201
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O'Donnell JP, Sugrue R, McLaughlin R, McInerney NM. Multidisciplinary approach to chest wall reconstruction in primary breast angiosarcoma resection. BMJ Case Rep 2020; 13:13/5/e233156. [PMID: 32381526 DOI: 10.1136/bcr-2019-233156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Angiosarcomas account for less than 1% of primary breast cancers. Typically, they occur in young women with a low-risk personal or family history. Diagnosis, resection and reconstruction require a multidisciplinary team of breast surgeons, oncologists and plastic reconstructive surgeons. Cross-disciplinary awareness among these specialities enables dimensional patient treatment. We report a case of primary angiosarcoma of the breast in a 33-year-old woman, with no previous radiotherapy exposure, treated with a radical mastectomy and chest wall reconstruction with a deep inferior epigastric perforator (DIEP) Flap. There is a general consensus in current literature regarding the difficulty for curative treatment in angiosarcomas. There is a requirement for surgical intervention to be aggressive to ensure oncological clearance. Subsequently, the extensive reconstructive task proves a major procedure for any plastic surgeon. DIEP autologous flap chest wall reconstruction accompanying radical mastectomy can be used in efforts to eradicate risks of deep margin incomplete excision in breast angiosarcomas. This case report and review of the current literature aim to provide guidance for colleagues managing angiosarcomas and also highlight the versatility of the DIEP flap.
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Affiliation(s)
- John Phineas O'Donnell
- Department of Surgery, Galway University Hospitals, Galway, Ireland .,Plastic & Reconstructive Surgery, National University of Ireland Galway, Galway, Ireland
| | - Ryan Sugrue
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,Plastic & Reconstructive Surgery, National University of Ireland Galway, Galway, Ireland
| | - Ray McLaughlin
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,Breast & General Surgery, National University of Ireland Galway, Galway, Ireland
| | - Niall M McInerney
- Department of Surgery, Galway University Hospitals, Galway, Ireland.,Plastic & Reconstructive Surgery, National University of Ireland Galway, Galway, Ireland
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202
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Zhang J, Chen M, Zhao Y, Xiong H, Sneh T, Fan Y, Wang J, Zhou X, Gong C. Complement and coagulation cascades pathway correlates with chemosensitivity and overall survival in patients with soft tissue sarcoma. Eur J Pharmacol 2020; 879:173121. [PMID: 32339514 DOI: 10.1016/j.ejphar.2020.173121] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/30/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
Chemotherapy is an indispensable method in treatment of Soft tissue sarcomas (STS), but variability in sensitivity as a result of tumor heterogeneity is a key factor in determining patient outcome. Several studies have investigated the phenomenon of chemotherapy resistance in STS, while its precise complex mechanism is still unknown. This study aims to identify potential biomarkers for predicting the STS chemosensitivity, with the goal of both aiding patient treatment determination in the clinic and providing insight into key parts of the underlying mechanism. Gene expression profiles of 265 patients were obtained from The Cancer Genome Atlas dataset and differentially expressed genes (DEGs) associated with chemosensitivity were identified in groups of varying chemosensitivity, including 177 upregulated and 21 downregulated genes (P < 0.05). Then, DEGs were found to be enriched in complement and coagulation cascades and the osteoclast differentiation pathway. Protein-protein interaction analysis showed 15 genes (52 edges) enriched in the complement and coagulation cascades while 11 genes (28 edges) enriched in the osteoclast differentiation pathway. Notably, all the genes that significantly correlated to disease-free survival (DFS) and overall survival (OS), such as C1QC, C3AR1, C7, CFI and SERPINE1, are enriched in complement and coagulation cascades pathway. The differential expression of these genes was further verified by using the GSE database. Our findings support that C1QC, C3AR1, C7, CFI and SERPINE1 in the complement and coagulation cascade pathway are potential biomarkers for chemotherapy resistance and survival of STS patients.
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Affiliation(s)
- Jing Zhang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Maoshan Chen
- Myeloma Research Group, Australian Centre for Blood Diseases (ACBD), Clinical Central School, Monash University, Melbourne, 3004, Australia
| | - Yuanyuan Zhao
- Department of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Huihua Xiong
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Tal Sneh
- Center for Molecular Design and Biomimetics, The Biodesign Institute, Arizona State University, Tempe, AZ, 85281, USA
| | - Yang Fan
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Jianhua Wang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Xiao Zhou
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Chen Gong
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China.
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203
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Lee EY, Yu JY, Paek AR, Lee SH, Jang H, Cho SY, Kim JH, Kang HG, Yun T, Oh SE, Park SY, You HJ. Targeting TJP1 attenuates cell-cell aggregation and modulates chemosensitivity against doxorubicin in leiomyosarcoma. J Mol Med (Berl) 2020; 98:761-773. [PMID: 32318747 DOI: 10.1007/s00109-020-01909-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/30/2020] [Accepted: 04/03/2020] [Indexed: 12/24/2022]
Abstract
Tight junction protein 1 (TJP1) is a membrane-associated cytosolic protein important for cell-cell communication in intercellular barriers in epithelial and non-epithelial cells. Here, we explored the functional involvement of TJP1 in non-epithelial tumors such as soft tissue sarcoma, especially in leiomyosarcoma (LMS). TJP1 expression in soft tissue sarcoma was analyzed in normal and tumor tissues as well as from public datasets such as the TCGA provisional dataset, in which TJP1 expression was compared with other subtypes such as undifferentiated sarcomas, and myxofibrosarcomas. SK-LMS-1 cell lines with reduced TJP1 expression showed attenuated anchorage-independent colony formation as well as reduced intercellular aggregation on non-coated culture plates compared with control as well as parental SK-LMS-1 cells. Transcriptome profiling following TJP1 knockdown in SK-LMS-1 cells suggested the involvement of several signaling pathways, including NF-κB pathway and growth factor receptor signaling. In addition, TJP1 downregulation induced enhanced response against anti-cancer agents, doxorubicin and gefitinib. Taken together, these results suggest that TJP1 contributes to sarcoma genesis and might be useful therapeutic target. KEY MESSAGES: • TJP1 expression at RNA level higher in tumor than in normal tissues of sarcoma. • Targeting TJP1 attenuates cell-cell aggregation and anchorage-independent growth. • Targeting TJP1 is beneficial in anti-cancer therapy in LMS.
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Affiliation(s)
- Eun-Young Lee
- Division of Translational Science, Research Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 10408, South Korea.,Department of Medical Biotechnology, Yeungnam University, 280 Daehak-ro, Gyeongsan, 38541, South Korea
| | - Jung Yeon Yu
- Division of Translational Science, Research Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 10408, South Korea
| | - A Rome Paek
- Division of Translational Science, Research Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 10408, South Korea
| | - So Hee Lee
- Division of Translational Science, Research Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 10408, South Korea
| | - Hyonchol Jang
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy (NCC-GCSP), National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 10408, South Korea.,Division of Cancer Biology, Research Institute, National Cancer Center, Goyang, South Korea
| | - Soo Young Cho
- Clinical Genomic Analysis Branch, Research Institute, National Cancer Center, Goyang, South Korea
| | - June Hyuk Kim
- National Cancer Center Hospital, National Cancer Center, Goyang, South Korea
| | - Hyun Guy Kang
- National Cancer Center Hospital, National Cancer Center, Goyang, South Korea
| | - Tak Yun
- National Cancer Center Hospital, National Cancer Center, Goyang, South Korea
| | - Sung Eun Oh
- National Cancer Center Hospital, National Cancer Center, Goyang, South Korea
| | - Seog Yun Park
- National Cancer Center Hospital, National Cancer Center, Goyang, South Korea
| | - Hye Jin You
- Division of Translational Science, Research Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 10408, South Korea. .,Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy (NCC-GCSP), National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 10408, South Korea.
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204
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Epithelioid Cutaneous Mesenchymal Neoplasms: A Practical Diagnostic Approach. Diagnostics (Basel) 2020; 10:diagnostics10040233. [PMID: 32316685 PMCID: PMC7236000 DOI: 10.3390/diagnostics10040233] [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: 03/27/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 12/16/2022] Open
Abstract
Epithelioid cells are rounded or polygonal cells with abundant eosinophilic or clear cytoplasm and ovoid to round nuclei, superficially resembling epithelial cells. Cutaneous mesenchymal neoplasms composed predominantly or exclusively of epithelioid cells are relatively uncommon and can cause considerable diagnostic difficulties due to overlapping histologic features among heterogeneous groups of tumors. Familiarity with practical diagnostic approaches and recognition of key histopathologic features are important for correct diagnosis and management. This review summarizes the histologic features of epithelioid cutaneous mesenchymal neoplasms and discusses their differential diagnoses from malignant melanomas and carcinomas.
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205
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Eberhard N, Cordier D. An Unusual Bump on the Head: Intracranial and Extracranial Cytokeratin-Positive Interstitial Reticular Cell Tumor. World Neurosurg 2020; 139:60-62. [PMID: 32298826 DOI: 10.1016/j.wneu.2020.03.173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND We describe a cytokeratin positive interstitial reticulum cell tumor (CPIRCT) as the cause of a large and defacing scalp tumor. Clinically these tumors manifest as progressive, painless swelling. Treatment usually consists of surgery with or without irradiation; chemotherapy is applied in metastatic disease. CASE DESCRIPTION A patient was referred after attempted removal of a large bump on the head. The tumor was initially noted about 12 months earlier. Assuming a benign lipoma, resection without prior imaging was attempted. During surgery, the underlying bone was found to be profoundly destroyed. Cranial magnetic resonance imaging revealed a large mass with an extracranial and intracranial component. Subsequent extensive resection finally led to the diagnosis of CPIRCT. CONCLUSIONS Most CPIRCTs manifest as progressive palpable or visible masses. Radical excision is usually the mainstay of treatment, although there is no generally accepted treatment strategy. A needle biopsy might not be diagnostic and can complicate future curative surgery. Especially in fast-growing lesions, imaging studies should be considered before surgery. Their potential recurrence and metastatic spread render CPIRCTs an interdisciplinary challenge and highlight the need for long-term follow-up.
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Affiliation(s)
- Noëmi Eberhard
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland.
| | - Dominik Cordier
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
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206
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Inarejos Clemente EJ, Navallas M, Barber Martínez de la Torre I, Suñol M, Munuera Del Cerro J, Torner F, Garraus M, Navarro OM. MRI of Rhabdomyosarcoma and Other Soft-Tissue Sarcomas in Children. Radiographics 2020; 40:791-814. [PMID: 32243230 DOI: 10.1148/rg.2020190119] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Soft-tissue sarcomas in children comprise a heterogeneous group of entities with variable manifestation depending on the age of the patient and the location of the tumor. MRI is the modality of choice for evaluating musculoskeletal soft-tissue tumors and plays a paramount role in both initial diagnosis and assessment of tumor response during and after treatment. Conventional MRI sequences, such as T1- and T2-weighted imaging, offer morphologic information, which is important for localizing the lesion and describing anatomic relationships but not accurate for determining its malignant or benign nature and may be limited in differentiating tumor response from therapy-related changes. Advanced multiparametric MRI offers further functional information that can help with these tasks by using different imaging sequences and biomarkers. The authors present the role of MRI in rhabdomyosarcoma and other soft-tissue sarcomas in children, emphasizing a multiparametric approach with focus on the utility and potential added value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI in characterization and staging, determination of pretreatment extent, and evaluation of tumor response and recurrence after treatment. ©RSNA, 2020.
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Affiliation(s)
- Emilio J Inarejos Clemente
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - María Navallas
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - Ignasi Barber Martínez de la Torre
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - Mariona Suñol
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - Josep Munuera Del Cerro
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - Ferran Torner
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - Moira Garraus
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
| | - Oscar M Navarro
- From the Departments of Diagnostic Imaging (E.J.I.C., M.N., I.B.M.d.l.T., J.M.d.C.), Pathology (M.S.), Orthopaedics (F.T.), and Oncology and Haematology (M.G.), Hospital Sant Joan de Déu, Av Sant Joan de Déu 2, 08950 Esplugues de Llobregat (Barcelona), Spain; Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (O.M.N.); and Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ont, Canada (O.M.N.)
