Annual Meeting Proceedings Part 1 - American Society of Clinical ...

644s Sarcoma
10056 General Poster Session (Board #49A), Sun, 8:00 AM-12:00 PM
Prospective web-based collection of sarcoma cases diagnosed and treated
in France: Experience of the NetSarc network of the French Sarcoma Tumor
Boards. Presenting Author: Francoise Ducimetiere, Centre Léon Berard,
Lyon, France
Background: The management of sarcomas, as for all rare tumors, is
hampered by the limited dissemination of medical knowledge. Management
within a specialized multidisciplinary sarcoma tumor board (STB)
improves compliance to clinical practice guidelines. Since 2010, a
national network with a dedicated system for referral, gathering the 26
regional STBs, is supported by the French NCI. Its objectives are to monitor
the management of sarcomas and give equal access to expertise and
innovative treatments to all patients with sarcoma. We report here the first
experience of a web-based data collection from these STBs. Methods: The
expected incidence of sarcoma in France is 6.1/105 /year, ie 4000 new
cases per year. A website collecting all files discussed in the 26 STBs was
generated from Jan 2010 (www.netsarc.org). The prospective collection of
clinical data, STB decision and patient follow-up was implemented in the
national database (40 items). Results: 7472 patients were accrued during
2 years, 6202 (83%) had sarcoma, 2860 (46%) were new cases,
representing 36% of expected incident cases. The number of new cases
discussed in STB increased between 2010 and 2011 (�38%). Patients
were referred to the STB (2010-2011; % of cases) prior 1) to biopsy
(9%-15%), 2) to first surgery (34%-39%), 3) to adjuvant treatment
(35%-34%), after treatment (14%-8%) and at time of relapse (8%-4%).
15% had a metastases at initial diagnosis. The R0�R1 resection rates for
primary surgery were 55% vs 42% within vs outside the STB centers of
NetSarc. 8% of declared patients were proposed to inclusion into a clinical
trial. Conclusions: This web-based tool enabled the description of the
activity of the STB at the national level. Clinical practices improved
between 2010 and 2011, but 64% of new cases of sarcoma were not
discussed in the referent STB prior to surgery. The yearly follow-up of the
database will help to monitor evolution of clinical practices.
10058 General Poster Session (Board #49C), Sun, 8:00 AM-12:00 PM
Neoadjuvant chemoradiotherapy for patients with high-risk extremity and truncal
sarcomas: A 10-year follow-up study. Presenting Author: Nicole J. Look Hong,
Massachusetts General Hospital, Boston, MA
Background: Patients with high-risk extremity and truncal soft tissue sarcomas
(STS) are at considerable risk for recurrence. A regimen of preoperative mesna,
doxorubucin hydrochloride (Adriamycin), ifosfamide, and dacarbazine (MAID),
interdigitated with radiotherapy (RT), followed by resection and postoperative
chemotherapy with or without RT, has demonstrated high rates of local and
distant control. The goal of this series is to study outcomes of our most recent
cohort of patients treated on this regimen. Methods: We retrospectively reviewed
records of 55 consecutive patients with STS of the extremity or superficial trunk
who completed all phases of treatment at our institution from January 2000–
July 2011. Clinicopathologic characteristics and patient outcomes were analyzed.
Results: Fifty-five patients were analyzed and had a median age of 53 years
(range 18-73). The median tumor size was 10.1cm (range 2.5-35.5 cm).
Twenty-seven (49%) and 28 (51%) patients had grade 2 and 3 tumors,
respectively. Margins were negative in 49 (89%) patients, and positive in 6
(11%) patients. At a median follow-up of 43 months, there were 7 (13%)
locoregional, and 17 (31%) distant recurrences. The local and distant 5-year
recurrence-free survival (RFS) rates were 92% and 64%, respectively. The
5-year overall (OS) and disease-specific survival rates were 86% and 89%,
respectively. There were no treatment-related deaths or secondary myelodysplasias.
There were no significant predictors of OS or RFS. Conclusions: Outcomes of
a contemporary cohort of patients with extremity and truncal STS treated with an
intense regimen of neoadjuvant chemoradiotherapy and surgery are consistent
with previous reports from our institution and better than reports of chemotherapy
alone.
Comparison of interdigitated chemoradiotherapy with adjuvant/neoadjuvant
chemotherapy.
N 5-year OS 5-year distant RFS
Current (2012) 1
55 86 % 64%
Gotzak et al. (2001) 2
134 65% -
DeLaney et al. (2003) 1
48 87% 75%
Sarcoma Meta-Analysis
Collaboration (2007) 3
1568 ~65% ~ 60%
Radiation Therapy Oncology Group trial 9514,
Kraybill et al. (2010) 1
64 71% 64%
Mullen et al. (2011) 1
48 84% 80%
1 2 3
MAID chemoradiotherapy. Neoadjuvant chemotherapy. Adjuvant chemotherapy.
