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. 2023 Jul 1;278(1):127-134.
doi: 10.1097/SLA.0000000000005492. Epub 2022 Jul 14.

Preoperative Radiotherapy in Patients With Primary Retroperitoneal Sarcoma: EORTC-62092 Trial (STRASS) Versus Off-trial (STREXIT) Results

Dario Callegaro  1 , Chandrajit P Raut  2 , Taiwo Ajayi  3 , Dirk Strauss  4 , Sylvie Bonvalot  5 , Deanna Ng  6   7 , Eberhard Stoeckle  8 , Mark Fairweather  2 , Piotr Rutkowski  9 , Winan J van Houdt  10 , Hans Gelderblom  11 , Claudia Sangalli  12 , Andrew Hayes  4 , Charles Honoré  13 , Rebecca A Gladdy  6 , Magali Fau  7 , Rick Haas  14   15 , Dimitri Tzanis  5 , Aisha B Miah  16 , Peter Chung  17   7 , Elizabeth H Baldini  18 , Sandrine Marreaud  19 , Saskia Litiere  3 , Carol J Swallow  6 , Alessandro Gronchi  1
Affiliations

Preoperative Radiotherapy in Patients With Primary Retroperitoneal Sarcoma: EORTC-62092 Trial (STRASS) Versus Off-trial (STREXIT) Results

Dario Callegaro et al. Ann Surg. .

Abstract

Objective: The aim of the present study was to compare the effect of radiotherapy (RT) on abdominal recurrence-free survival (ARFS) in patients with primary retroperitoneal sarcoma treated in the EORTC-STBSG-62092 (STRASS) phase 3 randomized controlled trial (STRASS cohort) and off-trial (STREXIT cohort) and to pool STRASS and STREXIT data to test the hypothesis that RT improves ARFS in patients with liposarcoma.

Background: The STRASS trial did not show any difference in ARFS between patients treated with preoperative radiotherapy+surgery (RT+S) versus surgery alone (S).

Methods: All consecutive adult patients not enrolled in STRASS and underwent curative-intent surgery for a primary retroperitoneal sarcoma with or without preoperative RT between 2012 and 2017 (STRASS recruiting period) among ten STRASS-recruiting centres formed the STREXIT cohort. The effect of RT in STREXIT was explored with a propensity score (PS)-matching analysis. Primary endpoint was ARFS defined as macroscopically incomplete resection or abdominal recurrence or death of any cause, whichever occurred first.

Results: STRASS included 266 patients, STREXIT included 831 patients (727 after excluding patients who received preoperative chemotherapy, 202 after 1:1 PS-matching). The effect of RT on ARFS in STRASS and 1:1 PS-matched STREXIT cohorts, overall and in patients with liposarcoma, was similar. In the pooled cohort analysis, RT administration was associated with better ARFS in patients with liposarcoma [N=321, hazard ratio (HR), 0.61; 95% confidence interval (CI), 0.42-0.89]. In particular, patients with well-differentiated liposarcoma and G1-2 dedifferentiated liposarcoma (G1-2 DDLPS, n=266) treated with RT+S had better ARFS (HR, 0.63; 95% CI, 0.40-0.97) while patients with G3 DDLPS and leiomyosarcoma had not. At the current follow-up, there was no association between RT and overall survival or distant metastases-free survival.

Conclusions: In this study, preoperative RT was associated with better ARFS in patients with primary well-differentiated liposarcoma and G1-2 DDLPS.

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Conflict of interest statement

The authors report no conflicts of interest.

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