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207
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Advances in image enhancement for sarcoma surgery. Cancer Lett 2020; 483:1-11. [PMID: 32247870 DOI: 10.1016/j.canlet.2020.03.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/19/2020] [Accepted: 03/29/2020] [Indexed: 12/12/2022]
Abstract
The recurrence rate of soft tissue and bone sarcomas strongly correlates to the status of the surgical margin after excision, yet excessive removal of tissue may lead to distinct, otherwise avoidable morbidity. Therefore, adequate margination of sarcomas both pre- and intra-operatively is a clinical necessity that has not yet fully been met. Current guidance for soft-tissue sarcomas recommends an ultrasound scan followed by magnetic resonance imaging (MRI). For bone sarcomas, two plane radiographs are required, followed similarly by an MRI scan. The introduction of more precise imaging modalities may reduce the morbidity associated with sarcoma surgery; the PET-CT and PET-MRI approaches in particular demonstrating high clinical efficacy. Despite advancements in the accuracy in pre-operative imaging, translation of an image to surgical margins is difficult, regularly resulting in wider resection margins than required. For soft tissue sarcomas there is currently no standard technique for image guided resections, while for bone sarcomas fluoroscopy may be used, however margins are not easily discernible during the surgical procedure. Near infra-red (NIR) fluorescence guided surgery offers an intra-operative modality through which complete tumour resection with adequate tumour-free margins may be achieved, while simultaneously minimising surgical morbidity. NIR imaging presents a potentially valuable adjunct to sarcoma surgery. Early reports indicate that it may be able to provide the surgeon with helpful information on anatomy, perfusion, lymphatic drainage, tumour margins and metastases. The use of NIR fluorochromes have also been demonstrated to be well tolerated by patients. However, prior to widespread implementation, studies related to cost-effectiveness and the development of protocols are essential. Nevertheless, NIR imaging may become ubiquitous in the future, carrying the potential to transform the surgical management of sarcoma.
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208
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Assessment of Familiarity With Work-up Guidelines for Bone and Soft Tissue Sarcoma Among Primary Care Practitioners in Minnesota. MAYO CLINIC PROCEEDINGS: INNOVATIONS, QUALITY & OUTCOMES 2020; 4:143-149. [PMID: 32280924 PMCID: PMC7140016 DOI: 10.1016/j.mayocpiqo.2019.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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209
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CORR Insights®: Is There an Association Between Insurance Status and Survival and Treatment of Primary Bone and Extremity Soft-tissue Sarcomas? A SEER Database Study. Clin Orthop Relat Res 2020; 478:537-539. [PMID: 31498260 PMCID: PMC7145082 DOI: 10.1097/corr.0000000000000932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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210
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Smolle MA, Schaffler A, Leithner A, Van Praag VM, Bergovec M, Szkandera J, Liegl‐Atzwanger B, Niethard M, Tunn P, Van De Sande M, Andreou D. Incidence, treatment and outcome of abdominal metastases in extremity soft tissue sarcoma: Results from a multi-centre study. J Surg Oncol 2020; 121:605-611. [PMID: 32003475 PMCID: PMC7065201 DOI: 10.1002/jso.25856] [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: 11/09/2019] [Accepted: 01/16/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Abdominal metastases (AM) from soft tissue sarcoma (STS) are rare and prognosis is poor. The aims of the study were to (a) identify risk factors for the development of AM and to (b) investigate the outcome of AM-patients. METHODS Seven-hundred-sixty-nine STS-patients with localised disease at diagnosis treated at three tumour centres (2000-2016) were retrospectively included (409 males; mean age, 55.6 years [range, 8-96 years]; median follow-up, 4.1 years [interquartile-range, 2.5-6.6 years]). RESULTS Two-hundred-two patients (26.3%) developed secondary metastases, and 24 of them AM (3.1%). Ten patients developed first AM (FAM) after a mean of 2.4 years and 14 patients late AM (LAM, after being diagnosed with metastases to other sites) after a mean of 2.0 years. Patients with liposarcoma had a significantly higher risk of developing AM (P = .007), irrespective of grading. There was no difference in post-metastasis-survival (PMS) between patients with AM at any time point and those with metastases to other sites (P = .585). Patients with LAM or FAM showed no difference in post-abdominal-metastasis-survival (P = .884). CONCLUSIONS Survival in patients with AM is poor, irrespective of whether they develop secondarily to other metastases or not. Patients at high-risk of AM (ie, liposarcoma) may be followed-up regularly by abdominal-ultrasound/CT.
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Affiliation(s)
- Maria A. Smolle
- Department of Orthopaedics and TraumaMedical University of GrazGrazAustria
| | | | - Andreas Leithner
- Department of Orthopaedics and TraumaMedical University of GrazGrazAustria
| | | | - Marko Bergovec
- Department of Orthopaedics and TraumaMedical University of GrazGrazAustria
| | - Joanna Szkandera
- Division of Clinical Oncology, Internal MedicineMedical University of GrazGrazAustria
| | | | - Maya Niethard
- Department of Orthopaedic OncologyHELIOS‐Klinikum Berlin‐BuchBerlinGermany
| | - Per‐Ulf Tunn
- Department of Orthopaedic OncologyHELIOS‐Klinikum Berlin‐BuchBerlinGermany
| | - Michiel Van De Sande
- Department of OrthopaedicsLeiden University Medical CentreZA LeidenThe Netherlands
| | - Dimosthenis Andreou
- Tumour Orthopaedics and Sarcoma SurgeryHELIOS Klinikum Bad SaarowBad SaarowGermany
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211
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Abstract
After initial treatment of sarcoma, disease progression may occur in the form of local recurrence, pulmonary metastases, or extrapulmonary metastases. As such, surveillance is an important aspect of management, but no universally accepted practice standards are found. In the absence of strong evidence, and to allow for individualized care, existing guidelines contain flexibility in terms of both the frequency and modality of surveillance. In general, they agree that follow-up should be more intense in the early years after treatment, especially for high-grade sarcomas, and continue for at least 10 years. For local recurrence, data suggest that physical examination is usually sufficient for monitoring; in addition, some guidelines endorse imaging routinely, whereas others only as clinically indicated. For pulmonary metastasis, either radiograph or CT is recommended, with the latter having theoretical advantages but no proven survival benefit to date. Extrapulmonary metastases are rare in most sarcoma types, so the literature only supports extrapulmonary surveillance for certain diagnoses. This topic is complicated by the diversity of sarcomas, the limited evidence, and the indefinite, often conflicting recommendations; therefore, it is critical for providers to understand the existing research and guidelines to determine optimal surveillance strategies for their patients.
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212
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Savvidou OD, Koutsouradis P, Bolia IK, Kaspiris A, Chloros GD, Papagelopoulos PJ. Soft tissue tumours of the elbow: current concepts. EFORT Open Rev 2020; 4:668-677. [PMID: 32010455 PMCID: PMC6986393 DOI: 10.1302/2058-5241.4.190002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Soft tissue tumours of the elbow are mostly benign. Malignant tumours in this area, although uncommon, often present unique clinical and histopathological characteristics that are helpful for diagnosis.Management of soft tissue tumours around the elbow may be challenging because of their rarity and the proximity to neurovascular structures. Careful staging, histological diagnosis and treatment are essential to optimize clinical outcome. A missed or delayed diagnosis or an improperly executed biopsy may have devastating consequences for the patient.This article reviews the most common benign and malignant soft tissue tumours of the elbow and discusses the clinicopathological findings, imaging features and current therapeutic concepts. Cite this article: EFORT Open Rev 2019;4:668-677. DOI: 10.1302/2058-5241.4.190002.
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Affiliation(s)
- Olga D Savvidou
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 'ATTIKON' Hospital, Athens, Greece
| | | | - Ioanna K Bolia
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 'ATTIKON' Hospital, Athens, Greece
| | - Angelos Kaspiris
- Laboratory of Molecular Pharmacology/Sector for Bone Research, School of Health Sciences, University of Patras, Patras 26504, Greece
| | - George D Chloros
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 'ATTIKON' Hospital, Athens, Greece
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 'ATTIKON' Hospital, Athens, Greece
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213
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Sommer A, Royle NJ. ALT: A Multi-Faceted Phenomenon. Genes (Basel) 2020; 11:E133. [PMID: 32012790 PMCID: PMC7073516 DOI: 10.3390/genes11020133] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/17/2020] [Accepted: 01/22/2020] [Indexed: 01/13/2023] Open
Abstract
One of the hallmarks of cancer cells is their indefinite replicative potential, made possible by the activation of a telomere maintenance mechanism (TMM). The majority of cancers reactivate the reverse transcriptase, telomerase, to maintain their telomere length but a minority (10% to 15%) utilize an alternative lengthening of telomeres (ALT) pathway. Here, we review the phenotypes and molecular markers specific to ALT, and investigate the significance of telomere mutations and sequence variation in ALT cell lines. We also look at the recent advancements in understanding the different mechanisms behind ALT telomere elongation and finally, the progress made in identifying potential ALT-targeted therapies, including those already in use for the treatment of both hematological and solid tumors.
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Affiliation(s)
| | - Nicola J. Royle
- Department of Genetics and Genome Biology, University of Leicester, Leicester LE1 7RH, UK;
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Spencer RMSSB, de Camargo VP, Silva MLG, Pinto FFE, Costa FD, Cequeira WS, Munhoz RR, Mello CA, Schmerling RA, Filho WJD, Coelho TM, Ambrosio AVA, Leite ETT, Hanna SA, Nakagawa SA, Baptista AM, Pinheiro RN, de Oliveira JL, de Araújo MS, de Araujo RLC, Laporte GA, de Almeida Quadros C, de Oliveira AF, Lopes A. Brazilian consensus on the diagnosis and treatment of extremities soft tissue sarcomas. J Surg Oncol 2020; 121:743-758. [PMID: 31970785 DOI: 10.1002/jso.25847] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/05/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Soft tissue sarcomas (STSs) are rare tumors and constitute only 1% of all tumors in adults. Indeed, due to their rarity, most cases in Brazil are not treated according to primary international guidelines. METHODS This consensus addresses the treatment of STSs in the extremities. It was made by workgroups from Brazilian Societies of Surgical Oncology, Orthopaedics, Clinical Oncology, Pathology, Radiology and Diagnostic Imaging, and Radiation Oncology. The workgroups based their arguments on the best level of evidence in the literature and recommendations were made according to diagnosis, staging, and treatment of STSs. A meeting was held with all the invited experts and the topics were presented individually with the definition of the degree of recommendation, based on the levels of evidence in the literature. RESULTS Risk factors and epidemiology were described as well as the pathological aspects and imaging. All recommendations are described with the degree of recommendation and levels of evidence. CONCLUSION Recommendations based on the best literature regional aspects were made to guide professionals who treat STS. Separate consensus on specific treatments for retroperitoneal, visceral, trunk, head and neck sarcomas, and gastrointestinal stromal tumor, are not contemplated into this consensus.
