Download PDF
CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2021; 42(04): 339-345
DOI: 10.1055/s-0041-1731856
Original Article

Adult Soft Tissue Sarcoma: A Prospective Observational Real-World Data

Shivashankara Mathighatta Shivarudraiah
1   Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Referral Centre, New Delhi, India
,
Sundaram Viswanath
2   Department of Medical Oncology, Army Hospital Research & Referral, New Delhi, India
,
Suresh Pandalanghat
2   Department of Medical Oncology, Army Hospital Research & Referral, New Delhi, India
,
Dharmesh Soneji
2   Department of Medical Oncology, Army Hospital Research & Referral, New Delhi, India
,
Manish Kumar
2   Department of Medical Oncology, Army Hospital Research & Referral, New Delhi, India
,
Amol Patel
2   Department of Medical Oncology, Army Hospital Research & Referral, New Delhi, India
,
Bupesh Guleria
3   Department of Medical Oncology, Basavatarakam Indo-American Cancer Institute and Research Centre, India
,
Nikhil Pathi
2   Department of Medical Oncology, Army Hospital Research & Referral, New Delhi, India
,
Rahul Sud
2   Department of Medical Oncology, Army Hospital Research & Referral, New Delhi, India
,
Abhishek Pathak
2   Department of Medical Oncology, Army Hospital Research & Referral, New Delhi, India
,
Anvesh Rathore
2   Department of Medical Oncology, Army Hospital Research & Referral, New Delhi, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Introduction There is a lacuna of prospective studies on soft tissue sarcoma (STS) from the Indian subcontinent in published literature.

Objectives We conducted this study to describe the clinical profile and outcomes of STS in North India.

Materials and Methods This is a single-center, prospective, observational study conducted from October 2017 to September 2019. All consecutive patients aged ≥18 years with histopathological diagnosis of STS were enrolled. The study end points included overall response rate, progression-free survival (PFS), and overall survival (OS).

Results A total of 140 patients were included with a median duration of follow-up of 14 months (range: 1–25 months). The median age of patients was 45 years. The median duration of symptoms before diagnosis was 5 months (range: 1–18 months). The most common histopathologic subtype was undifferentiated pleomorphic STS (22%). Of 105 localized patients, 21 received neoadjuvant therapy with external beam radiotherapy and/or doxorubicin-based chemotherapy and reported partial response in 38% (8/21) of the patients; the remaining 62% (13/21) of the patients had stable disease. Neoadjuvant therapy resulted in nonsignificantly higher complete resection rates with relative risk of 2.37 (p = 0.19). Of the remaining 35 metastatic STS patients, 31 received chemotherapy and reported partial response in 39.1% (n = 9/23), stable disease in 30.4% (n = 7/23), and disease progression in 30.4% (n = 7/23) of the patients. For localized STS patients, 1-year disease-free survival (DFS) and OS rates were 87.6 ±3.5 and 95.3 ± 2.3%, respectively. The median OS for metastatic STS patients was 23.90 months (95% confidence interval [CI]: 7.43–40.36). Among metastatic STS, median OS was not reached for those who underwent curative resection versus 12.66 months (95% CI: 9.28–16.04) for those who received systemic therapy alone.

Conclusion Median age of 45 years is a decade earlier than seen in the Western population. Neoadjuvant therapy improved complete resection rates, though it was statistically nonsignificant. Curative resection among metastatic STS patients improves survival.

Keywords

survival outcomes - developing countries - epidemiology - India - real-world data - soft tissue sarcoma - STS


