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Radaelli S, Merlini A, Khan M, Gronchi A. Progress in histology specific treatments in soft tissue sarcoma. Expert Rev Anticancer Ther 2024; 24:845-868. [PMID: 39099398 DOI: 10.1080/14737140.2024.2384584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/22/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION Soft tissue sarcomas (STS) represent a heterogenous group of rare tumors, primarily treated with surgery. Preoperative radiotherapy is often recommended for extremity high-risk STS. Neoadjuvant chemotherapy, typically based on doxorubicin with ifosfamide, has shown efficacy in limbs and trunk wall STS. Second-line chemotherapy, commonly utilized in the metastatic setting, is mostly histology-driven. Molecular targeted agents are used across various histologies, and although the use of immunotherapy in STS is still in its early stages, there is increasing interest in exploring its potential. AREAS COVERED This article involved an extensive recent search on PubMed. It explored the current treatment landscape for localized and metastatic STS, focusing on the combined use of radiotherapy and chemotherapy for both extremity and retroperitoneal tumors, and with a particular emphasis on the most innovative histopathology driven therapeutic approaches. Additionally, ongoing clinical trials identified via clinicaltrials.gov are included. EXPERT OPINION Recently there have been advancements in the treatment of STS, largely driven by the outcomes of clinical trials. However further research is imperative to comprehend the effect of chemotherapy, targeted therapy and immunotherapy in various STS, as well as to identify biomarkers able to predict which patients are most likely to benefit from these treatments.
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Affiliation(s)
- Stefano Radaelli
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandra Merlini
- Department of Oncology, University of Turin, Orbassano, Italy
- Department of Oncology, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Misbah Khan
- Surgery, East Sussex NHS Healthcare, East Sussex, UK
| | - Alessandro Gronchi
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Gervais MK, Basile G, Dulude JP, Mottard S, Gronchi A. Histology-Tailored Approach to Soft Tissue Sarcoma. Ann Surg Oncol 2024:10.1245/s10434-024-15981-8. [PMID: 39174839 DOI: 10.1245/s10434-024-15981-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 07/23/2024] [Indexed: 08/24/2024]
Abstract
Soft tissue sarcomas are a diverse and heterogeneous group of cancers of mesenchymal origin. Each histological type of soft tissue sarcoma has unique clinical particularities, which makes them challenging to diagnose and treat. Multidisciplinary management of these rare diseases is thus key for improved survival. The role of surgery has been well established, and it represents the cornerstone curative treatment for soft tissue sarcomas. To date, local recurrence is the leading cause of death in low-grade sarcomas located at critical sites, and distant metastasis in high-grade sarcomas, regardless of the site of origin. Management must be tailored to each individual histologic type. We describe the most common types of extremity, trunk, abdominal, and retroperitoneal soft tissue sarcoma along with characteristics to consider for optimized management.
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Affiliation(s)
- Mai-Kim Gervais
- Division of Surgical Oncology, Department of Surgery, Maisonneuve-Rosemont Hospital, Université de Montréal, Montreal, QC, Canada
| | - Georges Basile
- Division of Orthopedic Oncology, Department of Surgery, Maisonneuve-Rosemont Hospital, Université de Montréal, Montreal, QC, Canada
| | - Jean-Philippe Dulude
- Division of Surgical Oncology, Department of Surgery, Maisonneuve-Rosemont Hospital, Université de Montréal, Montreal, QC, Canada
| | - Sophie Mottard
- Division of Orthopedic Oncology, Department of Surgery, Maisonneuve-Rosemont Hospital, Université de Montréal, Montreal, QC, Canada
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Zhou XP, Xing JP, Sun LB, Tian SQ, Luo R, Liu WH, Song XY, Gao SH. Molecular characteristics and systemic treatment options of liposarcoma: A systematic review. Biomed Pharmacother 2024; 178:117204. [PMID: 39067161 DOI: 10.1016/j.biopha.2024.117204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/12/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024] Open
Abstract
Liposarcoma (LPS) is a rare soft tissue sarcoma that develops from the differentiation of fat cells, typically occurring in the lower extremities and retroperitoneal space. Depending on its histological morphology and molecular changes, LPS can be divided into various subtypes, each exhibiting distinct biological behaviors. During treatment, especially for LPS arising in the retroperitoneum, the extent and quality of the initial surgery are critically important. Treatment strategies must be tailored to the specific type of LPS. Over the past few decades, the treatment of LPS has undergone numerous advancements, with new therapeutic approaches such as targeted drugs and immunotherapies continually emerging. This paper reviews the biological characteristics, molecular alterations, as well as surgical and pharmacological treatments of various LPS subtypes, with the aim of enhancing clinicians' understanding and emphasizing the importance of individualized precision therapy. With a deeper understanding of the biological characteristics and molecular alterations of LPS, future treatment trends are likely to focus more on developing personalized treatment plans to better address the various types of LPS.
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Affiliation(s)
- Xuan-Peng Zhou
- China-Japan Union Hospital of Jilin University, Changchun, Jilin 130000, PR China
| | - Jian-Peng Xing
- China-Japan Union Hospital of Jilin University, Changchun, Jilin 130000, PR China
| | - Luan-Biao Sun
- China-Japan Union Hospital of Jilin University, Changchun, Jilin 130000, PR China
| | - Sheng-Qi Tian
- China-Japan Union Hospital of Jilin University, Changchun, Jilin 130000, PR China
| | - Ran Luo
- China-Japan Union Hospital of Jilin University, Changchun, Jilin 130000, PR China
| | - Wen-Hao Liu
- China-Japan Union Hospital of Jilin University, Changchun, Jilin 130000, PR China
| | - Xin-Yuan Song
- The Chinese University of Hong Kong, New Territories 999077, Hong Kong Special Administrative Region of China
| | - Shuo-Hui Gao
- China-Japan Union Hospital of Jilin University, Changchun, Jilin 130000, PR China.
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Campbell SR, Wooley JR, Nystrom LM. Modern Multidisciplinary Management of Soft Tissue Sarcoma of the Extremity and Trunk. JCO Oncol Pract 2024; 20:907-914. [PMID: 38574314 DOI: 10.1200/op.23.00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/20/2024] [Accepted: 03/06/2024] [Indexed: 04/06/2024] Open
Abstract
Soft tissue sarcomas (STS) of the extremity and trunk are heterogeneous and rare tumors that require coordinated multidisciplinary management. Surgical resection remains the backbone of treatment for localized tumors, with the addition of radiotherapy to surgery to achieve high rates of local control. Despite this, overall survival is limited because of significant distant metastatic risk and a lack of efficacious systemic therapies. Clinical trials have produced conflicting results on the impact of systemic therapy in the neoadjuvant and adjuvant settings for patients with localized disease, leaving systemic treatment decisions largely guided by shared decision making and prognostic prediction tools such as nomograms. This article will review the foundational data as well as latest developments in surgical, radiotherapy, and systemic management supporting current practice guidelines for localized STS of the extremity and trunk.
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Affiliation(s)
| | - Joseph R Wooley
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH
| | - Lukas M Nystrom
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
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Shimatani A, Katagiri H, Murata H, Wasa J, Miyagi M, Honda Y, Takahashi M, Harada H, Asakura H, Onoe T. Significance of radiation therapy in the myxoid round-cell liposarcoma treatment regimen. Int J Clin Oncol 2024; 29:1044-1051. [PMID: 38656356 DOI: 10.1007/s10147-024-02534-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND PURPOSE Because myxoid liposarcomas are more radiosensitive than other soft tissue sarcomas, there have been several reports of 50 Gy preoperative radiation therapy combined with surgery, but the wound complication rate is reportedly high. We have performed preoperative irradiation at a reduced dose of 40 Gy and definitive radiation therapy for unresectable cases. This study aimed to report the tumor reduction rate and oncological results with a reduced dose of preoperative irradiation and the outcome of definitive irradiation for unresectable cases. MATERIALS AND METHODS Forty-one patients with myxoid liposarcoma treated in our institution between 2002 and 2021 were included. We examined the tumor volume shrinkage rate with preoperative radiation, compared complications and oncological outcomes between preoperative radiation and surgery-only cases, and investigated the prognosis and tumor shrinkage of definitive radiation cases. RESULTS The total dose irradiated was 40 Gy except in two cases. The mean tumor volume reduction rate was 52.0%. A decreased dose of preoperative radiation did not worsen clinical outcomes with fewer complications. The total dose of definitive radiation was approximately 60 Gy. The mean tumor volume reduction rate was 55.0%. The tumor shrinkage maintenance rate was 100% in a median follow-up period of 50.5 months. CONCLUSION Preoperative radiation therapy for myxoid liposarcoma near vital organs is a good approach because even with a reduced dose of 40 Gy, significant tumor reduction and excellent results were achieved. Definitive radiation therapy is the recommended treatment for older patients with serious comorbidities or inoperable patients.
