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Local Control For High-Grade Nonrhabdomyosarcoma Soft Tissue Sarcoma Assigned to Radiation Therapy on ARST0332: A Report From the Childrens Oncology Group

International Journal of Radiation Oncology*Biology*Physics, ISSN: 0360-3016, Vol: 110, Issue: 3, Page: 821-830
2021
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Article Description

The ARST0332 trial for pediatric and young adults with nonrhabdomyosarcoma soft tissue sarcoma (NRSTS) used risk-based treatment including primary resection with lower-than-standard radiation doses to optimize local control (LC) while minimizing long-term toxicity in those requiring radiation therapy (RT). RT for high-grade NRSTS was based on extent of resection (R0: negative margins, R1: microscopic margins, R2/U: gross disease/unresectable); those with >5 cm tumors received chemotherapy (CT; ifosfamide/doxorubicin). This analysis evaluates LC for patients assigned to RT and prognostic factors associated with local recurrence (LR). Patients aged <30 years with high-grade NRSTS received RT (55.8 Gy) for R1 ≤5 cm tumor (arm B); RT (55.8 Gy)/CT for R0/R1 >5 cm tumor (arm C); or neoadjuvant RT (45 Gy)/CT plus delayed surgery, CT, and postoperative boost to 10.8 Gy R0 <5 mm margins/R1 or 19.8 Gy for R2/unresected tumors (arm D). One hundred ninety-three eligible patients had 24 LRs (arm B 1/15 [6.7%], arm C 7/65 [10.8%], arm D 16/113 [14.2%]) at median time to LR of 1.1 years (range, 0.11-5.27). Of 95 eligible for delayed surgery after neoadjuvant therapy, 89 (93.7%) achieved R0/R1 margins. Overall LC after RT were as follows: R0, 106 of 109 (97%); R1, 51 of 60 (85%); and R2/unresectable, 2 of 6 (33%). LR predictors include extent of delayed resection ( P <.001), imaging response before delayed surgery ( P <.001), histologic subtype ( P <.001), and no RT ( P =.046). The 5-year event-free survival was significantly lower ( P =.0003) for patients unable to undergo R0/R1 resection. Risk-based treatment for young patients with high-grade NRSTS treated on ARST0332 produced very high LC, particularly after R0 resection (97%), despite lower-than-standard RT doses. Neoadjuvant CT/RT enabled delayed R0/R1 resection in most patients and is preferred over adjuvant therapy due to the lower RT dose delivered.

Bibliographic Details

Million, Lynn; Hayes-Jordan, Andrea; Chi, Yueh-Yun; Donaldson, Sarah S; Wolden, Suzanne; Morris, Carol; Terezakis, Stephanie; Laurie, Fran; Morano, Karen; Fitzgerald, T J; Yock, Torunn I; Rodeberg, David A; Anderson, James R; Speights, Rose Anne; Black, Jennifer O; Coffin, Cheryl; McCarville, Mary Beth; Kao, Simon C; Hawkins, Douglas S; Spunt, Sheri L; Randall, R Lor

Elsevier BV

Physics and Astronomy; Medicine; Biochemistry, Genetics and Molecular Biology

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