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The Effect of Resection Margin on Local Recurrence and Survival in High Grade Soft Tissue Sarcoma of the Extremities: How Far Is Far Enough? Cancers (Basel) 2020; 12:cancers12092560. [PMID: 32911853 PMCID: PMC7563962 DOI: 10.3390/cancers12092560] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/30/2020] [Accepted: 09/05/2020] [Indexed: 12/20/2022] Open
Abstract
Simple Summary In soft tissue sarcomas the width of surgical margins after resection determines the extent of surgery and the function after resection. But how far is really necessary? 305 patients with deep-seated, G2/3 soft tissue sarcomas of the extremity, the trunk wall, or the pelvis were reviewed. The 5-year local recurrence-free survival (LRFS) was 82%. Overall survival (OS) at 5 years was 66%. Positive (contaminated) margins worsened LRFS and OS. A margin of >10 mm did not improve LRFS and OS as compared to one of >5 mm. A resection margin of <1 mm showed a trend but not significantly better LRFS or OS compared to a contaminated margin. In conclusion the margin should at least be free of tumor, in sound tissue. A margin of >5 mm sound tissue seems to be sufficient. Resecting more tissue does not benefit the patient. Abstract Background: The significance of surgical margins after resection of soft tissue sarcomas in respect to local-recurrence-free survival and overall survival is evaluated. Methods: A total of 305 patients with deep-seated, G2/3 soft tissue sarcomas (STS) of the extremity, the trunk wall, or the pelvis were reviewed. The margin was defined according to the Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) classification system (R0-2), the Union Internationale Contre le Cancer (UICC) classification (R + 1 mm) for which a margin <1 mm is included into the R1 group, and in groups of <1 mm, 1–5 mm, >5 mm, or >10 mm. Results: Of these patients, 31 (10.2%) had a contaminated margin, 64 (21%) a margin of <1 mm, 123 (40.3%) a margin of 1–5 mm, 47 (15.4%) a margin of >5 mm, and 40 (13.1%) a margin of >10 mm. The 5-year local recurrence-free survival (LRFS) was 81.6%. Overall survival (OS) at 5 years was 65.9%. Positive margins worsened LRFS and OS. A margin of >10 mm did not improve LRFS and OS as compared to one of >5 mm. Conclusions: A resection margin of <1 mm showed a trend but not significantly better LRFS or OS compared to a contaminated margin. This finding supports use of the UICC classification. A margin of more than 10 mm did not improve LRFS or OS.
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Mahyudin F, Edward M, Basuki MH, Basrewan Y, Hernugrahanto KD, Wahyudiputra AG. Analysis of prognostic factors in soft tissue sarcoma: Cancer registry from a single tertiary hospital in Indonesia. A retrospective cohort study. Ann Med Surg (Lond) 2020; 57:257-263. [PMID: 32884743 PMCID: PMC7453062 DOI: 10.1016/j.amsu.2020.07.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Soft tissue sarcoma is one cause of mortality in adult malignancies. This tumor is rare, persistent, and highly-recurrent. Many patients are came in late stage. It is important to identify a prognostic tool that is reliable, easily obtainable, and widely applicable. The aim of this study is to investigate and analyze the prognostic value of clinicopathological and biomarker factors in patients with soft tissue sarcoma. METHODS This retrospective study extracts data from the musculoskeletal tumor registry from January 2012 to December 2018 in a single tertiary hospital. Eighty patients with diagnosis of soft tissue sarcoma were included. Preoperative modified Glasgow Prognostic Score, Neutrophils/Lymphocytes Ratio, Hemoglobin, serum lactate dehydrogenase data were analyzed along with demographic, clinical, radiological and histopathological data. The relationship between variables on overall survival, distant metastasis, and local recurrence were evaluated using univariate and multivariate Cox regression. RESULTS On univariate analysis, there was significant relationship between hemoglobin, Neutrophils/Lymphocytes Ratio and modified Glasgow Prognostic Score with overall survival (p = 0.031, HR = 1.99; p = 0.04, HR = 1.129; and p = 0.044, HR = 3.89). A significant relationship was found between age and soft tissue sarcoma stage with distant metastasis (p = 0.046, HR = 1.95; and p = 0.00, HR = 3.22). In addition, we also found significant relationship between surgical margin with local recurrence (p = 0.018, OR = 3.44). However, on multivariate analysis the independent prognostic factor for overall survival was only modified Glasgow Prognostic Score (HR = 2.138; p = 0.011). Stage IIIA (HR = 5.32; p = 0.005) and IIIB (HR = 13.48; p = 0.00) were independent prognostic for distant metastasis. Surgical margin was independently associated with local recurrence (HR = 14.84; p = 0.001). CONCLUSION Modified Glasgow Prognostic Score can be used as prognostic tool of overall survival in soft tissue sarcoma patients. Moreover, stage of STS and surgical margin can be used as a prognostic factor for distant metastasis and local recurrence of soft tissue sarcoma respectively.
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Affiliation(s)
- Ferdiansyah Mahyudin
- Department of Orthopedics & Traumatology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Jl. Rungkut Mapan FD-2, Surabaya, East Java, Indonesia
| | - Mouli Edward
- Department of Orthopedics & Traumatology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Jl. Rungkut Mapan FD-2, Surabaya, East Java, Indonesia
| | - Muhammad Hardian Basuki
- Department of Orthopedics & Traumatology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Jl. Rungkut Mapan FD-2, Surabaya, East Java, Indonesia
| | - Yunus Basrewan
- Department of Orthopedics & Traumatology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Jl. Rungkut Mapan FD-2, Surabaya, East Java, Indonesia
| | - Kukuh Dwiputra Hernugrahanto
- Department of Orthopedics & Traumatology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Jl. Rungkut Mapan FD-2, Surabaya, East Java, Indonesia
| | - Adhinanda Gema Wahyudiputra
- Department of Orthopedics & Traumatology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Hospital, Jl. Rungkut Mapan FD-2, Surabaya, East Java, Indonesia
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Qi L, Wan L, Ren X, Zhang W, Tu C, Li Z. The Role of Chemotherapy in Extraskeletal Osteosarcoma: A Propensity Score Analysis of the Surveillance Epidemiology and End Results (SEER) Database. Med Sci Monit 2020; 26:e925107. [PMID: 32792473 PMCID: PMC7446278 DOI: 10.12659/msm.925107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/15/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Incidence of extraskeletal osteosarcoma (ESOS) is extremely low and the prognosis remains unclear. We conducted this study to explore prognostic factors and the role of chemotherapy in ESOS. MATERIAL AND METHODS We screened data from the Surveillance Epidemiology and End Results (SEER) database (1975-2016). Three hundred ten patients with ESOS were included and 49.4% (107/310) of them underwent chemotherapy. We performed logistic regression analysis to investigate potential factors determining selection of chemotherapy. An inverse probability of treatment weighting (IPTW) and propensity score matching (PSM)-adjusted Kaplan-Meier curve was created and log-rank test and Cox regression analysis were performed to compare overall survival (OS) and cancer-specific survival (CSS) in patients treated with and without chemotherapy. Subgroup analysis also was conducted based on age, tumor site, stage, size, and surgery. RESULTS Chemotherapy in ESOS was not associated with improved OS in the unmatched cohort (HR, 0.764; 95% CI, 0.555-1.051; p=0.098). The insignificant treatment effect of chemotherapy was also noted in IPTW-adjusted (HR, 0.737; 95% CI, 0.533-1.021; p=0.066) and PSM-adjusted (HR, 0.804; 95% CI, 0.552-1.172; p=0.257) Cox regression analysis. The insignificant treatment effect was consistent across all subgroups and there was no significant heterogeneity of chemotherapy effect (all p for interaction >0.05). CONCLUSIONS The study suggested that chemotherapy has no significant benefit on prognosis of patients with ESOS. These findings should be considered when making treatment decisions about patients with ESOS.
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Affiliation(s)
- Lin Qi
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, Hunan, P.R. China
| | - Lu Wan
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, Hunan, P.R. China
- Vaccine and Immunotherapy Center, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, U.S.A
| | - Xiaolei Ren
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, Hunan, P.R. China
| | - Wenchao Zhang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, Hunan, P.R. China
| | - Chao Tu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, Hunan, P.R. China
| | - Zhihong Li
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, Hunan, P.R. China
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Graham DS, Onyshchenko M, Eckardt MA, DiPardo BJ, Venigalla S, Nelson SD, Chmielowski B, Singh AS, Shabason JE, Eilber FC, Kalbasi A. Low Rates of Chemotherapy Use for Primary, High-Grade Soft Tissue Sarcoma: A National Cancer Database Analysis. J Natl Compr Canc Netw 2020; 18:1055-1065. [PMID: 32755981 DOI: 10.6004/jnccn.2020.7553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 02/19/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is conflicting evidence regarding the role of chemotherapy for high-grade soft tissue sarcoma (STS) in adults. We sought to characterize patterns of chemotherapy use, including multiagent and neoadjuvant chemotherapy, in the United States. PATIENTS AND METHODS Using the National Cancer Database, we identified 19,969 adult patients who underwent surgical resection for primary high-grade STS from 2004 to 2016. Using logistic regression, we examined factors associated with overall, multiagent, and neoadjuvant chemotherapy use. RESULTS Chemotherapy was administered to 22% (n=4,377) of the study population. Among patients treated using chemotherapy, 85% received multiagent treatment and 47% received neoadjuvant treatment. On multivariate analysis, factors associated with chemotherapy use included tumor size, depth, histology, and primary site; receipt of radiation treatment; younger age; higher patient income; and academic treatment facility. Factors associated with multiagent chemotherapy use included tumor histology, tumor primary site, and younger age. Factors associated with neoadjuvant chemotherapy use included tumor size, depth, margin status, and primary site; receipt of radiation treatment; higher patient income; academic treatment facility type; and distance to treatment facility. Treatment at a high-volume facility was the only factor associated with overall, multiagent, and neoadjuvant chemotherapy use. No significant temporal trend was seen in overall, multiagent, or neoadjuvant chemotherapy use. CONCLUSIONS Overall chemotherapy use was low (22%). The variability in chemotherapy use was driven by clinical, patient, demographic, and facility factors. Among patients treated with chemotherapy, the use of multiagent chemotherapy was high (85%), and nearly half received neoadjuvant therapy. There was a discrepancy in the use of chemotherapy-including neoadjuvant and multiagent chemotherapy-between high- and low-volume treatment centers.
