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Received Nov 29, 2017; Accepted Mar 5, 2018
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Introduction
Soft tissue sarcoma (STS) refers to a rare and heterogeneous group of malignant tumors comprising more than 50 histologic subtypes that are derived from connective tissues and other cells of mesenchymal origin (e.g., fat, smooth or striated muscle, blood vessels, nerve sheath, subcutaneous tissue, and visceral connective tissue). Soft tissue sarcomas account for approximately 1% of all incident malignancies [1], with an estimated 23,574 new cases in Europe annually [2]. The estimated 5-year relative survival of patients with STS of any stage in Europe is 58%, and 5-year overall survival is approximately 50% [2, 3]. However, this rate is dependent on a number of factors, including the stage at diagnosis, histologic subtype, primary site, and presence of metastases [3].
An estimated 40% to 50% of patients with STS either present initially with metastatic or unresectable locally advanced disease (collectively, “advanced STS”) or present initially with a more limited extent of disease and subsequently develop advanced STS [4]. Although there are curative surgical options for early-stage STS, treatment goals for advanced STS are more limited. Chemotherapy (e.g., doxorubicin or ifosfamide, alone or in combination with each other or other agents) is most commonly used to treat patients with advanced STS [3, 5, 6]. The intent of these treatments generally is palliative rather than curative, and response rates are low (typically in the range of 10%–25%) [3].
The objective of this study was to evaluate treatment patterns and survival outcomes among patients with advanced STS not amenable to surgery or radiotherapy in real-world clinical settings in the United Kingdom (UK), Spain, Germany, and France in order to provide context for the evaluation of emerging therapies for this population.
2. Methods
2.1. Study Design
This study was a retrospective review of medical records of patients in the UK, Spain, Germany, and France treated with systemic therapy for advanced, histologically diagnosed STS (excluding Kaposi’s sarcoma and gastrointestinal stromal tumor). Physicians abstracted anonymized data from medical records directly into a web-based data collection form. The relevant national competent authorities reviewed...