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Affiliation(s)
- Ranyell M S S B Spencer
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Veridiana P de Camargo
- Department of Directory, Brazilian Society of Clinical Surgical (BSCO), São Paulo, Brazil
| | - Maria L G Silva
- Department of Directory, Brazilian Society of Radiation Oncology (BSRO), São Paulo, Brazil
| | - Fabio F E Pinto
- Department of Directory, Brazilian Society of Orthopaedics and Traumatology (BSOT), São Paulo, Brazil
| | | | - Wagner S Cequeira
- AC Camargo Cancer Center, Department of Diagnosis and Imaging, São Paulo, Brazil
| | - Rodrigo R Munhoz
- Department of Directory, Brazilian Society of Clinical Surgical (BSCO), São Paulo, Brazil
| | - Celso A Mello
- Department of Directory, Brazilian Society of Clinical Surgical (BSCO), São Paulo, Brazil
| | - Rafael A Schmerling
- Department of Directory, Brazilian Society of Clinical Surgical (BSCO), São Paulo, Brazil
| | - Waldec J D Filho
- Department of Directory, Brazilian Society of Clinical Surgical (BSCO), São Paulo, Brazil
| | - Tharcisio M Coelho
- Department of Directory, Brazilian Society of Radiation Oncology (BSRO), São Paulo, Brazil
| | - Alexandre V A Ambrosio
- Department of Directory, Brazilian Society of Radiation Oncology (BSRO), São Paulo, Brazil
| | - Elton T T Leite
- Department of Directory, Brazilian Society of Radiation Oncology (BSRO), São Paulo, Brazil
| | - Samir A Hanna
- Department of Directory, Brazilian Society of Radiation Oncology (BSRO), São Paulo, Brazil
| | - Sueli A Nakagawa
- Department of Directory, Brazilian Society of Orthopaedics and Traumatology (BSOT), São Paulo, Brazil
| | - Andre M Baptista
- Department of Directory, Brazilian Society of Orthopaedics and Traumatology (BSOT), São Paulo, Brazil
| | - Rodrigo N Pinheiro
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Jadivan L de Oliveira
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Marcelo Sá de Araújo
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Raphael L C de Araujo
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Gustavo A Laporte
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | | | - Alexandre F de Oliveira
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Ademar Lopes
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
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215
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Kosela-Paterczyk H, Paziewska A, Kulecka M, Balabas A, Kluska A, Dabrowska M, Piatkowska M, Zeber-Lubecka N, Ambrozkiewicz F, Karczmarski J, Mikula M, Rutkowski P, Ostrowski J. Signatures of circulating microRNA in four sarcoma subtypes. J Cancer 2020; 11:874-882. [PMID: 31949491 PMCID: PMC6959019 DOI: 10.7150/jca.34723] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 09/27/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Sarcomas are rare malignant tumors of mesenchymal origin. The discovery of circulating biomarkers with high diagnostic value could supplement diagnosis of this heterogenous group of tumors. The aim of this study was to identify the profiles of circulating miRNA (c-miRNAs) in four groups of common bone and soft tissue sarcomas. Methods: At the time of diagnosis, blood samples were collected from 86 patients: 36 with locally advanced/unresectable/metastatic gastrointestinal stromal tumor (GIST) who received first-line treatment with imatinib; 16 with locally advanced osteosarcoma (OS); 26 with locally advanced synovial sarcoma (SS); and eight with locally advanced Ewing sarcoma (ES). In addition, samples were collected from 30 healthy controls. C-miRNAs were isolated using a miRCURY RNA Isolation Kit, followed by preparation of cDNA libraries and sequencing on the Ion Proton platform. Results: Pair-wise comparisons identified 156 unique c-miRNAs (adjusted P-value < 0.05) showing significant dysregulation between controls and patients; of these, 24, 36, 42, and 99 differentiated controls from pretherapeutic OS, SS, ES, and GIST, respectively. Ten c-miRNAs were commonly altered in at least three sarcoma types. Receiver operating characteristic curves and area under the curve (ROC-AUC) analyses revealed that a four-miRNA diagnostic classifier was able to differentiate controls from ES, GIST, OS, and SS, with AUC-ROC values of 1, 0.97, 0.95, and 0.94, respectively. Conclusions: Aberrant miRNA expression signatures were identified in serum from patients with four different sarcoma subtypes. Differences in miRNA expression profiles between sarcoma patients and healthy volunteers suggest that miRNAs may play a role in sarcoma development.
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Affiliation(s)
- Hanna Kosela-Paterczyk
- Department of Soft Tissue, Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute - Oncology Centre, Warsaw, Poland
| | - Agnieszka Paziewska
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Genetics, Maria Sklodowska-Curie Institute - Oncology Centre; 02-781 Warsaw, Poland
| | - Maria Kulecka
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Genetics, Maria Sklodowska-Curie Institute - Oncology Centre; 02-781 Warsaw, Poland
| | - Aneta Balabas
- Department of Genetics, Maria Sklodowska-Curie Institute - Oncology Centre; 02-781 Warsaw, Poland
| | - Anna Kluska
- Department of Genetics, Maria Sklodowska-Curie Institute - Oncology Centre; 02-781 Warsaw, Poland
| | - Michalina Dabrowska
- Department of Genetics, Maria Sklodowska-Curie Institute - Oncology Centre; 02-781 Warsaw, Poland
| | - Magdalena Piatkowska
- Department of Genetics, Maria Sklodowska-Curie Institute - Oncology Centre; 02-781 Warsaw, Poland
| | - Natalia Zeber-Lubecka
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Filip Ambrozkiewicz
- Department of Genetics, Maria Sklodowska-Curie Institute - Oncology Centre; 02-781 Warsaw, Poland
| | - Jakub Karczmarski
- Department of Genetics, Maria Sklodowska-Curie Institute - Oncology Centre; 02-781 Warsaw, Poland
| | - Michal Mikula
- Department of Genetics, Maria Sklodowska-Curie Institute - Oncology Centre; 02-781 Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue, Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute - Oncology Centre, Warsaw, Poland
| | - Jerzy Ostrowski
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Genetics, Maria Sklodowska-Curie Institute - Oncology Centre; 02-781 Warsaw, Poland
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216
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Impact of unplanned resection and re-excision of a soft tissue sarcoma on prognosis. Cir Esp 2019; 98:281-287. [PMID: 31806234 DOI: 10.1016/j.ciresp.2019.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/17/2019] [Accepted: 10/20/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Up to 40% of all initial operations for soft tissue sarcoma (STS) are unplanned, which would leave residual macroscopic tumor in more than 50% of the cases. The effect this has on local recurrence rate, metastases rate and survival has never been fully established, due to the lack of randomized studies. METHODS Retrospective review of patients with STS treated in our unit between January 2001-January 2016. We classified them whether they had been treated by initial planned or unplanned operation. Outcomes were compared in both groups globally and stage-matched. Endpoints were local recurrence and distant metastases. RESULTS Twenty-three patients of STS underwent a planned excision and 16 an unplanned excision, 13 of them underwent further re-excision. 40% of patients with planned excision had an advanced stage in regard to the unplanned excision group which presented earlier stages. 77% of patients with unplanned excision had residual tumor identified after surgical re-excision. Local recurrence rate in the unplanned excision group was considerably higher 73,5% vs. 43,8%. Metastases rate was lower in planned excision group, 45,5% vs 56,3% (P > .05). The recurrence pattern in the unplanned excision group was unstable, with worse outcomes in earlier stages. CONCLUSION The unplanned excision of a soft tissue sarcoma may compromise disease local control, with higher rates of local recurrence and metastases, and worse functional out- comes, despite further oncological treatment. We need to recognize the clinical features for malignancy risk in soft tissue lumps for a safe diagnosis to avoid inadequate resections.
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217
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Snow H, Davies E, Strauss DC, Smith M, Hayes AJ. Conservative Re-excision is a Safe and Simple Alternative to Radical Resection in Revision Surgery for Dermatofibrosarcoma Protuberans. Ann Surg Oncol 2019; 27:919-923. [DOI: 10.1245/s10434-019-08011-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Indexed: 11/18/2022]
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218
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Tween H, Peake D, Spooner D, Sherriff J. Radiotherapy for the Palliation of Advanced Sarcomas-The Effectiveness of Radiotherapy in Providing Symptomatic Improvement for Advanced Sarcomas in a Single Centre Cohort. Healthcare (Basel) 2019; 7:healthcare7040120. [PMID: 31635409 PMCID: PMC6955748 DOI: 10.3390/healthcare7040120] [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: 09/10/2019] [Accepted: 10/15/2019] [Indexed: 01/26/2023] Open
Abstract
Background: Sarcomas are rare and heterogeneous tumours with a large proportion of patients requiring palliative intervention. They are regarded as relatively radioresistant and therefore achieving good palliation with radiation may require larger doses than for more common solid tumour types. Limited data is available regarding appropriate palliative radiotherapy dose fractionation. This case series aims to assess the effectiveness of radiotherapy in providing symptomatic improvement for advanced sarcomas. Method: Data was retrospectively collected for patients treated with palliative radiotherapy between July 2010 and April 2019 at one institution. The primary outcome was documented symptomatic improvement following radiotherapy. Secondary outcome was overall survival. Results: One hundred and five patients had a total of 137 sites treated using 25 different dose fractionation schedules. The median patient age was 54 (range 8–90) years. Treated sites included 114 soft tissue and 23 bone sarcomas. Data on symptomatic improvement was available in 56% and 67% of cases respectively. A total of 70% of soft tissue and 55% of bone sarcoma patients reported symptomatic improvement. Symptomatic response rates appeared to increase to a biological effective dose (BED) of 50Grey4 (Gy4) (alpha beta ratio (α/β) = 4 for tumour) but did not continue to improve with further rises in dose beyond this. Conclusion: Palliative radiotherapy offers symptomatic improvement for sarcoma patients with two-thirds of patients reporting reduction in symptoms. These results are limited by the heterogeneous study population including different sarcoma subtypes each with a probable different radio-sensitivity, treated with different radiotherapy schedules. Further prospective data collection is needed considering sarcoma subtype radio-sensitivity, to determine appropriate palliative dose fractionation schedules.
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Affiliation(s)
- Hannah Tween
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK.
| | - David Peake
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK.
| | - David Spooner
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK.
| | - Jenny Sherriff
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK.
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219
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[French ccAFU guidelines - Update 2018-2020: Retroperitoneal sarcoma]. Prog Urol 2019; 28 Suppl 1:R167-R176. [PMID: 31610871 DOI: 10.1016/j.purol.2019.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To update French urological guidelines on retroperitoneal sarcoma. METHODS Comprehensive Medline search between 2016 and 2018 upon diagnosis, treatment and follow-up of retroperitoneal sarcoma. Level of evidence was evaluated. RESULTS Chest, abdomen and pelvis CT is mandatory to evaluate any suspected retroperitoneal sarcoma. MRI sometimes helps surgical planning. Before histological confirmation through biopsy, the patient must be registered in the French sarcoma pathology reference network. The biopsy standard should be an extraperitoneal coaxial percutaneous sampling before any retroperitoneal mass therapeutic decision. Surgery is retroperitoneal sarcoma cornerstone. The main objective is grossly negative margins and can be technically challenging. Multimodal treatment risks and benefits must be discussed in multidisciplinary teams. The relapse rate is related to tumor grade and surgical margins. CONCLUSION Retroperitoneal sarcoma prognosis is poor and closely related to the quality of initial management. Centralization through dedicated sarcoma pathology network in a high-volume center is mandatory.
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220
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Campana LG, Kis E, Bottyán K, Orlando A, de Terlizzi F, Mitsala G, Careri R, Curatolo P, Snoj M, Sersa G, Valpione S, Quaglino P, Mowatt D, Brizio M, Schepler H. Electrochemotherapy for advanced cutaneous angiosarcoma: A European register-based cohort study from the International Network for Sharing Practices of electrochemotherapy (InspECT). Int J Surg 2019; 72:34-42. [PMID: 31618680 DOI: 10.1016/j.ijsu.2019.10.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/24/2019] [Accepted: 10/09/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cutaneous angiosarcoma (cAS) is a highly aggressive malignancy that challenges the radicality of surgical treatment. Electrochemotherapy (ECT), a skin-directed treatment based on cytotoxic chemotherapy combined with local electric pulses, may be an intraoperative adjunct and a new opportunity in the therapeutic strategy. This cohort study reports the experience with ECT as an option. METHODS Data on patients with locally-advanced/metastatic cAS who underwent ECT between October 2013 and October 2018 at eight European centres were prospectively submitted to the InspECT (International network for sharing practices of ECT) register. Patients received therapy according to the European Standard Operating Procedures of ECT (ESOPE). Treatment feasibility was assessed based on tumour coverage with electrodes and recorded tissue current; treatment toxicity and tumour response were graded according to CTCAE v5.0 and RECIST v1.1 criteria, respectively; patient-reported outcomes (PRO) were evaluated using a visual analogue score (VAS) for pain, acceptance of retreatment and the EQ-5D questionnaire. RESULTS We enrolled 20 patients with advanced cAS in the scalp/face (n = 7), breast/trunk (n = 10) or limbs (n = 3). Target tumours (n = 51) had a median size of 2.3 cm (range, 1-20). We administered 24 ECT courses using 1-4 cm treatment safety margin around tumours. In five patients, ECT was combined/sequenced with surgery. Median tissue current was 3 A (range, 1.5-10), tumour margins coverage rate was 75% (15/20 patients). The objective response rate (ORR) was 80% (complete, 40%). Grade-3 toxicity included skin ulceration (15%) and pain (10%), with no significant change of PRO scores. Bleeding control was achieved in 13/14 patients with ulcerated tumours. With a median overall survival of 12.5 months, the local progression-free survival (LPFS) was 10.9 months. CONCLUSION ECT produces sustained response rate with minimal side effects and should be considered an option for advanced cAS. Palliative benefits include patient tolerability, local haemostasis and durable local control. Definition of optimal timing, treatment safety margins and combination with surgery need further investigation.