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Affiliation(s)
- Danielle S Graham
- Division of Surgical Oncology, Department of Surgery, University of California, Los Angeles, Los Angeles, California
| | - Mykola Onyshchenko
- Division of Hematology-Oncology, Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Mark A Eckardt
- Division of Surgical Oncology, Department of Surgery, University of California, Los Angeles, Los Angeles, California.,Department of Surgery, Yale School of Medicine, New Haven, Connecticut.,Department of Surgery, Greater Los Angeles Veterans Health Administration, Los Angeles, California
| | - Benjamin J DiPardo
- Division of Surgical Oncology, Department of Surgery, University of California, Los Angeles, Los Angeles, California.,Department of Surgery, Greater Los Angeles Veterans Health Administration, Los Angeles, California
| | - Sriram Venigalla
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Bartosz Chmielowski
- Division of Hematology-Oncology, Department of Internal Medicine, and.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
| | - Arun S Singh
- Division of Hematology-Oncology, Department of Internal Medicine, and.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
| | - Jacob E Shabason
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Family Cancer Research Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Fritz C Eilber
- Division of Surgical Oncology, Department of Surgery, University of California, Los Angeles, Los Angeles, California.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
| | - Anusha Kalbasi
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California.,Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
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Fujiwara T, Stevenson J, Parry M, Tsuda Y, Kaneuchi Y, Jeys L. The adequacy of resection margin for non-infiltrative soft-tissue sarcomas. Eur J Surg Oncol 2020; 47:429-435. [PMID: 32723608 DOI: 10.1016/j.ejso.2020.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/04/2020] [Accepted: 06/11/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES There remains no consensus on what constitutes an adequate margin of resection for non-infiltrative soft-tissue sarcomas (STSs). We aimed to investigate the role of resection margins in millimetres for non-infiltrative STSs. METHODS 502 patients who underwent surgical resection for a localized, non-infiltrative, high-grade STSs were studied. The prognostic significance of margin width was analysed and compared with the conventional R- and R+1-classification of surgical margins. RESULTS The overall local recurrence (LR) rate was 13%; 9% and 27% with negative and positive margins, respectively (p < 0.001). In patients with negative margins, the LR rates were greater than 10% in patients with margins ≤5.0 mm but reduced to less than 4% with margins >5.0 mm. When classified by the R- (or R+1)-classification, the 5-year cumulative LR incidence was 8%, 23% (16%), and 31% for R0, R1, and R2, respectively, which did not stratify the LR risk with negative margins. On the other hand, an accurate risk stratification was possible by metric distance; the 5-year cumulative incidence of LR was 29%, 10%, and 1% with 0 mm, 0.1-5.0 mm, and >5.0 mm, respectively (p < 0.001). This classification also stratified the LR risk in patients with or without adjuvant radiotherapy. CONCLUSION While a negative margin is essential to optimize local control in patients with non-infiltrative STSs, surgical margin width greater than 5 mm minimises the risk of local failure regardless of the use of adjuvant radiotherapy.
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Affiliation(s)
- Tomohiro Fujiwara
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK; Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | | | - Michael Parry
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Yusuke Tsuda
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Yoichi Kaneuchi
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Lee Jeys
- Oncology Service, The Royal Orthopaedic Hospital, Birmingham, UK
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Chiusole B, Le Cesne A, Rastrelli M, Maruzzo M, Lorenzi M, Cappellesso R, Del Fiore P, Imbevaro S, Sbaraglia M, Terrier P, Ruggieri P, Dei Tos AP, Rossi CR, Zagonel V, Brunello A. Extraskeletal Myxoid Chondrosarcoma: Clinical and Molecular Characteristics and Outcomes of Patients Treated at Two Institutions. Front Oncol 2020; 10:828. [PMID: 32612944 PMCID: PMC7308468 DOI: 10.3389/fonc.2020.00828] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/28/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Extraskeletal myxoid chondrosarcoma (EMC) is a rare subtype of STS, which usually arises in extremities. It carries reciprocal translocations involving the NR4A3 gene. It displays an indolent behavior, but studies with long follow-up showed a high proportion of local and distant recurrences. For patients with progressing metastatic disease anthracycline-based chemotherapy is the standard front-line regimen, though has limited activity. There is some evidence on possible activity of antiangiogenetics. Methods: This is a retrospective study conducted at Istituto Oncologico Veneto and at Institut Gustave Roussy. All patients with a confirmed diagnosis of EMC from January 1980 to December 2018 were extracted from a prospectively maintained database. Results: 59 patients were identified, 37 male (62.7%) and 22 female (37.3%) with a M/F ratio of 1.7/1. We performed molecular analysis in 23 cases, all carried a EWSR1-NR4A3. Out of 49 patients treated with curative intent, 28.6% developed local recurrence and 40.8% patients developed metastases. In patients who had been radically resected (R0) local recurrence occurred in 7.6% of cases and metastases occurred in 15.4% of cases; in patients treated with R1 surgery, rates of relapse were higher. Twenty patients received chemotherapy for metastatic disease; best response was partial response with clinical benefit in 50% of patients. Fourteen patients received a second line of chemotherapy, with 46.1% disease control rate. A drug holiday was proposed to 8 patients with a mean duration of 22.8 months. Median overall survival was 180 months for the study population and 76 months for metastatic patients. No significant prognostic role was found for all studied variables, yet a trend of better survival for complete surgery, location in extremities of primary tumor and solitary lung metastases was observed. Chemotherapy for metastatic disease was negatively associated with survival. Conclusion: In this large retrospective cohort of patients with ECM, location of primary tumor and solitary lung metastases seem to be associated with better survival. Chemotherapy did not impact survival in unselected patients. Further research is necessary in order to identify more active regimens and to provide clinical and molecular factors to select patients that could delay systemic treatment for metastatic disease.
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Affiliation(s)
| | - Axel Le Cesne
- Medical Oncology, Insitut Gustave Roussy, Villejuif, Ile-de-France, France
| | - Marco Rastrelli
- Surgical Oncology, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Marco Maruzzo
- Medical Oncology 1, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Martina Lorenzi
- Medical Oncology 1, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | | | - Paolo Del Fiore
- Surgical Oncology, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Silvia Imbevaro
- Accreditation and Aknowledgment Unit, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | | | - Philippe Terrier
- Department of Biology and Medical Pathology, Institut Gustave Roussy, Villejuif, France
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Padova, Italy
| | | | - Carlo Riccardo Rossi
- Surgical Oncology, Istituto Oncologico Veneto IRCCS, Padova, Italy.,Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padova, Italy
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Intraoperative radiotherapy with low energy x-rays for primary and recurrent soft-tissue sarcomas. Radiat Oncol 2020; 15:110. [PMID: 32410696 PMCID: PMC7227262 DOI: 10.1186/s13014-020-01559-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/03/2020] [Indexed: 02/08/2023] Open
Abstract
Background Soft tissue sarcomas (STS) treatment remains a therapeutic challenge. Intraoperative radiotherapy (IORT) resembles a safe and efficient for STS treatment. The first data on electronic-IORT (eIORT) using low-energy photons is herein presented. Methods Thirty-one patients with newly and recurrent STS were retrospectively assessed. EIORT was applied with low-energy photons during surgery. The dose was either prescribed to the applicator surface (spherical applicators) or 5 mm depth (flat applicators). Overall progression-free survival (O-PFS), local progression-free survival (L-PFS), overall survival (OS) and adverse events were evaluated. Results Median follow-up was 4.88 (1.0–8.95) years. Twenty-five patients (80.6%) had recurrent STS with prior treatment. The resection status was R1 in 25.8% and R2 in 6.5%. The distribution was 51.7% for extremities, 35.5% for abdomen and pelvis, 9.7% for thorax and 3.2% for head and neck tumors. The median O-PFS was 11.0 months, with 42.6% 5-year estimated O-PFS. The only local recurrence in the primary setting occurred after 22 months. Median L-PFS in recurrent STS was 12.5 months, with 65.5% 5-year estimated L-PFS. The 5-year OS estimated rate was 94.7% (3 events after 7 years). No G3 toxicity related to eIORT was observed. Two patients exhibited G2 acute neuropathic pain. Late neuropathic pain was seen in 6 patients being 3 graded as G1 and 3 as G2. No wound-related toxicity was found. Conclusion Electronic IORT with low-energy photons is a safe treatment option for STS, yielding similar outcomes as historical series reporting IORT with electrons or HDR brachytherapy.
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Fujiwara T, Stevenson J, Parry M, Tsuda Y, Tsoi K, Jeys L. What is an adequate margin for infiltrative soft-tissue sarcomas? Eur J Surg Oncol 2020; 46:277-281. [DOI: 10.1016/j.ejso.2019.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/24/2019] [Accepted: 10/05/2019] [Indexed: 01/18/2023] Open
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Smolle MA, van de Sande M, Callegaro D, Wunder J, Hayes A, Leitner L, Bergovec M, Tunn PU, van Praag V, Fiocco M, Panotopoulos J, Willegger M, Windhager R, Dijkstra SPD, van Houdt WJ, Riedl JM, Stotz M, Gerger A, Pichler M, Stöger H, Liegl-Atzwanger B, Smolle J, Andreou D, Leithner A, Gronchi A, Haas RL, Szkandera J. Individualizing Follow-Up Strategies in High-Grade Soft Tissue Sarcoma with Flexible Parametric Competing Risk Regression Models. Cancers (Basel) 2019; 12:cancers12010047. [PMID: 31877801 PMCID: PMC7017264 DOI: 10.3390/cancers12010047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 12/15/2019] [Accepted: 12/19/2019] [Indexed: 12/13/2022] Open
Abstract
Currently, patients with extremity soft tissue sarcoma (eSTS) who have undergone curative resection are followed up by a heuristic approach, not covering individual patient risks. The aim of this study was to develop two flexible parametric competing risk regression models (FPCRRMs) for local recurrence (LR) and distant metastasis (DM), aiming at providing guidance on how to individually follow-up patients. Three thousand sixteen patients (1931 test, 1085 validation cohort) with high-grade eSTS were included in this retrospective, multicenter study. Histology (9 categories), grading (time-varying covariate), gender, age, tumor size, margins, (neo)adjuvant radiotherapy (RTX), and neoadjuvant chemotherapy (CTX) were used in the FPCRRMs and performance tested with Harrell-C-index. Median follow-up was 50 months (interquartile range: 23.3–95 months). Two hundred forty-two (12.5%) and 603 (31.2%) of test cohort patients developed LR and DM. Factors significantly associated with LR were gender, size, histology, neo- and adjuvant RTX, and margins. Parameters associated with DM were margins, grading, gender, size, histology, and neoadjuvant RTX. C-statistics was computed for internal (C-index for LR: 0.705, for DM: 0.723) and external cohort (C-index for LR: 0.683, for DM: 0.772). Depending on clinical, pathological, and patient-related parameters, LR- and DM-risks vary. With the present model, implemented in the updated Personalised Sarcoma Care (PERSARC)-app, more individualized prediction of LR/DM-risks is made possible.
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Affiliation(s)
- Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Michiel van de Sande
- Department of Orthopaedic Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Jay Wunder
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, ON M5G IX5, Canada
| | - Andrew Hayes
- Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Marko Bergovec
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Per-Ulf Tunn
- Sarcoma Centre, HELIOS-Klinikum Berlin-Buch, 13125 Berlin, Germany
| | - Veroniek van Praag
- Department of Orthopaedic Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Marta Fiocco
- Institute of Mathematics, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Medical Statistics, Department of Biomedical Data Science, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Trial and Data Center, 3584 CT Utrecht, The Netherlands
| | - Joannis Panotopoulos
- Department of Orthopaedics and Traumatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Madeleine Willegger
- Department of Orthopaedics and Traumatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedics and Traumatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Sander P. D. Dijkstra
- Department of Orthopaedic Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Winan J. van Houdt
- Department of Surgery, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Jakob M. Riedl
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Michael Stotz
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Armin Gerger
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Martin Pichler
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Herbert Stöger
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | | | - Josef Smolle
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria
| | | | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Rick L. Haas
- Department of Radiotherapy, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Department of Radiotherapy, The Netherlands Cancer Institute Amsterdam, 1066 CX Amsterdam, The Netherlands
- Correspondence: (R.L.H.); (J.S.); Tel.: +31-20-5122135 (R.L.H.); +43-316-385-13115 (J.S.)
| | - Joanna Szkandera
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
- Correspondence: (R.L.H.); (J.S.); Tel.: +31-20-5122135 (R.L.H.); +43-316-385-13115 (J.S.)
