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Daigeler A, Kuhnen C, Moritz R, Stricker I, Goertz O, Tilkorn D, Steinstraesser L, Steinau HU, Lehnhardt M. Lymph node metastases in soft tissue sarcomas: a single center analysis of 1,597 patients. Langenbecks Arch Surg 2008; 394:321-9. [PMID: 18594854 DOI: 10.1007/s00423-008-0371-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 06/10/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to examine the clinical course of patients with the rare finding of regional lymph node metastasis (RLNM) from soft tissue sarcoma. MATERIALS AND METHODS Data from 28 out of 1,597 consecutive soft tissue sarcoma patients with RLNM were from the patients' charts and interviewing patients and general practitioners. Survival, including possible influencing factors, was statistically calculated. RESULTS RLNM was seen in 21.4% for epithelioid sarcoma and 17.6% for clear cell sarcoma. All other entities presented RLNM rates below 10%. At follow-up after an average of 9.6 years, only three patients were alive with no evidence of disease. Survival was independent from surgical resection status of the primary tumor and the RLNM as well as from adjuvant radiation and chemotherapy. Tumor entity as well as the length of the time period from primary to RLNM affect survival. CONCLUSIONS Surgical treatment as well as radiation and chemotherapy may improve survival in selected cases but probably have their value much more in terms of local disease control and improvement life quality of patients who probably already suffer from an aggressive systemic disease at time of nodal involvement.
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Affiliation(s)
- A Daigeler
- Department of Plastic Surgery, Burn Center, Hand Surgery, Sarcoma Reference Center, BG-University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
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GITAU G, SHEPHERD J, HUGHES G, ORIOLOWO A, YIANNAKIS D. Alveolar soft part sarcoma of the uterine cervix. Int J Gynecol Cancer 2008; 18:853-6. [DOI: 10.1111/j.1525-1438.2007.01073.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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253
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Kalofonos HP, Kourousis C, Karamouzis MV, Iconomou G, Tsiata E, Tzorzidis F, Megas P, Lambiris E, Georgoulias V. A Phase II Study of Docetaxel and Epirubicin in Advanced Adult Soft Tissue Sarcomas (STS). Sarcoma 2008; 8:129-33. [PMID: 18521407 PMCID: PMC2395619 DOI: 10.1080/13577140400016705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: The aim of this study was to determine the efficacy and safety of docetaxel plus epirubicin combination as first-line
chemotherapy in patients with locally advanced and/or metastatic adult STS. Patients and Methods: Eighteen patients were treated with epirubicin 30 mg/m2 on days 1 to 3 and docetaxel 100 mg/m2 on
day 1 every 3 weeks. Results: Fifteen out of 18 patients (83.4%) were assessable for response. No complete response was recorded. Three (20%)
patients achieved PR, 3 had SD and 9 PD. The overall median survival was 14 months (range, 3–48 months) and the median
time to disease progression was 4 months (range, 2–45 months). Grade ≥ 3 neutropenia occurred in 88% and neutropenic
fever in 27.8% of patients. Other toxicities were mild. No treatment related deaths occurred. Discussion: Docetaxel plus epirubicin combination achieved low response rate with severe myelotoxicity in patients with
advanced STS.
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Affiliation(s)
- Haralabos P Kalofonos
- Division of Oncology Department of Medicine University Hospital Patras Medical School Rion 26504 Greece
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Langer C, Schüler P, Becker H, Liersch T. Gastrointestinale Stromatumoren aus chirurgischer Sicht. Chirurg 2008; 79:644-9. [DOI: 10.1007/s00104-008-1528-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Dalal KM, Antonescu CR, Singer S. Diagnosis and management of lipomatous tumors. J Surg Oncol 2008; 97:298-313. [PMID: 18286473 DOI: 10.1002/jso.20975] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Lipomatous tumors range from benign lipomas to high-grade liposarcomas. Liposarcomas are classified into five histologic subtypes: well-differentiated, dedifferentiated, myxoid, round cell, and pleomorphic, which differ in outcomes and patterns of recurrence. Surgical resection is the mainstay of curative treatment; however, large, high grade liposarcomas may benefit from multimodality treatment with chemotherapy and radiation. A histologic-subtype specific nomogram provides accurate survival predictions. Prospective randomized clinical trials will continue to improve our care of patients with liposarcoma.
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Affiliation(s)
- Kimberly Moore Dalal
- Department of Surgery, David Grant United States Air Force Medical Center, Travis Air Force Base, California 94535, USA.
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258
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Fujisawa Y, Takahashi T, Enomoto H, Nakamura Y, Kawachi Y, Otsuka F. A case of proximal-type epithelioid sarcoma which showed positive reactivity to fibroblast growth factor receptor 2-IIIb isotype. J Eur Acad Dermatol Venereol 2008; 22:1372-3. [PMID: 18482307 DOI: 10.1111/j.1468-3083.2008.02625.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kayton ML, Delgado R, Busam K, Cody HS, Athanasian EA, Coit D, La Quaglia MP. Experience with 31 sentinel lymph node biopsies for sarcomas and carcinomas in pediatric patients. Cancer 2008; 112:2052-9. [DOI: 10.1002/cncr.23403] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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260
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Ryzewicz M, McLoughlin HA, Freudenberger C, Williams A, Lindeque B. Unusual metastases from extremity soft tissue sarcomas. Orthopedics 2008; 31:439. [PMID: 19292327 DOI: 10.3928/01477447-20080501-25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The most common metastatic route for extremity soft-tissue sarcomas is via the venous system to the lungs. Metastases to other sites such as the brain, liver, and soft tissue distant from the primary tumor are rare. A tumor registry, prospectively kept since 1986, was reviewed for unusual metastatic spread. Of 3671 tumors, 346 high-grade extremity soft-tissue sarcomas were evaluated. A total of 15 patients (4.3%) presented with initial recurrence of disease that was extrapulmonary and distant from the site of the primary tumor. Four of these patients (27%) were successfully treated for their recurrence. Based on these findings, a different strategy for follow-up of patients after treatment of a high-grade extremity soft-tissue sarcoma is suggested.