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Affiliation(s)
- Luca G Campana
- Department of Surgical Oncological and Gastroenterological Sciences - DISCOG, University of Padova, Padova, Italy.
| | - Erika Kis
- Department of Dermatology and Allergology, University of Szeged, Hungary
| | - Krisztina Bottyán
- Department of Dermatology and Allergology, University of Szeged, Hungary
| | - Antonio Orlando
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Grammatiki Mitsala
- Department of Plastic and Reconstructive Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Rosanna Careri
- Department of Dermatology and Plastic Surgery, Dermatologic Clinic, University 'La Sapienza', Rome, Italy
| | - Pietro Curatolo
- Department of Dermatology and Plastic Surgery, Dermatologic Clinic, University 'La Sapienza', Rome, Italy
| | - Marko Snoj
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Sara Valpione
- The Christie NHS Foundation Trust, CRUK Manchester Institute, The University of Manchester, Manchester, UK
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - David Mowatt
- Plastic Surgery Unit, The Christie NHS Foundation Trust, Manchester, UK
| | - Matteo Brizio
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Hadrian Schepler
- Department of Dermatology, University Medical Center, Mainz, Germany
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Ascari F, Segattini S, Varoli M, Beghi M, Muratori S, Scotto B, Gasperoni M. Abdominal wall reconstruction for desmoid tumour surgery: Case report. Int J Surg Case Rep 2019; 64:6-9. [PMID: 31586888 PMCID: PMC6796622 DOI: 10.1016/j.ijscr.2019.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/21/2019] [Accepted: 09/10/2019] [Indexed: 12/28/2022] Open
Abstract
Desmoid tumours are rare benign neoplasms with local invasion and recurrence. A margin-free excision may be challenging for the surgeon. If necessary, abdominal wall reconstruction can be required for rectus abdominis muscle tumours. A multidisciplinary approach is necessary approaching this rare disease.
Introduction Desmoid tumours are rare benign neoplasms with strong tendency to local invasion and recurrence. They usually rise from muscles and aponeurosis and could be challenging for medical treatment. We here report the case of a patient requiring the excision of part of the abdominal rectus muscle and an abdominal wall reconstruction. Presentation of case A 38 years old women referred to our institution complaining of a painful lump in the anterior abdominal wall. She underwent ultrasonography (US), magnetic resonance imaging (MRI) and a computed tomography (CT) biopsy who showed the presence of a desmoid tumour arising in the right abdominal rectus muscle. She underwent surgical excision of the mass and an abdominal wall reconstruction according to the posterior component separation technique, with a large polypropylene mesh reinforcement. The post-operative period was uneventful and at 6 months she shows no clinical nor radiological recurrence. Discussion Desmoid tumours are rare neoplasms rising in many anatomical spaces and requiring challenging decisions. A radical resection with free margins remains the principal determinant of outcome. Non-surgical approaches and adjuvant therapy may be useful for patients with unresectable lesions. Conclusion The optimal treatment strategy for desmoid tumours still remains unclear. A multidisciplinary approach is always the best strategy to establish the correct treatment.
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Affiliation(s)
- Francesca Ascari
- General Surgery Unit, "Bernardino Ramazzini" Hospital, Via Guido Molinari 2, 41012, Carpi, MO, Italy
| | - Silvia Segattini
- General Surgery Unit, "Bernardino Ramazzini" Hospital, Via Guido Molinari 2, 41012, Carpi, MO, Italy
| | - Michele Varoli
- General Surgery Unit, "Bernardino Ramazzini" Hospital, Via Guido Molinari 2, 41012, Carpi, MO, Italy
| | - Massimo Beghi
- General Surgery Unit, "Bernardino Ramazzini" Hospital, Via Guido Molinari 2, 41012, Carpi, MO, Italy
| | - Simone Muratori
- General Surgery Unit, "Bernardino Ramazzini" Hospital, Via Guido Molinari 2, 41012, Carpi, MO, Italy
| | - Bruno Scotto
- General Surgery Unit, "Bernardino Ramazzini" Hospital, Via Guido Molinari 2, 41012, Carpi, MO, Italy.
| | - Marco Gasperoni
- General Surgery Unit, "Bernardino Ramazzini" Hospital, Via Guido Molinari 2, 41012, Carpi, MO, Italy
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Cairncross L, Snow HA, Strauss DC, Smith MJF, Sjokvist O, Messiou C, Thway K, Hayes AJ. Diagnostic performance of MRI and histology in assessment of deep lipomatous tumours. Br J Surg 2019; 106:1794-1799. [PMID: 31502664 DOI: 10.1002/bjs.11309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/07/2019] [Accepted: 06/11/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Deep lipomatous tumours can be benign lipomas or intermediate/locally recurring atypical lipomatous tumours (ALTs). Differentiating between these two entities clinically and radiologically is difficult. The aims of this study were to report a series of deep lipomatous tumours, comparing the clinical, radiological and pathological features of ALTs and lipomas; and to predict the likelihood of a lipomatous tumour being ALT based on anatomical site and MRI characteristics. METHODS This was a retrospective review of patients with deep lipomatous tumours presenting over 6 years to a tertiary sarcoma centre, with preoperative MRI, and preoperative or postoperative histology including MDM2 gene analysis. Sensitivity, specificity, predictive values and accuracy in diagnosing ALT were calculated for MRI and histopathological features. RESULTS Some 248 patients were included; 81 (32·7 per cent) had a final diagnosis of ALT. ALTs were larger than lipomas (median 19 versus 10 cm; P < 0·001); there was no ALT smaller than 5 cm. A tumour presenting in the lower limb was more likely to be an ALT than a lesion at any other site (48·4 versus 13·5 per cent; P < 0·001). In patients with lipomatous tumours at sites other than the lower limbs, MRI had a negative predictive value of 95 per cent for excluding ALT. CONCLUSION Despite concern, most deep lipomatous tumours (nearly 70 per cent) are benign lipomas. Certain features imply that tumours are almost never ALT: smaller than 5 cm or located outside the lower limb with no suspicious characteristics on MRI. Tumours with these features might safely and confidently be managed outside tertiary sarcoma centres.
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Affiliation(s)
- L Cairncross
- Department of Academic Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK
| | - H A Snow
- Department of Academic Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK
| | - D C Strauss
- Department of Academic Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK
| | - M J F Smith
- Department of Academic Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK
| | - O Sjokvist
- Department of Academic Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK
| | - C Messiou
- Department of Radiology, Royal Marsden Hospital, London, UK
| | - K Thway
- Department of Pathology, Royal Marsden Hospital, London, UK
| | - A J Hayes
- Department of Academic Surgery, Sarcoma Unit, Royal Marsden Hospital, London, UK
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Challenges of Clinical Management of Adolescent and Young Adults With Bone and Soft Tissue Sarcoma. ACTA ACUST UNITED AC 2019; 24:301-306. [PMID: 30480574 DOI: 10.1097/ppo.0000000000000337] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Clinical management of adolescents and young adults with bone and soft tissue sarcomas is quite challenging, mainly because of different chemotherapy approaches adopted by pediatric and adult oncologists and tumor-associated factors related to this peculiar age group. Overcoming these barriers is essential for adolescent and young adult patients, whose survival and long-term physical effects are worse than their pediatric counterparts. Nowadays, constant efforts from international collaborations between pediatric and adult oncologists of sarcoma groups have optioned in converging toward a common therapeutic strategy, while improving quality of treatment, as well as research advances dedicated to this at-risk age group of patients with sarcomas.
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Gondim Teixeira PA, Biouichi H, Abou Arab W, Rios M, Sirveaux F, Hossu G, Blum A. Evidence-based MR imaging follow-up strategy for desmoid-type fibromatosis. Eur Radiol 2019; 30:895-902. [PMID: 31468156 DOI: 10.1007/s00330-019-06404-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/04/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To propose a follow-up strategy for desmoid-type fibromatosis (DF) based on tumor growth behavior and the signal on T2-weighted MRI. METHODS We retrospectively reviewed 296 MRI studies of 34 patients with histologically proven DF. In each study, tumor volume and T2 signal relatively normal striated muscle were assessed. Volume variation and monthly growth rates were analyzed to determine lesion growth behavior (progressing versus stable/regressing lesions). Growth behavior was correlated with T2 signal, tumor location, β-catenin status, treatment strategy, and follow-up duration. Interobserver variability of volume measurements and interobserver measurement variation ratio were assessed. RESULTS There were 25 women and 9 men with a mean age of 39.9 ± 19 (4-73) years. Mean follow-up time in the patients included was 55 ± 41 (12-148) months. In progressing lesions, the mean average monthly growth ratio was 10.9 ± 9.2 (1.1-42.5) %. Interobserver variability of volume measurements was excellent (ICC = 0.96). Mean interobserver measurement variation ratio was 20.4 ± 23.6%. The only factor correlated with tumor growth behavior was T2 signal ratio (p < 0.0001). Seventeen out of 34 (50%) patients presented a signal change over the threshold of 1 during follow-up. There were five occurrences of secondary growth after a period of stability with a mean delay until growth of 38.2 ± 44.2 (17-116) months. CONCLUSION DF growth rate was quantitatively assessed. A threshold for volume variation detection was established. DF growth behavior was significantly related to T2 signal. An evidence-based follow-up strategy is proposed. KEY POINTS • In progressing desmoid fibromatosis, the mean average monthly growth ratio was 10.9 ± 9.2%. • Lesions with muscle/tumor T2 signal ratios lower than 1 tended to be stable or regress over time. • Given the interobserver measurement variability and MRI in-plane spatial resolution, a variation higher than 42.6% in tumor volume is required to confirm punctual progression.
