Main Session
Sep
27
PQA 02 - Pediatric Cancer, Sarcoma and Cutaneous Tumors, Medical Education & Professional Development, and Health Services Research
2354 - Long-Term Outcomes for Localized Leiomyosarcoma of the Extremity and Superficial Trunk Treated with Surgery and Radiation Therapy
Presenter(s)
Jordan McDonald, MD - MD Anderson Cancer Center, Houston, TX
J. McDonald1, A. K. Yoder1, A. Farooqi1, D. Mitra1, C. L. Roland2, H. Lyu2, E. F. Nassif Haddad3, M. A. Zarzour3, B. Moon4, A. J. Bishop1, and B. A. Guadagnolo1; 1Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 2Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 3Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 4Department of Orthopedic Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
Purpose/Objective(s):
We evaluated outcomes for patients treated with combined modality local therapy (CMT) consisting of surgery and radiation therapy (RT) for localized non-cutaneous leiomyosarcoma (LMS) of the extremities or superficial trunk. We hypothesized that outcomes for LMS would be similar to other soft tissue sarcoma (STS) subtypes.Materials/Methods:
With IRB exemption, we queried our institutional database and performed a retrospective cohort review of medical records of patients treated curatively for localized LMS of the extremities or superficial trunk with CMT between 1967-2019. Survival outcomes were estimated using the Kaplan-Meier method with the log rank test for difference between curves (p < 0.05). Cox proportional hazards models were used to test for independent predictors of outcomes.Results:
109 patients met inclusion criteria with median follow up of 12.5 yrs (IQR 8.3-17.6). Median age was 57 yrs (range 17-88). Median tumor size was 5.0 cm (IQR 3.3-8.0). Tumors were located in the trunk (17, 16%), upper extremity (28, 26%), or lower extremity (64, 59%). Surgical resection margin was negative in 89 (82%) patients. Fifty-nine (54%) patients received preoperative RT (median dose: 50 Gy) and 50 (46%) postoperative RT (median dose: 60 Gy). Twenty-seven patients (25%) received either neoadjuvant or adjuvant chemotherapy as part of up-front therapy. Overall, 55 (50%) patients experienced any relapse (median time: 23 months, IQR 9-47). Ten patients (9%) experienced local recurrence (LR) and of those 8 had LR as their first or only site of relapse and 2 patients had distant metastases (DM) at the time of LR. Forty-eight (44%) patients developed DM. The local relapse free survival (LRFS) was 91% and 90% at 5 and 10 yrs, respectively. Distant metastasis-free survival (DMFS) was 65% and 57%) at 5 and 10 yrs, respectively. Disease-free survival (DFS) was 59% and 50, and disease specific survival (DSS) was 78% and 62% at 5 and 10 yrs, respectively. Positive/uncertain margins (HR: 4.94, 95% CI: 1.21-20.16) and truncal location of primary compared to lower extremity (HR 5.75, 95% CI: 1.44-22.94) were independently associated with worse LRFS. Tumor size > 5 cm (HR: 3.05, 95% CI: 1.61-5.80) was associated with DMFS. For DFS and DSS, both positive/uncertain margin status and tumor size > 5 cm were independently associated with inferior outcomes. Twenty-one (19%) patients experienced RT-related complications of any severity (mild, moderate, or severe). Six (6%) were severe (4 fractures, 1 periostitis requiring surgical stabilization, 1 necrosis) and five of which occurred in in patients treated with postoperative RT.Conclusion:
Patients treated with RT and surgery for LMS of the extremities or superficial trunk experienced long-term outcomes similar to those for other STS. RT continues to be an important component of curative local therapy for these patients. Preoperative RT remains the recommended approach.