10057 General Poster Session (Board #49B), Sun, 8:00 AM-12:00 PM
Advanced soft-tissue sarcoma in patients over age 75: Patterns of care and
survival. Presenting Author: Delphine Garbay Decoopman, Institut Bergonié,
Bordeaux, France
Background: There are no data regarding the management and the outcome
of elderly patients (pts) diagnosed with advanced soft-tissue sarcoma
(STS). Methods: The charts of pts aged � 75 years and diagnosed with
metastatic and/or unresectable STS between 1990 and 2011 at Memorial
Sloan Kettering (New York) and Institut Bergonié (Bordeaux, France) were
reviewed. Results: 189pts were included.Median age was 79 years (range
75-93).160 pts (84.5%) had metastatic disease. The most frequent
histological subtype was leiomyosarcoma (n�57, 30%). The median
age-adjusted Charlson comorbidity score was 10 (range 5-17). 120 pts
(63.5%) received systemic therapy whereas 69 pts (36.5%) were managed
with best supportive care (BSC) only. Pts who received BSC only were more
likely � 80 years old (58% versus 38%, p�0.01) and with performance
status (PS) � 2 (35% versus 14%, p�0.01). Single agent and combination
therapy were delivered in 87 (72.5%) and 33 (27.5%) cases respectively.
67 pts (56%) received a 1st-line anthracycline-containing regimen. The
median progression-free survival of pts treated with systemic therapy was 4
months (95% CI: 2.5-5.5). 21 pts (17.5%) had to stop 1st line treatment
because of toxicity. On multivariate analysis, age � 80 years, PS � 2, and
single-agent therapy were significantly associated with poor PFS. 51 pts
received one or more further lines of therapies. At the time of analysis, 170
pts (90%) had died. 96% of deaths were related to the disease. The median
OS for the entire cohort of pts was 9.6 months (95% CI: 7.3-12). The
1-year and 2-year OS rates were 43% (95% CI: 36–50), and 22% (95% CI:
16–28), respectively. The median OS of pts managed with systemic
therapy and BSC were 12.5 months (95% CI: 8.4-16.6) and 5.1 months
(95% CI: 3.7-6.5), respectively (p�0.02). However, on multivariate
analysis, PS � 2 and age-adjusted Charlson score � 10 were the sole
independent factors significantly associated with OS. Conclusions: A high
proportion of elderly pts with advanced STS were considered unfit for
chemotherapy. The OS of STS pts � 75 years who were managed with
systemic therapy seems similar to that of younger pts. Further efforts are
needed to better define the optimal care for fit and unfit elderly pts with
advanced STS.
10059 General Poster Session (Board #49D), Sun, 8:00 AM-12:00 PM
Risk factors leading to grading changes within 300 low-grade soft tissue
sarcomas. Presenting Author: Tanja Koshrawipour, BG University Hospital
Plastic Surgery, Bochum, Germany
Background: Soft tissue sarcomas (STS) are rare, mesenchymal derived
tumors. Based on malignancy, three grades are distinguished with G1
equaling low grade, G2 intermediate grade and G3 high grade, respectively.
Studies have shown that some G1 tumors which underwent complete
surgical resection reoccurred as lesions with a grading shift from G1 to
higher malignancy. This grading change is referred to as up grading.
Patients with grading changes were thoroughly examined in our study. Our
aim was to find possible risk factors for up gradings, such as age,
localization of tumor and tumor type. Methods: This retrospective case
control study evaluated 333 Patients, who, between 1996 to 2011 were
treated for G1 STS at Bergmannsheil Bochum, university clinic. These
patients received complete initial surgical resection. Among our 333
patients, 9.9% (n�33) developed up gradings of their STS. These were
then reviewed more closely in the aim of finding possible risk factors. We
did not exclude any patients from our data or deliberately pick any grading
changers and regard our collective as randomly sampled. The processed
data includes age, gender, tumor type, tumor localization, occurrence of
recidive and grading change. Results: Patients with up gradings were found
to have a higher mean age of 4, 5 years than reference collective. The tumor
type has a strong, statistically significant effect on grading change as
patients with fibrosarcomas have a threefold risk of developing up gradings
when compared to patients with other G1 STS. Conclusions: Our results
indicate that age and tumor type play the key role in the development of up
gradings in low malignant STS .Patients aged 60 and above diagnosed with
fibrosarcomas are at a 3 times higher risk of developing a grading change as
opposed to patients younger than 60 with other low grade STS than
fibrosarcoma. We discussed the significance of these risk factors and
argued whether, in addition to wide tumor resection, a short term
postoperative radiotherapy should be applied for these patients to improve
therapeutical outcome.
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