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Affiliation(s)
- P A Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, Regional University Hospital Center of Nancy (CHRU-Nancy), 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France.
| | - H Biouichi
- Guilloz Imaging Department, Central Hospital, Regional University Hospital Center of Nancy (CHRU-Nancy), 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France
| | - W Abou Arab
- Guilloz Imaging Department, Central Hospital, Regional University Hospital Center of Nancy (CHRU-Nancy), 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France
| | - M Rios
- Lorraine Cancer Institute, Vandoeuvre-lès-Nancy, France
| | - F Sirveaux
- Emile Gallé Surgical Center, Regional University Hospital Center of Nancy, Nancy, France
| | - G Hossu
- Inserm, IADI, Université de Lorraine, Nancy, France
| | - A Blum
- Guilloz Imaging Department, Central Hospital, Regional University Hospital Center of Nancy (CHRU-Nancy), 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France
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Gouin F, Renault A, Bertrand-Vasseur A, Bouilleau L, Crenn V, Rosset P, Tallegas M, Samargandi R, Le Nail LR. Early detection of multiple bone and extra-skeletal metastases by body magnetic resonance imaging (BMRI) after treatment of Myxoid/Round-Cell Liposarcoma (MRCLS). Eur J Surg Oncol 2019; 45:2431-2436. [PMID: 31447287 DOI: 10.1016/j.ejso.2019.08.014] [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: 03/17/2019] [Revised: 07/28/2019] [Accepted: 08/12/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Myxoid Round cell containing myxoid liposarcomas (MRCLS) have a high propensity to metastasize to soft tissue and bone. Whole Body Magnetic Resonance Imaging (BMRI) has been reported as a critical modality to early detect disease spreading in asymptomatic patients. The purpose of this study is to describe metastatic patterns and outcomes in patients through annual BMRI surveillance after diagnosis of MRCLS of the extremities and trunk. MATERIEL AND PATIENTS This retrospective study included patients with histology confirmed MRCLS. Initial BMRI were done within 6 months following the first line treatment then once a year. RESULTS Forty-five out of 51 consecutive MRCLS patients were included. At the last follow-up 10 patients (22.2%) had an extra-pulmonary soft-tissue or/and bone metastasis detected in a median delay of 22.7±16 months [0-49] from the diagnosis of the MRCLS. Nine patients were asymptomatic. Finally, 5-years metastatic free survival was 72±8%. All metastatic patients had multiple lesion within the year following the first lesion diagnosis. CONCLUSION Systematic BMRI in MRCLS patients following treatment frequently identify extra-pulmonary metastasis in asymptomatic patients within the first 5 years of follow-up. Despite a long survival can be expected after diagnosis, extra-skeletal metastasis was a signal of disseminated disease.
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Affiliation(s)
- Francois Gouin
- Clinique Chirurgicale Orthopédique, Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, France; INSERM UMR1238. Bone Sarcoma and Remodeling of Calcified Tissues. Faculté de Médecine de Nantes, France.
| | - Arthur Renault
- Service de Radiologie, Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, France
| | | | - Loic Bouilleau
- Service de Radiologie, Hôpital Trousseau, CHRU de Tours, France Faculté de Médecine, Université de Tours, France
| | - Vincent Crenn
- Service de Radiologie, Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, France; INSERM UMR1238. Bone Sarcoma and Remodeling of Calcified Tissues. Faculté de Médecine de Nantes, France
| | - Philippe Rosset
- Service de Chirurgie Orthopédique 1&2, Hôpital Trousseau, CHRU de Tours, France Faculté de Médecine, Université de Tours, France; INSERM UMR1238. Bone Sarcoma and Remodeling of Calcified Tissues. Faculté de Médecine de Nantes, France
| | - Matthias Tallegas
- Service d'Anatomie-Pathologique, Hôpital Trousseau, CHRU de Tours, France, Faculté de Médecine, Université de Tours, France
| | - Rami Samargandi
- Service de Chirurgie Orthopédique 1&2, Hôpital Trousseau, CHRU de Tours, France Faculté de Médecine, Université de Tours, France
| | - Louis-Romée Le Nail
- Service de Chirurgie Orthopédique 1&2, Hôpital Trousseau, CHRU de Tours, France Faculté de Médecine, Université de Tours, France; INSERM UMR1238. Bone Sarcoma and Remodeling of Calcified Tissues. Faculté de Médecine de Nantes, France
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Clinical features and treatment outcome of desmoid-type fibromatosis: based on a bone and soft tissue tumor registry in Japan. Int J Clin Oncol 2019; 24:1498-1505. [PMID: 31332613 DOI: 10.1007/s10147-019-01512-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/05/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Treatment modality of desmoid-type fibromatosis (DF) has changed from surgery with a wide surgical margin to conservative treatment. In this study, tumor characteristics of DF, transition of the treatment modality, and clinical outcome of surgical treatment were analyzed based on data obtained from the bone and soft tissue tumor registry established in Japan. METHODS Data were collected as registration data and follow-up data. Five hundred and thirty registered cases of DF were identified, including 223 cases with follow-up data with or without surgical treatment. RESULTS The number of registered patients increased gradually. The frequency of surgical treatment was gradually reduced year by year. The 3-year local recurrence free survival (LRFS) was 77.7%, with tumor location and size tending to correlate with LRFS. Interestingly, there was no significant difference in LRFS between wide and marginal margin (P = 0.34). CONCLUSIONS The treatment modality has shifted from surgical to conservative treatment, with risk factors for surgical treatment similar to those noted in previous studies. The National registry system is crucial for a rare disease such as DF, and in the future, a population based registry system should be established to better comprehend the actual status of DF.
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227
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Blay JY, Honoré C, Stoeckle E, Meeus P, Jafari M, Gouin F, Anract P, Ferron G, Rochwerger A, Ropars M, Carrere S, Marchal F, Sirveaux F, Di Marco A, Le Nail LR, Guiramand J, Vaz G, Machiavello JC, Marco O, Causeret S, Gimbergues P, Fiorenza F, Chaigneau L, Guillemin F, Guilloit JM, Dujardin F, Spano JP, Ruzic JC, Michot A, Soibinet P, Bompas E, Chevreau C, Duffaud F, Rios M, Perrin C, Firmin N, Bertucci F, Le Pechoux C, Le Loarer F, Collard O, Karanian-Philippe M, Brahmi M, Dufresne A, Dupré A, Ducimetière F, Giraud A, Pérol D, Toulmonde M, Ray-Coquard I, Italiano A, Le Cesne A, Penel N, Bonvalot S. Surgery in reference centers improves survival of sarcoma patients: a nationwide study. Ann Oncol 2019; 30:1143-1153. [PMID: 31081028 PMCID: PMC6637376 DOI: 10.1093/annonc/mdz124] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND NETSARC (netsarc.org) is a network of 26 sarcoma reference centers with specialized multidisciplinary tumor boards (MDTB) aiming to improve the outcome of sarcoma patients. Since 2010, presentation to an MDTB and expert pathological review are mandatory for sarcoma patients nationwide. In the present work, the impact of surgery in a reference center on the survival of sarcoma patients investigated using this national NETSARC registry. PATIENTS AND METHODS Patients' characteristics and follow-up are prospectively collected and data monitored. Descriptive, uni- and multivariate analysis of prognostic factors were conducted in the entire series (N = 35 784) and in the subgroup of incident patient population (N = 29 497). RESULTS Among the 35 784 patients, 155 different histological subtypes were reported. 4310 (11.6%) patients were metastatic at diagnosis. Previous cancer, previous radiotherapy, neurofibromatosis type 1 (NF1), and Li-Fraumeni syndrome were reported in 12.5%, 3.6%, 0.7%, and 0.1% of patients respectively. Among the 29 497 incident patients, 25 851 (87.6%) patients had surgical removal of the sarcoma, including 9949 (33.7%) operated in a NETSARC center. Location, grade, age, size, depth, histotypes, gender, NF1, and surgery outside a NETSARC center all correlated to overall survival (OS), local relapse free survival (LRFS), and event-free survival (EFS) in the incident patient population. NF1 history was one of the strongest adverse prognostic factors for LRFS, EFS, and OS. Presentation to an MDTB was associated with an improved LRFS and EFS, but was an adverse prognostic factor for OS if surgery was not carried out in a reference center. In multivariate analysis, surgery in a NETSARC center was positively correlated with LRFS, EFS, and OS [P < 0.001 for all, with a hazard ratio of 0.681 (95% CI 0.618-0.749) for OS]. CONCLUSION This nationwide registry of sarcoma patients shows that surgical treatment in a reference center reduces the risk of relapse and death.
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Affiliation(s)
- J-Y Blay
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth.
| | - C Honoré
- Department of Medical Oncology and Department of Surgical Oncology, Gustave Roussy Cancer Campus-Surgery, Villejuif
| | - E Stoeckle
- Department of Medical Oncology and Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - P Meeus
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - M Jafari
- Department of Medical Oncology and Department of Surgical Oncology, Centre Oscar Lambret, Lille; Department of Surgical Oncology, CHU, Lille
| | - F Gouin
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth; Department of Medical Oncology and Department of Surgical Oncology, Institut de Cancerologie Nantes, Nantes; Department of Orthopedics, CHU Nantes, Nantes
| | - P Anract
- Department of Orthopedics, Hôpital Cochin-Saint-Vincent de Paul, Paris
| | - G Ferron
- Department of Medical Oncology and Department of Surgical Oncology, Institut Universitaire de Cancerologie de Toulouse, Claudius Regaud, Toulouse
| | - A Rochwerger
- Department of Medical Oncology and Department of Orthopedics, La Timone University Hospital, Marseille
| | - M Ropars
- Medical Oncology Department, Eugene Marquis Comprehensive Cancer Center, Rennes; Department of Orthopedics, CHU, Rennes
| | - S Carrere
- Medical Oncology Department, Institut de Cancérologie de Montpellier, Montpellier
| | - F Marchal
- Department of Medical Oncology and Department of Surgical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - F Sirveaux
- Department of Medical Oncology and Department of Surgical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - A Di Marco
- Department of Surgical Oncology and Department of Medical Oncology, Centre Paul Strauss & CHU Strasbourg, Hôpitaux Universitaires de Strasbourg, Strasbourg
| | - L R Le Nail
- Department of Orthopedics, CHU de Tours, Tours
| | - J Guiramand
- Department of Medical Oncology and Department of Surgical Oncology, Institut Paoli Calmettes, Marseille
| | - G Vaz
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - J-C Machiavello
- Department of Medical Oncology and Department of Surgical Oncology, Centre Antoine-Lacassagne, Nice
| | - O Marco
- Oncology Unit, Saint Louis Hospital, Paris
| | - S Causeret
- Department of Surgery, Centre Georges François Leclerc, Dijon
| | - P Gimbergues
- Department of Surgery, Centre Jean Perrin/ERTICa EA, Clermont-Ferrand
| | - F Fiorenza
- Department of Medical Oncology and Department of Surgical Oncology, CHU Limoges, Limoges
| | - L Chaigneau
- Medical Oncology Department, CHU Besancon, Besançon
| | - F Guillemin
- Department of Medical Oncology and Department of Surgical Oncology, Institut J Godinot Reims
| | - J-M Guilloit
- Department of Surgical Oncology, Centre Francois Baclesse, Caen
| | - F Dujardin
- Department of Surgery, Centre Henri Becquerel, Rouen
| | - J-P Spano
- Medical Oncology Department, APHP La Pitié Salpetriere/Tenon/Bicetre, Paris
| | - J-C Ruzic
- Medical Oncology Department, CHU La Réunion, Saint-Pierre, La Réunion
| | - A Michot
- Department of Medical Oncology and Department of Surgical Oncology, Gustave Roussy Cancer Campus-Surgery, Villejuif
| | - P Soibinet
- Department of Medical Oncology and Department of Surgical Oncology, Institut J Godinot Reims
| | - E Bompas
- Department of Medical Oncology and Department of Surgical Oncology, Institut de Cancerologie Nantes, Nantes; Department of Orthopedics, CHU Nantes, Nantes
| | - C Chevreau
- Department of Medical Oncology and Department of Surgical Oncology, Institut Universitaire de Cancerologie de Toulouse, Claudius Regaud, Toulouse
| | - F Duffaud
- Department of Medical Oncology and Department of Orthopedics, La Timone University Hospital, Marseille
| | - M Rios
- Medical Oncology Department, Eugene Marquis Comprehensive Cancer Center, Rennes; Department of Orthopedics, CHU, Rennes
| | - C Perrin
- Medical Oncology Department, Eugene Marquis Comprehensive Cancer Center, Rennes; Department of Orthopedics, CHU, Rennes
| | - N Firmin
- Medical Oncology Department, Institut de Cancérologie de Montpellier, Montpellier
| | - F Bertucci
- Department of Medical Oncology and Department of Surgical Oncology, Institut Paoli Calmettes, Marseille
| | - C Le Pechoux
- Department of Medical Oncology and Department of Surgical Oncology, Gustave Roussy Cancer Campus-Surgery, Villejuif
| | - F Le Loarer
- Department of Medical Oncology and Department of Surgical Oncology, Gustave Roussy Cancer Campus-Surgery, Villejuif
| | - O Collard
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - M Karanian-Philippe
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - M Brahmi
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - A Dufresne
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - A Dupré
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - F Ducimetière
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - A Giraud
- Department of Orthopedics, Hôpital Cochin-Saint-Vincent de Paul, Paris
| | - D Pérol
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - M Toulmonde
- Department of Medical Oncology and Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - I Ray-Coquard
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - A Italiano
- Department of Medical Oncology and Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - A Le Cesne
- Department of Medical Oncology and Department of Surgical Oncology, Gustave Roussy Cancer Campus-Surgery, Villejuif
| | - N Penel
- Department of Medical Oncology and Department of Surgical Oncology, Centre Oscar Lambret, Lille; Department of Surgical Oncology, CHU, Lille
| | - S Bonvalot
- Surgery Department, Institut Curie, Paris, France
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Lex JR, Gregory J, Allen C, Reid JP, Stevenson JD. Distinguishing bone and soft tissue infections mimicking sarcomas requires multimodal multidisciplinary team assessment. Ann R Coll Surg Engl 2019; 101:405-410. [PMID: 31155889 PMCID: PMC6554572 DOI: 10.1308/rcsann.2019.0040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The aims of this study were to report the presenting characteristics and identify how best to distinguish bone and soft-tissue infections that mimic sarcomas. MATERIALS AND METHODS A total of 238 (211 osteomyelitis and 27 soft-tissue infections) patients referred to a tertiary sarcoma multidisciplinary team with suspected sarcoma who were ultimately diagnosed with a bone or soft tissue infection were included. Data from a prospectively collated database was analysed retrospectively. RESULTS Of all possible bone and soft-tissue sarcoma referrals, a diagnosis of infection was made in 2.1% and 0.7%, respectively. Median age was 18 years in the osteomyelitis group and 46 years in the soft-tissue infection group. In the osteomyelitis group, the most common presenting features were pain (85.8%) and swelling (32.7%). In the soft-tissue infection group, the most common clinical features were swelling (96.3%) and pain (70.4%). Those in the soft-tissue group were more likely to have raised inflammatory markers. Radiological investigations were unable to discern between tumour or infection in 59.7% of osteomyelitis and 81.5% of soft-tissue infection cases. No organism was identified in 64.9% of those who had a percutaneous biopsy culture. CONCLUSIONS This study has highlighted that infection is frequently clinically indistinguishable from sarcoma and remains a principle non-neoplastic differential diagnosis. When patients are investigated for suspected sarcoma, infections can be missed due to falsely negative radiological investigations and percutaneous biopsy. As no single clinical, biochemical or radiological feature or investigation can be relied upon for diagnosis, clinicians should have a low threshold for tissue biopsy and discussion in a sarcoma multidisciplinary team meeting.