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Early Lymph Node Metastasis May Predict Poor Prognosis in Soft Tissue Sarcoma. Int J Surg Oncol 2019; 2019:6708474. [PMID: 31915549 PMCID: PMC6930751 DOI: 10.1155/2019/6708474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 09/19/2019] [Accepted: 10/25/2019] [Indexed: 11/25/2022] Open
Abstract
Background Lymph node metastasis (LNM) is a relatively rare event in soft tissue sarcoma. An association between the timing of LNM detection and patient prognosis is presently unknown. Patients and Methods We retrospectively analyzed the clinicopathological features of 33 patients with LNM between 2001 and 2015. Analysis of the timing of LNM diagnosis was grouped according to patients presenting LNM in either <8 months (the median time from primary tumor diagnosis to LNM) or ≥8 months after primary tumor diagnosis. Results A relationship between the primary tumor size and the timing of the LNM was not significantly found (Rs = 0.0088, p=0.96). Sixteen patients had an LNM detection duration of <8 months, and 17 patients had a duration of ≥8 months. The 5-year survival for patients with an LNM detection duration of <8 months and ≥8 months was 19% and 71%, respectively (p=0.0016). There were 19 patients with pulmonary metastases. Among them, there were 13 patients with a duration of primary tumor diagnosis to LNM of <8 months and 6 with a duration of ≥8 months (p=0.01). Conclusion Early LNM (<8 months) may predict poor prognosis in soft tissue sarcoma.
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Zheng K, Yu XC, Xu M, Yang Y. Surgical Outcomes and Prognostic Factors of Myxoid Liposarcoma in Extremities: A Retrospective Study. Orthop Surg 2019; 11:1020-1028. [PMID: 31721459 PMCID: PMC6904597 DOI: 10.1111/os.12566] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/08/2019] [Indexed: 11/29/2022] Open
Abstract
Objectives To evaluate treatments and prognostic factors for the myxoid liposarcoma in extremities. Methods We retrospectively reviewed 34 patients histologically diagnosed with myxoid liposarcoma arising in the extremities, treated in our hospital from 2010 to 2017. We recorded tumor locations, max diameter, operations, complications, radiation, chemotherapy, survival, recrudescence, and metastases. Overall survival, treatments, and prognostic factors were subsequently analyzed. Results The mean age of 34 patients with myxoid liposarcoma in extremities was 49.1 years, and the mean follow‐up period was 65.1 months. The median survival time was 190 months. Five of 14 patients accepted recrudescence resection and two patients of 20 patients who underwent primary tumor resection or unplanned operation died of tumor progression. Although no statistical difference was found (X2 = 3.331, P = 0.068), the lower mortality was confirmed in the patients who accepted primary tumor resection or unplanned operation. Eleven patients with a tumor diameter of 8.6 ± 4.7 cm accepted wide resection, while 23 patients with 17.2 ± 8.8 cm tumors accepted marginal resection. Statistical difference was found between the size of tumors with relatively wide resection and those with relatively marginal resection (F = 9.130, P = 0.005). No recurrence or metastasis occurred in patients who accepted wide resection, while 14 patients presented with local recurrence and 8 patients developed distant metastases among the 23 patients with marginal resection. Seven patients died of metastases, while one patient lived with metastases. No significant difference in survival was found between different surgical methods (X2 = 0.9460, P = 0.3307). The average diameter of eight patients with distant metastases was 21.7 cm, which was considerable larger than the 12.1 cm of patients without metastasis. This difference was proven significant upon the statistical analysis (F = 9.412, P = 0.004). Conclusions Wide resection achieved good local control but was not unambiguously superior in long‐term survival. Myxoid liposarcoma tumors with larger diameters were more difficult to be submitted to wide resection and were more likely to present with distant metastasis.
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Affiliation(s)
- Kai Zheng
- Department of Orthopaedics, The 960th Hospital of the PLA Joint Logistice Support Force, Jinan, China
| | - Xiu-Chun Yu
- Department of Orthopaedics, The 960th Hospital of the PLA Joint Logistice Support Force, Jinan, China
| | - Ming Xu
- Department of Orthopaedics, The 960th Hospital of the PLA Joint Logistice Support Force, Jinan, China
| | - Yang Yang
- Department of Orthopaedics, The 960th Hospital of the PLA Joint Logistice Support Force, Jinan, China
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The Outcome of Patients With Localized Undifferentiated Pleomorphic Sarcoma of the Lower Extremity Treated at Stanford University. Am J Clin Oncol 2019; 42:166-171. [PMID: 30557163 DOI: 10.1097/coc.0000000000000496] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND As a diagnosis of exclusion, Undifferentiated Pleomorphic Sarcoma (UPS) has unclear clinical characteristics. The objective of this retrospective cohort study is to investigate which clinical and prognostic factors of primary lower-extremity UPS will determine failure. METHODS We retrospectively reviewed 55 primary lower-extremity UPS cases treated at Stanford between 1998 and 2015. Overall Survival (OS) and Disease-Free Survival (DFS) curves were calculated. Univariate Fisher's Exact Tests were used to examine relationships between disease recurrence, treatment, patient factors, tumor characteristics, and surgical margins. RESULTS 5-year DFS and OS rates were 60% (95% CI, 45%-72%) and 68% (95% CI, 53%-79%), respectively. The 5-year DFS rate for patients with positive margins was 33.3% (95% CI, 5%-68%) compared with 63% (95% CI, 47%-76%) for patients with negative margins. (Log-rank, P=0.03). The OS rate for those with disease recurrence was 42% % (95% CI, 16%-67%) compared with 76% (95% CI, 59%-87%) for patients who did not have disease recurrence (log-rank, P=0.021). Local failure occurred more frequently with omission of radiation therapy (Fisher's exact test, P=0.009). CONCLUSIONS Positive surgical margins are an important prognostic factor for predicting relapse in UPS. Relapse of any kind led to worse OS. Radiation therapy improved local control of disease but had no statistically significant effect on DFS, highlighting the need for improved diagnostics to identify those at highest risk for hematogenous metastasis and for selection of patients for adjuvant systemic treatment.
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Rath B, Hardes J, Tingart M, Braunschweig T, Eschweiler J, Migliorini F. [Resection margins in soft tissue sarcomas]. DER ORTHOPADE 2019; 48:768-775. [PMID: 31463543 DOI: 10.1007/s00132-019-03795-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Soft tissue sarcomas (STS) are a rare and heterogeneous group of malignant tumors that arise from the mesenchymal tissue. STS can form anywhere in the human body, with the extremities being preferred sites of predilection. TREATMENT A fundamental pillar of treatment is the surgical resection of soft tissue sarcomas. The goal is always an R0 resection with a safety margin. There is no consensus in the literature about the desired tumor-free resection margin. The decisive factors for these resection margins are histopathology, presence of anatomical barriers (capsule, tendon, fascia, cartilage, periosteum) and possibilities of (neo-) adjuvant therapy. DISCUSSION References in the literature support the role of resection margins as a predictor of local recurrence. Regarding the role of resection margins in overall survival, available data is divergent. There are known prognostic factors that influence overall survival, such as histological subtype, tumor size, tumor grading, and presence of metastases. So far, several studies have attempted to quantify the margins of resection, but no consensus has been reached, and debates are ongoing. When analyzing all the results of the data in the literature, it seems appropriate to aim for a negative resection margin >1 mm including an anatomical border structure, if possible.
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Affiliation(s)
- B Rath
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - J Hardes
- Abteilung für Tumororthopädie und Sarkomchirurgie, Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Essen, Deutschland
| | - M Tingart
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - T Braunschweig
- Institut für Pathologie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - J Eschweiler
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - F Migliorini
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
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Vos M, Boeve WC, van Ginhoven TM, Sleijfer S, Verhoef C, Grünhagen DJ. Impact of primary tumor location on outcome of liposarcoma patients, a retrospective cohort study. Eur J Surg Oncol 2019; 45:2437-2442. [PMID: 31493984 DOI: 10.1016/j.ejso.2019.08.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/15/2019] [Accepted: 08/30/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Tumor location as a prognostic factor for patients with liposarcoma (LPS) has been studied modestly with varying outcomes. The aim was to establish the impact of tumor location on recurrence and survival of LPS patients. METHODS A retrospective database of patients treated for LPS until December 2017 was used to assess 5-year local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS) and disease-specific survival (DSS) per tumor location using the Kaplan-Meier method and log-rank test. A multivariable Cox regression analysis was performed to adjust for other prognostic factors. RESULTS In total, 518 patients were identified with a median follow-up of 68 months (interquartile range 31-138). Patients with retroperitoneal/intrathoracic WDLPS or DDLPS (p = 0.014), or testicular WDLPS (p = 0.026) developed a local recurrence more often than patients with other tumor locations. No differences between LPS subtypes and tumor location in the development of metastases (p = 0.600) was observed. Five-year LRFS differed significantly between tumor locations (p < 0.001) as well as 5y-DSS (p < 0.001), but 5y-DMFS did not (p = 0.241), with retroperitoneal/intrathoracic LPS having a worse prognosis. Patients with WDLPS in the extremity, trunk or testicular region did not die of disease, except for the rare occasion of dedifferentiation upon recurrence. After adjustment for other prognostic factors, tumor location was only of prognostic value for DSS (retroperitoneal/intrathoracic vs. extremity: HR 5.08, 95% CI 2.41-10.71, p < 0.001). CONCLUSION For all tumor locations, DSS mimicked DMFS except for retroperitoneal/intrathoracic LPS, where DSS mimicked LRFS and where DSS was worse than DMFS. This implies that these patients die of local disease instead of metastatic disease.
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Affiliation(s)
- M Vos
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015, GD Rotterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015, GD Rotterdam, the Netherlands.
| | - W C Boeve
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015, GD Rotterdam, the Netherlands.
| | - T M van Ginhoven
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015, GD Rotterdam, the Netherlands.
| | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015, GD Rotterdam, the Netherlands.
| | - C Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015, GD Rotterdam, the Netherlands.
| | - D J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015, GD Rotterdam, the Netherlands.
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Barbieri A, Bimonte S, Loquercio G, Rea D, Cascella M, Anniciello A, Luciano A, Palma G, Di Costanzo G, Rosa A, Giuliano P, Arra C. The effects of the use of platelet-rich plasma gel on local recurrence in an animal model of human fibrosarcoma. Infect Agent Cancer 2019; 14:21. [PMID: 31467590 PMCID: PMC6712678 DOI: 10.1186/s13027-019-0237-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/21/2019] [Indexed: 12/30/2022] Open
Abstract
Background Platelet-rich-plasma (PRP) is largely used, thanks to its properties, as wound therapy after surgical resection. Several studies and clinical findings have demonstrated that the PRP can accelerate the regeneration and the repair of tissues through the action of the platelet-derived growth factors. Material and methods Our study aimed to investigate the effects of PRP-gel on the rate of tumor relapse by using a mouse model of Human Fibrosarcoma (HF). The radical resection of tumors of mice was conducted under fluorescence-guidance (FGR) by using MacroFluo microscope, after a primary tumor removal with bright-light surgery (BLS). Results It was found that the lesion recurrence and the tumor growth were reduced in mice treated with PRP observed in each group of treatment (50%) after 30 days from tumor excision, respect to controls (without statistical significance; p = 0.12). The histopathological and immune-histochemical analysis did not report differences in cellular morphology between the tumors of control and PRP-treated mice. Conclusion Our data suggest that PRP-gel, used as an adjuvant treatment for the stimulation of tissue repair and speed up recovery, can impair tumor growth and slow the tumor.
