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Observational Study
. 2018 Mar;25(3):776-783.
doi: 10.1245/s10434-017-6080-3. Epub 2017 Sep 11.

Benefit of Adjuvant Radiotherapy for Local Control, Distant Metastasis, and Survival Outcomes in Patients with Localized Soft Tissue Sarcoma: Comparative Effectiveness Analysis of an Observational Cohort Study

Florian Posch  1   2 , Richard Partl  2   3 , Carmen Döller  2   3 , Jakob M Riedl  1   2 , Maria Smolle  1   2   4 , Lukas Leitner  2   4 , Marko Bergovec  2   4 , Bernadette Liegl-Atzwanger  2   5 , Michael Stotz  1   2 , Angelika Bezan  1   2 , Armin Gerger  1   2 , Martin Pichler  1   2   6 , Karin S Kapp  2   3 , Herbert Stöger  1   2 , Andreas Leithner  2   4 , Joanna Szkandera  7   8
Affiliations
Observational Study

Benefit of Adjuvant Radiotherapy for Local Control, Distant Metastasis, and Survival Outcomes in Patients with Localized Soft Tissue Sarcoma: Comparative Effectiveness Analysis of an Observational Cohort Study

Florian Posch et al. Ann Surg Oncol. 2018 Mar.

Abstract

Background: This study aimed to quantify the benefit of adjuvant radiotherapy (AXRT) for local control, distant metastasis, and long-term survival outcomes in patients with localized soft tissue sarcoma (STS).

Methods: This single-center retrospective observational study enrolled 433 STS patients who underwent surgery with curative intent. An inverse probability of treatment-weighted (IPTW) analysis was implemented to account rigorously for imbalances in prognostic variables between the adjuvant treatment groups.

Results: During a median follow-up period of 5.5 years, the study observed 38 local recurrences (9%), 73 occurrences of distant metastasis (17%), 63 STS-related deaths (15%), and 57 deaths from other causes (13%). As expected, patients receiving AXRT (n = 258, 60%) were more likely to have high-grade G3 tumors (p < 0.0001) than patients not receiving AXRT. A crude analysis showed that AXRT was not associated with improved recurrence-free survival [hazard ratio (HR) 1.00; 95% confidence interval (CI) 0.72-1.38; p = 0.98]. However, after IPTW, AXRT was associated with a 38% relative reduction in the risk of recurrence or death (HR 0.62; 95% CI 0.39-1.00; p = 0.05). This benefit was driven by a strong reduction in the risk of local recurrence (HR 0.42; 95% CI 0.19-0.91; p = 0.03), whereas the relative risk of distant metastasis (HR 0.69; 95% CI 0.39-1.25; p = 0.22) and overall survival (HR 0.76; 95% CI 0.44-1.30; p = 0.32) were only nonsignificantly in favor of AXRT. An exploratory analysis showed an overall survival benefit of AXRT for patients with high-grade G3 tumors (HR 0.51; 95% CI 0.33-0.78; p = 0.002). However, this finding may have been attributable to residual confounding.

Conclusion: In this observational cohort, AXRT was associated with a 58% reduction in the relative risk of local recurrence. No consistent association between AXRT and lower risks of distant metastasis or death was observed.

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Figures

Fig. 1
Fig. 1
Cumulative incidence of local recurrence by adjuvant radiotherapy (AXRT) status. a Unadjusted analysis using a competing risk estimator with death from any cause as the competing event. b Inverse probability of treatment-weighted (IPTW) analysis using a competing risk estimator with death from any cause as the competing event
Fig. 2
Fig. 2
Cumulative incidence of distant metastasis by adjuvant radiotherapy (AXRT) status. a Unadjusted analysis using a competing risk estimator with death from any cause as the competing event. b Inverse probability of treatment-weighted (IPTW) analysis using a competing risk estimator with death from any cause as the competing event
Fig. 3
Fig. 3
Cumulative incidence of death from any cause by adjuvant radiotherapy (AXRT) status. a Unadjusted analysis using a 1-Kaplan–Meier estimator. b Inverse probability of treatment-weighted (IPTW) analysis using an IPTW-weighted 1-Kaplan–Meier estimator
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References

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