Real-World Trends and Outcomes for Localized High-Grade Soft Tissue Sarcoma: Insights from a Sarcoma Unit in...

Area of Science:

• Oncology
• Surgical Oncology
• Radiation Oncology

Background:

• Localized soft tissue sarcomas (STSs) are rare cancers requiring multimodal treatment.
• Treatment patterns for STSs have evolved, influenced by emerging evidence and technological advancements.
• Understanding temporal trends in STS treatment is crucial for optimizing patient outcomes.

Purpose of the Study:

• To evaluate temporal trends in treatment modalities for localized soft tissue sarcomas (STSs).
• To identify factors influencing relapse-free survival (RFS) and overall survival (OS) in STS patients.
• To assess the impact of changing treatment practices on patient outcomes.

Main Methods:

• Retrospective cohort study utilizing the Australian Comprehensive Cancer Outcomes and Research Database (ACCORD) and electronic health records.
• Inclusion criteria: patients aged ≥18 years with grade 3, localized STS ≥5 cm diagnosed between 2013 and 2023.
• Analysis included Kaplan-Meier and Cox proportional hazards models to assess RFS and OS, comparing two treatment periods (2013-2017 and 2018-2023).

Main Results:

• Radiation use decreased (79% vs. 64%, p=0.03) and systemic therapy use trended towards increase (8% vs. 16%, p=0.13) in the later period.
• No significant differences in median RFS (19 months) or OS (48 months) were observed between the two periods.
• Radiotherapy improved RFS (HR 0.69, p=0.04) but not OS. Systemic therapy showed no survival benefit. Age, tumor size, FDG-PET SUVmax, site, and Sarculator risk were prognostic factors.

Conclusions:

• Treatment patterns for localized STSs have evolved, but current changes have not yet translated into significant improvements in RFS or OS.
• Radiotherapy remains a significant factor for improving RFS in localized STSs.
• Further research into prognostic factors, including FDG-PET SUVmax, is warranted to refine treatment strategies.