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Affiliation(s)
- Antonio Barbieri
- 1Animal Facility, Istituto Nazionale Tumori -IRCCS - Fondazione "G. Pascale", "Fondazione G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Sabrina Bimonte
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - "Fondazione G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Giovanna Loquercio
- 3S.S.D. Virology and Molecular Biology, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Via Mariano Semmola, 80131 , Naples, Italy
| | - Domenica Rea
- 1Animal Facility, Istituto Nazionale Tumori -IRCCS - Fondazione "G. Pascale", "Fondazione G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori - IRCCS - "Fondazione G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Annamaria Anniciello
- 4Division of Pathology, Istituto Nazionale Tumori - IRCCS - Fondazione "G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Antonio Luciano
- 1Animal Facility, Istituto Nazionale Tumori -IRCCS - Fondazione "G. Pascale", "Fondazione G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Giuseppe Palma
- 1Animal Facility, Istituto Nazionale Tumori -IRCCS - Fondazione "G. Pascale", "Fondazione G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
| | - Gaetano Di Costanzo
- 5SSD Medicina Trasfusionale, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Azzaro Rosa
- 5SSD Medicina Trasfusionale, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale, Naples, Italy
| | - Pasquale Giuliano
- Cirugía Plástica, Estética y Reparadora, Hospital Quironsalud Valencia, Valencia, Spain
| | - Claudio Arra
- 1Animal Facility, Istituto Nazionale Tumori -IRCCS - Fondazione "G. Pascale", "Fondazione G. Pascale", Via Mariano Semmola, 80131 Naples, Italy
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Decanter G, Stoeckle E, Honore C, Meeus P, Mattei JC, Dubray-Longeras P, Ferron G, Carrere S, Causeret S, Guilloit JM, Fau M, Rosset P, Machiavello JC, Delhorme JB, Regenet N, Gouin F, Blay JY, Coindre JM, Penel N, Bonvalot S. Watch and Wait Approach for Re-excision After Unplanned Yet Macroscopically Complete Excision of Extremity and Superficial Truncal Soft Tissue Sarcoma is Safe and Does Not Affect Metastatic Risk or Amputation Rate. Ann Surg Oncol 2019; 26:3526-3534. [DOI: 10.1245/s10434-019-07494-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Indexed: 01/07/2023]
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Abstract
OBJECTIVES Myxofibrosarcoma (MFS) is reported to have a higher risk of local recurrence (LR) following definitive surgical excision relative to other soft tissue sarcomas. We reviewed our clinical experience treating MFS to investigate predictors of LR. MATERIALS AND METHODS We retrospectively reviewed treatment outcomes for MFS patients treated at our institution between 1999 and 2015. A total of 52 patients were identified. Median age was 65 years (range, 21 to 86 y). Site of disease was: upper extremity (27%), lower extremity (46%), trunk (15%), pelvic (8%), and head and neck (4%). Patients had low, intermediate, high-grade, and unknown grade in: 23%, 8%, 67%, and 2% of tumors, respectively. Tumors were categorized as ≤5 cm (35%), >5 cm (56%), or unknown size (9%). In total, 71% received radiotherapy: 19% preoperative, 50% postoperative, and 2% both. All patients underwent surgery. Margins were negative in 71%, close/positive in 21%, and unknown in 8%. In total, 27% of patients received chemotherapy. Univariate Cox regression analysis was utilized to determine associations between clinical and treatment factors with LR. RESULTS Median follow-up time was 2.9 years (range, 0.4 to 14.3 y). The 3-year actuarial LR, distant metastasis, and overall survival were: 31%, 15%, and 87%, respectively. Predictors of LR were patient age greater than or equal to the median of 65 years (hazard ratio, 13.46, 95% confidence interval, 1.71-106.18, P=0.013), and having close/positive tumor margins (hazard ratio, 3.4, 95% confidence interval, 1-11.53, P=0.049). CONCLUSIONS In this institutional series of MFS older age and positive/close margins were significantly associated with a higher risk of LR.
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Gannon NP, King DM, Ethun CG, Charlson J, Tran TB, Poultsides G, Grignol V, Howard JH, Tseng J, Roggin KK, Votanopoulos K, Krasnick B, Fields RC, Cardona K, Bedi M. The role of radiation therapy and margin width in localized soft-tissue sarcoma: Analysis from the US Sarcoma Collaborative. J Surg Oncol 2019; 120:325-331. [PMID: 31172531 DOI: 10.1002/jso.25522] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/12/2019] [Accepted: 05/13/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND OBJECTIVES Soft-tissue sarcomas (STSs) are often treated with resection and radiation (RT)±chemotherapy. The role of RT in decreasing resection width to achieve local control is unclear. We evaluated RT on margin width to achieve local control and local recurrence (LR). METHODS From 2000 to 2016, 514 patients with localized STS were identified from the US Sarcoma Collaborative database. Patients were stratified by a margin and local control was compared amongst treatment groups. RESULTS LR was 9% with positive, 4.2% with ≤1 mm, and 9.3% with >1 mm margins (P = .315). In the ≤1 mm group, LR was 5.7% without RT, 0% with preoperative RT, and 0% with postoperative RT (P < .0001). In the >1 mm group, LR was 10.2%, 0%, and 3.7% in the no preoperative and postoperative RT groups, respectively (P = .005). RT did not influence LR in patients with positive margins. In stage I-III and II-III patients, local recurrence-free survival was higher following RT (P = .008 and P = .05, respectively). CONCLUSIONS RT may play a larger role in minimizing LR than margin status. In patients with positive margins, RT may decrease LR to similar rates as a negative margin without RT and may be considered to decrease the risk of LR with anticipated close/positive margins.
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Affiliation(s)
- Nicholas P Gannon
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David M King
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Cecilia G Ethun
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - John Charlson
- Division of Hematology and Oncology, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Thuy B Tran
- Department of Surgery, Stanford University, Palo Alto, California
| | | | - Valerie Grignol
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio
| | - J Harrison Howard
- Division of Surgical Oncology, Department of Surgery, University of South Alabama, Mobile, Alabama
| | - Jennifer Tseng
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Kevin K Roggin
- Department of Surgery, University of Chicago, Chicago, Illinois
| | | | - Bradley Krasnick
- Department of Surgery, Washington University, St. Louis, Missouri
| | - Ryan C Fields
- Department of Surgery, Washington University, St. Louis, Missouri
| | - Kenneth Cardona
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Meena Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Abstract
OPINION STATEMENT The proper diagnosis and treatment planning for subcutaneous soft tissue sarcoma is very important. Soft tissue tumors can occur anywhere in the body, but if they occur subcutaneously, patients can easily notice a subcutaneous soft tissue mass. Therefore, it is possible to determine through recording, the growth speed of the mass, which is often difficult to obtain with deep-situated soft tissue masses. Palpation can also provide information about the firmness and mobility of the mass. Thus, history taking and physical examinations are informative for subcutaneous soft tissue tumors, compared to tumors that occur deeply. Because subcutaneous soft tissue tumors are easily recognized, they are often resected, without sufficient imaging analyses or thorough treatment planning. An operation performed based on such an inadequate preoperative plan is called a "whoops surgery." In the case of "whoops surgeries," subsequent radical surgery is required to remove additional areas, including hematomas that result from the initial surgery, that require a wider range of resection and soft tissue reconstruction. Therefore, as with deep-seated soft tissue tumors, it is important to conduct careful imaging examinations and make appropriate preoperative plans for subcutaneous soft tissue tumors. Subcutaneous soft tissue sarcomas often show an invasive pattern, and such tumors require a more careful assessment to prevent local recurrence after surgery. During surgery, it is necessary to remove the entire infiltration area along the fascia. Sometimes, an adequately wide excision is necessary, which is considered the minimum necessary procedure to eradicate the lesion. As noted above, clinicians who see patients with subcutaneous soft tissue tumors are encouraged to have sufficient knowledge and experience regarding the diagnosis and treatment. This article is intended for all doctors who deal with subcutaneous soft tissue tumors and focuses on essential points regarding their diagnosis and management.
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71
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Kim Y, Kim HS, Cho HS, Han I. Changing odds of survival over time among patients undergoing surgical resection of extremity soft tissue sarcoma. J Surg Oncol 2019; 120:193-199. [PMID: 31042013 DOI: 10.1002/jso.25487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/16/2019] [Accepted: 04/13/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND While survival after surgical treatment of extremity soft tissue sarcoma (STS) is traditionally reported as actuarial survival, conditional survival (CS) may be more clinically relevant as it accounts for time already survived. We compared actuarial survival and CS of STS patients. MATERIALS AND METHODS We analyzed 567 patients who underwent surgery for localized extremity STS. Actuarial survival was estimated using the Kaplan-Meier method. Cox proportional hazards model was used to evaluate factors associated with disease-specific survival. Five-year CS (CS5) estimates at "χ" year(s) after surgery were calculated as CS5 = S(χ + 5)/S(χ). RESULTS Whereas actuarial survival decreased over time, CS5 increased. The postsurgical 1-, 3-, and 5-year CS5 values were 84.5%, 90.0%, and 93.8%, respectively, whereas the 6-, 8-, and 10-year actuarial survival rates were 82.0%, 79.4%, and 78.5%, respectively. The calculated CS5 exceeded actuarial survival especially in patients with risk factors such as large tumor size and Federation Nationale des Centers de Lutte Contre le Cancer (FNCLCC) grades 2 and 3 tumors. Patients with tumor size ≥5 cm had an actuarial survival of 73.9% at 10 years compared to a CS5 of 95.4% in patients alive at 5 years. Likewise, patients with FNCLCC grade 3 tumors had an actuarial survival of 71.1% at 10 years compared to a CS5 of 96.0% in patients alive at 5 years. CONCLUSIONS Survival estimation by determination of CS can be dynamic and accurate especially in high-risk patients. CS can be useful for survival prediction and clinical decision making in extremity STS patients.
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Affiliation(s)
- Yongsung Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Han-Soo Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hwan Seong Cho
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ilkyu Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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De Angelis F, Guy F, Bertaut A, Méjean N, Varbedian O, Hervieu A, Truc G, Thibouw D, Barra CC, Fraisse J, Burnier P, Isambert N, Causeret S. Limbs and trunk soft tissue sarcoma systematic local and remote monitoring by MRI and thoraco-abdomino-pelvic scanner: A single-centre retrospective study. Eur J Surg Oncol 2019; 45:1274-1280. [PMID: 30765271 DOI: 10.1016/j.ejso.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/25/2019] [Accepted: 02/02/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Soft tissue sarcomas (STS) are rare malignant tumors that require management by an expert center. Monitoring modalities are not consensual. The objective of our study is to report systematic radiological monitoring data obtained by local MRI and by thoracic-abdominal-pelvic computed tomography (TAP CT). MATERIAL AND METHODS 113 consecutive patients managed at "Centre Georges François Leclerc, Dijon", between 2008 and 2016, for an initially localized STS were included. Patient follow-up consisted of a local MRI and a TAP CT. Follow-up exams schedule was initially every 4 months during 2 years, followed by every 6 months during 3 years and finally every year during 5 years. RESULTS Median follow-up time was 37.2 months [min = 2.4 - max = 111.6]. After 5 years of surveillance, local recurrence (LR) rate was 8.8% and diagnosed by imaging in 60% of cases. No deep LR was clinically found. Median LR diagnosis time was 23.9 months [min = 2.0 - max = 52.4]. 50% of patients locally treated for their LR were alive without recurrence. Metastatic recurrence (MR) rate was 31%. 42.8% had extra-pulmonary involvement and 17.1% had exclusive extrathoracic metastases. The median time to diagnosis of MR was 17.4 months [min = 2.7- max = 77.2]. High-grade tumors relapsed more (20.4%) and earlier (all before the 5th year) than low grade. CONCLUSION Local MRI seems particularly suitable for monitoring deep tumors. In addition, the systematic monitoring by TAP CT highlighted a limited number of cases of exclusive extrathoracic metastases. The schedule of local and remote monitoring should primarily be adjusted to tumor grade.
