Game, set, match.

Top Line: No one really knows if chemo works for soft tissue sarcoma of the extremity and trunk.

The Study: While we have a pretty good idea of which sarcomas are at the highest risk for badness (read: high-grade and ≥5 cm in size), that doesn’t necessarily mean more intensive therapy changes anything. Here’s an NCDB analysis that looks at outcomes among patients with such “high-risk” sarcoma treated with neoadjuvant radiation and limb-salvage surgery between 2006-2014. Among 884 patients, roughly a quarter received chemo concurrent with radiation. On unadjusted analysis, overall survival at 5 years was 56% after neoadjuvant radiation and 72% after neoadjuvant chemoradiation. We know what you’re thinking: biased much? At least the addition of chemo remained a significant predictor of longer survival on multivariate analysis. And to top it off, there’s propensity score matching—would it really be an NCDB analysis without it? Matched cohorts (n=212 each) still showed a large discrepancy in survival at 5 years without versus with the addition of chemo to neoadjuvant radiation: 55% versus 70%, respectively. Again, chemo remained predictive of survival on multivariate analysis.

TBL: A modern randomized trial assessing the benefit of adding concurrent systemic therapy to neoadjuvant radiation for high-risk soft tissue sarcoma of the extremity and trunk is probably warranted. | Chowdhary, Cancer 2019