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Affiliation(s)
- Akiyoshi Shimatani
- Division of Orthopedic Oncology, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
- Department of Orthopedic Surgery, Osaka Saiseikai Nakatsu Hospital, 2-10-39, Shibata, Kita-ku, Osaka-shi, Osaka, 530-0012, Japan.
| | - Hirohisa Katagiri
- Division of Orthopedic Oncology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Hideki Murata
- Division of Orthopedic Oncology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Junji Wasa
- Division of Orthopedic Oncology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Michihito Miyagi
- Division of Orthopedic Oncology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yosuke Honda
- Division of Orthopedic Oncology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Mitsuru Takahashi
- Division of Orthopedic Oncology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Hiroyuki Harada
- Division of Radiation Oncology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Hirofumi Asakura
- Division of Radiation Oncology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Tsuyoshi Onoe
- Division of Radiation Oncology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
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van der Burg SJC, Kuijpers A, Baetens T, van Akkooi ACJ, Reijers SJM, Wouters MWJM, Schrage YM, van Houdt WJ. Magnetic seed localization is feasible for non-palpable melanoma, Merkel cell carcinoma, and soft tissue sarcoma lesions. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108485. [PMID: 39047326 DOI: 10.1016/j.ejso.2024.108485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/28/2024] [Accepted: 06/12/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Localization of non-palpable melanoma, Merkel cell carcinoma (MCC) and soft tissue sarcoma (STS) lesions can be difficult due to size, location, and obesity of patients or fibrosis due to previous treatments. Magnetic seed localization (MSL) is a common method to localize non-palpable breast lesions, but the feasibility of MSL for non-palpable melanoma, MCC and STS lesions has not yet been described. METHODS In this retrospective single center cohort study, all consecutive patients between January 2021 and October 2023 who had a resection of a non-palpable melanoma, MCC or STS lesion guided by Sirius Pintuition, a MSL technique, were included. The primary endpoint was successful lesion localization during surgery and the secondary endpoints were seed migration, negative resection margins, and complications. RESULTS Seventy-nine seeds were placed for 76 lesions, which were resected during 68 surgeries in 61 patients. All lesions (100 %) were localized and resected. Median time of surgery was 44 min. No seed migration was observed. A negative resection margin was achieved for 60 (78.9 %) lesions. Clavien Dindo grade ≥2 complications occurred in 7.4 %. CONCLUSION Magnetic seed localization with Sirius Pintuition is feasible for both non-palpable melanoma, MCC, and STS lesions.
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Affiliation(s)
- S J C van der Burg
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NCI-AVL), Department of Surgery, Amsterdam, the Netherlands
| | - A Kuijpers
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NCI-AVL), Department of Surgery, Amsterdam, the Netherlands
| | - T Baetens
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NCI-AVL), Department of Radiology, Amsterdam, the Netherlands
| | - A C J van Akkooi
- Melanoma Institute Australia, University of Sydney and Royal Prince Alfred Hospital, Department of Surgical Oncology, Sidney, Australia
| | - S J M Reijers
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NCI-AVL), Department of Surgery, Amsterdam, the Netherlands
| | - M W J M Wouters
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NCI-AVL), Department of Surgery, Amsterdam, the Netherlands
| | - Y M Schrage
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NCI-AVL), Department of Surgery, Amsterdam, the Netherlands
| | - W J van Houdt
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NCI-AVL), Department of Surgery, Amsterdam, the Netherlands.
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Ciongariu AM, Țăpoi DA, Dumitru AV, Bejenariu A, Marin A, Costache M. Pleomorphic Liposarcoma Unraveled: Investigating Histopathological and Immunohistochemical Markers for Tailored Diagnosis and Therapeutic Innovations. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:950. [PMID: 38929567 PMCID: PMC11205576 DOI: 10.3390/medicina60060950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/01/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
Liposarcomas are some of the most challenging soft tissue tumors and are subclassified into multiple subtypes with special histologic and molecular features. The peculiarities of each histopathological subtype influence the clinical behavior, management, and treatment of these neoplasms. For instance, well-differentiated liposarcomas are common soft tissue malignancies and usually display a favorable outcome. On the other hand, pleomorphic liposarcoma is the rarest, yet the most aggressive subtype of liposarcoma. This histopathological diagnosis may be challenging due to the scarce available data and because pleomorphic liposarcomas can mimic other pleomorphic sarcomas or other neoplasms of dissimilar differentiation. Nevertheless, the correct diagnosis of pleomorphic liposarcoma is of utmost importance as such patients are prone to develop local recurrences and metastases. Treatment usually consists of surgical excision along with radiotherapy and follow-up of the patients. Therefore, this review aims to assess the complex clinical, histological, and immunohistochemical features of liposarcomas in order to establish how these characteristics influence the management and prognosis of the patients, emphasizing the particularities of pleomorphic liposarcoma.
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Affiliation(s)
- Ana-Maria Ciongariu
- Department of Pathology, “Carol Davila’’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.C.); (D.-A.Ț.); (M.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania;
| | - Dana-Antonia Țăpoi
- Department of Pathology, “Carol Davila’’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.C.); (D.-A.Ț.); (M.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania;
| | - Adrian-Vasile Dumitru
- Department of Pathology, “Carol Davila’’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.C.); (D.-A.Ț.); (M.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania;
| | - Adrian Bejenariu
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania;
| | - Andrei Marin
- Department of Plastic Surgery, “Carol Davila’’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Mariana Costache
- Department of Pathology, “Carol Davila’’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-M.C.); (D.-A.Ț.); (M.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania;
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Gogineni E, Chen H, Hu C, Boudadi K, Engle J, Levine A, Deville C. Prospective phase II trial of preoperative hypofractionated proton therapy for extremity and truncal soft tissue sarcoma: the PRONTO study rationale and design. Radiat Oncol 2024; 19:56. [PMID: 38745333 PMCID: PMC11095023 DOI: 10.1186/s13014-024-02447-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/30/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Oncologic surgical resection is the standard of care for extremity and truncal soft tissue sarcoma (STS), often accompanied by the addition of pre- or postoperative radiation therapy (RT). Preoperative RT may decrease the risk of joint stiffness and fibrosis at the cost of higher rates of wound complications. Hypofractionated, preoperative RT has been shown to provide acceptable outcomes in prospective trials. Proton beam therapy (PBT) provides the means to decrease dose to surrounding organs at risk, such as the skin, bone, soft tissues, and adjacent joint(s), and has not yet been studied in patients with extremity and truncal sarcoma. METHODS Our study titled "PROspective phase II trial of preoperative hypofractionated protoN therapy for extremity and Truncal soft tissue sarcOma (PRONTO)" is a non-randomized, prospective phase II trial evaluating the safety and efficacy of preoperative, hypofractionated PBT for patients with STS of the extremity and trunk planned for surgical resection. Adult patients with Eastern Cooperative Group Performance Status ≤ 2 with resectable extremity and truncal STS will be included, with the aim to accrue 40 patients. Treatment will consist of 30 Gy radiobiological equivalent of PBT in 5 fractions delivered every other day, followed by surgical resection 2-12 weeks later. The primary outcome is rate of major wound complications as defined according to the National Cancer Institute of Canada Sarcoma2 (NCIC-SR2) Multicenter Trial. Secondary objectives include rate of late grade ≥ 2 toxicity, local recurrence-free survival and distant metastasis-free survival at 1- and 2-years, functional outcomes, quality of life, and pathologic response. DISCUSSION PRONTO represents the first trial evaluating the use of hypofractionated PBT for STS. We aim to prove the safety and efficacy of this approach and to compare our results to historical outcomes established by previous trials. Given the low number of proton centers and limited availability, the short course of PBT may provide the opportunity to treat patients who would otherwise be limited when treating with daily RT over several weeks. We hope that this trial will lead to increased referral patterns, offer benefits towards patient convenience and clinic workflow efficiency, and provide evidence supporting the use of PBT in this setting. TRIAL REGISTRATION NCT05917301 (registered 23/6/2023).
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Affiliation(s)
- Emile Gogineni
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 W 10 Ave, Columbus, OH, 43210, USA.
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Hao Chen
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chen Hu
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karim Boudadi
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jessica Engle
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adam Levine
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Lebas A, Le Fevre C, Waissi W, Chambrelant I, Brinkert D, Noel G. Factors Influencing Long-Term Local Recurrence, Distant Metastasis, and Survival in Patients with Soft Tissue Sarcoma of the Extremities Treated with Radiotherapy. Cancers (Basel) 2024; 16:1789. [PMID: 38791868 PMCID: PMC11119935 DOI: 10.3390/cancers16101789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/04/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION The prognostic factors for extremity soft-tissue sarcomas (ESTSs) treated with multimodal surgery and radiotherapy (RT) remain a subject of debate across diverse and heterogeneous studies. METHODS We retrospectively analyzed nonmetastatic ESTS patients treated with RT between 2007 and 2020 in Strasbourg, France. We assessed local control (LC), distant control (DC), overall survival (OS), and complications. RESULTS A total of 169 patients diagnosed with localized ESTS were included. The median age was 64 years (range 21-94 years). ESTS primarily occurred proximally (74.6%) and in the lower limbs (71%). Most tumors were grade 2-3 (71.1%), deep-seated (86.4%), and had R0 margins (63.9%). Most patients were treated with helical tomotherapy (79.3%). The median biologically effective dose (BED) prescribed was 75 BEDGy4 (range 45.0-109.9). The median follow-up was 5.5 years. The 5- and 10-year LC, DC, and OS rates were 91.7%, 76.8%, and 83.8% and 84.2%, 74.1%, and 77.6%, respectively. According to the univariate analysis, LC was worse for patients who received less than 75 BEDGy4 (p = 0.015). Deep tumors were associated with worse OS (p < 0.05), and grade 2-3 and undifferentiated pleomorphic sarcoma (UPS) were linked to both shorter DC and shorter OS (p < 0.05). IMRT was associated with longer LC than 3DRT (p = 0.018). Multivariate analysis revealed that patients with liposarcoma had better OS (p < 0.05) and that patients with distant relapse had shorter OS (p < 0.0001). CONCLUSION RT associated with surgical resection was well tolerated and was associated with excellent long-term rates of LC, DC, and OS. Compared with 3DRT, IMRT improved local control. Liposarcoma was a favorable prognostic factor for OS. Intermediate- and high-grade tumors and deep tumors were associated with lower DC and OS.
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Affiliation(s)
- Arthur Lebas
- Radiotherapy Department, Institut de Cancérologie Strasbourg Europe (ICANS), 17 Rue Albert Calmette, BP 23025, 67033 Strasbourg, France; (A.L.); (C.L.F.); (I.C.)
| | - Clara Le Fevre
- Radiotherapy Department, Institut de Cancérologie Strasbourg Europe (ICANS), 17 Rue Albert Calmette, BP 23025, 67033 Strasbourg, France; (A.L.); (C.L.F.); (I.C.)
| | - Waisse Waissi
- Radiotherapy Department, Léon Bérard Center, 28 Rue Laennec, 69008 Lyon, France;
| | - Isabelle Chambrelant
- Radiotherapy Department, Institut de Cancérologie Strasbourg Europe (ICANS), 17 Rue Albert Calmette, BP 23025, 67033 Strasbourg, France; (A.L.); (C.L.F.); (I.C.)
| | - David Brinkert
- Orthopedic Surgery Department, University Hospital of Hautepierre, 1 Rue Molière, 67200 Strasbourg, France;
| | - Georges Noel
- Radiotherapy Department, Institut de Cancérologie Strasbourg Europe (ICANS), 17 Rue Albert Calmette, BP 23025, 67033 Strasbourg, France; (A.L.); (C.L.F.); (I.C.)