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Affiliation(s)
- Floriane De Angelis
- Department of Radiology, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France; Department of Radiology, Centre Hospitalier Universitaire, 14 rue Paul Gaffarel, 21000, Dijon, France.
| | - France Guy
- Department of Radiology, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Aurélie Bertaut
- Department of Statistic, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Nathalie Méjean
- Department of Radiology, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Olivier Varbedian
- Department of Radiology, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Alice Hervieu
- Department of Oncology, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Gilles Truc
- Department of Radiotherapy, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - David Thibouw
- Department of Radiotherapy, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Céline Charon Barra
- Department of Anatomopathology, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Jean Fraisse
- Department of Surgery, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Pierre Burnier
- Department of Surgery, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Nicolas Isambert
- Department of Oncology, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Sylvain Causeret
- Department of Surgery, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
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Ezuddin NS, Pretell-Mazzini J, Yechieli RL, Kerr DA, Wilky BA, Subhawong TK. Local recurrence of soft-tissue sarcoma: issues in imaging surveillance strategy. Skeletal Radiol 2018; 47:1595-1606. [PMID: 29785452 DOI: 10.1007/s00256-018-2965-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/16/2018] [Accepted: 04/30/2018] [Indexed: 02/02/2023]
Abstract
Soft-tissue sarcomas pose diagnostic and therapeutic challenges to physicians, owing to the large number of subtypes, aggressive tumor biology, lack of consensus on management, and controversy surrounding interval and duration of surveillance scans. Advances in multidisciplinary management have improved the care of sarcoma patients, but controversy remains regarding strategies for surveillance following definitive local control. This review provides an updated, comprehensive overview of the current understanding of the risk of local recurrence of soft-tissue sarcoma, by examining the literature based on features such as histological type and grade, tumor size, and resection margin status, with the aim of helping clinicians, surgeons, and radiologists to develop a tailored approach to local imaging surveillance.
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Affiliation(s)
- Nisreen S Ezuddin
- Department of Radiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Avenue, JMH WW 279, Miami, FL, 33136, USA
| | - Juan Pretell-Mazzini
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Raphael L Yechieli
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Darcy A Kerr
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Breelyn A Wilky
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Ty K Subhawong
- Department of Radiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Avenue, JMH WW 279, Miami, FL, 33136, USA.
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Abaricia S, Hirbe AC. Diagnosis and Treatment of Myxoid Liposarcomas: Histology Matters. Curr Treat Options Oncol 2018; 19:64. [DOI: 10.1007/s11864-018-0590-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Åhlén J, Karlsson F, Wejde J, Nilsson IL, Larsson C, Bränström R. Wide Surgical Margin Improves the Outcome for Patients with Gastrointestinal Stromal Tumors (GISTs). World J Surg 2018; 42:2512-2521. [PMID: 29435627 PMCID: PMC6060789 DOI: 10.1007/s00268-018-4498-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Surgical resection is still the main treatment for gastrointestinal stromal tumor (GIST), and R0 excision, regardless of surgical margins, is considered sufficient. Methods A cohort of 79 consecutive GIST cases treated at the Karolinska University Hospital, who were without metastasis at diagnosis and who had not received any pre-or postoperative treatment with tyrosine kinase inhibitors, was included. Surgical margins were evaluated at the time of surgery and classified as wide, marginal or intralesional. Time to local/peritoneal recurrence, distant metastasis, and survival were recorded. Cox regression analysis was used to investigate the association between surgical margin, and recurrence and survival. Results Local/peritoneal recurrence was diagnosed in 2/39 cases with wide margins, in 7/22 cases with marginal margins, and in 13/18 cases with intralesional surgery. Compared to wide margins this gives a hazard ratio of 6.8 (confidence interval 1.4–32.7) for marginal margins and 13.5 (3–61) for intralesional margins. In multivariate analysis, adjusting for size, site, and mitotic index, surgical margin remained an independent significant predictor of risk for recurrence. When classifying patients according to R0/R1 surgery, patients with R0 surgery showed longer time to peritoneal recurrence and better recurrence-free and disease-specific survival as compared to those with R1 resection. However, when excluding patients operated with wide surgical margin, no significant difference was observed. Conclusion Wide surgical margins are of significant prognostic importance, supporting the strategy of en bloc resection with good margin and careful handling of the tumor to avoid damaging the peritoneal surface in surgical resection of GIST. Electronic supplementary material The online version of this article (10.1007/s00268-018-4498-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jan Åhlén
- Endocrine and Sarcoma Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, P9:03, 171 76, Stockholm, Sweden.
| | - Fredrik Karlsson
- Endocrine and Sarcoma Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, P9:03, 171 76, Stockholm, Sweden
| | - Johan Wejde
- Department of Oncology-Pathology, Cancer Center Karolinska (CCK), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Inga-Lena Nilsson
- Endocrine and Sarcoma Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, P9:03, 171 76, Stockholm, Sweden
| | - Catharina Larsson
- Department of Oncology-Pathology, Cancer Center Karolinska (CCK), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Robert Bränström
- Endocrine and Sarcoma Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, P9:03, 171 76, Stockholm, Sweden.
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Kapoor T, Banuelos J, Adabi K, Moran SL, Manrique OJ. Analysis of clinical outcomes of upper and lower extremity reconstructions in patients with soft-tissue sarcoma. J Surg Oncol 2018; 118:614-620. [DOI: 10.1002/jso.25201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/19/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Trishul Kapoor
- Department of Surgery, Division of Plastic Surgery; Mayo Clinic; Rochester Minnesota
| | - Joseph Banuelos
- Department of Surgery, Division of Plastic Surgery; Mayo Clinic; Rochester Minnesota
| | - Kian Adabi
- Department of Surgery, Division of Plastic Surgery; Mayo Clinic; Rochester Minnesota
| | - Steven L. Moran
- Department of Surgery, Division of Plastic Surgery; Mayo Clinic; Rochester Minnesota
| | - Oscar J. Manrique
- Department of Surgery, Division of Plastic Surgery; Mayo Clinic; Rochester Minnesota
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Differences in recurrence and survival of extremity liposarcoma subtypes. Eur J Surg Oncol 2018; 44:1391-1397. [DOI: 10.1016/j.ejso.2018.03.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/19/2018] [Accepted: 03/29/2018] [Indexed: 12/13/2022] Open
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Pennati A, Riggio E, Marano G, Biganzoli E. Autologous fat grafting after sarcoma surgery: Evaluation of oncological safety. J Plast Reconstr Aesthet Surg 2018; 71:1723-1729. [PMID: 30224167 DOI: 10.1016/j.bjps.2018.07.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/27/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The regenerative effectiveness of lipoaspirate procedures relies on the presence of mesenchymal stem cells, but the stromal microenvironment and hormonal secretions of the adipose tissue may be involved in cancer growth. Only few oncological outcome studies of fat grafting at the surgical site of malignant neoplasms of mesenchymal origin are available; none of these studies examined a series of sarcoma cases. OBJECTIVES We analyzed outcome in terms of local or distant spread and overall survival to investigate the oncological safety of fat grafting in patients with sarcoma. PATIENTS AND METHODS Sixty consecutive patients who had undergone 143 fat grafting procedures after surgical resection of bone and soft tissue sarcomas of the head, trunk, and limbs with clear resection margins were enrolled from 2004 to 2015 in our tertiary care center. A multidisciplinary sarcoma team administered adjuvant therapies. Patients were recurrence free at fat grafting. RESULTS The overall median follow-up was 7.5 years. At follow-up after fat grafting (2.4 years), one patient had distant metastasis and two had local relapse. Kaplan-Meier analysis showed disease-free survival rate of 95.4% (CI: 89.1-100.0) at 24 months. The risk of local recurrence (LR) within 24 months was 4.6% (CI: 0.0-20.9). The probability of not having LR after fat grafting was ≥ 89.1%. CONCLUSION We found no evidence of an increased cancer risk after fat grafting procedures in patients with sarcoma, but a stimulatory role of fat cannot be excluded for bone sarcomas based on the cases reported here, and further studies are therefore needed.
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Affiliation(s)
- Angela Pennati
- Unit of Plastic and Reconstructive Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milano, Italy
| | - Egidio Riggio
- Unit of Plastic and Reconstructive Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milano, Italy.
| | - Giuseppe Marano
- Laboratory of Medical Statistics, Biometry and Bioinformatics 'G. A. Maccacaro', Department of Clinical Science and Community Health, University of Milan, Campus Cascina Rosa, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Vanzetti 5, 20133 Milano, Italy
| | - Elia Biganzoli
- Laboratory of Medical Statistics, Biometry and Bioinformatics 'G. A. Maccacaro', Department of Clinical Science and Community Health, University of Milan, Campus Cascina Rosa, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Vanzetti 5, 20133 Milano, Italy; Unit of Medical Statistics, Biometry and Bioinformatics, Campus Cascina Rosa, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Vanzetti 5, 20133 Milano, Italy
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Stevenson MG, Hoekstra HJ, Song W, Suurmeijer AJH, Been LB. Histopathological tumor response following neoadjuvant hyperthermic isolated limb perfusion in extremity soft tissue sarcomas: Evaluation of the EORTC-STBSG response score. Eur J Surg Oncol 2018; 44:1406-1411. [PMID: 29858098 DOI: 10.1016/j.ejso.2018.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/17/2018] [Accepted: 05/09/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION This study aims to evaluate the applicability and prognostic value of the European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group (EORTC-STBSG) histopathological response score in extremity soft tissue sarcoma (ESTS) patients treated with neoadjuvant hyperthermic isolated limb perfusion (HILP) and delayed surgical resection. METHODS Patients treated between 1991 and 2016 were included. The histopathological tumor response was established in accordance with the EORTC-STBSG response score. The distribution of patients was assorted according to the 5-tier histopathological response score for tumor grade, histological subtype and HILP regimen. Predictors for local recurrence free survival (LRFS) and overall survival (OS) were identified through Kaplan-Meier and Cox regression analyses. RESULTS Ninety-one patients were included and their resection specimens were reanalyzed. Which resulted in 11 Grade A (12.1%), ten Grade B (11.0%), 15 Grade C (16.5%), 22 Grade D (24.2%) and 33 Grade E (36.3%) responses found among the series. The histopathological response was significantly influenced by the HILP regimen used, p = 0.033. Median follow-up was 65.0 (18.0-157.0) months. The histopathological response was not associated with LRFS nor OS. Resection margins, HILP regimen and adjuvant radiotherapy were associated with LRFS. Patients' age, tumor grade, tumor size and histological subtype were predictors for OS. CONCLUSIONS The EORTC-STBSG response score is applicable for determining the histopathological response to neoadjuvant ESTS treatment. However, this response does not seem to predict LRFS nor OS in locally advanced ESTS.
