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

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

doi:10.1016/j.ijrobp.2021.01.051

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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

Journal article

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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

Lynn Million, Andrea Hayes-Jordan, Yueh-Yun Chi, Sarah S Donaldson, Suzanne Wolden, Carol Morris, Stephanie Terezakis, Fran Laurie, Karen Morano, T J Fitzgerald, …

International journal of radiation oncology, biology, physics, Vol.110(3), pp.821-830

07/01/2021

DOI: 10.1016/j.ijrobp.2021.01.051

PMCID: PMC8767764

PMID: 33548339

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https://www.ncbi.nlm.nih.gov/pmc/articles/8767764View

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Abstract

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.

Adolescent

Child

Child, Preschool

Female

Humans

Male

Neoplasm Grading

Research Design

Soft Tissue Neoplasms - pathology

Soft Tissue Neoplasms - radiotherapy

Young Adult

Details

Title: Subtitle: Local Control For High-Grade Nonrhabdomyosarcoma Soft Tissue Sarcoma Assigned to Radiation Therapy on ARST0332: A Report From the Childrens Oncology Group
Creators: Lynn Million - Stanford University
Andrea Hayes-Jordan - University of North Carolina at Chapel Hill
Yueh-Yun Chi - University of Southern California
Sarah S Donaldson - Stanford University
Suzanne Wolden - Memorial Sloan Kettering Cancer Center
Carol Morris - Johns Hopkins University
Stephanie Terezakis - University of Minnesota
Fran Laurie - Imaging and Radiation Oncology Core Rhode Island
Karen Morano - Imaging and Radiation Oncology Core Rhode Island
T J Fitzgerald - University of Massachusetts Medical School
Torunn I Yock - Harvard University ,
David A Rodeberg - East Carolina University
James R Anderson - MERCK
Rose Anne Speights - St. Jude Children's Research Hospital
Jennifer O Black - The Children's Hospital, Aurora
Cheryl Coffin - Vanderbilt University
Mary Beth McCarville - St. Jude Children's Research Hospital
Simon C Kao - University of Iowa
Douglas S Hawkins - Seattle Children's Hospital
Sheri L Spunt - Stanford University
R Lor Randall - University of California, Davis
Resource Type: Journal article
Publication Details: International journal of radiation oncology, biology, physics, Vol.110(3), pp.821-830
DOI: 10.1016/j.ijrobp.2021.01.051
PMID: 33548339
PMCID: PMC8767764
NLM abbreviation: Int J Radiat Oncol Biol Phys
ISSN: 0360-3016
eISSN: 1879-355X
Grant note: U10 CA098413 / NCI NIH HHS U24 CA180803 / NCI NIH HHS U10 CA180886 / NCI NIH HHS U10 CA180801 / NCI NIH HHS P01 CA023099 / NCI NIH HHS P30 CA021765 / NCI NIH HHS U10 CA180899 / NCI NIH HHS U10 CA029511 / NCI NIH HHS U10 CA098543 / NCI NIH HHS
Language: English
Date published: 07/01/2021
Academic Unit: Radiology; Stead Family Department of Pediatrics
Record Identifier: 9984318807202771

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