Synovial Sarcoma in Children, Adolescents, and Young Adults: A Report From the Children's Oncology Group ARST0332 Study
| Autor: | Wei Xue, Jennifer O. Black, Andrew Ostrenga, Simon C. Kao, Barry L. Shulkin, James R. Anderson, R. Lor Randall, Rajkumar Venkatramani, Suzanne L. Wolden, Dolores Lopez-Terrada, Alberto S. Pappo, Sheri L. Spunt |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
Cancer Research Prospective Studies Young adult Child Cancer Pediatric screening and diagnosis Soft tissue sarcoma Soft tissue Sarcoma ORIGINAL REPORTS Prognosis Combined Modality Therapy Synovial sarcoma Neoadjuvant Therapy 6.5 Radiotherapy and other non-invasive therapies Survival Rate Detection Oncology Child Preschool Treatment strategy Female Patient Safety 4.2 Evaluation of markers and technologies Adult medicine.medical_specialty Pediatric Research Initiative Adolescent Pediatric Cancer Clinical Trials and Supportive Activities Clinical Sciences Oncology and Carcinogenesis Sarcoma Synovial Young Adult Rare Diseases Clinical Research Internal medicine medicine Humans Oncology & Carcinogenesis Preschool Synovial business.industry Infant Evaluation of treatments and therapeutic interventions medicine.disease Orphan Drug Early adolescents business Follow-Up Studies |
| Zdroj: | Journal of clinical oncology : official journal of the American Society of Clinical Oncology, vol 39, iss 35 J Clin Oncol |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|