
Proc. Am. Sco. Clin. Oncol.
(1995) - et al.
Is high dose chemoherapyu of interest in advanced soft tissue sarcomas. An EORTC randomized phase III trial
Proc. Am. Soc. Clin. Oncol.
(1996) - et al.
Randomized comparison of doxorubicin alone versus ifosfamide plus doxorubicin or mitomycin, doxorubicin and cisplatin against advanced soft tissue sarcomas
J. Clin. Oncol.
(1993)
An intergroup phase III randomized study of doxorubicin and dacarbazine with or without ifosfamide an Mesna in advanced soft tissue and bone sarcomas
J. Clin. Oncol.
A randomized phase III study of MAID vs intensified MAID in patients with advanced soft tissue sarcomas
Proc. Am. Soc. Clin. Oncol.
Cited by (152)
Epithelioid hemangio-endothelioma (EHE) in NETSARC: The nationwide series of 267 patients over 12 years
2023, European Journal of CancerManagement of Synovial Sarcoma and Myxoid Liposarcoma
2022, Surgical Oncology Clinics of North AmericaSELNET clinical practice guidelines for soft tissue sarcoma and GIST
2022, Cancer Treatment ReviewsCitation Excerpt :The presence of distant metastasis is a poor prognostic factor for OS, ranging currently 18–20 months [30,31]. However, a fraction of patients with advanced sarcoma could benefit from long term remission, especially those reaching a complete response and a smaller percentage of those obtaining partial response after first line of treatment for advanced disease [32]. Supportive care and quality of life evaluation should be included in the early management of all patients with advanced sarcoma [33].
- ☆
on behalf of the EORTC Soft Tissue and Bone Sarcoma Group (STBSG), EORTC, 1200 Brussels, Belgium.