- Faculty of Medicine, University of Strasbourg, 4 Rue Kirschleger, 67000 Strasbourg, France
- Radiobiology Laboratory, Centre Paul Strauss, IIMIS—Imagerie Multimodale Integrative en Santé, ICube, Strasbourg University, 67081 Strasbourg, France
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Roohani S, Wiltink LM, Kaul D, Spałek MJ, Haas RL. Update on Dosing and Fractionation for Neoadjuvant Radiotherapy for Localized Soft Tissue Sarcoma. Curr Treat Options Oncol 2024; 25:543-555. [PMID: 38478330 PMCID: PMC10997691 DOI: 10.1007/s11864-024-01188-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 04/06/2024]
Abstract
OPINION STATEMENT Neoadjuvant radiotherapy (RT) over 5-6 weeks with daily doses of 1.8-2.0 Gy to a total dose of 50-50.4 Gy is standard of care for localized high-grade soft tissue sarcomas (STS) of the extremities and trunk wall. One exception is myxoid liposarcomas where the phase II DOREMY trial applying a preoperative dose of 36 Gy in 2 Gy fractions (3-4 weeks treatment) has achieved excellent local control rates of 100% after a median follow-up of 25 months.Hypofractionated preoperative RT has been investigated in a number of phase II single-arm studies suggesting that daily doses of 2.75-8 Gy over 1-3 weeks can achieve similar oncological outcomes to conventional neoadjuvant RT. Prospective data with direct head-to-head comparison to conventional neoadjuvant RT investigating oncological outcomes and toxicity profiles is eagerly awaited.For the entire group of retroperitoneal sarcomas, RT is not the standard of care. The randomized multi-center STRASS trial did not find a benefit in abdominal recurrence-free survival by the addition of preoperative RT. However, for the largest histological subgroup of well-differentiated and grades I and II dedifferentiated liposarcomas, the STRASS trial and the post-hoc propensity-matched STREXIT analysis have identified a possible benefit in survival by preoperative RT. These patients deserve to be informed about the pros and cons of preoperative RT while the longer follow-up data from the STRASS trial is awaited.
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Affiliation(s)
- Siyer Roohani
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- BIH Charité Junior Clinician Scientist Program, BIH Biomedical Innovation Academy, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- German Cancer Consortium (DKTK), Partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Lisette M Wiltink
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - David Kaul
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- German Cancer Consortium (DKTK), Partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mateusz Jacek Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Department of Radiotherapy I, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Rick L Haas
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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Wiltink LM, Miah AB, Scholten AN, Haas RL. Unraveling the Myth of Radiation Resistance in Soft Tissue Sarcomas. Semin Radiat Oncol 2024; 34:172-179. [PMID: 38508782 DOI: 10.1016/j.semradonc.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
There is a misconception that sarcomas are resistant to radiotherapy. This manuscript summarizes available (pre-) clinical data on the radiosensitivity of soft tissue sarcomas. Currently, clinical practice guidelines suggest irradiating sarcomas in 1.8-2 Gy once daily fractions. Careful observation of myxoid liposarcomas patients during preoperative radiotherapy led to the discovery of this subtype's remarkable radiosensitivity. It resulted subsequently in an international prospective clinical trial demonstrating the safety of a reduced total dose, yet still delivered with conventional 1.8-2 Gy fractions. In several areas of oncology, especially for tumors of epithelial origin where radiotherapy plays a curative role, the concurrent application of systemic compounds aiming for radiosensitization has been incorporated into routine clinical practice. This approach has also been investigated in sarcomas and is summarized in this manuscript. Observing relatively low α/β ratios after preclinical cellular investigations, investigators have explored hypofractionation with daily doses ranging from 2.85-8.0 Gy per day in prospective clinical studies, and the data are presented. Finally, we summarize work with mouse models and genomic investigations to predict observed responses to radiotherapy in sarcoma patients. Taken together, these data indicate that sarcomas are not resistant to radiation therapy.
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Affiliation(s)
- L M Wiltink
- Department of Radiotherapy, The Leiden University Medical Center, Leiden, The Netherlands.
| | - A B Miah
- Department of Radiotherapy and Physics, The Royal Marsden Hospital and The Institute of Cancer Research, London, UK.
| | - A N Scholten
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - R L Haas
- Department of Radiotherapy, The Leiden University Medical Center, Leiden, The Netherlands; Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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12
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Ewongwo A, Hui C, Moding EJ. Opportunity in Complexity: Harnessing Molecular Biomarkers and Liquid Biopsies for Personalized Sarcoma Care. Semin Radiat Oncol 2024; 34:195-206. [PMID: 38508784 DOI: 10.1016/j.semradonc.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Due to their rarity and complexity, sarcomas represent a substantial therapeutic challenge. However, the incredible diversity within and across sarcoma subtypes presents an opportunity for personalized care to maximize efficacy and limit toxicity. A deeper understanding of the molecular alterations that drive sarcoma development and treatment response has paved the way for molecular biomarkers to shape sarcoma treatment. Genetic, transcriptomic, and protein biomarkers have become critical tools for diagnosis, prognostication, and treatment selection in patients with sarcomas. In the future, emerging biomarkers like circulating tumor DNA analysis offer the potential to improve early detection, monitoring response to treatment, and identifying mechanisms of resistance to personalize sarcoma treatment. Here, we review the current state of molecular biomarkers for sarcomas and highlight opportunities and challenges for the implementation of new technologies in the future.
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Affiliation(s)
- Agnes Ewongwo
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Caressa Hui
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Everett J Moding
- Department of Radiation Oncology, Stanford University, Stanford, CA.; Stanford Cancer Institute, Stanford University, Stanford, CA..
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13
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Cripe TP, Roberts RD, Chandler DS, Setty BA, Chen S, Shenoy A, Venkataramany AS, Ringwalt EM, Scharschmidt T, Utset-Ward T, Konieczkowski DJ, Grignol VP, Beane JD, Ruff SM, Pollock RE. Progress in sarcomas: Highlights from the 2023 annual meetingof the Connective Tissue Oncology Society. MOLECULAR THERAPY. ONCOLOGY 2024; 32:200779. [PMID: 38596308 PMCID: PMC10915594 DOI: 10.1016/j.omton.2024.200779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Timothy P. Cripe
- Center for Childhood Cancer Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Ryan D. Roberts
- Center for Childhood Cancer Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Dawn S. Chandler
- Center for Childhood Cancer Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Bhuvana A. Setty
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Sonja Chen
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Archana Shenoy
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Akila S. Venkataramany
- Center for Childhood Cancer Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- Biomedical Sciences Graduate Program, The Ohio State University, Columbus, OH, USA
- Medical Scientist Training Program, The Ohio State University, Columbus, OH, USA
- Center for RNA Biology, The Ohio State University, Columbus, OH, USA
| | - Emily M. Ringwalt
- Center for Childhood Cancer Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
- Molecular, Cellular, and Developmental Biology Graduate Program, The Ohio State University, Columbus, OH, USA
| | - Thomas Scharschmidt
- Department of Orthopaedic Surgery, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Thomas Utset-Ward
- Department of Orthopaedic Surgery, Nationwide Children’s Hospital, Columbus, OH, USA
| | | | - Valerie P. Grignol
- Department of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joel D. Beane
- Department of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Samantha M. Ruff
- Department of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Raphael E. Pollock
- Department of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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14
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Walker K, Simister SK, Carr-Ascher J, Monument MJ, Thorpe SW, Randall RL. Emerging innovations and advancements in the treatment of extremity and truncal soft tissue sarcomas. J Surg Oncol 2024; 129:97-111. [PMID: 38010997 DOI: 10.1002/jso.27526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
In this special edition update on soft tissue sarcomas (STS), we cover classifications, emerging technologies, prognostic tools, radiation schemas, and treatment disparities in extremity and truncal STS. We discuss the importance of enhancing local control and reducing complications, including the role of innovative imaging, surgical guidance, and hypofractionated radiation. We review advancements in systemic and immunotherapeutic treatments and introduce disparities seen in this vulnerable population that must be considered to improve overall patient care.
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Affiliation(s)
- Kyle Walker
- Department of Orthopaedics, University of California, Davis, Sacramento, California, USA
| | - Samuel K Simister
- Department of Orthopaedics, University of California, Davis, Sacramento, California, USA
| | - Janai Carr-Ascher
- Department of Hematology and Oncology, University of California, Davis, Sacramento, California, USA
| | - Michael J Monument
- Department of Surgery, The University of Calgary, Calgary, Alberta, Canada
| | - Steven W Thorpe
- Department of Orthopaedics, University of California, Davis, Sacramento, California, USA
| | - R Lor Randall
- Department of Orthopaedics, University of California, Davis, Sacramento, California, USA
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15
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Masunaga T, Tsukamoto S, Honoki K, Fujii H, Kido A, Akahane M, Tanaka Y, Mavrogenis AF, Errani C, Kawai A. Comparison of pre-operative and post-operative radiotherapy in patients with localized myxoid liposarcoma. Jpn J Clin Oncol 2023; 53:1153-1161. [PMID: 37814462 DOI: 10.1093/jjco/hyad119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/22/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Myxoid liposarcoma is more radiosensitive than other soft tissue sarcomas, and radiotherapy has been reported to reduce tumour size. This study was performed to compare the rates of local recurrence, survival and wound complications between pre- and post-operative radiotherapy for localized myxoid liposarcoma. METHODS From the Japanese Nationwide Bone and Soft Tissue Tumor Registry database, 200 patients with localized myxoid liposarcoma who received pre- (range, 30-56 Gy) or post-operative (range, 45-70 Gy) radiotherapy and surgery were included in this retrospective study. Propensity score matching was used to adjust for background differences between patients who received pre- and post-operative radiotherapy. RESULTS Local recurrence occurred in five (5.0%) and nine (9.0%) patients in the pre- and post-operative radiotherapy groups, respectively (both n = 100). The median follow-up time from diagnosis was 40.5 months (IQR, 26.3-74). Univariate analysis showed a similar risk of local recurrence between the pre- and post-operative radiotherapy groups (5-year local recurrence-free survival 94.9% [95% CI 87.0-98.1] vs. 89.0% [95% CI 79.6-94.3]; P = 0.167). Disease-specific survival was similar between the pre- and post-operative radiotherapy groups (5-year disease-specific survival 88.1% [95% CI 75.5-94.6] vs. 88.4% [95% CI 77.3-94.5]; P = 0.900). The incidence of wound complications was similar between the pre- and post-operative radiotherapy groups (7.0% vs. 12.0%; P = 0.228). CONCLUSIONS There was no difference in local recurrence, survival or incidence of wound complications between pre- and post-operative radiotherapy for localized myxoid liposarcoma. Therefore, pre-operative radiotherapy for myxoid liposarcoma provides clinical results equivalent to post-operative radiotherapy.