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Affiliation(s)
- Mark Ryzewicz
- Department of Orthopedics, University of Colorado Health Sciences Center, 4200 E 9th Ave, Mail Stop B202, Denver, CO 80262, USA
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261
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Wolf PS, Flum DR, Tanas MR, Rubin BP, Mann GN. Epithelioid sarcoma: the University of Washington experience. Am J Surg 2008; 196:407-12. [PMID: 18436180 DOI: 10.1016/j.amjsurg.2007.07.029] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Revised: 07/13/2007] [Accepted: 07/13/2007] [Indexed: 01/25/2023]
Abstract
BACKGROUND Epithelioid sarcoma is a rare sarcoma with a high local recurrence rate that frequently metastasizes to lymph nodes. We reviewed our experience with adjuvant therapy in patients with this disease. METHODS Between 1990 and 2003, we treated 11 patients with epithelioid sarcoma. Patient, tumor, and treatment characteristics were analyzed, and effect of treatment on survival was evaluated by the Kaplan-Meier method. RESULTS Nine men and 2 women were treated. Tumors presented on the trunk, the upper extremities, and the lower extremities. Five patients developed nodal disease. All patients underwent surgery for the primary tumor, and 7 patients had nodal evaluation. Ten patients underwent adjuvant chemotherapy, and 9 underwent radiotherapy. Recurrence developed in 9 patients. Five-year disease-free and overall survival rates were 46% and 65%, respectively. Chemotherapy and radiation therapy did not impact disease-free survival. CONCLUSIONS Although surgery remains the primary treatment modality, multi-institutional trials are needed to develop more effective adjuvant therapy for patients with epithelioid sarcoma.
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Affiliation(s)
- Patrick S Wolf
- University of Washington Medical Center, Seattle, WA 98195, USA
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262
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Al-Refaie WB, Andtbacka RHI, Ensor J, Pisters PWT, Ellis TL, Shrout A, Hunt KK, Cormier JN, Pollock RE, Feig BW. Lymphadenectomy for isolated lymph node metastasis from extremity soft-tissue sarcomas. Cancer 2008; 112:1821-6. [PMID: 18306370 DOI: 10.1002/cncr.23363] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Previous studies have suggested that the prognosis in patients with extremity soft-tissue sarcomas (ESTS) with isolated lymph node (LN) metastases (stage IV) is comparable to that of patients with high-risk ESTS without metastases (stage III). This study was performed to determine the outcomes of patients who underwent aggressive therapy, including lymphadenectomy in patients with LN metastasis from ESTS. METHODS Demographic details, pathology of the primary disease, timing of LN metastasis, and details of the multimodality treatment were obtained from the medical records of 35 patients with nodal metastasis from ESTS who were treated between 1981 and 2003. Survival after the diagnosis of primary disease and LN metastasis was compared with established historical outcomes for patients with American Joint Commission on Cancer (AJCC) stages III and IV ESTS. RESULTS Epithelioid sarcomas (23%) and malignant fibrous histiocytomas (23%) were the most common primary histologic types. Twenty (57%) patients presented with synchronous nodal metastasis. Median follow-up from the time of diagnosis of lymph node metastasis was 48.5 months. The 1-year, 2-year, and 5-year actuarial survival rates in patients with synchronous nodal metastasis after lymphadenectomy and additional therapy were 79%, 62%, and 52%, respectively. In comparison, the 1-year, 2-year, and 5-year actuarial survival rates in patients with metachronous nodal metastasis after lymphadenectomy and additional therapy were 100%, 95%, and 66%, respectively. CONCLUSIONS Patients with isolated regional lymph node metastases who are treated with aggressive approaches, including regional LN dissection, may experience prolonged survival similar to that which more closely approximates the survival seen in patients with stage III disease (5-year survival rate, 50%) rather than the survival seen in patients with stage IV disease (5-year survival rate, 25%). These data lend support for reconsideration of the current AJCC staging system for ESTS.
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Affiliation(s)
- Waddah B Al-Refaie
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77203-1402, USA
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Kapp DS, Shin JY, Chan JK. Prognostic factors and survival in 1396 patients with uterine leiomyosarcomas: emphasis on impact of lymphadenectomy and oophorectomy. Cancer 2008; 112:820-30. [PMID: 18189292 DOI: 10.1002/cncr.23245] [Citation(s) in RCA: 227] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The objectives of the current study were to determine the prognostic factors associated with disease-specific survival (DSS) and to analyze the role of lymphadenectomy (LND) and oophorectomy in the management of uterine leiomyosarcomas (LMS). METHODS Data were abstracted from the Surveillance, Epidemiology, and End Results database (1988-2003). Kaplan-Meier and Cox proportional hazards regression models were used for analyses. RESULTS The median age of the 1396 patients was 52 years. There were 951 patients (68.1%) with International Federation of Gynecology and Obstetrics (FIGO) stage I disease, 43 patients (3.1%) with stage II disease, 99 patients (7.1%) with stage III disease, and 303 patients (21.7%) with stage IV disease. Distribution by tumor grade included 87 patients with grade 1 tumors, 208 with grade 2, and 509 patients with grade 3 tumors. The 5-year DSS rates for patients with stage I, II, III, and IV disease were 75.8%, 60.1%, 44.9%, and 28.7%, respectively. Lymph node metastases were identified in 23 of 348 patients (6.6%) who underwent LND. The 5-year DSS rate was 26% in patients who had positive lymph nodes compared with 64.2% in patients who had negative lymph nodes (P < .001). Of 341 patients aged <50 years with stage I or II disease, 240 (70.4%) underwent oophorectomy. There was no difference in 5-year DSS based on oophorectomy. On multivariate analysis, older age at diagnosis, more recent year of diagnosis, African-American race, higher tumor grade, higher stage of disease, and lack of primary surgical treatment all were associated significantly with worse survival. CONCLUSIONS Independent predictors of DSS in patients with uterine LMS included age, race, stage, grade, and primary surgery. Oophorectomy was not found to have an independent impact on survival.
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Affiliation(s)
- Daniel S Kapp
- Division of Radiation Therapy, Department of Radiation Oncology, Stanford University School of Medicine, Stanford Cancer Center, Stanford, California 94305-5847, USA.
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264
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265
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Itakura E, Yamamoto H, Oda Y, Tsuneyoshi M. Detection and characterization of vascular endothelial growth factors and their receptors in a series of angiosarcomas. J Surg Oncol 2008; 97:74-81. [PMID: 18041747 DOI: 10.1002/jso.20766] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Angiosarcomas are malignant mesenchymal neoplasms, including sarcomas of presumptive vascular endothelial origin and sarcomas of probable lymphatic origin. It is, however, often difficult to determine whether they are from blood vascular or lymphatic endothelium. The majority of angiosarcomas are thought to originate from vascular endothelia and spread via bloodstream to lung, but lymphatic metastases can occur. METHODS We investigated immunohistochemical expression of vascular endothelial growth factors (VEGF-A, VEGF-C) and their receptors (VEGFR-1, VEGFR-2, VEGFR-3) in a series of 34 angiosarcomas. RESULTS VEGF-A was expressed by 32/34 (94%), VEGF-C by 4/34 (12%), VEGFR-1 by 32/34 (94%), VEGFR-2 by 22/34 (65%), and VEGFR-3 by 27/34 (79%). Patients who expressed low or no VEGFR-2 showed a significantly unfavorable prognosis by log-rank test (P = 0.010) and multivariate analysis (hazard ratio, 5.16; 95% CI, 1.40-19.04; P = 0.014). VEGFR-1 and VEGFR-3 were not significantly associated with patients' prognosis. CONCLUSIONS VEGF-A and VEGFR-1 were detected in diverse subtypes of angiosarcomas. In cooperation, VEGF-A and VEGF-C are likely to be involved in the development of angiosarcoma associated with lymphedema. VEGF-C expression may cause susceptibility to lymphatic metastasis through tumor lymphangiogenesis. Angiosarcoma of the scalp, which is traditionally considered as a true hemangiosarcoma, may include some cases of lymphatic origin.