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Affiliation(s)
- JR Lex
- Royal Orthopaedic Hospital Oncology Service, Birmingham, UK
| | - J Gregory
- Royal Orthopaedic Hospital Oncology Service, Birmingham, UK
| | - C Allen
- Royal Orthopaedic Hospital Oncology Service, Birmingham, UK
| | - JP Reid
- Royal Orthopaedic Hospital Oncology Service, Birmingham, UK
| | - JD Stevenson
- Royal Orthopaedic Hospital Oncology Service, Birmingham, UK
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Iannessi A, Bertrand AS, Peyrottes I, Thyss A, Machiavello JC, Liberatore M. One-bloc percutaneous large biopsy of soft-tissue tumours: feasibility study and possible indications. Clin Radiol 2019; 74:649.e11-649.e17. [PMID: 31178068 DOI: 10.1016/j.crad.2019.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 05/02/2019] [Indexed: 11/26/2022]
Abstract
AIM To report the early results of the Intact lesion excision system (LES) regarding feasibility, tolerance and efficiency in obtaining soft-tissue tumour samples under ultrasound guidance. MATERIALS AND METHODS The feasibility and tolerance of Intact LES procedures under ultrasound guidance were studied prospectively in 15 patients. The procedure was performed on an outpatient basis under local anaesthesia by a single interventional radiologist with 6 years of experience and lasted around 30 min. RESULTS The feasibility of the Intact LES for soft-tissue masses was good except when lesions were hard and calcified. Tolerance was good, with median pain experienced during the procedure evaluated at 4.5/10 (SD 2.2) and median post-procedural pain at day 1 evaluated at 1.8/10 (SD 2.5). No major complications were observed; however, for vascularised lesions, one case of acute wound bleeding and two post-procedural haematomas led to delayed pain. CONCLUSION Percutaneous biopsy of suspected soft-tissue sarcoma using the LES device under ultrasound guidance is well tolerated and feasible. After a first non-contributing core biopsy, and especially, in the case of lipomatous lesions, it is a valuable option to consider, as is surgical incision biopsy.
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Affiliation(s)
- A Iannessi
- Interventional and Diagnostic Imaging Department, Cancer Center Antoine Lacassagne, 33 Avenue de Valombrose, 06100 Nice, France.
| | - A S Bertrand
- Interventional and Diagnostic Imaging Department, Cancer Center Antoine Lacassagne, 33 Avenue de Valombrose, 06100 Nice, France
| | - I Peyrottes
- Pathology Department, Cancer Center Antoine Lacassagne, 33 Avenue de Valombrose, 06100 Nice, France
| | - A Thyss
- Oncology Department, Cancer Center Antoine Lacassagne, 33 Avenue de Valombrose, 06100 Nice, France
| | - J C Machiavello
- Visceral Surgery Department, Cancer Center Antoine Lacassagne, 33 Avenue de Valombrose, 06100 Nice, France
| | - M Liberatore
- Diagnostic Imaging Department, Princess Grace Hospital, 1 Avenue Pasteur, 98012 Monaco
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230
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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
Inadvertent excision of lumps which turn out to be sarcomas is not uncommon.Imaging has a limited role in detecting microscopic residual disease but can show the extent of the previous surgical field.Standard treatment is wide re-excision, usually combined with radiotherapy.Residual tumour is found in an average of 50% of reported cases.The presence of residual disease is an adverse prognostic factor.All lumps bigger than a golf ball should have a diagnosis prior to excision. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180060.
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232
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Hassan MK, LaPolla JJ. Traumatic neuroma of the posterior tibial nerve due to previous surgery presenting as a massive tumor in the midfoot: A case report. Foot (Edinb) 2019; 39:68-71. [PMID: 30974343 DOI: 10.1016/j.foot.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/31/2019] [Accepted: 02/14/2019] [Indexed: 02/04/2023]
Abstract
A case report of traumatic neuroma, a benign non-neoplastic tumor of the posterior tibial nerve is presented. The soft tissue mass in the midfoot region was likely a sequela of previous nerve decompression surgery that the patient underwent five years previously in the same region and on the same nerve. Physical examination and history taking, along with an MRI, were important steps in reaching a definitive diagnosis of traumatic neuroma based on the findings of an interventional radiologist and histopathological evaluation of the biopsy by a pathologist. The lesion was subsequently surgically removed utilizing a multidisciplinary management approach. The patient recovered uneventfully and no symptom recurrence was noted at the 30-month follow-up. The tumor was the largest reported in the literature at the time. This case was also unique in that the patient was relieved of pronation and regained tactile sensation in the midfoot.
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Affiliation(s)
- Mohammed K Hassan
- Resident Physician, East Liverpool City Hospital, 425 W 5th St, East Liverpool, OH 43920 USA.
| | - James J LaPolla
- Attending Physician, Trumbull Memorial Regional Hospital, 1350 E Market St, Warren, OH 44483 USA
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Intraluminal capillary hemangioma of the foot presenting clinically as a neuroma: A case report. Foot (Edinb) 2019; 39:76-78. [PMID: 30978660 DOI: 10.1016/j.foot.2019.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 02/04/2023]
Abstract
Capillary hemangiomas are rarely seen in the foot, especially in the deeper soft tissue compartment. If left untreated, they can give rise to benign soft-tissue tumors. A rare case of a capillary hemangioma on the right dorsal medial midfoot that, because of its location adjacent to the saphenous nerve, mimicked the signs and symptoms of a neuroma. In addition, the patient had a history of previous surgery for neuroma excision at the same location. Despite the strong suggestion of another recurrence of a neuroma, a careful workup, including the use of MRI and multidisciplinary consultation was implemented to rule out a possible malignancy. Its nature was confirmed by careful biopsy and histopathological findings prior to surgical resection. This case illustrates how a benign vascular lesion could elicit nerve-related pain in the foot and should be distinguished from malignant tumors, such as soft tissue sarcoma, prior to surgical planning.
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Vickers AJ, Thiruthaneeswaran N, Coyle C, Manoharan P, Wylie J, Kershaw L, Choudhury A, Mcwilliam A. Does magnetic resonance imaging improve soft tissue sarcoma contouring for radiotherapy? BJR Open 2019; 1:20180022. [PMID: 33178916 PMCID: PMC7592468 DOI: 10.1259/bjro.20180022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 11/27/2022] Open
Abstract
Objective: Soft tissue sarcomas (STS) are a rare, heterogeneous tumour group. Radiotherapy improves local control. CT is used to plan radiotherapy, but has poor soft tissue definition. MRI has superior soft tissue definition. Contour variation amongst oncologists is an important factor in treatment failure. This study is the first to directly compare STS tumour contouring using CT vs MRI. Methods: Planning CT and T2 weighted MR images of eight patients with STS were distributed to four oncologists. Gross tumour volume was contoured on both imaging modalities using in-house software. Images were recontoured 6 weeks later. The mean distance to agreement (DTA), standard deviation of the DTA, dice similarity coefficient (DSC) and contour volume were calculated for each oncologist and compared to a median contour volume. Results for CT and MRI were compared using a pairwise Student's t-test. Results: When comparing MRI to CT, tumour volumes were significantly smaller, with a difference of 21.4 cm3 across all patients (p = 0.008). There was not a statistically significant difference in the mean distance to agreement or dice similarity coefficient, but the standard deviation of the DTA showed a statistically significant improvement ( p = 0.04). For intraobserver variation, there was no statistically significant improvement using MRI vs CT. Conclusion: Oncologists contour smaller tumour volumes using MRI, with reduced interobserver variation. Improving the reliability and consistency of contouring is needed for improved quality assurance. Advances in knowledge: With further experience, the use of MRI in STS radiotherapy planning may reduce variation between oncologists and contribute to improved local control and reduced treatment toxicities.
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Affiliation(s)
- Alexander John Vickers
- Department of Clinical Oncology, The Christie NHS Foundation Trust, 550 Wilmslow Road, Withington, Manchester, United Kingdom
| | | | - Catherine Coyle
- Department of Clinical Oncology, The Christie NHS Foundation Trust, 550 Wilmslow Road, Withington, Manchester, United Kingdom
| | - Prakash Manoharan
- Department of Clinical Oncology, The Christie NHS Foundation Trust, 550 Wilmslow Road, Withington, Manchester, United Kingdom
| | - James Wylie
- Department of Clinical Oncology, The Christie NHS Foundation Trust, 550 Wilmslow Road, Withington, Manchester, United Kingdom
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Campana LG, Miklavčič D, Bertino G, Marconato R, Valpione S, Imarisio I, Dieci MV, Granziera E, Cemazar M, Alaibac M, Sersa G. Electrochemotherapy of superficial tumors - Current status:: Basic principles, operating procedures, shared indications, and emerging applications. Semin Oncol 2019; 46:173-191. [PMID: 31122761 DOI: 10.1053/j.seminoncol.2019.04.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 12/18/2022]
Abstract
Treatment of superficial tumors with electrochemotherapy (ECT) has shown a steep rise over the past decade and indications range from skin cancers to locally advanced or metastatic neoplasms. Based on reversible electroporation, which is a physical method to achieve transient tumor cell membrane permeabilization by means of short electric pulses, ECT increases cellular uptake of bleomycin and cisplatin and their cytotoxicity by 8,000- and 80-fold, respectively. Standard operating procedures were established in 2006 and updated in 2018. Ease of administration, patient tolerability, efficacy across histotypes, and repeatability are peculiar advantages, which make standard ECT (ie, ECT using fixed-geometry electrodes) a reliable option for controlling superficial tumor growth locally and preventing their morbidity. Consolidated indications include superficial metastatic melanoma, breast cancer, head and neck skin tumors, nonmelanoma skin cancers, and Kaposi sarcoma. In well-selected patients with oropharyngeal cancers, ECT ensures appreciable symptom control. Emerging applications include skin metastases from visceral or hematological malignancies, vulvar cancer, and some noncancerous skin lesions (keloids and capillary vascular malformations). Repeatability and integration with other oncologic therapies allow for consolidation of response and sustained tumor control. In this review, we present the basic principles of ECT, recently updated operating procedures, anesthesiological management, and provide a synthesis of the efficacy of standard ECT across histotypes.