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Affiliation(s)
- Tomoya Masunaga
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Kanya Honoki
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Hiromasa Fujii
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, Nara, Japan
| | - Manabu Akahane
- Department of Health and Welfare Services, National Institute of Public Health, Saitama, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Akira Kawai
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
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16
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Matsunobu T, Maekawa A, Inaba Y, Makihara K, Hisaoka M, Iwamoto Y. Myxoid liposarcoma in an 11-year-old patient. Int Cancer Conf J 2023; 12:233-240. [PMID: 37577339 PMCID: PMC10421792 DOI: 10.1007/s13691-023-00615-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/28/2023] [Indexed: 08/15/2023] Open
Abstract
Myxoid liposarcoma is a mesenchymal malignancy that most commonly presents in young adults, with peak incidence between the ages of 30-50 years. The clinical behavior of myxoid liposarcoma has been well characterized in adults. However, little is known about the clinical features and treatment outcomes of myxoid liposarcoma in child, owing to its rarity. This case report describes an 11-year-old previously healthy female who presented with a painless mass in her right thigh. Ultrasonography, computed tomography, and magnetic resonance imaging demonstrated a soft tissue mass with clear margins in the subfascial plane superficial to the gracilis and sartorius muscles. She was diagnosed with myxoid liposarcoma based on histological and molecular cytogenetic examinations of the core-needle biopsy specimen. The patient subsequently underwent wide resection without any adjuvant treatment. The patient has not experienced any symptoms of local recurrence and metastases as of 2.5 years after surgery.
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Affiliation(s)
- Tomoya Matsunobu
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu, Fukuoka 800-0296 Japan
| | - Akira Maekawa
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu, Fukuoka 800-0296 Japan
| | - Yuna Inaba
- Department of Surgical Pathology, Kyushu Rosai Hospital, Fukuoka Kitakyushu, Japan
| | - Kosuke Makihara
- Department of Surgical Pathology, Kyushu Rosai Hospital, Fukuoka Kitakyushu, Japan
| | - Masanori Hisaoka
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Fukuoka Kitakyushu, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokura Minami-Ku, Kitakyushu, Fukuoka 800-0296 Japan
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17
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Lam SW, Silva TM, Traast-Kooistra J, Bruijn IBD, van den Akker B, Bakker PAC, Lansu J, Haas RLM, Bovée JVMG. Histological response to radiotherapy is an early event in myxoid liposarcoma. Virchows Arch 2023; 483:487-495. [PMID: 37572156 PMCID: PMC10611607 DOI: 10.1007/s00428-023-03615-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/14/2023]
Abstract
Compared to other sarcomas, myxoid liposarcoma (MLS) is exceptionally sensitive to radiation therapy, but the underlying mechanism remains unknown. The objective was to assess the tissue-based changes in MLS during and after neoadjuvant radiotherapy in 26 patients of the DOREMY trial. Morphological assessment was performed on biopsies pre-treatment, after 8 fractions, 16 factions, and after surgical resection and included percentage of viable tumor cells, hyalinization, necrosis, and fatty maturation. Furthermore, immunohistochemistry was performed for apoptosis (cleaved caspase-3), anti-apoptosis (Bcl-2), activity of mTOR signaling (phospho-S6), hypoxia (CAIX), proliferation (Ki67), inflammation (CD45 and CD68), and microvessel density (CD34 Chalkley count). A pronounced reduction in vital tumor cells was observed early with a drop to 32.5% (median) tumor cells (IQR 10-93.8%) after 8 fractions. This decreased further to 10% (IQR 5-30%) after 16 fractions and 7.5% (IQR 5-15%) in the surgical specimen. All but one patient had an excellent response with < 50% remaining tumor cells. Inversely, treatment response was mainly observed as hyalinization and less often as fatty maturation. Additionally, a decrease of inflammatory cells was noticed especially during the first eight fractions. Microvessel density remained stable over time. Immunohistochemical markers for apoptosis, anti-apoptosis, activity of mTOR signaling, proliferation, and hypoxia did not show any marked changes within the remaining tumor cells during and after radiotherapy. As a modest dose of neoadjuvant radiotherapy induces profound tissue changes in MLS, mainly during the first 8 fractions, current findings might suggest that in a carefully selected patient population further deintensification of radiotherapy might be explored.
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Affiliation(s)
- Suk Wai Lam
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tulio M Silva
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Pathology, Vall d´Hebron University Hospital, Barcelona, Spain
| | | | | | - Brendy van den Akker
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Pauline A C Bakker
- Department of Radiotherapy, Leiden University Medical Center, Leiden, the Netherlands
| | - Jules Lansu
- Department of Radiotherapy, Leiden University Medical Center, Leiden, the Netherlands
- Sarcoma Unit, Department of Radiotherapy, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Rick L M Haas
- Department of Radiotherapy, Leiden University Medical Center, Leiden, the Netherlands
- Sarcoma Unit, Department of Radiotherapy, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands.
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18
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Lebas A, Le Fèvre C, Waissi W, Chambrelant I, Brinkert D, Noël G. Prognostic Factors in Extremity Soft Tissue Sarcomas Treated with Radiotherapy: Systematic Review of the Literature. Cancers (Basel) 2023; 15:4486. [PMID: 37760456 PMCID: PMC10526842 DOI: 10.3390/cancers15184486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Soft tissue sarcomas of the extremities are rare tumors with various prognostic factors. Their management is debatable due to their inconsistent results within the literature and the lack of large prospective studies. The objective of this systematic review is to analyze the available scientific data on prognostic factors concerning the characteristics of the patients, the disease and the treatments performed, as well as their potential complications, on studies with a median follow-up of 5 years at minimum. A search of articles following the "PRISMA method" and using the PubMed search engine was conducted to select the most relevant studies. Twenty-five articles were selected, according to preestablished criteria. This review provides a better understanding of the prognosis and disease outcome of these tumors. Many factors were described comparing the frequency of occurrence according to the studies, which remain heterogeneous between them. Significant factors that could orient patients to radiotherapy were highlighted. These positive prognostic factors provide valuable insight to optimize radiotherapy treatments for patients treated for soft tissue sarcoma of the extremities.
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Affiliation(s)
- Arthur Lebas
- Radiotherapy Department, ICANS, 17 Rue Albert Calmette, 67100 Strasbourg, France; (A.L.); (C.L.F.); (I.C.)
| | - Clara Le Fèvre
- Radiotherapy Department, ICANS, 17 Rue Albert Calmette, 67100 Strasbourg, France; (A.L.); (C.L.F.); (I.C.)
| | - Waisse Waissi
- Radiotherapy Department, Léon Bérard Center, 28 Rue Laennec, 69008 Lyon, France;
| | - Isabelle Chambrelant
- Radiotherapy Department, ICANS, 17 Rue Albert Calmette, 67100 Strasbourg, France; (A.L.); (C.L.F.); (I.C.)
| | - David Brinkert
- Orthopedic Surgery Department, University Hospital of Hautepierre, 1 Rue Molière, 67200 Strasbourg, France;
| | - Georges Noël
- Radiotherapy Department, ICANS, 17 Rue Albert Calmette, 67100 Strasbourg, France; (A.L.); (C.L.F.); (I.C.)
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19
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Simões R, Augustin Y, Gulliford S, Dehbi HM, Hoskin P, Miles E, Harrington K, Miah AB. Toxicity, normal tissue and dose-volume planning parameters for radiotherapy in soft tissue sarcoma of the extremities: A systematic review of the literature. Radiother Oncol 2023; 186:109739. [PMID: 37315584 DOI: 10.1016/j.radonc.2023.109739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/25/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Patients with soft tissue sarcoma of the extremities (STSE) are left with high incidence of toxicities after Radiotherapy (RT). Understanding the normal tissue dose relationship with the development of long-term toxicities may enable better RT planning in order to reduce treatment toxicities for STSE. This systematic review of the literature aims at reporting the incidence of acute and late toxicities and identifying RT delineation guidance the normal tissues structures and dose-volume parameters for STSE. METHODS A literature search of PUBMED-MEDLINE for studies that reported data on RT toxicity outcomes, delineation guidelines and dose-volume parameters for STSE from 2000 to 2022. Data has been tabulated and reported. RESULTS Thirty of 586 papers were selected after exclusion criteria. External beam RT prescriptions ranged from 30 to 72 Gy. The majority of studies reported the use of Intensity Modulated RT (IMRT) (27%). Neo-adjuvant RT was used in 40%. The highest long-term toxicities were subcutaneous and lymphoedema, reported when delivering 3DCRT. IMRT had a lower incidence of toxicities. Normal tissue outlining such as weight-bearing bones, skin and subcutaneous tissue, corridor and neurovascular bundle was recommended in 6 studies. Nine studies recommended the use of dose-volume constraints, but only one recommended evidence-based dose-volume constraints. CONCLUSION Although the literature is replete with toxicity reports, there is a lack of evidence-based guidance on normal tissue and dose-volume parameters and strategies to reduce the normal tissues irradiation when optimising RT plans for STSE are poor compared to other tumour sites.