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Affiliation(s)
- Eijun Itakura
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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266
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Gerrish ST, Smith JW. Gastrointestinal stromal tumors-diagnosis and management: a brief review. Ochsner J 2008; 8:197-204. [PMID: 21603502 PMCID: PMC3096364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are rare but are the most common mesenchymal tumor in the gastrointestinal tract. They arise from a precursor cell in the myenteric plexus, and most tumors express a characteristic CD117 antigen, which is part of a tyrosine kinase receptor. This finding has led to the development of novel chemotherapeutic agents targeted at these receptors and has revolutionized the treatment of these tumors, which had been historically disappointing. Surgery is recommended for tumors >2 cm in size and even has a role in metastatic disease. The approach to tumors <2 cm in size is more controversial, as these lesions tend to be less aggressive, but the true malignant potential of GISTs can only be determined by surgical resection and histologic evaluation.
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Affiliation(s)
- Stephen T. Gerrish
- Address correspondence to: Stephen T Gerrish, MD, MPH, Department of Gastroenterology/Hepatology, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, Tel: (504) 842-4015, e-mail:
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267
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Soft Tissue Sarcoma. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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268
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Nascimento AF, Raut CP. Diagnosis and management of pleomorphic sarcomas (so-called “MFH”) in adults. J Surg Oncol 2008; 97:330-9. [DOI: 10.1002/jso.20972] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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269
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Christopher Windham T, Sondak VK. Soft Tissue Sarcoma. Oncology 2007. [DOI: 10.1007/0-387-31056-8_58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Jassó A, Bertha L, Gyökeres T, Takács IG, Bursics A. [Small bowel GIST causing gastrointestinal bleeding, diagnosed by preoperative angiography]. Magy Seb 2007; 60:218-21. [PMID: 17932000 DOI: 10.1556/maseb.60.2007.4.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The authors present a case of a 65 year-old man, who was treated with massive gastrointestinal bleeding. The bleeding source was in the jejunum, as it was demonstrated by preoperative angiography. The histopathology report of the resected tumour confirmed the diagnosis of gastrointestinal stromal tumour. The authors discuss various preoperative diagnostic methods for small intestinal bleeding along with some current issues of the molecular biology as well as the treatment of GIST tumors.
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Affiliation(s)
- András Jassó
- MAV Kórház és Központi Rendelointézet, Sebészeti Osztály, 1062 Budapest, Podmaniczky u. 111
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Abstract
Sarcomas comprise a heterogeneous group of mesenchymal neoplasms. They can be grouped into 2 general categories, soft tissue sarcoma and primary bone sarcoma, which have different staging and treatment approaches. This review includes a discussion of both soft tissue sarcomas (malignant fibrous histiocytoma, liposarcoma, leiomyosarcoma, synovial sarcoma, dermatofibrosarcoma protuberans, angiosarcoma, Kaposi sarcoma, gastrointestinal stromal tumor, aggressive fibromatosis or desmoid tumor, rhabdomyosarcoma, and primary alveolar soft-part sarcoma) and primary bone sarcomas (osteosarcoma, Ewing sarcoma, giant cell tumor, and chondrosarcoma). The 3 most important prognostic variables are grade, size, and location of the primary tumor. The approach to a patient with a sarcoma begins with a biopsy that obtains adequate tissue for diagnosis without interfering with subsequent optimal definitive surgery. Subsequent treatment depends on the specific type of sarcoma. Because sarcomas are relatively uncommon yet comprise a wide variety of different entities, evaluation by oncology teams who have expertise in the field is recommended. Treatment and follow-up guidelines have been published by the National Comprehensive Cancer Network (www.nccn.org).
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Affiliation(s)
- Keith M Skubitz
- Department of Medicine, University of Minnesota Medical School and Masonic Cancer Center, Minneapolis, USA.
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272
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Akatsu T, Aiura K, Kawachi S, Tanabe M, Shimazu M, Ueda M, Kameyama K, Kitajima M. Duodenal gastrointestinal stromal tumor adjacent to the minor papilla with concomitant pancreatic divisum. Dig Dis Sci 2007; 52:3191-8. [PMID: 17443410 DOI: 10.1007/s10620-006-9254-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2005] [Accepted: 02/08/2006] [Indexed: 01/30/2023]
Affiliation(s)
- Tomotaka Akatsu
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan
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273
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Marín-Gómez LM, Vega-Ruiz V, García-Ureña MA, Navarro-Piñero A, Calvo-Durán A, Díaz-Godoy A, de la Vega Olías MC. [Retroperitoneal sarcomas. Report of five new cases and review of the current situation]. Cir Esp 2007; 82:172-6. [PMID: 17916289 DOI: 10.1016/s0009-739x(07)71694-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Soft-tissue sarcomas represent a heterogeneous group of rare tumors arising from the mesenchymal cells of the connective tissue. Approximately 15% of these tumors arise in the retroperitoneum. These neoplasms are locally aggressive and the only curative treatment is surgical resection "en-bloc". The main cause of mortality is locoregional recurrence. Five-year survival is 3-58%, depending on the histologic subtype and grade. PATIENTS AND METHOD Over a 5-year period (2001 to 2006), we performed surgery in five patients with retroperitoneal sarcomas. The mean age was 59 years (range, 46-76) with a male-to-female ratio of 3:2. The most frequent signs were abdominal pain and the appearance of a mass. In 2 patients, an incidental diagnosis was made during the surgical intervention. RESULTS Surgical resection was performed in 5 patients but was incomplete in two patients. We removed 2 liposarcomas, 1 leiomyosarcoma, 1 chondrosarcoma and 1 fusocellular sarcoma arising in the kidney. Locoregional recurrence occurred in four patients, requiring between 1 and 2 new relaparotomies (using the retroperitoneal approach in 2 patients). There was one death. CONCLUSIONS Retroperitoneal sarcomas are a heterogeneous group of tumors, in which the only common factor is the anatomical location. New randomized, prospective, multicenter trials are required to apply different therapeutic options according to the subtype of retroperitoneal sarcoma.