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Affiliation(s)
- Luca G Campana
- Department of Surgery Oncology and Gastroenterology (DISCOG), University of Padua, Italy; Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
| | - Damijan Miklavčič
- University of Ljubljana, Faculty of Electrical Engineering, Ljubljana, Slovenia
| | - Giulia Bertino
- Department of Otolaryngology Head Neck Surgery, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | | | | | - Ilaria Imarisio
- Medical Oncology Unit, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Maria Vittoria Dieci
- Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy; Medical Oncology-2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Elisa Granziera
- Anesthesiology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Mauro Alaibac
- Dermatology, Department of Medicine, University of Padua, Padua, Italy
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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236
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Chamberlain FE, Jones RL, Chawla SP. Aldoxorubicin in soft tissue sarcomas. Future Oncol 2019; 15:1429-1435. [DOI: 10.2217/fon-2018-0922] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aldoxorubicin is a prodrug formulation of doxorubicin currently under investigation for the treatment of soft tissue sarcomas. Early studies have demonstrated a promising reduction in the cardiotoxicity of aldoxorubicin compared with equivalent doses of doxorubicin leading to an increase in the equivalent cumulative dose of aldoxorubicin. The current clinical and pharmacological data available for aldoxorubicin are extremely promising for its use in the treatment of advanced and metastatic soft tissue sarcomas compared with equivalent doses of doxorubicin although Phase III data are lacking. We review aldoxorubicin for the treatment of advanced and metastatic soft tissue sarcomas and discuss the impact it may have in the future.
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Affiliation(s)
- Florence E Chamberlain
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
- The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB, UK
- Sarcoma Oncology Center, 2811 Wilshire Blvd #414, Santa Monica, CA 90403, USA
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
- The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB, UK
- Sarcoma Oncology Center, 2811 Wilshire Blvd #414, Santa Monica, CA 90403, USA
| | - Sant P Chawla
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
- The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB, UK
- Sarcoma Oncology Center, 2811 Wilshire Blvd #414, Santa Monica, CA 90403, USA
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237
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Chamberlain FE, Wilding C, Jones RL, Huang P. Pazopanib in patients with advanced intermediate-grade or high-grade liposarcoma. Expert Opin Investig Drugs 2019; 28:505-511. [DOI: 10.1080/13543784.2019.1607291] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Chris Wilding
- Division of Molecular Pathology, Institute of Cancer Research, London,
UK
| | - Robin L Jones
- Division of Molecular Pathology, The Royal Marsden NHS Foundation Trust, London,
UK
- Division of Molecular Pathology, Institute of Cancer Research, London,
UK
| | - Paul Huang
- Division of Molecular Pathology, Institute of Cancer Research, London,
UK
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238
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Natural history of well-differentiated liposarcoma of the extremity compared to patients treated with surgery. Surg Oncol 2019; 29:84-89. [PMID: 31196499 DOI: 10.1016/j.suronc.2019.04.004] [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: 02/05/2019] [Revised: 04/01/2019] [Accepted: 04/08/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients with well-differentiated liposarcoma (WDLPS) of the extremity are mostly treated surgically, thereby possibly inducing severe morbidities. Despite the excellent prognosis, the natural history is barely studied. The aim of this study was to evaluate the natural history of extremity WDLPS by evaluating the outcome of patients treated with active surveillance (AS), who thereby exhibited the natural history of extremity WDLPS, and of patients treated surgically. METHODS A large retrospective database of patients with extremity WDLPS was assessed to evaluate treatment, dedifferentiation and disease-specific survival. Lastly, our experience with patients treated with AS was explored. RESULTS Distant metastases (5/191 patients, 2.6%) were mainly seen after a dedifferentiated local recurrence. Death of disease occurred in 4/191 patients (2.1%); two patients died from metastatic disease (although not pathologically proven), two patients died of treatment-related complications. In our center, 24 patients are treated with AS. Time of AS varied from 0.1 to 8.9 years (median 1.8). Four patients eventually underwent surgery after a period of AS (range 14-52 months) because of symptoms and/or tumor growth. No areas of dedifferentiation were found in these resection specimens. The other patients are still under active surveillance. CONCLUSION Since surgical treatment might induce morbidity and even mortality, there might be overtreatment of these patients. Evaluation of the natural history of extremity WDLPS showed that AS could be a reasonable option for selected patients. Prospective studies in patients with extremity WDLPS are needed to assess the safety of AS as a treatment option.
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239
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Successful salvage of failed post-sarcoma excision reconstruction and exposed alloplastic mesh with an anterolateral thigh flap. Arch Plast Surg 2019; 46:390-391. [PMID: 30940792 PMCID: PMC6657199 DOI: 10.5999/aps.2018.00766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/12/2018] [Indexed: 11/13/2022] Open
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240
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Cardiac MRI: a Promising Diagnostic Tool to Detect Cancer Therapeutics–Related Cardiac Dysfunction. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019. [DOI: 10.1007/s12410-019-9489-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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241
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Ballesteros M, Montero N, López-Pousa A, Urrútia G, Solà I, Rada G, Pardo-Hernandez H, Bonfill X. Evidence mapping based on systematic reviews of therapeutic interventions for soft tissue sarcomas. Clin Transl Oncol 2019; 21:1398-1412. [PMID: 30875063 DOI: 10.1007/s12094-019-02069-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 02/22/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Soft tissue sarcomas are a heterogeneous group of rare tumours of mesenchymal origin. Evidence mapping is one of the most didactic and friendly approaches to organise and summarise the range of research activity in broad topic fields. The objective of this evidence mapping is to identify, describe and organise the current available evidence about therapeutic interventions on soft tissues sarcomas. METHODS We followed the methodology of global evidence mapping. We performed a search of the PubMed, EMBASE, The Cochrane Library and Epistemonikos to identify systematic reviews (SRs) with or without meta-analyses published between 1990 and March 2016. Two independent literature reviewers assessed eligibility and extracted data. Methodological quality of the included systematic reviews was assessed using AMSTAR. We organised the results according to identified PICO questions and used tables and a bubble plot to display the results. RESULTS The map is based on 24 SRs that met eligibility criteria and included 66 individual studies. Three-quarters were either observational or uncontrolled clinical trials. The quality of the included SRs was in general moderate or high. We identified 64 PICO questions from them. The corresponding results mostly favoured the intervention arm. CONCLUSIONS This evidence mapping was built on the basis of SRs, which mostly included non-experimental studies and were qualified by the AMSTAR tool as of moderate quality. The evidence mapping created from PICO questions is a useful approach to describe complex and huge clinical topics through graphical media and orientate further research to fulfil the existing gaps. However, it is important to delimitate the steps of the evidence mapping in a pre-established protocol.
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Affiliation(s)
- M Ballesteros
- C/Sant Antoni Maria Claret, 167, Pavelló 18, Ground Floor, 08025, Barcelona, Spain.
| | - N Montero
- Centro de Investigación en Salud Pública y Epidemiología Clínica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador
| | - A López-Pousa
- Oncología Médica y Unidad de Curas Paliativas, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - G Urrútia
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - I Solà
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - G Rada
- Evidence Based Health Care Program, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - H Pardo-Hernandez
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - X Bonfill
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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242
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Pathologic necrosis following neoadjuvant radiotherapy or chemoradiotherapy is prognostic of poor survival in soft tissue sarcoma. J Cancer Res Clin Oncol 2019; 145:1321-1330. [DOI: 10.1007/s00432-019-02885-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/01/2019] [Indexed: 12/14/2022]
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243
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Sajko N, Murphy S, Tran A. Undifferentiated epithelioid sarcoma presenting as a fever of unknown origin: a case report. J Med Case Rep 2019; 13:24. [PMID: 30684969 PMCID: PMC6348079 DOI: 10.1186/s13256-018-1951-1] [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: 08/20/2018] [Accepted: 12/12/2018] [Indexed: 11/13/2022] Open
Abstract
Background Fever of unknown origin is often a diagnostic dilemma for clinicians due to its extremely broad differential. One of the rarer categories of disease causing fever of unknown origin is malignancies; of these, soft tissue sarcoma is one of the least common. Soft tissue sarcomas make up < 1% of all adult malignancies and often do not present with any systemic manifestations or neoplastic fevers. Case presentation A 73-year-old Caucasian woman presented with a 2-week history of fever and profound fatigue. The only other symptom she endorsed was a transient history of left knee pain, initially thought to be unrelated. There was no clear cause on initial examination and routine investigations, but her C-reactive protein was significantly elevated at 207 mg/L. Blood cultures and a urine culture were drawn. She was admitted to hospital for further investigation and placed on empiric antibiotics. Her blood cultures were negative, but she had one further fever in hospital. Computed tomography scans did not yield a cause of her fever. No vegetations were seen on echocardiography. Antibiotics were stopped as she did not seem to have an acute infectious cause of her fever. No new symptoms developed. She felt well enough to proceed with out-patient follow up and was discharged after 8 days in hospital. At 1-month post-discharge: no resolution of symptoms, but she endorsed a recurrence of her left knee pain. Ultrasound and magnetic resonance imaging revealed a 4.5 × 6.8 × 11.6 cm soft tissue mass, identified as a sarcoma on biopsy. She subsequently underwent a distal femur resection. Final staging was pT2bN0M0. She underwent adjuvant radiation therapy, but was found to have developed metastatic disease. Conclusion This case revealed an atypical presentation of a rare soft tissue sarcoma as the cause of the illness. The etiology behind a fever of unknown origin can be difficult to elucidate, making the approach to investigation particularly important. Repeated history-taking and serial physical examinations can be crucial in guiding investigations and ultimately arriving at a diagnosis. In addition, we believe this case highlights the adage that no seemingly innocuous symptom should be left out when working up a condition with such an extensive and complex differential.
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Affiliation(s)
- Nicholas Sajko
- Clinical Research Centre, Dalhousie University, Room C-125, 5849 University Avenue, Halifax, NS, B3H 4R2, Canada. .,Dalhousie University, Faculty of Medicine, 1469 Oxford Street, Halifax, NS, B3H 4R2, Canada.
| | - Shannon Murphy
- QEII Health Sciences Centre, Room 483 Bethune Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.,Dalhousie University, Faculty of Medicine, 1469 Oxford Street, Halifax, NS, B3H 4R2, Canada
| | - Allen Tran
- QEII Health Sciences Centre, Room 409 Bethune Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.,Dalhousie University, Faculty of Medicine, 1469 Oxford Street, Halifax, NS, B3H 4R2, Canada
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244
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Hewitt L, Powell R, Zenginer K, Coyle C, Murray H, Cooper L, Gregory J. Patient Perceptions of the Impact of Treatment (Surgery and Radiotherapy) for Soft Tissue Sarcoma. Sarcoma 2019; 2019:9581781. [PMID: 31049021 PMCID: PMC6462335 DOI: 10.1155/2019/9581781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/21/2018] [Accepted: 01/06/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Treatment for soft tissue sarcoma (STS) is challenging for patients. This study aimed to gain an in-depth understanding of patients' experiences of STS treatment, including whether the sequence of treatment (preoperative or postoperative radiotherapy) influences patient perceptions. METHODS Face-to-face semi-structured interviews were conducted with nineteen patients who had been treated for STS with surgery and radiotherapy between 2011 and 2016. Topics discussed included perceptions of treatment, social support, and coping mechanisms. Qualitative, inductive, thematic analysis was conducted and structured using the Framework approach. RESULTS Treatment sequence itself did not appear to cause concern, but uncertainty regarding treatment and side effects could negatively impact participants. Social relationships and individual coping strategies influenced participants' experiences of treatment. CONCLUSIONS Participants' perceptions of the treatment process varied; the experience was highly individual. It is important to ensure individual psychosocial and information needs are met. In particular, the removal of uncertainty regarding treatment is important in supporting patients undergoing treatment for soft tissue sarcoma.