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Affiliation(s)
- Rita Simões
- The Institute of Cancer Research, London, UK; The Royal Marsden Hospital, London, UK; Radiotherapy Trials Quality Assurance (RTTQA) group, Mount Vernon Hospital, Northwood, UK; University College London Hospital NHS Foundation Trust, London, UK.
| | | | - Sarah Gulliford
- University College London Hospital NHS Foundation Trust, London, UK; University College London, London, UK.
| | | | - Peter Hoskin
- Radiotherapy Trials Quality Assurance (RTTQA) group, Mount Vernon Hospital, Northwood, UK; University of Manchester, Manchester, UK.
| | - Elizabeth Miles
- Radiotherapy Trials Quality Assurance (RTTQA) group, Mount Vernon Hospital, Northwood, UK.
| | - Kevin Harrington
- The Institute of Cancer Research, London, UK; The Royal Marsden Hospital, London, UK.
| | - Aisha B Miah
- The Institute of Cancer Research, London, UK; The Royal Marsden Hospital, London, UK.
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20
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Salerno KE, Hill-Kayser C, Indelicato DJ, Ermoian RP, Baldini EH. Toward Risk Stratification in Adult Extremity and Truncal Soft Tissue Sarcoma Radiation Therapy by Addition and Subtraction. Int J Radiat Oncol Biol Phys 2023; 116:701-704. [PMID: 37355302 DOI: 10.1016/j.ijrobp.2023.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Kilian E Salerno
- Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland.
| | - Christine Hill-Kayser
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Ralph P Ermoian
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Elizabeth H Baldini
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
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21
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Houdek MT, Mallett KE, Heidenreich MJ, Ahmed SK, Wenger DE, Smith JRH, Siontis BL, Robinson SI, Folpe AL, Petersen IA, Rose PS. Lack of radiosensitivity predicts poor disease specific survival in myxoid liposarcoma. J Surg Oncol 2023; 127:848-854. [PMID: 36573830 DOI: 10.1002/jso.27190] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/10/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Compared to other sarcomas, myxoid liposarcoma (ML) is known to be radiosensitive, with improved oncologic outcomes. Although these tumors "shrink" following radiotherapy, there is a paucity of data examining the degree of radiosensitivity and oncologic outcome. The purpose of the study was to evaluate pre- and postradiotherapy tumor volume to determine if size reduction impacts outcome. METHODS We reviewed 62 patients with ML undergoing surgical resection combined with preoperative radiotherapy, with pre- and postradiotherapy MRI. This included 34 (55%) males, with a mean age of 47 ± 14 years. All tumors were deep to the fascia, and 12 (19%) patients had tumors with a >5% round-cell component. RESULTS The mean volume reduction was 54% ± 29%. Compared to patients with >25% volume reduction, patients with reduction ≤25% had worse 10-year disease specific survival (86% vs. 37%, p < 0.01), in addition to an increased risk of metastatic disease (HR 4.63, p < 0.01) and death due to disease (HR 4.52, p < 0.01). CONCLUSION Lack of volume reduction is a risk factor for metastatic disease and subsequent death due to disease in patients with extremity ML treated with combined preoperative radiotherapy and surgery. This data could be used to stratify patients for adjuvant therapies and follow-up intervals.
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Affiliation(s)
- Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mark J Heidenreich
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Safia K Ahmed
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Doris E Wenger
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Steven I Robinson
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ivy A Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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22
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Early outcomes of ultra-hypofractionated preoperative radiation therapy for soft tissue sarcoma followed by immediate surgical resection. Radiother Oncol 2023; 180:109439. [PMID: 36481382 DOI: 10.1016/j.radonc.2022.109439] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND There is increasing interest in shorter courses of radiation therapy (RT) in the management of soft tissue sarcoma (STS). We report our institutional experience for patients undergoing ultra-hypofractionated preoperative RT followed by immediate resection. METHODS An IRB approved review of patients treated with preoperative 5 fraction, once daily RT followed by immediate resection (within 7 days) for STS of the extremity or trunk was conducted. The primary endpoints are major wound complications and local control (LC). Secondary endpoints include grade ≥ 2 toxicity, metastasis free survival (MFS), and overall survival (OS). RESULTS Twenty-two patients with a median age of 67 years (range 30-87) and median follow-up of 24.5 months (IQR 17.0-35.7) met eligibility criteria; 18/22 patients (81.8 %) had ≥ 1 year follow-up. Primary tumor location was lower extremity in 15 patients (68.2 %), upper extremity in 5 (22.7 %), and trunk in 2 (9.1 %). All patients received 30 Gy in 5 fractions. The median time to resection following RT was 1 day (range 0-5). The median time from biopsy to resection was 34 days (range 20-69). Local control was 100 %; in patients with localized disease, 2-year MFS and OS were 71.3 % and 76.9 %, respectively. Major wound complications occurred in 9 patients (40.9 %), with wound complications requiring reoperation occurring in 8 patients (36.4 %). Other acute and late grade ≥ 2 toxicities were seen in 0 and 4 patients (18.2 %), respectively. CONCLUSION Ultra-hypofractionated preoperative RT followed by immediate resection permits expedited completion of oncologic therapy with early results demonstrating excellent local control and acceptable toxicity. Prospective data with long-term follow-up is needed.
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Intermuscular extremity myxoid liposarcoma can be managed by marginal resection following neoadjuvant radiotherapy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:362-367. [PMID: 36243649 DOI: 10.1016/j.ejso.2022.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Compared with other soft tissue sarcomas, myxoid liposarcoma (MLS) occurs in younger patients, has a propensity for intermuscular locations and is highly radiosensitive. With pre-operative radiotherapy, intermuscular MLS demonstrates substantial volume reduction and can be easily separated from surrounding tissues during resection. However, it is unclear whether marginal excision of MLS is oncologically safe. This study aimed to assess the association between margins and survival in irradiated, intermuscular MLS. METHODS The study identified 198 patients from seven sarcoma centres with a first presentation of localized, extremity, intermuscular MLS that received pre-operative radiotherapy and was diagnosed between 1990 and 2017. Patient and treatment characteristics, radiological and histological responses to neoadjuvant treatment and clinical surveillance were recorded. RESULTS Margins were microscopically positive in 11% (n = 22), <1.0 mm in 15% (n = 29) and ≥1.0 mm in 72% (n = 143). There was no association between margin status and local recurrence-free, metastasis-free or overall survival. This finding held true even in patients at higher risk of worse overall survival based on multivariable analysis (% round cell≥5%, percentage ellipsoid tumour volume change ≤ -60.1%). CONCLUSION Irradiated, extremity, intermuscular myxoid liposarcoma can safely undergo marginal resection without compromising oncologic control.
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Dossa F, Gladdy RA. Evidence for the Current Management of Soft-tissue Sarcoma and Gastrointestinal Stromal Tumors and Emerging Directions. Surg Oncol Clin N Am 2023; 32:169-184. [PMID: 36410916 DOI: 10.1016/j.soc.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Soft-tissue sarcoma (STS) is not a single entity but, rather, a family of diseases with differing biologic behaviors and anatomic site- and histotype-specific responses to treatment. Whereas surgery remains the mainstay of treatment of primary, localized disease, evolving evidence is establishing the role of multimodality treatment of these tumors. This article summarizes prospective evidence to date informing our treatment of STS. Key future directions will include advancing our understanding of fundamental tumor biology and mechanisms of response and recurrence, as well as defining the optimal provision of regional, systemic, and targeted therapies, including the role of immunotherapy. Ongoing global collaborations will be integral to progress in treating these rare tumors.
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Affiliation(s)
- Fahima Dossa
- Department of Surgery, University of Toronto, Stewart Building, 149 College Street, Toronto, Ontario M5T 1P5, Canada
| | - Rebecca A Gladdy
- Department of Surgery, University of Toronto, Stewart Building, 149 College Street, Toronto, Ontario M5T 1P5, Canada; Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital and Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada; Sinai Health System, 600 University Avenue, Suite 1225, Toronto, Ontario M5G 1X5, Canada.
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25
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Soft-tissue sarcoma in adolescents and young adults. Int J Clin Oncol 2023; 28:1-11. [PMID: 35084598 DOI: 10.1007/s10147-022-02119-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/09/2022] [Indexed: 01/11/2023]
Abstract
Soft-tissue sarcoma is a rare cancer that accounts for approximately 1% of all malignant tumors. Although they occur in various age groups, soft-tissue sarcomas account for 8% of all malignant tumors developing in adolescents and young adults, suggesting that they are not rare in this age group. This study aimed to evaluate the clinical and pathological characteristics of soft-tissue sarcoma in adolescents and young adults. According to the Bone and Soft-Tissue Tumor Registry in Japan, myxoid liposarcoma is the most common type of soft-tissue sarcoma found in adolescents and young adults; alveolar soft part sarcoma, extraskeletal Ewing sarcoma, epithelioid sarcoma, clear cell sarcoma and synovial sarcoma occur predominantly in this age group among soft-tissue sarcomas. The analysis based on this registry demonstrated that age was not a prognostic factor for poor survival of soft-tissue sarcoma, although the prognosis in adolescents and young adults was better than that in older patients in the US and Scandinavia. Adolescent and young adult patients with soft-tissue sarcoma have age-specific problems, and a multidisciplinary approach to physical, psychological, and social issues is necessary to improve the management of these young patients both during and after treatment.