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Affiliation(s)
- Luis M Marín-Gómez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Puerto Real, Puerto Real (Cádiz), España.
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274
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Baratti D, Pennacchioli E, Casali PG, Bertulli R, Lozza L, Olmi P, Collini P, Radaelli S, Fiore M, Gronchi A. Epithelioid sarcoma: prognostic factors and survival in a series of patients treated at a single institution. Ann Surg Oncol 2007; 14:3542-51. [PMID: 17909905 DOI: 10.1245/s10434-007-9628-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Revised: 08/28/2007] [Accepted: 08/28/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Epithelioid sarcoma (ES) is a rare subtype of soft-tissue sarcoma of unknown histogenesis. Typically, it occurs superficially as single/multiple nodules (nodular ES), or in deeper tissues as a mass. The correlation between initial presentation and clinical outcome was investigated. METHODS Fifty-four consecutive patients surgically treated at a single referral center were retrospectively reviewed. Thirty-six patients presented with a primary and 18 with a recurrent tumor. Potential prognostic clinicopathological variables, including macroscopic features at first presentation, were tested by univariable and multivariable analysis with respect to overall (OS), metastasis-free (MFS), and local recurrence-free survival (LRFS). RESULTS The 10-year OS was 61.8% for the whole series. Thirty patients relapsed; in detail, local and distant failure occurred in 14 (25.9%) and 24 (44.4%) patients, respectively. The lymph node involvement rate was 16/54 (29.6%). In both the whole series and the subset of patient with primary ES, single localized tumor correlated with increased OS at multivariable analysis; occurrence of nodal involvement during postoperative follow-up correlated to worse OS and MFS. Nodular ES was an independent predictor of worse LRFS. In univariable analysis, nodular ES was associated with smaller tumor size, distal limb locations, earlier classification of malignant tumor (TNM) stage, and higher amputation rate. A statistical difference in the pattern of failure between nodular and mass ES was found. CONCLUSIONS Primary tumor macroscopic features seem to correlate to different local aggressiveness and failure patterns. Better prognosis is associated with single localized disease stage and no occurrence of locoregional spread.
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Affiliation(s)
- Dario Baratti
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
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275
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Zwaans BMM, Bielenberg DR. Potential therapeutic strategies for lymphatic metastasis. Microvasc Res 2007; 74:145-58. [PMID: 17950368 DOI: 10.1016/j.mvr.2007.08.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 08/24/2007] [Accepted: 08/24/2007] [Indexed: 12/20/2022]
Abstract
Physiologically, the lymphatic system regulates fluid volume in the interstitium and provides a conduit for immune cells to travel to lymph nodes, but pathologically, the lymphatic system serves as a primary escape route for cancer cells. Lymphatic capillaries have a thin discontinuous basement membrane, lack pericyte coverage and often contain endothelial cell gaps that can be invaded by immune cells (or tumor cells). In addition, tumor cells and stromal cells in the tumor microenvironment secrete factors that stimulate lymphangiogenesis, the growth of lymphatic endothelial cells and the sprouting of lymphatic capillaries. As a result, many tumors are surrounded by large, hyperplastic, peri-tumoral lymphatic vessels and less frequently are invaded by intra-tumoral lymphatic vessels. Carcinoma cells commonly metastasize through these lymphatic vessels to regional lymph nodes. The presence of metastatic cells in the sentinel lymph node is a prognostic indicator for many types of cancer, and the degree of dissemination determines the therapeutic course of action. Lymphangiogenesis is currently at the frontier of metastasis research. Recent strides in this field have uncovered numerous signaling pathways specific for lymphatic endothelial cells and vascular endothelial cells. This review will provide an overview of tumor lymphangiogenesis and current strategies aimed at inhibiting lymphatic metastasis. Novel therapeutic approaches that target the tumor cells as well as the vascular and lymphatic endothelial compartments are discussed.
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Affiliation(s)
- Bernadette M M Zwaans
- Program in Vascular Biology, Department of Surgery, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Masuda T, Toh Y, Kabashima A, Aoki Y, Harimoto N, Ito S, Taomoto J, Ikeda O, Ohga T, Adachi E, Sakaguchi Y, Hirahashi M, Nishiyama K, Okamura T. Overt lymph node metastases from a gastrointestinal stromal tumor of the esophagus. J Thorac Cardiovasc Surg 2007; 134:810-1. [PMID: 17723845 DOI: 10.1016/j.jtcvs.2007.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Accepted: 06/01/2007] [Indexed: 12/23/2022]
Affiliation(s)
- Takaaki Masuda
- Department of Gastroenterogical Surgery, National Kyushu Cancer Center, Fukuoka, Japan
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Würl P. Möglichkeiten der operativen Therapie fortgeschrittener und rezidivierender intraabdomineller und retroperitonealer Sarkome. Visc Med 2007. [DOI: 10.1159/000101534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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278
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Atalay C, Altinok M, Seref B. The impact of lymph node metastases on survival in extremity soft tissue sarcomas. World J Surg 2007; 31:1433-7. [PMID: 17510769 DOI: 10.1007/s00268-007-9078-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 03/09/2007] [Accepted: 03/10/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND The impact of lymph node metastases on survival in extremity soft tissue sarcomas has been studied for a long time with controversial results. The purpose of this study was to compare survival of patients with initial lymph node metastases with those having lymph node or distant metastases or both after initial curative surgery. METHODS Patients treated between 1995 and 2000 for extremity soft tissue sarcoma were retrospectively studied in four groups: those with metastatic regional lymph nodes at the time of diagnosis, those with only regional lymph node recurrences, those with only distant metastatic relapses, and those with both regional lymph node recurrences and distant metastatic relapses, all of the last three groups after initial curative surgery. The impact of timing of lymph node metastases on disease-free and overall survival was evaluated. RESULTS A total of 110 patients (73 men) with a median age of 45 years were eligible for the study. Three-year disease-free survival was significantly longer in patients with initial regional lymph node metastases than in patients with only lymph node recurrences after curative surgery (p = 0.04) and patients with initial (p = 0.0002) and recurrent (p = 0.0004) regional lymph node metastases had longer disease-free survival than patients with distant metastases. Overall survival difference between patients with initial regional lymph node metastases and patients with only lymph node recurrences after curative surgery was significant at 5 years (p = 0.01). CONCLUSIONS It is logical to separate patients with initial lymph node metastases from those with distant metastases in staging and to treat patients with initial lymph node metastases with radical surgical interventions if complete tumor resection seems feasible.
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Affiliation(s)
- Can Atalay
- Department of General Surgery, Ankara Oncology Hospital, 13. Cad. No:56 Demetevler, 06200 Ankara, Turkey.