Publication History

Article published online:
25 November 2021

© 2021. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020; 70 (01) 7-30
    CrossrefPubMedGoogle Scholar
  • 2 Fletcher CDM, Bridge JA, Hogendoorn PC. Mertens F, eds. WHO Classification of Tumours of Soft Tissue and Bone. 4th ed. Lyon, France: IARC Publications 2013
  • 3 Albertsmeier M, Rauch A, Roeder F. et al External beam radiation therapy for resectable soft tissue sarcoma: a systematic review and meta-analysis. Ann Surg Oncol 2018; 25 (03) 754-767
    CrossrefPubMedGoogle Scholar
  • 4 Pervaiz N, Colterjohn N, Farrokhyar F, Tozer R, Figueredo A, Ghert M. A systematic meta-analysis of randomized controlled trials of adjuvant chemotherapy for localized resectable soft-tissue sarcoma. Cancer 2008; 113 (03) 573-581
    CrossrefPubMedGoogle Scholar
  • 5 Dangoor A, Seddon B, Gerrand C, Grimer R, Whelan J, Judson I. UK guidelines for the management of soft tissue sarcomas. Clin Sarcoma Res 2016; 6: 20
    CrossrefPubMedGoogle Scholar
  • 6 Ferrari A, Sultan I, Huang TT. et al Soft tissue sarcoma across the age spectrum: a population-based study from the Surveillance Epidemiology and End Results database. Pediatr Blood Cancer 2011; 57 (06) 943-949
    CrossrefPubMedGoogle Scholar
  • 7 Nandra R, Hwang N, Matharu GS, Reddy K, Grimer R. One-year mortality in patients with bone and soft tissue sarcomas as an indicator of delay in presentation. Ann R Coll Surg Engl 2015; 97 (06) 425-433
    CrossrefPubMedGoogle Scholar
  • 8 Martinez SR, Robbins AS, Meyers FJ. Bold RJ, Khatri VP, Goodnight JE Jr. Racial and ethnic differences in treatment and survival among adults with primary extremity soft-tissue sarcoma. Cancer 2008; 112 (05) 1162-1168
    CrossrefPubMedGoogle Scholar
  • 9 Bajpai J, Khanna N, Vora T. et al Analysis of bone and soft-tissue sarcomas registered during the year 2012 at Tata Memorial Hospital, Mumbai, with clinical outcomes. Indian J Cancer 2018; 55 (01) 37-44
    CrossrefPubMedGoogle Scholar
  • 10 Shukla NK, Deo SV. Soft tissue sarcoma-review of experience at a tertiary care cancer centre. Indian J Surg Oncol 2011; 2 (04) 309-312
    CrossrefPubMedGoogle Scholar
  • 11 Badanale R, Rekhi B, Jambhekar NA. et al Histopathologic review of 400 biopsies and resection specimens of trunk and extremity-based soft tissue tumors. Indian J Cancer 2017; 54 (02) 401-408
    CrossrefPubMedGoogle Scholar
  • 12 Rastogi S, Sharma A, Aggarwal A. et al Outcomes of advanced soft tissue sarcoma from dedicated medical oncology sarcoma clinic in North India and evaluation of the respective model. JCO 2018; 36 (Suppl. 15) e23561
    CrossrefGoogle Scholar
  • 13 Trojani M, Contesso G, Coindre JM. et al Soft-tissue sarcomas of adults; study of pathological prognostic variables and definition of a histopathological grading system. Int J Cancer 1984; 33 (01) 37-42
    CrossrefPubMedGoogle Scholar
  • 14 Guillou L, Coindre JM, Bonichon F. et al Comparative study of the National Cancer Institute and French Federation of Cancer Centers Sarcoma Group grading systems in a population of 410 adult patients with soft tissue sarcoma. J Clin Oncol 1997; 15 (01) 350-362
    CrossrefPubMedGoogle Scholar
  • 15 Amin MB, Edge S, Greene F. et al. eds. AJCC Cancer Staging Manual. 8th ed. Switzerland: Springer Nature 2017
  • 16 Burningham Z, Hashibe M, Spector L, Schiffman JD. The epidemiology of sarcoma. Clin Sarcoma Res 2012; 2 (01) 14
    CrossrefPubMedGoogle Scholar
