TY - JOUR
T1 - Multimodality treatment of desmoplastic small round cell tumor
T2 - Chemotherapy and complete cytoreductive surgery improve patient survival
AU - Subbiah, Vivek
AU - Lamhamedi-Cherradi, Salah Eddine
AU - Cuglievan, Branko
AU - Menegaz, Brian A.
AU - Camacho, Pamela
AU - Huh, Winston
AU - Ramamoorthy, Vandhana
AU - Anderson, Pete M.
AU - Pollock, Raphael E.
AU - Lev, Dina C.
AU - Qiao, Wei
AU - McAleer, Mary Frances
AU - Benjamin, Robert S.
AU - Patel, Shreyaskumar
AU - Herzog, Cynthia E.
AU - Daw, Najat C.
AU - Feig, Barry W.
AU - Lazar, Alexander J.
AU - Hayes-Jordan, Andrea
AU - Ludwig, Joseph A.
N1 - Publisher Copyright:
© 2018 American Association for Cancer Research.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Purpose: Desmoplastic small round cell tumor (DSRCT), which harbors EWSR1-WT1 t(11;22)(p13:q12) chromosomal translocation, is an aggressive malignancy that typically presents as intra-abdominal sarcomatosis in young males. Given its rarity, optimal treatment has not been defined. Experimental Design: We conducted a retrospective study of 187 patients with DSRCT treated at MD Anderson Cancer Center over 2 decades. Univariate and multivariate regression analyses were performed. We determined whether chemotherapy, complete cytoreductive surgery (CCS), hyperthermic intraperitoneal cisplatin (HIPEC), and/or whole abdominal radiation (WART) improve overall survival (OS) in patients with DSRCT. Critically, because our institutional practice limits HIPEC and WART to patients with less extensive, potentially resectable disease that had benefited from neoadjuvant chemotherapy, a time-variant analysis was performed to evaluate those adjunct treatment modalities. Results: The pre-2003 5-year OS rate of 5% has substantially improved to 25% with the advent of newer chemotherapies and better surgical and radiotherapy techniques (HR, 0.47; 95% CI, 0.29-0.75). Chemotherapy response (log rank P ¼ 0.004) and CCS (log rank P < 0.0001) were associated with improved survival. Although WART and HIPEC lacked statistical significance, our study was not powered to detect their potential impact upon OS. Conclusions: Improved 3- and 5-year OS were observed following multidisciplinary treatment that includes Ewing sarcoma (ES)-based chemotherapy and complete tumor cytoreductive surgery, but few if any patients are cured. Prospective randomized studies will be required to prove whether HIPEC or WART are important. In the meantime, chemotherapy and CCS remain the cornerstone of treatment and provide a solid foundation to evaluate new biologically targeted therapies.
AB - Purpose: Desmoplastic small round cell tumor (DSRCT), which harbors EWSR1-WT1 t(11;22)(p13:q12) chromosomal translocation, is an aggressive malignancy that typically presents as intra-abdominal sarcomatosis in young males. Given its rarity, optimal treatment has not been defined. Experimental Design: We conducted a retrospective study of 187 patients with DSRCT treated at MD Anderson Cancer Center over 2 decades. Univariate and multivariate regression analyses were performed. We determined whether chemotherapy, complete cytoreductive surgery (CCS), hyperthermic intraperitoneal cisplatin (HIPEC), and/or whole abdominal radiation (WART) improve overall survival (OS) in patients with DSRCT. Critically, because our institutional practice limits HIPEC and WART to patients with less extensive, potentially resectable disease that had benefited from neoadjuvant chemotherapy, a time-variant analysis was performed to evaluate those adjunct treatment modalities. Results: The pre-2003 5-year OS rate of 5% has substantially improved to 25% with the advent of newer chemotherapies and better surgical and radiotherapy techniques (HR, 0.47; 95% CI, 0.29-0.75). Chemotherapy response (log rank P ¼ 0.004) and CCS (log rank P < 0.0001) were associated with improved survival. Although WART and HIPEC lacked statistical significance, our study was not powered to detect their potential impact upon OS. Conclusions: Improved 3- and 5-year OS were observed following multidisciplinary treatment that includes Ewing sarcoma (ES)-based chemotherapy and complete tumor cytoreductive surgery, but few if any patients are cured. Prospective randomized studies will be required to prove whether HIPEC or WART are important. In the meantime, chemotherapy and CCS remain the cornerstone of treatment and provide a solid foundation to evaluate new biologically targeted therapies.
UR - http://www.scopus.com/inward/record.url?scp=85054100509&partnerID=8YFLogxK
U2 - 10.1158/1078-0432.CCR-18-0202
DO - 10.1158/1078-0432.CCR-18-0202
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C2 - 29871905
AN - SCOPUS:85054100509
SN - 1078-0432
VL - 24
SP - 4865
EP - 4873
JO - Clinical Cancer Research
JF - Clinical Cancer Research
IS - 19
ER -