Journal article
Synovial Sarcoma in Children, Adolescents, and Young Adults: A Report From the Children's Oncology Group ARST0332 Study
Journal of clinical oncology, Vol.39(35), pp.3927-3937
12/10/2021
DOI: 10.1200/JCO.21.01628
PMCID: PMC8660012
PMID: 34623899
Abstract
PURPOSE
Synovial sarcoma (SS) is the second most common malignant soft tissue tumor in children. ARST0332 evaluated a risk-based treatment strategy for young patients with soft tissue sarcoma designed to limit therapy for low-risk (LR) disease and to test neoadjuvant chemoradiotherapy for unresected higher-risk disease.
METHODS
Newly diagnosed patients with SS age < 30 years were assigned to four treatment arms based on disease features: A (surgery only), B (55.8 Gy radiotherapy [RT]), C (ifosfamide and doxorubicin [ID] chemotherapy plus 55.8 Gy RT), and D (neoadjuvant ID and 45 Gy RT, then surgery and RT boost based on margins followed by adjuvant ID). Patients treated in Arms A and B were considered LR, arms C and D without metastases as intermediate-risk (IR), and those with metastases as high-risk (HR).
RESULTS
Of the 146 patients with SS enrolled, 138 were eligible and evaluable: LR (46), IR (71), and HR (21). Tumors were 80% extremity, 70% > 5 cm, 70% high-grade, 62% invasive, 95% deep, and 15% metastatic. Treatment was on arm A (29.7%), B (3.6%), C (16.7%), and D (50%). There were no toxic deaths and four unexpected grade 4 adverse events. By risk group, at a median follow-up of 6.8 years, estimated 5-year event-free survival was LR 82%, IR 70%, and HR 8%, and overall survival was LR 98%, IR 89%, and HR 13%. After accounting for the features that defined risk category, none of the other patient or disease characteristics (age, sex, tumor site, tumor invasiveness, and depth) improved the risk stratification model.
CONCLUSION
The risk-based treatment strategy used in ARST0332 produced favorable outcomes in patients with nonmetastatic SS relative to historical controls despite using RT less frequently and at lower doses. The outcome for metastatic SS remains unsatisfactory and new therapies are urgently needed.
Details
- Title: Subtitle
- Synovial Sarcoma in Children, Adolescents, and Young Adults: A Report From the Children's Oncology Group ARST0332 Study
- Creators
- Rajkumar Venkatramani - Texas Children's HospitalWei Xue - University of Florida College of Public Health and Health ProfessionsR. Lor Randall - University of California, DavisSuzanne Wolden - Memorial Sloan Kettering Cancer CenterJames Anderson - MSDDolores Lopez-Terrada - Texas Children's HospitalJennifer Black - Children's Hospital ColoradoSimon C. Kao - University of IowaBarry Shulkin - St. Jude Children's Research HospitalAndrew Ostrenga - University of Mississippi Medical CenterAlberto Pappo - St. Jude Children's Research HospitalSheri L. Spunt - Stanford University
- Resource Type
- Journal article
- Publication Details
- Journal of clinical oncology, Vol.39(35), pp.3927-3937
- DOI
- 10.1200/JCO.21.01628
- PMID
- 34623899
- PMCID
- PMC8660012
- NLM abbreviation
- J Clin Oncol
- ISSN
- 0732-183X
- eISSN
- 1527-7755
- Language
- English
- Date published
- 12/10/2021
- Academic Unit
- Radiology; Stead Family Department of Pediatrics
- Record Identifier
- 9984318724602771
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