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Affiliation(s)
- Lauren Hewitt
- School of Health Sciences & Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Rachael Powell
- School of Health Sciences & Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Kaan Zenginer
- School of Health Sciences & Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | | | - Helen Murray
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Lisa Cooper
- The Christie NHS Foundation Trust, Manchester, UK
| | - Jonathan Gregory
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
- Molecular and Clinical Cancer Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
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Zheng H, Li J, Wang M, Luo X, Qiu Q, Hu L, Li C, Song Y, Deng Y. Exhausting tumor associated macrophages with sialic acid-polyethyleneimine-cholesterol modified liposomal doxorubicin for enhancing sarcoma chemotherapy. Int J Pharm 2019; 558:187-200. [PMID: 30654062 DOI: 10.1016/j.ijpharm.2019.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/13/2018] [Accepted: 01/01/2019] [Indexed: 02/03/2023]
Abstract
To overstep the dilemma of chemical drug degradation within powerful lysosomes of tumor associated macrophages (TAMs), a sialic acid-polyethylenimine-cholesterol (SA-PEI-CH) modified liposomal doxorubicin (DOX-SPCL) was designed with both TAMs targeting and smart lysosomal trafficking. The modified liposome DOX-SPCL performed particle size as 103.2 ± 3.1 nm and zeta potential as -4.5 ± 0.9 mV with encapsulation efficiency as 95.8 ± 0.5%. In in vitro cell experiments, compared with conventional liposomal doxorubicin (DOX-CL) and PEGylated liposomal doxorubicin (DOX-PL), DOX-SPCL showed a selective binding on TAMs and a mere lysosomal concentration. In pharmacokinetic study, DOX-SPCL effectively impeded/delayed the disposition of mononuclear phagocyte system (MPS) with a value of AUC0-t as 796.03 ± 66.93 mg L-1 h. In S180 sarcomas bearing mice, DOX-SPCL showed the greatest tumor inhibition rate (92.7% ± 3.6%) compared with DOX-CL (46.4% ± 2.0%) or DOX-PL (58.8% ± 7.6%). The <0.5% positive region of TAMs in tumor section indicated a super TAMs exhaustion for DOX-SPCL treatment. Conclusively, DOX-SPCL was supposed as a safe and effective liposomal preparation for clinical sarcoma treatment via TAMs targeting/deletion delivery strategy.
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Affiliation(s)
- Huangliang Zheng
- School of Pharmacy, Shenyang Pharmaceutical University, No. 103 Wenhua Road, Shenyang, Liaoning 110016, China
| | - Jiaqi Li
- School of Pharmacy, Shenyang Pharmaceutical University, No. 103 Wenhua Road, Shenyang, Liaoning 110016, China
| | - Mengjing Wang
- School of Pharmacy, Shenyang Pharmaceutical University, No. 103 Wenhua Road, Shenyang, Liaoning 110016, China
| | - Xiang Luo
- College of Chemistry and Chemical Engineering, Shaoxing University, No. 508 Huancheng West Road, Shaoxing, Zhejiang 312000, China
| | - Qiujun Qiu
- School of Pharmacy, Shenyang Pharmaceutical University, No. 103 Wenhua Road, Shenyang, Liaoning 110016, China
| | - Ling Hu
- School of Pharmacy, Shenyang Pharmaceutical University, No. 103 Wenhua Road, Shenyang, Liaoning 110016, China
| | - Cong Li
- School of Pharmacy, Shenyang Pharmaceutical University, No. 103 Wenhua Road, Shenyang, Liaoning 110016, China
| | - Yanzhi Song
- School of Pharmacy, Shenyang Pharmaceutical University, No. 103 Wenhua Road, Shenyang, Liaoning 110016, China.
| | - Yihui Deng
- School of Pharmacy, Shenyang Pharmaceutical University, No. 103 Wenhua Road, Shenyang, Liaoning 110016, China.
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Lee EM, Kim DH, Kim DY, Seol YM, Choi YJ, Kim H. Efficacy of adjuvant radiotherapy in non-extremity soft tissue sarcoma with moderate chemosensitivity. Radiat Oncol J 2019; 36:325-331. [PMID: 30630271 PMCID: PMC6361253 DOI: 10.3857/roj.2018.00262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/24/2018] [Indexed: 11/21/2022] Open
Abstract
Purpose Soft tissue sarcoma (STS) is a rare and heterogeneous cancer with over 50 known subtypes. It is difficult to understand the role of adjuvant treatment in STS. We aimed to determine the benefits of adjuvant treatment for a rare STS subset: non-extremity STS with moderate chemosensitivity. Materials and Methods We reviewed medical records from Pusan National University Hospital and Kosin University Gospel Hospital, which had detailed pathological reports on patients diagnosed between 2006 and 2016. The most important inclusion criterion was resection with curative intent. We grouped STS by chemosensitivity based on reported data and analyzed non-extremity STS with moderate chemosensitivity. Results We investigated 142 patients with 20 pathological subtypes of STS. Eighty-six patients had extremity STS and 56 had non-extremity STS. Thirty-eight of 56 patients were categorized as having moderate chemosensitivity. Seventeen of 38 patients (44.7%) received adjuvant radiotherapy and 14 (36.8%) received adjuvant chemotherapy. A log-rank test showed longer disease-free survival (DFS) in the adjuvant radiotherapy group than in the group treated without adjuvant radiotherapy (not reached vs. 1.468 years, p = 0.037). Multivariate Cox proportional hazard analysis, with covariates including age, stage, resection margin, adjuvant chemotherapy, and adjuvant radiotherapy, revealed that adjuvant radiotherapy was associated with longer DFS (odds ratio = 0.369, p = 0.045). Overall survival was not correlated with adjuvant radiotherapy. Conclusion Adjuvant radiotherapy may be associated with longer DFS in patients with non-extremity STS with moderate chemosensitivity.
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Affiliation(s)
- Eun Mi Lee
- Division of Hemato-oncology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Dong Hyun Kim
- Department of Radiation Oncology, Pusan National University School of Medicine, Busan, Korea
| | - Do Young Kim
- Division of Hemato-oncology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Young Mi Seol
- Division of Hemato-oncology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Young Jin Choi
- Division of Hemato-oncology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hyojeong Kim
- Division of Hemato-oncology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
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A meta-analysis of randomized controlled trials that compare standard doxorubicin with other first-line chemotherapies for advanced/metastatic soft tissue sarcomas. PLoS One 2019; 14:e0210671. [PMID: 30629708 PMCID: PMC6328231 DOI: 10.1371/journal.pone.0210671] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 12/28/2018] [Indexed: 12/14/2022] Open
Abstract
Objective The standard treatment for patients with advanced/metastatic soft tissue sarcomas (ASTS) is systemic chemotherapy with doxorubicin. A previous meta-analysis of 8 randomized controlled trials (RCTs) demonstrated the superiority of single-agent doxorubicin over doxorubicin-based combination chemotherapy for ASTS. However, meta-analyses of all RCTs that compare doxorubicin to other single-agent or combination regimens as first-line treatments for ASTS are lacking. We conducted a systematic review and meta-analysis to evaluate the efficacy and toxicity of current primary treatments for ASTS. Methods Eligible studies were RCTs of first-line chemotherapies for ASTS comparing doxorubicin alone to other single agents or to combination therapies (experimental arm). Data from studies reporting hazard ratios (HR) and 95% confidence intervals (CI) for overall survival (OS) and progression-free survival (PFS) were pooled. Other time-to-event endpoints were extracted from the studies based on Kaplan-Meier estimates, and pooled odds ratios (OR) and 95% CI were calculated. Results Twenty-seven eligible RCTs comprising 6156 patients were identified. Overall, the 1-year OS (OR 0.88, 95% CI 0.79–0.99, P = 0.03) was significantly improved in the experimental arm over the doxorubicin-only arm; however, there was no significant difference in 2-year OS (OR 0.87, 95% CI 0.73–1.03, P = 0.11) or OS (HR 0.97, 95% CI 0.91–1.03, P = 0.28) between the two groups. PFS and other time-to-event endpoints were not significantly different between the two treatment arms. While incidences of overall severe adverse events were not significantly different (OR 1.20, 95% CI 0.88–1.65, P = 0.26), severe nausea/vomiting was significantly more frequent in the experimental arm (OR 1.90, 95% CI 1.27–2.83, P = 0.002). Conclusion The efficacies of doxorubicin-only and experimental arm regimens were similar, although toxicities were more frequent in the experimental arms. Hence, doxorubicin monotherapy remains suitable as a standard first-line regimen for ASTS.
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Wadkin JCR, Senes S, Evans S, Stevenson J. Tumour in a tumour: a well-differentiated spindle cell sarcoma within a forearm lipoma. BMJ Case Rep 2019; 12:12/1/bcr-2018-227533. [PMID: 30635310 DOI: 10.1136/bcr-2018-227533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Lipomas are common, benign, soft tissue masses in adults. Sarcomatous change within a giant lipoma is a very rare event. We present a case of a woman presenting with a forearm lipoma that subsequently developed a central, well-differentiated, spindle-cell sarcoma within the lipoma. This case underlines the importance of identifying red flags for referral of soft tissue tumours.
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Affiliation(s)
- James C R Wadkin
- Kingston Hospital NHS Foundation Trust, Kingston upon Thames, UK
| | - Sebastian Senes
- Department of Orthopaedics, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
| | - Scott Evans
- Department of Orthopaedic Oncology and Arthroplasty, Royal Orthopaedic Hospital, Birmingham, UK
| | - Jonathan Stevenson
- Department of Orthopaedic Oncology and Arthroplasty, Royal Orthopaedic Hospital, Birmingham, UK
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Kattepur A, Pareekutty N, Alapatt J, Satheesan B. Unplanned excision in soft-tissue sarcomas – Is it the unkindest cut of all? CANCER RESEARCH, STATISTICS, AND TREATMENT 2019. [DOI: 10.4103/crst.crst_72_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Loong HH, Blay JY, Munhoz RR. International Collaborations and Regional Challenges in Providing Specialist Multidisciplinary Sarcoma Care. Am Soc Clin Oncol Educ Book 2019; 39:616-623. [PMID: 31099628 DOI: 10.1200/edbk_239131] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Sarcomas represent a highly heterogeneous group of malignancies of mesenchymal original that pose significant therapeutic challenges. Although surgery still represents the cornerstone of therapeutics for those amenable to treatment with curative intent, advances have been achieved with radiation therapy and systemic agents, highlighting the need for a multidisciplinary approach to patients with sarcomas. Significant heterogeneity occurs within this group of rare diseases, as well as in the pattern of care provided to these patients, with significant global and regional discrepancies in diagnosis, frontline treatments, access to emerging therapies, and clinical trials. In this setting, establishing reference centers and cooperative networks represents a successful approach to optimizing the care and improving the outcomes of patients with sarcomas. In this article, we discuss the importance of international and regional collaborations and propose frameworks for the construction of integrated groups based on successful examples of existing referral networks and multidisciplinary collaborations.
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Affiliation(s)
- Herbert H Loong
- 1 Department of Clinical Oncology, State Key Laboratory in Translational Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jean-Yves Blay
- 2 Centre Léon Bérard and Université Claude Bernard, Lyon, France
| | - Rodrigo R Munhoz
- 3 Oncology Center, Hospital Sírio Libanês, São Paulo, Brazil
- 4 Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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