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Affiliation(s)
- Marc G Stevenson
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harald J Hoekstra
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wangzhao Song
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Albert J H Suurmeijer
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lukas B Been
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Harati K, Daigeler A, Lange K, Niggemann H, Stricker I, Steinau HU, Lehnhardt M, Goertz O. Somatic Leiomyosarcoma of the Soft Tissues: A Single-Institutional Analysis of Factors Predictive of Survival in 164 Patients. World J Surg 2018; 41:1534-1541. [PMID: 28116485 DOI: 10.1007/s00268-017-3899-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Somatic leiomyosarcoma (LMS) is an aggressive soft tissue sarcoma entity with a high metastatic potential. The purpose of this study was to identify prognostic indicators of survival in patients with somatic LMS of the soft tissues. METHODS We retrospectively assessed the relationship between local recurrence-free survival (LRFS), disease-specific survival (DSS), overall survival (OS) and potential prognostic factors in 164 patients who were suitable for surgical treatment in curative intent. Patients with soft tissue LMS of the extremities, the truncal wall and the head and neck area were included. The median follow-up time was 4.9 years. RESULTS In the entire cohort, the 5-year estimate of the DSS, OS and LRFS rate were 74.5% (95% confidence interval [CI] 65.0-81.8), 70.6% (95% CI: 60.9-78.3) and 63.4% (95% CI 53.4-71.9), respectively. Thirty-eight patients (23.2%) developed distant metastases with a median survival time of 1.5 years after diagnosis of metastasis. Surgical margins attained at the initial oncologic resection and eventual re-excisions did not influence DSS, OS and LRFS significantly. Within the R0 subgroup, close and wide negative margins led to similar outcomes. High histologic grade (P < 0.001), size >5 cm (P = 0.002) and subfascial localisation (P = 0.002) were associated with significantly diminished DSS in univariate analysis. In multivariate analysis, only histologic grade was found to be an independent prognostic factor of DSS. CONCLUSIONS The data from this study could not determine a prognostic significance of surgical margins suggesting that tumour characteristics other than margin status are important. Tumour biology reflected by the histologic grade dictates the final outcome.
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Affiliation(s)
- Kamran Harati
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Adrien Daigeler
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Kim Lange
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Hiltrud Niggemann
- Statistical Consulting and Data Analysis, Schlehendornweg 24, 07751, Jena, Germany
| | - Ingo Stricker
- Institute of Pathology, Ruhr-University Bochum, Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Hans-Ulrich Steinau
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Ole Goertz
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.,Department of Plastic Surgery, Martin-Luther Hospital, Caspar-Theyss-Strasse 27-29, 14193, Berlin, Germany
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81
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Tan MTL, Thompson SR, Schipp D, Bae S, Crowe PJ. Patterns of care of superficial soft tissue sarcomas: it is not always just a lump. Asia Pac J Clin Oncol 2018; 14:e472-e478. [PMID: 29383831 DOI: 10.1111/ajco.12823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 09/22/2017] [Indexed: 11/29/2022]
Abstract
AIM Superficial soft tissue sarcomas (S-STS) are generally considered low-risk tumors and have an excellent prognosis when treated with appropriate surgery and adjuvant therapy. However, they are often misdiagnosed then mistreated, leading to significant morbidity. This study aims to examine the patterns of care and outcomes of patients with S-STS, comparing those initially managed through sarcoma units versus elsewhere. METHODS Patients with S-STS from Prince of Wales Hospital in NSW (1995-2013) and Peter MacCallum Cancer Centre in Victoria (2009-2013) were identified from a national sarcoma database. Baseline variables, treatment and disease outcomes were recorded. Statistical tests performed included univariate and multivariate analyses, chi-square tests, as well as the Kaplan-Meier method for 5-year local recurrence and survival rates. RESULTS Eighty-nine patients were identified, with 35% initially managed at a sarcoma unit and 65% elsewhere. Patients initially managed at sarcoma units had larger tumors (>5 cm 39% vs 17%; P = 0.036) with a trend to higher grade (61% vs 48%; P = 0.39). Patients that were initially managed outside a sarcoma unit more often underwent open surgical biopsies (P < 0.0005), had multiple operations (P < 0.0005) and had higher rates of local recurrences (24% vs 6.5%, P = 0.038). They also had lower 5-year local recurrence-free survival rates (P = 0.022), but had higher metastasis-free survival (P = 0.014). On multivariate analysis, only larger STS size and male gender predicted for poorer metastasis-free survival (P = 0.042 and 0.018, respectively). CONCLUSION Patients with S-STS initially managed outside specialized sarcoma units undergo more operations, with risk of greater morbidity, and have greater risk of local recurrence.
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Affiliation(s)
- Mark Ting Le Tan
- Prince of Wales Hospital Clinical School, Faculty of Medicine, University of New South Wales, Australia
| | - Stephen R Thompson
- Prince of Wales Hospital Clinical School, Faculty of Medicine, University of New South Wales, Australia.,Sydney Sarcoma Unit, Prince of Wales Hospital, Sydney, Australia.,Department of Radiation Oncology, Prince of Wales Hospital, Sydney, Australia
| | - Diane Schipp
- Sydney Sarcoma Unit, Prince of Wales Hospital, Sydney, Australia
| | - Susie Bae
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Philip J Crowe
- Prince of Wales Hospital Clinical School, Faculty of Medicine, University of New South Wales, Australia.,Sydney Sarcoma Unit, Prince of Wales Hospital, Sydney, Australia.,Department of Surgery, Prince of Wales Hospital, Sydney, Australia
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Okuda KS, Lee HM, Velaithan V, Ng MF, Patel V. Utilizing Zebrafish to Identify Anti-(Lymph)Angiogenic Compounds for Cancer Treatment: Promise and Future Challenges. Microcirculation 2018; 23:389-405. [PMID: 27177346 DOI: 10.1111/micc.12289] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/11/2016] [Indexed: 12/13/2022]
Abstract
Cancer metastasis which predominantly occurs through blood and lymphatic vessels, is the leading cause of death in cancer patients. Consequently, several anti-angiogenic agents have been approved as therapeutic agents for human cancers such as metastatic renal cell carcinoma. Also, anti-lymphangiogenic drugs such as monoclonal antibodies VGX-100 and IMC-3C5 have undergone phase I clinical trials for advanced and metastatic solid tumors. Although anti-tumor-associated angiogenesis has proven to be a promising therapeutic strategy for human cancers, this approach is fraught with toxicities and development of drug resistance. This emphasizes the need for alternative anti-(lymph)angiogenic drugs. The use of zebrafish has become accepted as an established model for high-throughput screening, vascular biology, and cancer research. Importantly, various zebrafish transgenic lines have now been generated that can readily discriminate different vascular compartments. This now enables detailed in vivo studies that are relevant to both human physiological and tumor (lymph)angiogenesis to be conducted in zebrafish. This review highlights recent advancements in the zebrafish anti-vascular screening platform and showcases promising new anti-(lymph)angiogenic compounds that have been derived from this model. In addition, this review discusses the promises and challenges of the zebrafish model in the context of anti-(lymph)angiogenic compound discovery for cancer treatment.
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Affiliation(s)
- Kazuhide S Okuda
- Drug Discovery, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Hui Mei Lee
- Drug Discovery, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Vithya Velaithan
- Drug Discovery, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Mei Fong Ng
- Drug Discovery, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
| | - Vyomesh Patel
- Drug Discovery, Cancer Research Malaysia, Subang Jaya, Selangor, Malaysia
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Bifulco K, De Chiara A, Fazioli F, Longanesi-Cattani I, Cantelmo AR, Tirino V, Apice G, Rocco G, Lombardi ML, Carriero MV. Cell Invasiveness in Sarcomas: A Possibly Useful Clinical Correlation. TUMORI JOURNAL 2018; 94:505-10. [DOI: 10.1177/030089160809400411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and Background The prognosis of each individual patient affected by sarcoma, including those with low histopathologic grading, cannot be reliably predicted at the time of surgery. We have developed an in vitro cell invasion assay on early primary cell cultures derived from surgically removed sarcomas. Methods Primary cell cultures were subjected to in vitro cell invasion assays by using Boyden chambers, filters coated with matrigel and fetal bovine serum as a source of chemoattractant. For each primary cell culture, the sarcoma cell invasion index was determined in comparison with the percentage of human fibrosarcoma HT1080 cell invasion extent. The cell invasion index of 7 different sarcomas was evaluated in respect to the outcome of the disease, after a follow-up ranging from 14 to 48 months. Results Data evidenced that a low cell invasion index (39.7% ± 8.9) was retained by tumor cells derived from patients with no progression of the disease and with a longer interval of disease-free survival (21 ± 0.8 months). However, an increase in cell invasion index (61% ± 5) was retained by tumor cells derived from patients with progression of the disease and with a shorter disease-free survival (9 ± 3 months). Overall, although only 7 cases were analyzed, a statistically significant correlation was found between disease-free survival and cell invasion index (P = 0.003). Conclusions Our data support the possibility that cell invasion assays performed in vitro on cells derived from human sarcomas may be predictive of a more aggressive form of the disease.
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Affiliation(s)
- Katia Bifulco
- Departments of Experimental Oncology, National Cancer Institute of Naples, Naples, Italy
| | | | - Flavio Fazioli
- Departments of Surgical Oncology, National Cancer Institute of Naples, Naples, Italy
| | | | - Anna Rita Cantelmo
- Departments of Experimental Oncology, National Cancer Institute of Naples, Naples, Italy
| | - Virginia Tirino
- Departments of Experimental Oncology, National Cancer Institute of Naples, Naples, Italy
| | - Gaetano Apice
- Departments of Medical Oncology, National Cancer Institute of Naples, Naples, Italy
| | - Gaetano Rocco
- Departments of Surgical Oncology, National Cancer Institute of Naples, Naples, Italy
| | - Maria Luisa Lombardi
- Departments of Experimental Oncology, National Cancer Institute of Naples, Naples, Italy
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84
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Abstract
This article discusses the epidemiology, diagnosis, and management of primary soft-tissue sarcomas (STS). These musculoskeletal tumors are a rare and heterogeneous group of malignancies, which are best managed by multidisciplinary teams in specialist sarcoma referral centers. Historically, the standard for local control of these tumors has been amputation. Evolutions in multimodality treatment have seen a shift toward preservation of the limb. Advances in limb-sparing surgery have seen the quality of life in sarcoma patients to improve drastically; however, unplanned surgical excision of STS remains a major treatment dilemma in the control of local disease.