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279
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Abstract
Hand tumours of soft-tissue and bony origin are frequently encountered, and clinicians must be able to distinguish typical benign entities from life-threatening or limb-threatening malignant diseases. In this Review, we present a diagnostic approach to hand tumours and describe selected cancers and their treatments. Soft-tissue tumours include ganglion cysts, giant-cell cancers and fibromas of the tendon sheath, epidermal inclusion cysts, lipomas, vascular lesions, peripheral-nerve tumours, skin cancers, and soft-tissue sarcomas. Bony tumours encompass enchondromas, aneurysmal bone cysts, osteoid osteomas, giant-cell lesions of bone, bone sarcomas, and metastases. We look at rates of recurrence and 5-year survival, and recommendations for adjunct chemotherapy and radiotherapy for malignant lesions.
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Affiliation(s)
- Charles S Hsu
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, CA 94305, USA
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280
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Leong SPL, Cady B, Jablons DM, Garcia-Aguilar J, Reintgen D, Werner JA, Kitagawa Y. Patterns of metastasis in human solid cancers. Cancer Treat Res 2007; 135:209-221. [PMID: 17953419 DOI: 10.1007/978-0-387-69219-7_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Stanley P L Leong
- Department of Surgery, University of California San Francisco, California, USA
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281
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Affiliation(s)
- Murray F Brennan
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room H-1203, New York, NY 10021, USA.
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282
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Leong SPL, Cady B, Jablons DM, Garcia-Aguilar J, Reintgen D, Jakub J, Pendas S, Duhaime L, Cassell R, Gardner M, Giuliano R, Archie V, Calvin D, Mensha L, Shivers S, Cox C, Werner JA, Kitagawa Y, Kitajima M. Clinical patterns of metastasis. Cancer Metastasis Rev 2006; 25:221-32. [PMID: 16770534 DOI: 10.1007/s10555-006-8502-8] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In human solid cancer, lymph node status is the most important indicator for clinical outcome. Recent developments in the sentinel lymph node concept and technology have resulted in a more precise way of examining micrometastasis in the sentinel lymph node and the role of lymphovascular system in the facilitation of cancer metastasis. Different patterns of metastasis are described with respect to different types of solid cancer. Expect perhaps for papillary carcinoma and sarcoma, the overwhelming evidence is that solid cancer progresses in an orderly progression from the primary site to the regional lymph node or the sentinel lymph node in the majority of cases with subsequent dissemination to the systemic sites. The basic mechanisms of cancer metastasis through the lymphovascular system form the basis of rational therapy against cancer. Beyond the clinical patterns of metastasis, it is imperative to understand the biology of metastasis and to characterize patterns of metastasis perhaps due to heterogeneous clones based on their molecular signatures.
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Affiliation(s)
- Stanley P L Leong
- Department of Surgery, University of California, and UCSF Comprehensive Cancer Center, San Francisco, CA, USA.
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283
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Abstract
Epithelioid sarcoma is a rare soft tissue sarcoma with a propensity for local aggressiveness, regional nodal spread, and pulmonary metastases. We report a case of epithelioid sarcoma in a neonate with bilateral optic nerve hypoplasia who developed liver, kidney, and bone metastases. The unusual presenting features and pattern of disease progression in this patient suggest that a different disease evaluation strategy should be considered for infants with epithelioid sarcoma.
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Affiliation(s)
- Himesh Gupta
- Department of Surgery, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA
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284
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Labow DM, Brennan MF. Extremity Soft Tissue Sarcomas. Surg Oncol 2006. [DOI: 10.1007/0-387-21701-0_43] [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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285
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Pawlik TM, Ross MI, Prieto VG, Ballo MT, Johnson MM, Mansfield PF, Lee JE, Cormier JN, Gershenwald JE. Assessment of the role of sentinel lymph node biopsy for primary cutaneous desmoplastic melanoma. Cancer 2006; 106:900-6. [PMID: 16411225 DOI: 10.1002/cncr.21635] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The role of sentinel lymph node biopsy (SLNB) in the treatment of desmoplastic melanoma (DM) remains undefined. The purpose of this study was to evaluate the use of SLNB for DM. METHODS In all, 1850 patients with cutaneous melanoma underwent wide local excision and SLNB. Patients with DM were identified and stratified as 'pure' DM or 'mixed' DM (i.e., DM associated with at least one other common histologic subtype). RESULTS Of the 1850 patients, 65 (3.5%) had DM. Of these, 46 (70.8%) had pure DM and 19 (29.2%) had mixed DM. Patients with pure DM had a median tumor thickness of 3.5 mm and 6.5% were ulcerated. Compared with patients with pure DM, patients with either mixed DM or non-DM (n = 1785) had thinner primary tumors (median, 1.7 mm and 1.5 mm, respectively, each P < 0.001 vs. pure DM) that were more likely to be ulcerated (27.7% and 21.3%, respectively, each P < 0.05 vs. pure DM). Although the incidence of a positive SLN was similar in patients with mixed DM (15.8%) and non-DM (17.5%), patients with pure DM were less likely to have a positive SLN (2.2%) (each P < 0.01 vs. non-DM and mixed DM). At a median follow-up of 2.9 years, no patient with pure DM had recurred. CONCLUSIONS Despite having thicker primary tumors, patients with pure DM have a lower incidence of positive SLNs compared with patients with non-DM. Whereas the treatment approach for patients with mixed DM should be similar to that of other melanoma patients, patients with pure DM are unlikely to have metastatic disease in regional lymph nodes and SLNB may not be warranted.
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Affiliation(s)
- Timothy M Pawlik
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, 77230, USA
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286
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Pfannschmidt J, Klode J, Muley T, Dienemann H, Hoffmann H. Nodal Involvement at the Time of Pulmonary Metastasectomy: Experiences in 245 Patients. Ann Thorac Surg 2006; 81:448-54. [PMID: 16427829 DOI: 10.1016/j.athoracsur.2005.08.049] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2005] [Revised: 08/22/2005] [Accepted: 08/25/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although routine systematic mediastinal and hilar lymph node dissection contemporary with pulmonary metastasectomy has not been uniformly performed in many thoracic surgical centers, the value of this procedure needs to be investigated. METHODS Between 1996 and 2001, 245 patients (157 men, 88 women) underwent pulmonary resection of metastatic colorectal carcinoma, sarcoma, and renal cell carcinoma. Generally, systematic mediastinal and hilar lymph node dissection was performed concurrently with pulmonary metastasectomy. Patients were assessed for patterns of lymph node metastases. The frequency of lymph node involvement was determined. Patients and tumor characteristics were assessed to ascertain whether certain factors were likely to predict lymph node spread. RESULTS Of the 245 patients (328 primary thoracic procedures), 165 had no lymph node involvement, 45 had pulmonary and hilar metastases, 22 had pulmonary, hilar, and mediastinal metastases, and 13 had only mediastinal involvement without pulmonary and hilar spread. Patients with more than one pulmonary metastasis or metachronous disease were more likely to have thoracic lymph node metastases. The risk for mediastinal lymph node involvement was even more likely for patients who had already pulmonary or hilar lymph node spread; the odds ratios (with 95% confidence intervals) were 1.30 (0.71 to 2.36), 1.32 (0.59 to 2.99), and 5.87 (2.73 to 12.6), respectively. Median survival for the group of patients after complete resection was 54.8 months (95% CI: 40.9 to 68.7); and for the patients with no lymph node involvement, it was 63.9 months (95% CI: 45.3 to 82.6); with N1 disease, 32.7 months (95% CI: 9.2 to 56.2); and with N1 + N2 disease, 20.6 months (95% CI: 5.1 to 36.1). The log-rank test revealed significance between N0 and N1 (p = 0.018) and N0 versus N1, 2 (p = 0.001). CONCLUSIONS We conclude that systematic mediastinal and hilar lymph node dissection contemporary with pulmonary metastasectomy offers a further understanding of metastatic disease and provides important information for complete surgical staging.
