Multi-Institutional Soft Tissue Sarcoma Real-Time Peer Review Radiation Therapy Quality Assurance Rounds (original) (raw)

2016, International Journal of Radiation Oncology Biology Physics

combination (ACRT), neoadjuvant chemoradiotherapy combination (NCRT), and mixed (M) CRT (NCT + ART or NRT + ACT). Kaplan-Meier method estimated overall survival (OS). Proportional hazards model estimated OS hazard ratios for prognostic factors including age, comorbidity, gender, race, margin, histology, RT technique, RT dose, and CT type. Results: With a median follow-up of 34 months, the cohort included 2,298 male and 1,774 females with a median age of 61 years (range: 18-90). RT and CT were delivered in 2,567 and 1,228 patients reducing mortality hazards ratio (HR) 0.61 (95% confidence intervals (CIs) 0.54-0.68); and 0.65 (CI: 0.58-0.73), respectively, compared with surgery alone. The 5year OS was 36%, 58%, 59%, 49%, 56%, 55%, 52%, and 51% in SA, ACRT, NCRT, ACT, NCT, M, ART, and NRT, respectively. Timing of treatment intervention, either adjuvant or neoadjuvant, did not result in significant survival advantage. ACRT, NCRT, and M trended towards an improvement in survival compared to other approaches. There was a mortality HR reduction of 0.46 (CI: 0.39-0.55), 0.66 (CI: 0.53-0.84), and 0.60 (CI: 0.53-0.68) in combined modalities, when compared to CT alone and RT alone, respectively. On multivariate analysis, age older than 50 years, positive margins, higher Charlson comorbidity score, and surgery alone were significant predictors of poor outcome. Conclusion: Our analysis hints that combined modality approach leads to better survival in patients with large, high-grade sarcoma. Further studies are warranted to establish this paradigm as the standard of care.