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Reijers SJM, Gennaro N, Bruining A, van Boven H, Snaebjornsson P, Bekers EM, van Coevorden F, Scholten AN, Schrage Y, van der Graaf WTA, Haas RLM, van Houdt WJ. Correlation of radiological and histopathological response after neoadjuvant radiotherapy in soft tissue sarcoma. Acta Oncol 2023; 62:25-32. [PMID: 36637511 DOI: 10.1080/0284186x.2023.2166427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The aim of this study was to assess the association between radiological and histopathological response after neoadjuvant radiotherapy (nRT) in soft tissue sarcoma (STS), as well as the prognostic value of the different response evaluation methods on the oncological outcome. METHODS A retrospective cohort of patients with localized STS of the extremity and trunk wall, treated with nRT followed by resection were included. The radiological response was assessed by RECIST 1.1 (RECIST) and MR-adapted Choi (Choi), histopathologic response was evaluated according to the EORTC-STBSG recommendations. Oncological outcome parameters of interest were local recurrence-free survival (LRFS), disease metastases-free survival (DMFS), and overall survival (OS). RESULTS For 107 patients, complete pre- and postoperative pathology and imaging datasets were available. Most tumors were high-grade (77%) and the most common histological subtypes were undifferentiated pleomorphic sarcoma/not otherwise specified (UPS/NOS, 40%), myxoid liposarcoma (MLS, 21%) and myxofibrosarcoma (MFS, 16%). When comparing RECIST to Choi, the response was differently categorized in 58%, with a higher response rate (CR + PR) with Choi. Radiological responders showed a significant lower median percentage of viable cells (RECIST p = .050, Choi p = .015) and necrosis (RECIST p < .001), and a higher median percentage of fibrosis (RECIST p = .005, Choi p = .008), compared to radiological non-responders (SD + PD). RECIST, Choi, fibrosis, and viable cells were not significantly associated with altered oncological outcome, more necrosis was associated with poorer OS (p = .038). CONCLUSION RECIST, Choi and the EORTC-STBSG response score show incongruent results in response evaluation. The radiological response was significantly correlated with a lower percentage of viable cells and necrosis, but a higher percentage of fibrosis. Apart from necrosis, radiological nor other histopathological parameters were associated with oncologic outcomes.
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Affiliation(s)
- Sophie J M Reijers
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nicolò Gennaro
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annemarie Bruining
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hester van Boven
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Petur Snaebjornsson
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elise M Bekers
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frits van Coevorden
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Astrid N Scholten
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Yvonne Schrage
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Rick L M Haas
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Winan J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Guadagnolo BA, Bassett RL, Mitra D, Farooqi A, Hempel C, Dorber C, Willis T, Wang WL, Ratan R, Somaiah N, Benjamin RS, Torres KE, Hunt KK, Scally CP, Keung EZ, Satcher RL, Bird JE, Lin PP, Moon BS, Lewis VO, Roland CL, Bishop AJ. Hypofractionated, 3-week, preoperative radiotherapy for patients with soft tissue sarcomas (HYPORT-STS): a single-centre, open-label, single-arm, phase 2 trial. Lancet Oncol 2022; 23:1547-1557. [PMID: 36343656 PMCID: PMC9817485 DOI: 10.1016/s1470-2045(22)00638-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The standard preoperative radiotherapy regimen of 50 Gy delivered in 25 fractions for 5 weeks for soft tissue sarcomas results in excellent local control, with major wound complications occurring in approximately 35% of patients. We aimed to investigate the safety of a moderately hypofractionated, shorter regimen of radiotherapy, which could be more convenient for patients. METHODS This single-centre, open-label, single-arm, phase 2 trial (HYPORT-STS) was done at a single tertiary cancer care centre (MD Anderson Cancer Center, Houston, TX, USA). We administered preoperative radiotherapy to a dose of 42·75 Gy in 15 fractions of 2·85 Gy/day for 3 weeks (five fractions per week) to adults (aged ≥18 years) with non-metastatic soft tissue sarcomas of the extremities or superficial trunk and an Eastern Cooperative Oncology Group performance status of 0-3. The primary endpoint was a major wound complication occurring within 120 days of surgery. Major wound complications were defined as those requiring a secondary operation, or operations, under general or regional anaesthesia for wound treatment; readmission to the hospital for wound care; invasive procedures for wound care; deep wound packing to an area of wound measuring at least 2 cm in length; prolonged dressing changes; repeat surgery for revision of a split thickness skin graft; or wet dressings for longer than 4 weeks. We analysed our primary outcome and safety in all patients who enrolled. We monitored safety using a Bayesian, one-arm, time-to-event stopping rule simulator comparing the rate of major wound complications at 120 days post-surgery among study participants with the historical rate of 35%. This trial is registered with ClinicalTrials.gov, NCT03819985, recruitment is complete, and follow-up continues. FINDINGS Between Dec 18, 2018, and Jan 6, 2021, we assessed 157 patients for eligibility, of whom 120 were enrolled and received hypofractionated preoperative radiotherapy. At no time did the stopping rule computation indicate that the trial should be stopped early for lack of safety. Median postoperative follow-up was 24 months (IQR 17-30). Of 120 patients, 37 (31%, 95% CI 24-40) developed a major wound complication at a median time of 37 days (IQR 25-59) after surgery. No patient had acute radiation toxicity (during radiotherapy or within 4 weeks of the radiotherapy end date) of grade 3 or worse (Common Terminology Criteria for Adverse Events [CTCAE] version 4.0) or an on-treatment serious adverse event. Four (3%) of 115 patients had late radiation toxicity (≥6 months post-surgery) of at least grade 3 (CTCAE or Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer Late Radiation Morbidity Scoring Scheme): femur fractures (n=2), lymphoedema (n=1), and skin ulceration (n=1). There were no treatment-related deaths. INTERPRETATION Moderately hypofractionated preoperative radiotherapy delivered to patients with soft tissue sarcomas was safe and could therefore be a more convenient alternative to conventionally fractionated radiotherapy. Patients can be counselled about these results and potentially offered this regimen, particularly if it facilitates care at a sarcoma specialty centre. Results on long-term oncological, late toxicity, and functional outcomes are awaited. FUNDING The National Cancer Institute.
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Affiliation(s)
| | - Roland L Bassett
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX, USA
| | - Devarati Mitra
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Ahsan Farooqi
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Caroline Hempel
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Courtney Dorber
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Tiara Willis
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Wei-Lien Wang
- Department of Pathology, MD Anderson Cancer Center, Houston, TX, USA
| | - Ravin Ratan
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Neeta Somaiah
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Robert S Benjamin
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Keila E Torres
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly K Hunt
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Emily Z Keung
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Robert L Satcher
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Justin E Bird
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Patrick P Lin
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Bryan S Moon
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Valerae O Lewis
- Department of Orthopaedic Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Christina L Roland
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew J Bishop
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
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Yu JI. Myxoid liposarcoma: a well-defined clinical target variant in radiotherapy for soft tissue sarcoma. Radiat Oncol J 2022; 40:213-215. [PMID: 36606298 PMCID: PMC9830037 DOI: 10.3857/roj.2022.00598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/01/2022] [Indexed: 12/27/2022] Open
Affiliation(s)
- Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea,Correspondence: Jeong Il Yu Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea. Tel: +82-2-3410-2612 Fax: +82-2-3410-2619 E-mail:
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Roohani S, Ehret F, Kobus M, Flörcken A, Märdian S, Striefler JK, Rau D, Öllinger R, Jarosch A, Budach V, Kaul D. Preoperative hypofractionated radiotherapy for soft tissue sarcomas: a systematic review. Radiat Oncol 2022; 17:159. [PMID: 36104789 PMCID: PMC9472188 DOI: 10.1186/s13014-022-02072-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/24/2022] [Indexed: 12/04/2022] Open
Abstract
Background Soft tissue sarcomas (STS) represent a diverse group of rare malignant tumors. Currently, five to six weeks of preoperative radiotherapy (RT) combined with surgery constitute the mainstay of therapy for localized high-grade sarcomas (G2–G3). Growing evidence suggests that shortening preoperative RT courses by hypofractionation neither increases toxicity rates nor impairs oncological outcomes. Instead, shortening RT courses may improve therapy adherence, raise cost-effectiveness, and provide more treatment opportunities for a wider range of patients. Presumed higher rates of adverse effects and worse outcomes are concerns about hypofractionated RT (HFRT) for STS. This systematic review summarizes the current evidence on preoperative HFRT for the treatment of STS and discusses toxicity and oncological outcomes compared to normofractionated RT.
Methods We conducted a systematic review of clinical trials describing outcomes for preoperative HFRT in the management of STS using PubMed, the Cochrane library, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Embase, and Ovid Medline. We followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Trials on retroperitoneal sarcomas, postoperative RT, and hyperthermia were excluded. Articles published until November 30th, 2021, were included. Results Initial search yielded 94 articles. After removal of duplicate and ineligible articles, 13 articles qualified for analysis. Eight phase II trials and five retrospective analyses were reviewed. Most trials applied 5 × 5 Gy preoperatively in patients with high-grade STS. HFRT courses did not show increased rates of adverse events compared to historical trials of normofractionated RT. Toxicity rates were mostly comparable or lower than in trials of normofractionated RT. Moreover, HFRT achieved comparable local control rates with shorter duration of therapy. Currently, more than 15 prospective studies on HFRT + / − chemotherapy are ongoing. Conclusions Retrospective data and phase II trials suggest preoperative HFRT to be a reasonable treatment modality for STS. Oncological outcomes and toxicity profiles were favorable. To date, our knowledge is mostly derived from phase II data. No randomized phase III trial comparing normofractionated and HFRT in STS has been published yet. Multiple ongoing phase II trials applying HFRT to investigate acute and late toxicity will hopefully bring forth valuable findings. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-02072-9.
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Relevant Trials Update in Sarcomas and Gastrointestinal Stromal Tumors: What Surgeons Should Know. Surg Oncol Clin N Am 2022; 31:341-360. [PMID: 35715138 DOI: 10.1016/j.soc.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In the past few years, the sarcoma community has successfully completed several trials in patients with soft tissue sarcoma (STS) or gastrointestinal stromal tumor (GIST). The current review summarizes recently reported relevant trials or trial updates investigating radiotherapy, chemotherapy, and targeted therapy in patients with localized extremity or superficial trunk STS, retroperitoneal sarcoma, and GIST.
