STRASS (EORTC 62092): preoperative radiotherapy plus surgery versus surgery alone for primary retroperitoneal sarcoma
Adding radiotherapy before surgery for retroperitoneal sarcoma did not improve abdominal recurrence-free survival overall, so it is no longer routine, though a possible benefit in liposarcoma keeps it under discussion.
Overview
Phase 3 trial of 266 patients with primary resectable retroperitoneal sarcoma randomised to preoperative radiotherapy (50.4 Gy) followed by surgery or surgery alone.
Median abdominal recurrence-free survival was 4.5 versus 5.0 years (hazard ratio 1.01), with more serious adverse events in the radiotherapy group; exploratory analysis suggested benefit in well-differentiated and low-grade dedifferentiated liposarcoma but not leiomyosarcoma.
- Median abdominal recurrence-free survival 4.5 vs 5.0 years; hazard ratio 1.01.
- Serious adverse events 24 percent vs 10 percent.
Surgery alone in a reference centre is the standard for primary retroperitoneal sarcoma; preoperative radiotherapy is considered case by case in liposarcoma.
- Trial did not meet its endpoint, but the liposarcoma subgroup signal remains debated.
- Surgery-alone arm had excellent outcomes at expert centres.
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