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The first randomised trial in retroperitoneal sarcoma found that radiotherapy before surgery did not reduce recurrence in the abdomen, ending a decades-long debate for most patients.
STRASS, EORTC 62092, randomised 266 patients with primary resectable retroperitoneal sarcoma across European and North American sarcoma centres to preoperative radiotherapy followed by surgery or surgery alone. Its primary endpoint of abdominal recurrence-free survival was not improved by radiotherapy, and preoperative treatment added toxicity and delayed surgery. An unplanned subgroup analysis suggested a benefit in well-differentiated and low-grade dedifferentiated liposarcoma, which continues to be studied but did not change the primary result. Published in Lancet Oncology in 2020, it made surgery alone the standard for most retroperitoneal sarcomas and shifted attention to neoadjuvant chemotherapy (STRASS2).
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
266 enrolled.
95% CI 3.9 to not estimable; median follow-up 43.1 months · 95% CI 3.4 to not estimable
SourceHad both radiotherapy and surgery · Had surgery
SourceOne death from gastropleural fistula
Source| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Abdominal recurrence-free survival (median)primary | Preoperative radiotherapy + surgery | 133 | 4.5 years | 1.01 (0.71 to 1.44) | 0.95 | link |
| Surgery alone | 133 | 5 years | ||||
| Completed allocated treatment | Preoperative radiotherapy + surgery | 133 | 89% | - | - | link |
| Surgery alone | 133 | 96% | ||||
| Grade 3-4 lymphopenia | Preoperative radiotherapy + surgery | 127 | 77% | - | - | link |
| Surgery alone | 128 | 1% | ||||
| Grade 3-4 anaemia | Preoperative radiotherapy + surgery | 127 | 12% | - | - | link |
| Surgery alone | 128 | 8% | ||||
| Grade 3-4 hypoalbuminaemia | Preoperative radiotherapy + surgery | 127 | 12% | - | - | link |
| Surgery alone | 128 | 4% | ||||
| Serious adverse events | Preoperative radiotherapy + surgery | 127 | 24% | - | - | link |
| Surgery alone | 128 | 10% | ||||
| Treatment-related deaths | Preoperative radiotherapy + surgery | 127 | 1% | - | - | link |
| Surgery alone | 128 | 0% |
Shares Retroperitoneal sarcoma, Leiomyosarcoma, Sarcomas (soft tissue, bone, GIST) and the tag subtype-page.
Shares Liposarcoma, Leiomyosarcoma, Sarcomas (soft tissue, bone, GIST), IMRT / IGRT (modern external beam) and the tag subtype-page.
Shares EORTC, Sarcomas (soft tissue, bone, GIST) and the tag subtype-page.
Shares Retroperitoneal sarcoma, Liposarcoma, Leiomyosarcoma, Sarcomas (soft tissue, bone, GIST) and the tag subtype-page.
Shares Retroperitoneal sarcoma, Liposarcoma, Leiomyosarcoma, Sarcomas (soft tissue, bone, GIST) and the tag subtype-page.
Shares Liposarcoma, Leiomyosarcoma, Sarcomas (soft tissue, bone, GIST), IMRT / IGRT (modern external beam) and the tag subtype-page.
Shares Retroperitoneal sarcoma, Sarcomas (soft tissue, bone, GIST) and the tag subtype-page.
Shares Sarcomas (soft tissue, bone, GIST), IMRT / IGRT (modern external beam) and the tag subtype-page.