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31
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Hindi N, Haas RL. Management of Synovial Sarcoma and Myxoid Liposarcoma. Surg Oncol Clin N Am 2022; 31:547-558. [PMID: 35715149 DOI: 10.1016/j.soc.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Synovial sarcoma and myxoid liposarcoma are translocation-related sarcomas, with a high risk of developing distant metastasis, which often affect young patients and which are sensitive to chemo and radiotherapy. Surgery is the mainstay of therapy in localized disease. In these entities, perioperative radiotherapy is frequently administered, and chemotherapy is evaluated in patients with high-risk limb/trunk wall tumors in which an advantage in overall survival has been shown in the latest clinical trials. In the advanced setting, new strategies, such as cellular therapy are being developed in these histologic types, with promising, although still preliminary, results.
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Affiliation(s)
- Nadia Hindi
- Department of Oncology, Fundación Jimenez Diaz University Hospital and Hospital General de Villalba, Madrid, Spain; Health Research Institute Fundación Jimenez Diaz, Universidad Autonoma de Madrid (IIS-FJD, UAM), Madrid, Spain.
| | - Rick L Haas
- Department of Radiotherapy at the Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Radiotherapy at the Leiden University Medical Center, Leiden, the Netherlands
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Abstract
Radiation therapy is an integral component of local management with oncologic resection for soft tissue sarcoma. Radiotherapy is indicated in patients at an increased risk of local recurrence so that improved local control may be achieved. Sequencing of radiotherapy and resection should be determined by multidisciplinary input before treatment initiation. For most patients, preoperative delivery of radiation therapy is preferred. In patients initially thought to be at low risk for local recurrence and found to have unexpected adverse pathologic features at resection, postoperative radiation therapy is indicated. The use of radiation therapy for retroperitoneal sarcoma is controversial; when used, preoperative delivery of radiation is recommended.
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Preoperative Radiation for Soft Tissue Sarcomas: How Much Is Needed? Curr Treat Options Oncol 2022; 23:68-77. [PMID: 35167005 DOI: 10.1007/s11864-022-00943-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/03/2022]
Abstract
OPINION STATEMENT Preoperative radiation therapy is an important component of curative treatment for extremity and superficial trunk soft tissue sarcomas. It has traditionally been delivered to a dose of 50 Gy in 2 Gy fractions over 5 weeks. With significant advances in the multidisciplinary approach to soft tissue sarcomas, preoperative radiation therapy may be omitted for certain cases, delivered over a shortened period of time (1-3 weeks), deintensified for myxoid liposarcomas, or combined with systemic therapy to improve the therapeutic ratio. This article reviews the innovative preoperative radiation therapy strategies currently used to treat extremity and superficial trunk soft tissue sarcomas.
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Spałek MJ, Teterycz P, Borkowska A, Poleszczuk J, Rutkowski P. Stereotactic radiotherapy for soft tissue and bone sarcomas: real-world evidence. Ther Adv Med Oncol 2022; 14:17588359211070646. [PMID: 35186124 PMCID: PMC8848098 DOI: 10.1177/17588359211070646] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction: Selected patients with locally advanced or metastatic soft tissue and bone sarcomas (STBS) may benefit from intensive local treatment, such as stereotactic radiotherapy (SRT). This study aimed to summarize the utilization and outcomes of SRT in STBS and to identify predictive factors for progression and survival. Materials and methods: Consecutive patients with advanced STBS who underwent STBS in a sarcoma tertiary center were identified. We collected tumor- and treatment-related factors. Endpoints comprised time to local progression (TTLP), local progression-free survival (LPFS), time to progression, progression-free survival, and overall survival (OS). The Cox proportional-hazards model was used to identify prognostic factors. Results: We identified 141 patients who underwent 233 SRTs. Median follow-up was 21 months. Local and distant progression occurred after 19 and 163 SRTs, respectively. SRT for lung metastases was predictive for better TTLP and LPFS (hazard ratio, HR = 0.12, p = 0.007 and HR = 0.42, p = 0.002, respectively). Bone sarcoma (HR for TTLP = 3.18, p = 0.043; HR for LPFS = 1.99, p = 0.028) and lower administered dose (HR for TTLP = 0.98, p = 0.007; HR for LPFS = 0.99, p = 0.012) were predictive for worse TTLP and LPFS. SRT for oligometastases (HR = 0.46, p = 0.021) and lung metastases (HR = 0.55, p = 0.046) was predictive for better OS, whereas diagnosis of bone sarcoma (HR = 2.05, p = 0.029) was predictive for worse OS. Conclusion: SRT provides excellent local control in STBS patients without significant toxicity. Patients with oligometastatic disease, lung metastases, and soft tissue sarcomas benefit the most from SRT. The dose escalation moderately enhances local control; however, it does not translate into better survival.
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Affiliation(s)
- Mateusz Jacek Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Paweł Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Department of Computational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Aneta Borkowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Jan Poleszczuk
- Department of Computational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Polish Academy of Sciences, Nalecz Institute of Biocybernetics and Biomedical Engineering, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Roulleaux Dugage M, Nassif EF, Italiano A, Bahleda R. Improving Immunotherapy Efficacy in Soft-Tissue Sarcomas: A Biomarker Driven and Histotype Tailored Review. Front Immunol 2021; 12:775761. [PMID: 34925348 PMCID: PMC8678134 DOI: 10.3389/fimmu.2021.775761] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/19/2021] [Indexed: 12/16/2022] Open
Abstract
Anti-PD-(L)1 therapies yield a disappointing response rate of 15% across soft-tissue sarcomas, even if some subtypes benefit more than others. The proportions of TAMs and TILs in their tumor microenvironment are variable, and this heterogeneity correlates to histotype. Tumors with a richer CD8+ T cell, M1 macrophage, and CD20+ cells infiltrate have a better prognosis than those infiltrated by M0/M2 macrophages and a high immune checkpoint protein expression. PD-L1 and CD8+ infiltrate seem correlated to response to immune checkpoint inhibitors (ICI), but tertiary lymphoid structures have the best predictive value and have been validated prospectively. Trials for combination therapies are ongoing and focus on the association of ICI with chemotherapy, achieving encouraging results especially with pembrolizumab and doxorubicin at an early stage, or ICI with antiangiogenics. A synergy with oncolytic viruses is seen and intratumoral talimogene laherpavec yields an impressive 35% ORR when associated to pembrolizumab. Adoptive cellular therapies are also of great interest in tumors with a high expression of cancer-testis antigens (CTA), such as synovial sarcomas or myxoid round cell liposarcomas with an ORR ranging from 20 to 50%. It seems crucial to adapt the design of clinical trials to histology. Leiomyosarcomas are characterized by complex genomics but are poorly infiltrated by immune cells and do not benefit from ICI. They should be tested with PIK3CA/AKT inhibition, IDO blockade, or treatments aiming at increasing antigenicity (radiotherapy, PARP inhibitors). DDLPS are more infiltrated and have higher PD-L1 expression, but responses to ICI remain variable across clinical studies. Combinations with MDM2 antagonists or CDK4/6 inhibitors may improve responses for DDLPS. UPS harbor the highest copy number alterations (CNA) and mutation rates, with a rich immune infiltrate containing TLS. They have a promising 15-40% ORR to ICI. Trials for ICB should focus on immune-high UPS. Association of ICI with FGFR inhibitors warrants further exploration in the immune-low group of UPS. Finally translocation-related sarcomas are heterogeneous, and although synovial sarcomas a poorly infiltrated and have a poor response rate to ICI, ASPS largely benefit from ICB monotherapy or its association with antiangiogenics agents. Targeting specific neoantigens through vaccine or adoptive cellular therapies is probably the most promising approach in synovial sarcomas.