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287
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de Visscher SAHJ, van Ginkel RJ, Wobbes T, Veth RPH, Ten Heuvel SE, Suurmeijer AJH, Hoekstra HJ. Epithelioid sarcoma: Still an only surgically curable disease. Cancer 2006; 107:606-12. [PMID: 16804932 DOI: 10.1002/cncr.22037] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Epithelioid sarcoma is a rare soft tissue sarcoma with a known high propensity for locoregional recurrence and distant metastases. The clinical behavior and prognostic factors that influence the survival of patients with epithelioid sarcoma were studied. METHODS Twenty-three patients, including 16 men (70%) and 7 women (30%), who were treated for epithelioid sarcoma between 1979-2003 at the University Medical Center Groningen and Radboud University Nijmegen Medical Center, were reviewed retrospectively. The median age at diagnosis was 22 years (range, 1-54 years). At the time of diagnosis, 11 patients (48%) had metastases. Six patients with distant metastasis and 1 patient with an unresectable tumor received palliative treatment (30%). The remaining 16 patients underwent surgical treatment of local disease (11 patients) or locoregional disease (5 patients). Five patients in that group received isolated limb perfusion with tumor necrosis factor and melphalan. RESULTS The 5-year and 10-year disease-free survival rates for all patients were 34% and 17%, respectively; for the 16 patients who received curative treatment, both rates were 56%. In the latter group, 8 patients developed local recurrence (50%) after a median follow-up of 4 months (range, 1-14 months). Nine patients were disease free after a median follow-up of 50 months (range, 6-290 months). Tumor size >5 cm (P < .0026) at diagnosis and local recurrence (P < .0008) were significant predictors of survival. CONCLUSIONS The prognosis for patients with epithelioid sarcoma is poor, because a substantial number of patients present with extensive disease, lymph node metastases, and/or distant metastases. Treatment consists of radical surgical excision of the tumor and, if indicated, therapeutic lymph node dissection. In patients who have large tumors, isolated limb perfusion may be useful.
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Affiliation(s)
- Sebastiaan A H J de Visscher
- Department of Surgical Oncology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
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288
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289
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Affiliation(s)
- Matthew A Clark
- Sarcoma Unit, the Royal Marsden Hospital National Health Service Foundation Trust, London.
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290
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Seal A, Tse R, Wehrli B, Hammond A, Temple CLF. Sentinel node biopsy as an adjunct to limb salvage surgery for epithelioid sarcoma of the hand. World J Surg Oncol 2005; 3:41. [PMID: 15987509 PMCID: PMC1192822 DOI: 10.1186/1477-7819-3-41] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Accepted: 06/29/2005] [Indexed: 11/25/2022] Open
Abstract
Background Epithelioid sarcomas of the hand are rare, high-grade tumors with a propensity for regional lymphatic spread approaching 40%. Case presentation A 54-year-old male with an epithelioid sarcoma of the palm was treated with neoadjuvant radiation, wide excision, and two-stage reconstruction. Sentinel lymph node biopsy was used to stage the patient's axilla. Sentinel node biopsy results were negative. The patient has remained free of local, regional and distant disease for the follow-up time of 16 months. Conclusion The rarity of this tumor makes definitive conclusions difficult but SLN biopsy appears to be a useful adjunct in the treatment of these sarcomas.
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Affiliation(s)
- Alex Seal
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Raymond Tse
- Division of Plastic Surgery, University of Western Ontario, London, Ontario, Canada
| | - Bret Wehrli
- Department of Pathology, University of Western Ontario, London, Ontario, Canada
| | - Alex Hammond
- Department of Radiation Oncology, London Region Cancer Centre, London, Ontario, Canada
| | - Claire LF Temple
- Division of Plastic Surgery, University of Western Ontario, London, Ontario, Canada
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291
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Hindmarsh A, Koo B, Lewis MPN, Rhodes M. Laparoscopic resection of gastric gastrointestinal stromal tumors. Surg Endosc 2005; 19:1109-12. [PMID: 16021371 DOI: 10.1007/s00464-004-8168-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2004] [Accepted: 12/22/2004] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are neoplasms with low malignant potential. They occur most commonly in the stomach, where they are amenable to laparoscopic resection. METHODS A case note review of all patients undergoing laparoscopic resection of a presumed gastric GIST at the Norfolk and Norwich University Hospital, United Kingdom, was conducted. RESULTS Since September 1995, 30 patients have undergone this procedure. The patients had a mean age of 64.2 years (range, 31-87 years) and a mean weight of 74.1 kg (range, 44-104 kg). A presumptive diagnosis of GIST was made in all the cases based on the endoscopic and radiologic appearance of the lesion. Laparoscopic resection was completed successfully in 23 patients with a mean operating time of 73.8 min (range, 26-160 min). Seven procedures were converted to open surgery: three because the tumor was deemed too large for laparoscopic resection, two because the tumor could not be identified, one because of dense peritoneal adhesions, and one because of bleeding. The mean estimated blood loss was 196 ml (range, 0-1,000 ml), and the mean hospital stay was 5 days (ranges, 1-11 days). Pathologic analysis of the resected specimens showed 22 GISTs, 3 inflammatory fibroids, 2 submucosal lipomas, 1 submucosal varix, and 1 nest of heterotopic pancreatic tissue. D: uring a median follow-up period of 18 months (range, 2-101 months) there have been two cases of recurrence. In both cases, the tumor was catagorized as high risk for aggressive behavior after primary resection. CONCLUSION Stapled laparoscopic resection is a safe and effective treatment option for nonmetastatic primary gastric GIST.