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Affiliation(s)
- Domagoj Ante Vodanovich
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Victoria, Australia,Department of Surgery, St. Vincent's Hospital Melbourne, University of Melbourne, Victoria, Australia
| | - Peter F M Choong
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Victoria, Australia,Department of Surgery, St. Vincent's Hospital Melbourne, University of Melbourne, Victoria, Australia,Bone and Soft Tissue Sarcoma Service, Peter MacCallum Cancer Centre, Victoria, Australia,Address for correspondence: Prof. Peter F M Choong, Level 2, Clinical Sciences Building, 29 Regent Street, Fitzroy 3065, Victoria, Australia. E-mail:
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85
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George A, Grimer RJ, J James SL. Could Routine Magnetic Resonance Imaging Detect Local Recurrence of Musculoskeletal Sarcomas Earlier? A Cost-effectiveness Study. Indian J Orthop 2018; 52:81-86. [PMID: 29416175 PMCID: PMC5791237 DOI: 10.4103/ortho.ijortho_234_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Current practice in our unit is to perform clinical assessment and plain film radiographs at regular intervals following treatment of a bone or soft tissue sarcoma (STS). Cross-sectional imaging is used in cases with a clinical suspicion of recurrence. We aimed to investigate the effectiveness of this protocol to determine if earlier detection may have been possible had more intensive imaging been undertaken, and whether this may have affected outcome. MATERIALS AND METHODS We reviewed clinical records and imaging of all patients with diagnosed local recurrence (LR) in the previous 5 years to investigate: how it was diagnosed, the site and size of recurrence, and management. A value judgment was then made as to whether earlier diagnosis may have altered treatment and/or outcome. RESULTS 161 patients with LR were identified: 87 with a STS and 74 with bone sarcoma. Median time from diagnosis to LR was 17.8 months for STS and 20.1 months for bone sarcoma. One hundred and fifteen cases (71%) were identified by the patient, 28 by routine imaging (17%), 13 by a doctor (8%), and five diagnosed by other methods. Median size of LR was 5.5 cm for STS and 5 cm for bone sarcomas. Seventy nine of the patients (49%) could have had their LR diagnosed earlier with routine imaging. Of these, 53 would have received the same treatment, but 26 (33%) could have had different treatment. CONCLUSION Earlier diagnosis could have led to altered management in one-third of those patients with the potential to have their LR diagnosed earlier. If all patients had regular magnetic resonance imaging, it would cost £6987 per recurrence where management was altered in imaging costs alone. We suggest a stratified approach whereby patients at highest risk of LR and those in whom early detection of LR may be easily treatable are prioritised for more intensive followup.
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Affiliation(s)
- Andrew George
- Department of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK,Address for correspondence: Mr. Andrew George, Royal Orthopaedic Hospital, Bristol Rd S, Birmingham, B31 2AP, UK. E-mail:
| | - Robert J Grimer
- Department of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Steven L J James
- Department of Orthopaedic Oncology, Royal Orthopaedic Hospital, Birmingham, UK
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86
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Harati K, Lehnhardt M. The changing paradigm of resection margins in sarcoma resection. Innov Surg Sci 2017; 2:165-170. [PMID: 31579750 PMCID: PMC6754025 DOI: 10.1515/iss-2017-0043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 11/20/2017] [Indexed: 11/15/2022] Open
Abstract
Soft tissue sarcomas (STS) are a heterogeneous group of rare mesenchymal tumors that account for approximately 1% of all adult malignancies. They can arise throughout the body due to their mesenchymal origin, although 60% of all STS occur in the extremities. Locally advanced STS can lead to significant functional morbidity and tend to local recurrences despite surgical resection. About 30% of all STS patients develop distant metastases with a median overall survival of less than 15 months. The treatment of choice in patients with localized disease is still surgical resection with negative margins. However, there has been a paradigm shift in the last few decades. Large retrospective analyses could not establish a strong association between radical resections and improved local control or survival. Previous radical concepts in STS surgery have been gradually replaced by more moderate approaches with function- and limb-sparing resections combined with radiotherapy. Here, the margin status appears to be of prognostic significance. However, several large retrospective analyses have presented inconsistent results, questioning the independent prognostic impact of surgical margins. This article reviews the literature critically, focusing on the changing role of surgical margins in STS surgery.
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Affiliation(s)
- Kamran Harati
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Bochum, Germany
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87
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Weichteilsarkome: Wie lassen sich posttherapeutische Veränderungen von Rezidiven unterscheiden? Radiologe 2017; 57:923-937. [DOI: 10.1007/s00117-017-0310-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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88
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Bleloch JS, Ballim RD, Kimani S, Parkes J, Panieri E, Willmer T, Prince S. Managing sarcoma: where have we come from and where are we going? Ther Adv Med Oncol 2017; 9:637-659. [PMID: 28974986 PMCID: PMC5613860 DOI: 10.1177/1758834017728927] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/26/2017] [Indexed: 02/06/2023] Open
Abstract
Sarcomas are a heterogeneous group of neoplasms of mesenchymal origin. Approximately 80% arise from soft tissue and 20% originate from bone. To date more than 100 sarcoma subtypes have been identified and they vary in molecular characteristics, pathology, clinical presentation and response to treatment. While sarcomas represent <1% of adult cancers, they account for approximately 21% of paediatric malignancies and thus pose some of the greatest risks of mortality and morbidity in children and young adults. Metastases occur in one-third of all patients and approximately 10-20% of sarcomas recur locally. Surgery in combination with preoperative and postoperative therapies is the primary treatment for localized sarcoma tumours and is the most promising curative possibility. Metastasized sarcomas, on the other hand, are treated primarily with single-agent or combination chemotherapy, but this rarely leads to a complete and robust response and often becomes a palliative form of treatment. The heterogeneity of sarcomas results in variable responses to current generalized treatment strategies. In light of this and the lack of curative strategies for metastatic and unresectable sarcomas, there is a need for novel subtype-specific treatment strategies. With the more recent understanding of the molecular mechanisms underlying the pathogenesis of some of these tumours, the treatment of sarcoma subtypes with targeted therapies is a rapidly evolving field. This review discusses the current management of sarcomas as well as promising new therapies that are currently underway in clinical trials.
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Affiliation(s)
- Jenna S Bleloch
- Department of Human Biology, University of Cape Town, South Africa
| | - Reyna D Ballim
- Department of Human Biology, University of Cape Town, South Africa
| | - Serah Kimani
- Department of Human Biology, University of Cape Town, South Africa
| | - Jeannette Parkes
- Department of Radiation Oncology, University of Cape Town, South Africa
| | - Eugenio Panieri
- Department of Surgery, University of Cape Town, South Africa
| | - Tarryn Willmer
- Department of Human Biology, University of Cape Town, South Africa
| | - Sharon Prince
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7925, South Africa
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89
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Management of Unplanned Excision for Soft-Tissue Sarcoma With Preoperative Radiotherapy Followed by Definitive Resection. Am J Clin Oncol 2017; 39:586-592. [PMID: 24879470 DOI: 10.1097/coc.0000000000000095] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES The purpose of this study was to review the outcomes after preoperative radiotherapy and definitive surgery for patients who initially had inadvertent excision for sarcoma. MATERIALS AND METHODS Treatment records of 44 consecutive patients, who initially underwent unplanned excision of soft-tissue sarcoma between January 2004 and January 2012, were reviewed. All patients had clinically localized disease before treatment and received preoperative external-beam radiotherapy followed by definitive oncologic surgery at our institution. RESULTS The median follow-up was 36 months. Residual tumor after preoperative radiotherapy and wound bed excision was identified in 39% (17/44) of the cases. Kaplan-Meier estimates for 5-year local control, recurrence-free survival, and overall survival are 95% (95% confidence interval [CI], 80-99), 86% (95% CI, 69-94), and 94% (95% CI, 79-99) respectively. Perioperative morbidity occurred in 25% of patients (11/44.) All patients with perioperative wound complications had lower extremity sarcomas. CONCLUSIONS Optimal management for unplanned excision of soft-tissue sarcoma is unknown. Our institution has adopted the approach of preoperative radiotherapy, followed by definitive surgery. In our series of 44 patients, local control was excellent at 95%, with perioperative complications seen only in patients with lower extremity sarcomas, suggesting that this is a reasonable approach to manage inadvertently resected sarcoma.
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Mahmoud O, Tunceroglu A, Chokshi R, Benevenia J, Beebe K, Patterson F, DeLaney TF. Overall survival advantage of chemotherapy and radiotherapy in the perioperative management of large extremity and trunk soft tissue sarcoma; a large database analysis. Radiother Oncol 2017; 124:277-284. [DOI: 10.1016/j.radonc.2017.07.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 07/10/2017] [Accepted: 07/16/2017] [Indexed: 11/16/2022]
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Harati K, Goertz O, Pieper A, Daigeler A, Joneidi-Jafari H, Niggemann H, Stricker I, Lehnhardt M. Soft Tissue Sarcomas of the Extremities: Surgical Margins Can Be Close as Long as the Resected Tumor Has No Ink on It. Oncologist 2017; 22:1400-1410. [PMID: 28739867 DOI: 10.1634/theoncologist.2016-0498] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 06/04/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Soft tissue sarcomas (STS) arising in the extremities pose a therapeutic challenge due to concerns of functional morbidity. Resections with negative margins are the mainstay of therapy, but the prognostic significance of surgical margins remains controversial. The purpose of this study was to determine the prognostic impact of surgical margins and clear margin widths in patients with STS of the extremities. MATERIALS AND METHODS We assessed the relationship between local recurrence-free (LRFS), disease-specific (DSS), and metastasis-free survival (MFS) and potential prognostic factors retrospectively in a consecutive series of 643 patients treated at our institution between 1996 and 2016. Potential prognostic factors were assessed using univariate and multivariate analyses. RESULTS The median follow-up time after primary diagnosis was 5.4 years (95% confidence interval [CI]: 4.8-6.0). The five-year estimates of the DSS, LRFS, and MFS rates in the entire cohort were 85.3% (95% CI: 81.6-88.3), 65.3% (95% CI: 60.8-69.5) and 78.0% (95% CI: 74.1-81.4), respectively. Histological grade and the quality of surgical margins were independent prognostic factors of all three survival endpoints (LRFS, DSS, MFS) in multivariate analyses. Within the R0 subgroup, univariate and multivariate analyses of categorized (≤1 mm vs. 1-5 mm vs. >5 mm) and non-categorized margin widths revealed that close and wide negative margins led to similar outcomes. Adjuvant radiation improved local control independently, but not DSS and MFS. CONCLUSION Microscopically negative margins were associated with better LRFS, DSS, and MFS regardless of whether adjuvant radiation was applied. Here, surgical margins can be close as long as the resected tumor has no ink on it. IMPLICATIONS FOR PRACTICE In the present retrospective analysis of 643 patients with primary soft issue sarcomas of the extremities, surgical margins could be identified as independent predictors of local recurrence-free, disease-specific, and metastasis-free survival. Given the diminished outcome of patients left with positive margins, surgical efforts should aim to achieve microscopically negative margins whenever feasible. It is noteworthy that only the quality of surgical margins, but not the negative margin width attained, had an influence on the prognosis. Our findings suggest that surgical margins can be close as long as the resected tumor has no ink on it.
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Affiliation(s)
- Kamran Harati
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Bochum, Germany
| | - Ole Goertz
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Bochum, Germany
| | - Andreas Pieper
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Bochum, Germany
| | - Adrien Daigeler
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Bochum, Germany
| | - Hamid Joneidi-Jafari
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Bochum, Germany
| | | | - Ingo Stricker
- Institute of Pathology, Ruhr-University Bochum, Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Bochum, Germany
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92
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Antbring R, Parker SG, Lordan JT, Windsor AC. High-grade myxofibrosarcoma of the abdominal wall. BMJ Case Rep 2017; 2017:bcr-2017-219643. [PMID: 28576911 DOI: 10.1136/bcr-2017-219643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The authors present a case of a 57-year-old man, who presented to the surgical clinic with a mass in the suprapubic region. A CT scan revealed a well-circumscribed lobular, heterogeneous soft tissue mass measuring 12×8.6×7.8 cm. The final histopathological diagnosis from the resection of the lesion was a myxofibrosarcoma (MFS), grade 3. The management of MFS includes surgical and oncological options which are reviewed here. These are aimed at complete excision and reducing the risk of local occurrence.
