A recent analysis showed that aftercare strategies for soft-tissue sarcoma are misguided and are in need of time- and risk-adapted methods, presented at the Connective Tissue Oncology Society 2017 Annual Meeting (November 8-11, 2017; Wailea, Hawaii).
Currently, there are no consensus standard-of-care strategy for soft-tissue sarcoma aftercare. However, a recent team of researchers believe that understanding when recurrence or metastasis of disease happens is more important than understanding the risk of recurrence over a 5-year aftercare span.
Florian Posch, MD, MSc, Medical University of Graz (Australia), and colleagues conducted a study to better understand the rate of recurrence and metastasis of soft-tissue sarcoma for patients in aftercare. A total of 835 patients were included who were treated with curative intent between 1994 and 2016. Among the total patient population, liposarcoma (30%) comprised the largest percentage, followed by myxofibrosarcoma (27%) and other subtypes (40% collectively).
Over a 5.4-year follow-up period, researchers noted that there were 107 documented local recurrences and 179 distant metastases documented. The time at which these events occurred were non-consistent over the follow-up period, though both events demonstrated substantial peaks at around 12 months following surgery.
Researchers reported that grade 1 tumors had the lowest post-surgery peak for local recurrence. Grade 2 and 3 tumors had similar rates. Local recurrence rates varied based on histology, with the highest rate observed in malignant peripheral nerve sheath tumors and myxofibrosarcoma. Both of these histologies exhibited elevated rates compared with other histologies after 5 years.
As for distant metastases, occurrence was significantly more frequent in grade 3 tumors. The collective “other” subgroup of histologic tumors demonstrated the highest peak in distant metastasis, followed by malignant peripheral nerve sheath tumors and myxofibrosarcoma.
“There is not much happening after 5 years, which suggests you could safely discontinue aftercare after that” explained Dr Posch in the presentation. Results from the study should lead to a more standardized approach to aftercare for patients with soft-tissue sarcoma and special protocols for specific subsets of patients, especially within 12 months of surgery, Dr Posch noted.—Zachary Bessette