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Affiliation(s)
- A Hindmarsh
- Department of General Surgery, Norfolk and Norwich University Hospital, Norwich NR4 7UY, United Kingdom.
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292
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Abstract
Soft tissue sarcomas are a rare group of neoplasms readily dispersed throughout the body with different histopathologies and different outcomes. The present review summarizes advances made in biology, distribution and natural history, and emphasises predictive models for outcome. Complete resection remains the major factor in providing cure, with limited benefits in the control of the local disease by radiation therapy and only minimal benefit of systemic therapy for metastatic disease. Identification of targeted therapy utilising direct specific molecular targets raises hope that future progress in control, if not cure, is realistic.
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Affiliation(s)
- M F Brennan
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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293
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Stelzner F, Friedrichs N, Büttner R, Wernert N, von Mallek D, Ruhlmann J, Steinau HU. Das Lymphgefäßsystem (LGS I und II) aus chirurgischer Sicht. Chirurg 2005; 76:493-500. [PMID: 15827707 DOI: 10.1007/s00104-005-1015-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Sarcomatous malignancies only rarely develop regional lymph node metastases: about 2.7% of our evaluated cases. In this paper we provide evidence supporting a new hypothesis that two entirely separate lymph vascular systems exist in humans. One system (LGS I) exists in close proximity to the epithelium and drains into regional lymph nodes. Only sarcomas that originate in the epithelium or its immediate proximity are able to form regional lymph node metastases. The vast majority of sarcomatous malignancies (97.4% of cases) do not give rise to lymph node metastases, since they originate in proximity to a second, more deeply localized lymph node system (LGS II) in the mesenchymally derived tissues of the body. This second system has no connection to regional lymph nodes. Supporting evidence is provided by experience in the operative treatment of extremity lymphedema, PET-CT examinations, radionuclear lymphography, and scientific investigations using antibodies specifically directed at the elements of the lymph vascular system.
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Affiliation(s)
- F Stelzner
- Zentrum für Chirurgie der Universität Bonn
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294
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Behranwala KA, A'Hern R, Omar AM, Thomas JM. Prognosis of lymph node metastasis in soft tissue sarcoma. Ann Surg Oncol 2005; 11:714-9. [PMID: 15231526 DOI: 10.1245/aso.2004.04.027] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND We defined the tumor characteristics and prognosis of patients with regional lymph node metastasis (RLNM) from soft tissue sarcoma. METHODS All patients with RLNM from soft tissue sarcoma were identified from the Royal Marsden Hospital Sarcoma Unit prospective database from January 1990. RESULTS A total of 73 (3.4%) of 2127 patients had RLNM. Fifty-seven patients (78.1%) had RLNM as the first site of spread, and 16 patients (21.9%) presented with RLNM and distant metastasis synchronously. The most common histologies were rhabdomyosarcoma, epithelioid sarcoma, and angiosarcoma. There were 9 T1 and 36 T2 tumors, and tumor size was not available in 28 patients. There were 6 grade 1, 16 grade 2, and 51 grade 3 tumors. Forty-two patients presented with RLNM along with the primary tumor. Of the remaining patients, the median time to development of RLNM from diagnosis of the primary tumor was 13.5 months (95% confidence interval [CI], 1-100 months). The 1-year survival for patients with isolated RLNM was 77.49% (95% CI, 62.99%-86.88%), compared with 36.27% (95% CI, 13.32%-60.04%) for patients who presented with RLNM and distant metastasis (P =.005). The 1-year survival for metachronous and synchronous RLNM was 94.44% (95% CI, 66.64%-99.20%) and 67.54% (95% CI, 47.89%-81.12%), respectively (P =.05). CONCLUSIONS Lymph node metastasis is rare. Patients who present with isolated RLNM have an improved survival compared with patients who present with regional and distant metastasis at diagnosis. Synchronous RLNM with the primary tumor have a poorer outcome than metachronous RLNM in the absence of distant metastasis.
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Affiliation(s)
- Kasim A Behranwala
- Sarcoma and Melanoma Unit, Royal Marsden NHS Trust, 203 Fulham Road, London SW3 6JJ, UK.
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295
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Abstract
Twenty-eight patients were treated for a primary epithelioid sarcoma of the hand. Twenty-seven patients (96%) had excisions before evaluation, including 11 (39%) with multiple prior excisions with varying diagnoses before epithelioid sarcoma, and all had surgical treatment after referral. The patients' surgical management included three patients with amputation at the forearm, three patients with wide excision, and 21 patients with a partial amputation of the hand. The followup period averaged 120 months (range, 24-276 months). Eighteen patients have no evidence of disease at last followup. Treatment failures included one local recurrence, four regional metastases, and five distant metastases. Five patients died secondary to disease. Two patients are alive with disease, and three are alive with no evidence of disease after additional treatment. After aggressive surgical management with negative margins, 71% of the patients were alive without evidence of disease at the last followup, with a 5- and 10-year survivorship of 85%. Our goal is to review: (1) the effectiveness of preoperative imaging, (2) the role of adjuvant therapy, (3) survival after alternative resections, and (4) function after resection.
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Affiliation(s)
- Mark J Herr
- Department of Orthopedic Surgery, Mayo Clinic, 200 SW First Street, Rochester, MN 55905, USA
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296
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Heinrich MC, Corless CL. Gastric GI stromal tumors (GISTs): The role of surgery in the era of targeted therapy. J Surg Oncol 2005; 90:195-207; discussion 207. [PMID: 15895440 DOI: 10.1002/jso.20230] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasm arising in the stomach. These tumors were previously classified as smooth muscle tumors, but in recent years it has become clear that they are clinically, pathologically, and molecularly distinct from other tumors and are much more common than previously appreciated. Historically, patients with primary localized or advanced GIST have been managed surgically, as there was no proven role of other treatment modalities such as radiation or chemotherapy. However, the field of GIST was revolutionized with the 1998 discovery that the vast majority of these tumors have oncogenic gain-of-function mutations of the KIT receptor tyrosine kinase. Follow-up studies have confirmed that KIT is both a useful diagnostic marker and an excellent therapeutic target. Imatinib, an inhibitor of KIT kinase activity, is now the standard front-line therapy for patients with advanced GIST. In this review, we discuss pathological and molecular features of gastric GISTs and review the historic and current roles of surgery in the treatment of patients with primary or metastatic GIST. The importance of a multi-disciplinary approach using both surgery and imatinib therapy is emphasized.
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Affiliation(s)
- Michael C Heinrich
- OHSU Cancer Institute, Oregon Health and Science University and VA Medical Center, Portland, Oregon 97239, USA.