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Affiliation(s)
- Richard Antbring
- Oncology Department, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Sam G Parker
- Colorectal Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jeffrey T Lordan
- Sarcoma Department, Royal Free London NHS Foundation Trust, London, UK
| | - Alastair Cj Windsor
- Colorectal Department, University College London Hospitals NHS Foundation Trust, London, UK
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93
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Cipriano A, Burfeind W. Management of Primary Soft Tissue Tumors of the Chest Wall. Thorac Surg Clin 2017; 27:139-147. [DOI: 10.1016/j.thorsurg.2017.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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94
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Bianchi G, Sambri A, Cammelli S, Galuppi A, Cortesi A, Righi A, Caldari E, Ferrari S, Donati D. Impact of residual disease after "unplanned excision" of primary localized adult soft tissue sarcoma of the extremities: evaluation of 452 cases at a single Institution. Musculoskelet Surg 2017; 101:243-248. [PMID: 28444540 DOI: 10.1007/s12306-017-0475-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/17/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Soft tissue sarcomas are often inappropriately excised; it is, however, still a matter of debate whether the presence of residual disease in the re-excision specimen can affect patients' prognosis. The aim of this study is to investigate the impact of re-excision after unplanned surgery of primary soft tissue sarcomas (STS) of the extremities. PATIENTS AND METHODS We retrospectively evaluated 452 adults with grade 2-3, localized STS (349 primary and 103 unplanned excisions). RESULTS In the re-excision group, a full 43% of the patients had residual tumor. The re-excision group achieved a significantly better outcome in terms of sarcoma-specific survival (SS) (p = 0.002), local recurrence (LR) (p = 0.004) and distant metastasis (DM) (p = 0.028). Residual tumor was associated with a higher risk of DM (p = 0.005). CONCLUSION We confirm that unplanned surgery does not compromise patients' prognosis; scar re-excision guarantees at least the same SS, LR and DM rates compared to STS primarily treated in a referral center. Routine use of radiation therapy after re-excision could improve local control. Distant metastases seem to be negatively affected by the presence of residual tumor, and therefore, the use of CT in deep and large STS is suggested. The main goal is to avoid unplanned surgery by referring suspected lumps (especially deep, large, increasing in size) to a specialist center.
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Affiliation(s)
- G Bianchi
- Orthopedic Oncology Department, Istituto Ortopedico Rizzoli, via Pupilli 1, Bologna, Italy
| | - A Sambri
- Orthopedic Oncology Department, Istituto Ortopedico Rizzoli, via Pupilli 1, Bologna, Italy.
| | - S Cammelli
- Radiation Oncology Center, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - A Galuppi
- Radiation Oncology Center, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - A Cortesi
- Radiation Oncology Center, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - A Righi
- Anatomic Pathology Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - E Caldari
- Orthopedic Oncology Department, Istituto Ortopedico Rizzoli, via Pupilli 1, Bologna, Italy
| | - S Ferrari
- Chemotherapy Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - D Donati
- Orthopedic Oncology Department, Istituto Ortopedico Rizzoli, via Pupilli 1, Bologna, Italy
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95
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Ramu EM, Houdek MT, Isaac CE, Dickie CI, Ferguson PC, Wunder JS. Management of soft-tissue sarcomas; treatment strategies, staging, and outcomes. SICOT J 2017; 3:20. [PMID: 28287387 PMCID: PMC5347369 DOI: 10.1051/sicotj/2017010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/03/2017] [Indexed: 12/20/2022] Open
Abstract
Soft-tissue sarcomas (STS) are a rare group of malignant tumors which can affect any age group. For the majority of patients who present with a localized STS, treatment involves a multidisciplinary team decision-making approach ultimately relying on surgical resection with or without adjuvant radiation for successful limb salvage. The goals of treatment are to provide the patient with a functional extremity without local tumor relapse. The purpose of this article is to review the treatment of extremity STS, with a focus on staging, treatment options, and outcomes.
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Affiliation(s)
- Eyal M Ramu
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, M5G 1X5 Ontario, Canada - Department of Surgical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, M5G 2C4 Ontario, Canada - Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, M5G 2C4 Ontario, Canada
| | - Matthew T Houdek
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, M5G 1X5 Ontario, Canada - Department of Surgical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, M5G 2C4 Ontario, Canada - Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, M5G 2C4 Ontario, Canada
| | - Christian E Isaac
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, M5G 1X5 Ontario, Canada - Department of Surgical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, M5G 2C4 Ontario, Canada - Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, M5G 2C4 Ontario, Canada
| | - Colleen I Dickie
- Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, M5G 2C4 Ontario, Canada
| | - Peter C Ferguson
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, M5G 1X5 Ontario, Canada - Department of Surgical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, M5G 2C4 Ontario, Canada - Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, M5G 2C4 Ontario, Canada
| | - Jay S Wunder
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, M5G 1X5 Ontario, Canada - Department of Surgical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, M5G 2C4 Ontario, Canada - Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, M5G 2C4 Ontario, Canada
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96
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Mahmoud O, Beck R, Kalyoussef E, Chan Park R, Baredes S, Kim S, Samuels MA. Adjuvant therapies utilization pattern and survival outcomes in high-grade head and neck soft tissue sarcoma; a population based study. Oral Oncol 2017; 66:28-37. [DOI: 10.1016/j.oraloncology.2016.12.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/19/2016] [Accepted: 12/29/2016] [Indexed: 11/16/2022]
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97
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Tsuda Y, Ogura K, Kobayashi E, Hiruma T, Iwata S, Asano N, Kawai A, Chuman H, Ishii T, Morioka H, Kobayashi H, Kawano H. Impact of geriatric factors on surgical and prognostic outcomes in elderly patients with soft-tissue sarcoma. Jpn J Clin Oncol 2017; 47:422-429. [DOI: 10.1093/jjco/hyx016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 02/07/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Yusuke Tsuda
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Koichi Ogura
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo
| | - Eisuke Kobayashi
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo
| | - Toru Hiruma
- Division of Musculoskeletal Tumor Surgery, Kanagawa Cancer Center, Kanagawa
| | - Shintaro Iwata
- Division of Orthopedic Surgery, Chiba Cancer Center, Chiba
| | - Naofumi Asano
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo
| | - Akira Kawai
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo
| | - Hirokazu Chuman
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo
| | - Takeshi Ishii
- Division of Orthopedic Surgery, Chiba Cancer Center, Chiba
| | - Hideo Morioka
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo
| | - Hiroshi Kobayashi
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Hirotaka Kawano
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo
- Department of Orthopedic Surgery, Graduate School of Medicine, The University of Teikyo, Tokyo, Japan
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98
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Willeumier JJ, Rueten-Budde AJ, Jeys LM, Laitinen M, Pollock R, Aston W, Dijkstra PDS, Ferguson PC, Griffin AM, Wunder JS, Fiocco M, van de Sande MAJ. Individualised risk assessment for local recurrence and distant metastases in a retrospective transatlantic cohort of 687 patients with high-grade soft tissue sarcomas of the extremities: a multistate model. BMJ Open 2017; 7:e012930. [PMID: 28196946 PMCID: PMC5318556 DOI: 10.1136/bmjopen-2016-012930] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES This study investigates the effect of surgical margins and radiotherapy, in the presence of individual baseline characteristics, on survival in a large population of high-grade soft tissue sarcoma of the extremities using a multistate model. DESIGN A retrospective multicentre cohort study. SETTING 4 tertiary referral centres for orthopaedic oncology. PARTICIPANTS 687 patients with primary, non-disseminated, high-grade sarcoma only, receiving surgical treatment with curative intent between 2000 and 2010 were included. MAIN OUTCOME MEASURES The risk to progress from 'alive without disease' (ANED) after surgery to 'local recurrence' (LR) or 'distant metastasis (DM)/death'. The effect of surgical margins and (neo)adjuvant radiotherapy on LR and overall survival was evaluated taking patients' and tumour characteristics into account. RESULTS The multistate model underlined that wide surgical margins and the use of neoadjuvant radiotherapy decreased the risk of LR but have little effect on survival. The main prognostic risk factors for transition ANED to LR are tumour size (HR 1.06; 95% CI 1.01 to 1.11 (size in cm)) and (neo)adjuvant radiotherapy. The HRs for patients treated with adjuvant or no radiotherapy compared with neoadjuvant radiotherapy are equal to 4.36 (95% CI 1.34 to 14.24) and 14.20 (95% CI 4.14 to 48.75), respectively. Surgical resection margins had a protective effect for the occurrence of LR with HRs equal to 0.61 (95% CI 0.33 to 1.12), and 0.16 (95% CI 0.07 to 0.41) for margins between 0 and 2 mm and wider than 2 mm, respectively. For transition ANED to distant metastases/Death, age (HR 1.64 (95% CI 0.95 to 2.85) and 1.90 (95% CI 1.09 to 3.29) for 25-50 years and >50 years, respectively) and tumour size (1.06 (95% CI 1.04 to 1.08)) were prognostic factors. CONCLUSIONS This paper underlined the alternating effect of surgical margins and the use of neoadjuvant radiotherapy on oncological outcomes between patients with different baseline characteristics. The multistate model incorporates this essential information of a specific patient's history, tumour characteristics and adjuvant treatment modalities and allows a more comprehensive prediction of future events.
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Affiliation(s)
- Julie J Willeumier
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Lee M Jeys
- Department of Orthopaedic Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - Minna Laitinen
- Department of Orthopaedic Surgery, Royal Orthopaedic Hospital, Birmingham, UK
| | - Rob Pollock
- Department of Orthopaedic Surgery, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Will Aston
- Department of Orthopaedic Surgery, Royal National Orthopaedic Hospital, Stanmore, UK
| | - P D Sander Dijkstra
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter C Ferguson
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Anthony M Griffin
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Jay S Wunder
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Marta Fiocco
- Mathematical Institute, Leiden University, Leiden, The Netherlands
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
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99
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Abstract
The management of recurrent soft tissue sarcoma is a challenging problem for clinicians and has a significant physical, mental, emotional, and oncologic impact for the patient. Despite excellent limb-preservation therapies, approximately one-quarter of patients may eventually develop recurrence of disease. How to most appropriately manage these patients is a matter of debate. Several treatment options exist, including surgical resection, irradiation, systemic chemotherapy, amputation, and regional therapies. This article highlights the management of recurrent extremity soft tissue sarcoma.
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Affiliation(s)
- Whitney M Guerrero
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave, Suite 300, Memphis, TN 38163, USA
| | - Jeremiah L Deneve
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave, Suite 300, Memphis, TN 38163, USA; Division of Surgical Oncology, University of Tennessee Health Science Center, 910 Madison Avenue, Suite 300, Memphis, TN 38163, USA.
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100
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Effects of resection margins on local recurrence of osteosarcoma in extremity and pelvis: Systematic review and meta-analysis. Int J Surg 2016; 36:283-292. [DOI: 10.1016/j.ijsu.2016.11.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/05/2016] [Indexed: 12/26/2022]
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