title: The role of adjuvant chemotherapy in children and adolescents with surgically resected, high-risk adult-type soft tissue sarcomas.
abstract: OBJECTIVE
  This analysis evaluates whether adjuvant chemotherapy can be recommended for high-risk, surgically-resected, adult-type non-rhabdomyosarcoma soft tissue sarcomas (NRSTS) within the new European Pediatric Soft Tissue Sarcoma Study Group (EpSSG) protocol. The Italian and German Cooperative Groups reviewed their data-bases, analyzing patients classified as group I-II, with high-grade tumor (G3) larger than 5 cm in size.
  
  
  METHODS
  The analysis included 36 patients, and compared the clinical features and outcome of the group of 21 patients who received chemotherapy versus the group of 15 patients treated with local therapies only.
  
  
  RESULTS
  For the series as a whole, 5-year event-free survival (EFS), metastasis-free survival (MFS), and overall survival (OS) were 26.2%, 34.0%, and 37.5%, respectively. In patients treated with chemotherapy, MFS and OS were 49.5% and 41.5% (median time to relapse: 13 months). In patients who did not receive chemotherapy, MFS and OS were 0% and 23.8% (median time to relapse: 3 months).
  
  
  CONCLUSIONS
  The role of adjuvant chemotherapy in NRSTS is still uncertain, however, the current retrospective analysis showed that: (1) despite the globally good prognosis of grossly-resected cases, patients with G3 and large-size have a high-risk of metastatic spread, and (2) MFS appears to be better in patients who had chemotherapy. Based in part on these results, and in accordance with recent suggestions coming from the literature on adult sarcomas, the EpSSG NRSTS protocol will recommend adjuvant chemotherapy in high-risk surgically-resected patients.
authors.affiliation: Pediatric Oncology Unit, Istituto Nazionale Tumori, Milano, Italy. andrea.ferrari@istitutotumori.mi.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferrari
authors.forename: Ines B
authors.initials: IB
authors.lastname: Brecht
authors.forename: Ewa
authors.initials: E
authors.lastname: Koscielniak
authors.forename: Michela
authors.initials: M
authors.lastname: Casanova
authors.forename: Angela
authors.initials: A
authors.lastname: Scagnellato
authors.forename: Gianni
authors.initials: G
authors.lastname: Bisogno
authors.forename: Rita
authors.initials: R
authors.lastname: Alaggio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cecchetto
authors.forename: Serena
authors.initials: S
authors.lastname: Catania
authors.forename: Cristina
authors.initials: C
authors.lastname: Meazza
authors.forename: Christoph
authors.initials: C
authors.lastname: Int-Veen
authors.forename: Sylvia
authors.initials: S
authors.lastname: Kirsch
authors.forename: Tobias
authors.initials: T
authors.lastname: Dantonello
authors.forename: Modesto
authors.initials: M
authors.lastname: Carli
authors.forename: Joern
authors.initials: J
authors.lastname: Treuner
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D012509:Sarcoma / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D015996:Survival Rate