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297
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Behranwala KA, Roy P, Giblin V, A'hern R, Fisher C, Thomas JM. Intra-abdominal metastases from soft tissue sarcoma. J Surg Oncol 2004; 87:116-20. [PMID: 15334637 DOI: 10.1002/jso.20105] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To define the clinical features and prognosis of patients with abdominal metastasis from primary soft tissue sarcoma (STS) at other sites. METHODS All patients with abdominal metastasis from STS were identified from the Royal Marsden Hospital Sarcoma Unit prospective database from January 1990 to July 2001. RESULTS Nineteen patients developed abdominal metastasis out of a cohort of 2127 patients (0.9%) evaluated during the study interval. The median age was 49 (19-71) years. The median time to abdominal metastasis from diagnosis of the primary was 27 (8-91) months. The presenting complaints were incomplete intestinal obstruction (n = 5), abdominal pain (n = 4), mass (n = 2), gastrointestinal bleed (n = 2), urinary obstruction (n = 2), anorexia (n = 1), and abdominal distension (n = 1). Emergency laparotomy was done for perforative peritonitis (n = 2), intussusception (n = 2), and bleed in spleen (n = 1). Two patients were asymptomatic. The common histologies were myxoid liposarcoma (n = 6) and leiomyosarcoma (n = 4). The median follow-up of survivors post metastasis was 12 months. Abdominal metastatectomy was performed in 16 patients, 3 of these patients had abdominal recurrences. The 1- and 2-year overall disease specific survival for the 19 patients was 66% (SE = 11%) and 43% (SE = 13%) with a median survival of 13 months (95% CI = 11.8-14.7). Metastasectomy was associated with slight improved median post-metastasis survival (33 months vs. 8 months for unresected patients). CONCLUSIONS Although abdominal metastasis is rare, vigilance is warranted. Symptomatic patients should be examined and investigated thoroughly for metastases. Surgery is the treatment of choice for patients with an acute presentation; however, survival is dismal.
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298
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Riad S, Griffin AM, Liberman B, Blackstein ME, Catton CN, Kandel RA, O'Sullivan B, White LM, Bell RS, Ferguson PC, Wunder JS. Lymph node metastasis in soft tissue sarcoma in an extremity. Clin Orthop Relat Res 2004:129-34. [PMID: 15346063 DOI: 10.1097/01.blo.0000141660.05125.46] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
For patients with soft tissue sarcoma in an extremity, the outcome is thought to be poor if lymph node metastasis develops. The purpose of this study was to examine the impact of lymphatic involvement from soft tissue sarcoma on patient survival. Thirty-nine (3.7%) of 1066 patients who had surgery for soft tissue sarcoma in an extremity had lymph node metastases develop. Three (20%) of 15 patients with epithelioid sarcoma, four (19%) of 21 patients with rhabdomyosarcoma, two (11.1%) of 18 patients with clear cell sarcoma, and two (11.1%) of 18 patients with angiosarcoma had lymphatic involvement. Thirty patients who had resection of involved lymph nodes had an estimated 5-year survival of 57%, whereas nine patients treated without surgery all died within 30 months. An estimated 4-year survival of 71% for patients with isolated lymph node metastases was significantly better than 21% for patients with synchronous systemic and lymph node involvement. There was no difference in outcome for patients with isolated lymphatic involvement compared with patients with American Joint Committee on Cancer Stage III extremity sarcomas. These results suggest that long-term survival is possible after surgical resection of lymphatic metastases from soft tissue sarcoma. The American Joint Committee on Cancer should consider separating isolated nodal metastases from systemic involvement in patients with Stage IV sarcoma.
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Affiliation(s)
- Soha Riad
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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299
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Lee CM, Chen HC, Leung TK, Chen YY. Gastrointestinal stromal tumor: Computed tomographic features. World J Gastroenterol 2004; 32:447-52. [PMID: 15285033 DOI: 10.1016/j.clinimag.2008.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Revised: 02/01/2008] [Accepted: 04/02/2008] [Indexed: 02/06/2023] Open
Abstract
AIM Gastrointestinal stromal tumor (GIST) is a rare type of cancer. Computed tomography (CT) is an imaging modality of choice for diagnosing GIST. The aim of this retrospective study was to review the CT imaging features of 17 GIST patients. METHODS From 1995 to 2003, there were 47 patients with pathologically proven GISTs at our hospital. Of these, 17 patients underwent preoperative CT. We collected and analyzed these CT images. The CT imaging features included tumor diameter, number and location, tumor margin, location of metastasis, hounsfield units of tumor and effect of contrasts. In addition, we also recorded the surgical findings, including complications, tumor size and location for comparative analysis. RESULTS The results showed that 12 (70%) tumors were located in the stomach and five (30%) were located in the jejunum mesentery. GISTs were extraluminal in 12 (70%) patients. The tumor margins of 13 (76%) tumors were well defined and irregular in four (24%). The effect of contrast enhancement on GIST CT imaging was homogenous enhancement in 13 (76%) and heterogeneous enhancement in four (24%). The hounsfield units (HU) were 30.41 +/-5.01 for precontrast images and postcontrast hounsfield units were 51.80 +/- 9.24. CONCLUSION The stomach was the commonest site of GIST occurrence among our patients. The CT features of GIST were well-defined tumor margins, homogenous enhancement on postcontrast CT images.
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Affiliation(s)
- Chi-Ming Lee
- Department of Diagnostic Radiology, Taipei Medical University Hospital, Taipei, Taiwan, China.
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Abstract
AIM: Gastrointestinal stromal tumor (GIST) is a rare type of cancer. Computed tomography (CT) is an imaging modality of choice for diagnosing GIST. The aim of this retrospective study was to review the CT imaging features of 17 GIST patients.
METHODS: From 1995 to 2003, there were 47 patients with pathologically proven GISTs at our hospital. Of these, 17 patients underwent preoperative CT. We collected and analyzed these CT images. The CT imaging features included tumor diameter, number and location, tumor margin, location of metastasis, hounsfield units of tumor and effect of contrasts. In addition, we also recorded the surgical findings, including complications, tumor size and location for comparative analysis.
RESULTS: The results showed that 12 (70%) tumors were located in the stomach and five (30%) were located in the jejunum mesentery. GISTs were extraluminal in 12 (70%) patients. The tumor margins of 13 (76%) tumors were well defined and irregular in four (24%). The effect of contrast enhancement on GIST CT imaging was homogenous enhancement in 13 (76%) and heterogeneous enhancement in four (24%). The hounsfield units (HU) were 30.41 ± 5.01 for precontrast images and postcontrast hounsfield units were 51.80 ± 9.24.
CONCLUSION: The stomach was the commonest site of GIST occurrence among our patients. The CT features of GIST were well-defined tumor margins, homogenous enhancement on postcontrast CT images.
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Affiliation(s)
- Chi-Ming Lee
- Department of Diagnostic Radiology, Taipei Medical University Hospital, Taipei, Taiwan, China.
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