Does a less intensive surveillance protocol affect the survival of patients after treatment of a sarcoma of the limb?: updated results of the randomized TOSS study
2018
Aims A single-centre prospective randomized trial was conducted to
investigate whether a less intensive follow-up protocol would not
be inferior to a conventional follow-up protocol, in terms of overall
survival, in patients who have undergone surgery for sarcoma of
the limb. Initial short-term results were published in 2014. Patients and Methods The primary objective was to show non-inferiority of a chest
radiograph (CXR) group compared with a CT scan group, and of a less
frequent (six-monthly) group than a more frequent (three-monthly)
group, in two-by-two comparison. The primary outcome was overall
survival and the secondary outcome was a recurrence-free survival.
Five-year survival was compared between the CXR and CT scan groups
and between the three-monthly and six-monthly groups. Of 500 patients
who were enrolled, 476 were available for follow-up. Survival analyses
were performed on a per-protocol basis (n = 412). Results The updated results recorded 12 (2.4%) local recurrences, 182
(36.8%) metastases, and 56 (11.3%) combined (local + metastases)
recurrence at a median follow-up of 81 months (60 to 118). Of 68
local recurrences, 60 (88%) were identified by the patients themselves.
The six-monthly regime (overall survival (OS) 54%, recurrence-free
survival (RFS) 46%) did not lead to a worse survival and was not
inferior to the three-monthly regime (OS 55%, RFS 47%) in terms
of detecting recurrence. Although CT scans (OS 53%, RFS 54%) detected
pulmonary metastasis earlier, it did not lead to a better survival
compared with CXR (OS 56%, RFS 59%). Conclusion The overall survival of patients who are treated for a sarcoma
of the limb is not inferior to those followed up with a less intensive
regimen than a more intensive protocol, in terms of frequency of
visits and mode of imaging. CXR at six-monthly intervals and patient
education about examination of the site of the surgery will detect
most recurrences without deleterious effects on the eventual outcome. Cite this article: Bone Joint J 2018;100-B:262–8.
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