  • 17 Honoré C, Méeus P, Stoeckle E, Bonvalot S. Soft tissue sarcoma in France in 2015: Epidemiology, classification and organization of clinical care. J Visc Surg 2015; 152 (04) 223-230
    CrossrefPubMedGoogle Scholar
  • 18 Chen C, Borker R, Ewing J. et al Epidemiology, treatment patterns, and outcomes of metastatic soft tissue sarcoma in a community-based oncology network. Sarcoma 2014; 145764
    PubMedGoogle Scholar
  • 19 Bansal S, Das K, Jain N. et al Retrospective analysis of spectrum of presentation and treatment outcome in extremity sarcomas: a single-centre experience. Sarcoma 2018; 2018: 4350634
    CrossrefPubMedGoogle Scholar
  • 20 Gupta A, Rao HK, Gupta S. The incidence of soft tissue sarcoma in Dakshina Kannada: study in a District Government Hospital. Indian J Surg 2009; 71 (01) 10-14
    CrossrefPubMedGoogle Scholar
  • 21 Tiwari A, Shah S, Sharma AK. et al Prognostic factors in Indian patients operated for soft tissue sarcomas-a retrospective cross-sectional analysis. Indian J Surg Oncol 2017; 8 (02) 128-135
    CrossrefPubMedGoogle Scholar
  • 22 Hui JY. Epidemiology and etiology of sarcomas. Surg Clin North Am 2016; 96 (05) 901-914
    CrossrefPubMedGoogle Scholar
  • 23 George A, Grimer R. Early symptoms of bone and soft tissue sarcomas: could they be diagnosed earlier. ? Ann R Coll Surg Engl 2012; 94 (04) 261-266
    CrossrefPubMedGoogle Scholar
  • 24 Fletcher CD, Gustafson P, Rydholm A, Willén H, Akerman M. Clinicopathologic re-evaluation of 100 malignant fibrous histiocytomas: prognostic relevance of subclassification. J Clin Oncol 2001; 19 (12) 3045-3050
    CrossrefPubMedGoogle Scholar
  • 25 Italiano A, Di Mauro I, Rapp J. et al Clinical effect of molecular methods in sarcoma diagnosis (GENSARC): a prospective, multicentre, observational study. Lancet Oncol 2016; 17 (04) 532-538
    CrossrefPubMedGoogle Scholar
  • 26 Coindre JM, Terrier P, Guillou L. et al Predictive value of grade for metastasis development in the main histologic types of adult soft tissue sarcomas: a study of 1240 patients from the French Federation of Cancer Centers Sarcoma Group. Cancer 2001; 91 (10) 1914-1926
    CrossrefPubMedGoogle Scholar
  • 27 ESMO/European Sarcoma Network Working Group. Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25 (Suppl. 03) iii102-iii112
    CrossrefPubMedGoogle Scholar
  • 28 Kraybill WG, Harris J, Spiro IJ. et al Long-term results of a phase 2 study of neoadjuvant chemotherapy and radiotherapy in the management of high-risk, high-grade, soft tissue sarcomas of the extremities and body wall: Radiation Therapy Oncology Group Trial 9514. Cancer 2010; 116 (19) 4613-4621
    CrossrefPubMedGoogle Scholar
  • 29 Kuklo TR, Temple HT, Owens BD. et al Preoperative versus postoperative radiation therapy for soft-tissue sarcomas. Am J Orthop 2005; 34 (02) 75-80
    PubMedGoogle Scholar
  • 30 Saltus CW, Calingaert B, Candrilli S. et al Epidemiology of adult soft-tissue sarcomas in Germany. Sarcoma 2018; 2018: 5671926
    CrossrefPubMedGoogle Scholar
  • 31 Savina M, Le Cesne A, Blay JY. et al Patterns of care and outcomes of patients with METAstatic soft tissue SARComa in a real-life setting: the METASARC observational study. BMC Med 2017; 15 (01) 78
    CrossrefPubMedGoogle Scholar
  • 32 van Geel AN, Pastorino U, Jauch KW. et al Surgical treatment of lung metastases: The European organization for research and treatment of cancer-soft tissue and bone sarcoma group study of 255 patients. Cancer 1996; 77 (04) 675-682
    CrossrefPubMedGoogle Scholar