Synovial Sarcoma in Children, Adolescents, and Young Adults: A Report From the Children's Oncology Group ARST0332 Study
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- Rajkumar Venkatramani
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
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- Wei Xue
- Department of Biostatistics, College of Public Health and Health Professions College of Medicine, University of Florida, Gainesville, FL
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- R. Lor Randall
- UC Davis Department of Orthopedic Surgery, Sacramento, CA
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- Suzanne Wolden
- Memorial Sloan Kettering Cancer Center, New York, NY
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- James Anderson
- Merck and Co, North Wales, PA
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- Dolores Lopez-Terrada
- Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
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- Jennifer Black
- Children's Hospital Colorado, Denver, CO
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- Simon C. Kao
- Division of Pediatric Radiology, Department of Radiology, Carver College of Medicine and University of Iowa Stead Family Children's Hospital, University of Iowa, Iowa City, IA
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- Barry Shulkin
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN
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- Andrew Ostrenga
- University of Mississippi Medical Center, Jackson, MS
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- Alberto Pappo
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
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- Sheri L. Spunt
- Division of Hematology/Oncology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
抄録
<jats:sec><jats:title>PURPOSE</jats:title><jats:p> Synovial sarcoma (SS) is the second most common malignant soft tissue tumor in children. ARST0332 evaluated a risk-based treatment strategy for young patients with soft tissue sarcoma designed to limit therapy for low-risk (LR) disease and to test neoadjuvant chemoradiotherapy for unresected higher-risk disease. </jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p> Newly diagnosed patients with SS age < 30 years were assigned to four treatment arms based on disease features: A (surgery only), B (55.8 Gy radiotherapy [RT]), C (ifosfamide and doxorubicin [ID] chemotherapy plus 55.8 Gy RT), and D (neoadjuvant ID and 45 Gy RT, then surgery and RT boost based on margins followed by adjuvant ID). Patients treated in Arms A and B were considered LR, arms C and D without metastases as intermediate-risk (IR), and those with metastases as high-risk (HR). </jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p> Of the 146 patients with SS enrolled, 138 were eligible and evaluable: LR (46), IR (71), and HR (21). Tumors were 80% extremity, 70% > 5 cm, 70% high-grade, 62% invasive, 95% deep, and 15% metastatic. Treatment was on arm A (29.7%), B (3.6%), C (16.7%), and D (50%). There were no toxic deaths and four unexpected grade 4 adverse events. By risk group, at a median follow-up of 6.8 years, estimated 5-year event-free survival was LR 82%, IR 70%, and HR 8%, and overall survival was LR 98%, IR 89%, and HR 13%. After accounting for the features that defined risk category, none of the other patient or disease characteristics (age, sex, tumor site, tumor invasiveness, and depth) improved the risk stratification model. </jats:p></jats:sec><jats:sec><jats:title>CONCLUSION</jats:title><jats:p> The risk-based treatment strategy used in ARST0332 produced favorable outcomes in patients with nonmetastatic SS relative to historical controls despite using RT less frequently and at lower doses. The outcome for metastatic SS remains unsatisfactory and new therapies are urgently needed. </jats:p></jats:sec>
収録刊行物
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- Journal of Clinical Oncology
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Journal of Clinical Oncology 39 (35), 3927-3937, 2021-12-10
American Society of Clinical Oncology (ASCO)