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Affiliation(s)
- Matthieu Roulleaux Dugage
- Département d’Innovation Thérapeutique et des Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Elise F. Nassif
- Département d’Innovation Thérapeutique et des Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Antoine Italiano
- Département d’Innovation Thérapeutique et des Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
- Département d’Oncologie Médicale, Institut Bergonié, Bordeaux, France
| | - Rastislav Bahleda
- Département d’Innovation Thérapeutique et des Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
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Gronchi A, Miah AB, Dei Tos AP, Abecassis N, Bajpai J, Bauer S, Biagini R, Bielack S, Blay JY, Bolle S, Bonvalot S, Boukovinas I, Bovee JVMG, Boye K, Brennan B, Brodowicz T, Buonadonna A, De Álava E, Del Muro XG, Dufresne A, Eriksson M, Fagioli F, Fedenko A, Ferraresi V, Ferrari A, Frezza AM, Gasperoni S, Gelderblom H, Gouin F, Grignani G, Haas R, Hassan AB, Hecker-Nolting S, Hindi N, Hohenberger P, Joensuu H, Jones RL, Jungels C, Jutte P, Kager L, Kasper B, Kawai A, Kopeckova K, Krákorová DA, Le Cesne A, Le Grange F, Legius E, Leithner A, Lopez-Pousa A, Martin-Broto J, Merimsky O, Messiou C, Mir O, Montemurro M, Morland B, Morosi C, Palmerini E, Pantaleo MA, Piana R, Piperno-Neumann S, Reichardt P, Rutkowski P, Safwat AA, Sangalli C, Sbaraglia M, Scheipl S, Schöffski P, Sleijfer S, Strauss D, Strauss S, Sundby Hall K, Trama A, Unk M, van de Sande MAJ, van der Graaf WTA, van Houdt WJ, Frebourg T, Casali PG, Stacchiotti S. Soft tissue and visceral sarcomas: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up ☆. Ann Oncol 2021; 32:1348-1365. [PMID: 34303806 DOI: 10.1016/j.annonc.2021.07.006] [Citation(s) in RCA: 386] [Impact Index Per Article: 128.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 02/08/2023] Open
Affiliation(s)
- A Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - A B Miah
- Department of Oncology, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - A P Dei Tos
- Department of Pathology, Azienda Ospedale Università Padova, Padua, Italy
| | - N Abecassis
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - J Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Bauer
- Department of Medical Oncology, Interdisciplinary Sarcoma Center, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - R Biagini
- Department of Oncological Orthopedics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - S Bielack
- Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - J Y Blay
- Centre Leon Berard and UCBL1, Lyon, France
| | - S Bolle
- Radiation Oncology Department, Gustave Roussy, Villejuif, France
| | - S Bonvalot
- Department of Surgery, Institut Curie, Paris, France
| | | | - J V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - K Boye
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - B Brennan
- Paediatric Oncology, Royal Manchester Children's Hospital, Manchester, UK
| | - T Brodowicz
- Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - A Buonadonna
- Centro di Riferimento Oncologico di Aviano, Aviano, Italy
| | - E De Álava
- Hospital Universitario Virgen del Rocio-CIBERONC, Seville, Spain; Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Seville, Spain
| | - X G Del Muro
- Integrated Unit ICO Hospitalet, HUB, Barcelona, Spain
| | - A Dufresne
- Département d'Oncologie Médicale, Centre Leon Berard, Lyon, France
| | - M Eriksson
- Skane University Hospital-Lund, Lund, Sweden
| | - F Fagioli
- Paediatric Onco-Haematology Department, Regina Margherita Children's Hospital, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - A Fedenko
- P. A. Herzen Cancer Research Institute, Moscow, Russian Federation
| | - V Ferraresi
- Sarcomas and Rare Tumors Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A M Frezza
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - S Gasperoni
- Azienda Ospedaliera Universitaria Careggi Firenze, Florence, Italy
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - F Gouin
- Centre Leon-Berard Lyon, Lyon, France
| | - G Grignani
- Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy
| | - R Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - A B Hassan
- Oxford University Hospitals NHS Foundation Trust and University of Oxford, Oxford, UK
| | | | - N Hindi
- Department of Medical Oncology, Fundación Jimenez Diaz University Hospital, Advanced Therapies in Sarcoma Lab, Madrid, Spain
| | - P Hohenberger
- Mannheim University Medical Center, Mannheim, Germany
| | - H Joensuu
- Helsinki University Hospital (HUH) and University of Helsinki, Helsinki, Finland
| | - R L Jones
- Sarcoma Unit, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - C Jungels
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - P Jutte
- University Medical Center Groningen, Groningen, The Netherlands
| | - L Kager
- St. Anna Children's Hospital, Department of Pediatrics and Medical University Vienna Children's Cancer Research Institute, Vienna, Austria
| | - B Kasper
- Mannheim University Medical Center, Mannheim, Germany
| | - A Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - K Kopeckova
- University Hospital Motol, Prague, Czech Republic
| | - D A Krákorová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - A Le Cesne
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - F Le Grange
- Department of Oncology, University College London Hospitals NHS Foundation Trust (UCLH), London, UK
| | - E Legius
- Department for Human Genetics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - A Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - A Lopez-Pousa
- Medical Oncology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - J Martin-Broto
- Department of Medical Oncology, Fundación Jimenez Diaz University Hospital, Advanced Therapies in Sarcoma Lab, Madrid, Spain
| | - O Merimsky
- Tel Aviv Sourasky Medical Center (Ichilov), Tel Aviv, Israel
| | - C Messiou
- Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - O Mir
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | - M Montemurro
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - B Morland
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - C Morosi
- Department of Radiology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - E Palmerini
- Department of Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M A Pantaleo
- Division of Oncology, IRCCS Azienda Ospedaliero-Universitaria, di Bologna, Bologna, Italy
| | - R Piana
- Azienda Ospedaliero, Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - P Reichardt
- Helios Klinikum Berlin Buch, Berlin, Germany
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - A A Safwat
- Aarhus University Hospital, Aarhus, Denmark
| | - C Sangalli
- Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Sbaraglia
- Department of Pathology, Azienda Ospedale Università Padova, Padua, Italy
| | - S Scheipl
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - P Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - D Strauss
- Department of Surgery, Royal Marsden Hospital, London, UK
| | - S Strauss
- Department of Oncology, University College London Hospitals NHS Foundation Trust (UCLH), London, UK
| | - K Sundby Hall
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - A Trama
- Department of Research, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Unk
- Institute of Oncology of Ljubljana, Ljubljana, Slovenia
| | - M A J van de Sande
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - W T A van der Graaf
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Department of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - W J van Houdt
- Department of Surgical Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - T Frebourg
- Department of Genetics, Normandy Center for Genomic and Personalized Medicine, Normandie Univ, UNIROUEN, Inserm U1245 and Rouen University Hospital, Rouen, France
| | - P G Casali
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Department of Oncology and Hemato-oncology University of Milan, Milan, Italy
| | - S Stacchiotti
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Kousi E, Messiou C, Miah A, Orton M, Haas R, Thway K, Hopkinson G, Zaidi S, Smith M, Barquin E, Moskovic E, Fotiadis N, Strauss D, Hayes A, Schmidt MA. Descriptive analysis of MRI functional changes occurring during reduced dose radiotherapy for myxoid liposarcomas. Br J Radiol 2021; 94:20210310. [PMID: 34545764 PMCID: PMC9328045 DOI: 10.1259/bjr.20210310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Myxoid liposarcomas (MLS) show enhanced response to radiotherapy due to their distinctive vascular pattern and therefore could be effectively treated with lower radiation doses. This is a descriptive study to explore the use of functional MRI to identify response in a uniform cohort of MLS patients treated with reduced dose radiotherapy. METHODS 10 patients with MLS were imaged pre-, during, and post-radiotherapy receiving reduced dose radiotherapy and the response to treatment was histopathologically assessed post-radiotherapy. Apparent diffusion coefficient (ADC), T2* relaxation time, volume transfer constant (Ktrans), initial area under the gadolinium curve over 60 s (IAUGC60) and (Gd) were estimated for a central tumour volume. RESULTS All parameters showed large inter- and intrasubject variabilities. Pre-treatment (Gd), IAUGC60 and Ktrans were significantly different between responders and non-responders. Post-radiotherapy reductions from baseline were demonstrated for T2*, (Gd), IAUGC60 and Ktrans for responders. No statistically significant ADC differences were demonstrated between the two response groups. Significantly greater early tumour volume reductions were observed for responders. CONCLUSIONS MLS are heterogenous lesions, characterised by a slow gradual contrast-agent uptake. Pre-treatment vascular parameters, early changes to tumour volume, vascular parameters and T2* have potential in identifying response to treatment. The delayed (Gd) is a suitable descriptive parameter, relying simply on T1 measurements. Volume changes precede changes in MLS functionality and could be used to identify early response. ADVANCES IN KNOWLEDGE MLS are are characterised by slow gradual contrast-agent uptake. Measurement of the delayed contrast-agent uptake (Gd) is simple to implement and able to discriminate response.
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Affiliation(s)
- Evanthia Kousi
- MRI unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - Christina Messiou
- Radiology department, The Royal Marsden NHS Foundation Trust, London, UK
| | - Aisha Miah
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Matthew Orton
- MRI unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - Rick Haas
- Sarcoma Unit, Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Khin Thway
- Molecular pathology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Georgina Hopkinson
- MRI unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - Shane Zaidi
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Myles Smith
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Eleanor Moskovic
- Radiology department, The Royal Marsden NHS Foundation Trust, London, UK
| | - Nicos Fotiadis
- Department of Interventional Radiology, The Royal Marsden NHS Foundation trust, London, UK
| | - Dirk Strauss
- Sarcoma/Melanoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Andrew Hayes
- Sarcoma/Melanoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Maria A Schmidt
- MRI unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
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Magnetic resonance imaging of trunk and extremity myxoid liposarcoma: diagnosis, staging, and response to treatment. Skeletal Radiol 2021; 50:1963-1980. [PMID: 33792747 DOI: 10.1007/s00256-021-03769-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023]
Abstract
Myxoid liposarcoma (MLS) accounts for approximately 30% of all liposarcomas. The majority are intermediate-grade tumours, but the presence of >5% round cell component renders it a high-grade sarcoma with subsequent poorer outcome. MLS most commonly arises in the lower extremities, has a predilection for extra-pulmonary sites of metastatic disease, and is recognized to be radiosensitive. The purpose of the current article is to review the role of MRI in the management of MLS, including the characteristic features of the primary tumour, features which help to identify a round cell component and thus determine prognosis, the role of whole-body MRI for evaluation of extra-pulmonary metastatic disease, and the utility of MRI for assessing treatment response. The MRI differential diagnosis of MLS is also considered.
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Radiation Therapy in Metastatic Soft Tissue Sarcoma: From Palliation to Ablation. Cancers (Basel) 2021; 13:cancers13194775. [PMID: 34638260 PMCID: PMC8508247 DOI: 10.3390/cancers13194775] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary In the United States, over 13,000 patients are diagnosed with soft tissue sarcoma annually leading to over 5000 deaths per year despite aggressive treatments including radiotherapy, surgery, and chemotherapy. Although the majority of patients present with localized disease, unfortunately many will develop metastatic disease, which is generally not curable. There is growing evidence that local ablative therapies may be beneficial in patients with a variety of metastatic malignancies. In this review article, we explore the evolving role of radiotherapy in patients with metastatic soft tissue sarcoma. In particular, we review the growing role of ablative radiotherapy for oligometastatic disease, local control of the primary site, and palliation. Abstract The management of patients with metastatic cancer is rapidly changing. Historically, radiotherapy was utilized for the treatment of localized disease or for palliation. While systemic therapy remains the mainstay of management for patients with metastatic cancer, radiotherapy is becoming increasingly important not only to palliate symptoms, but also to ablate oligometastatic or oligoprogressive disease and improve local control in the primary site. There is emerging evidence in multiple solid malignancies that patients with low volume metastatic disease that undergo local ablative therapy to metastatic sites may have improved progression free survival and potentially overall survival. In addition, there is increasing evidence that select patients with metastatic disease may benefit from aggressive treatment of the primary site. Patients with metastatic soft tissue sarcoma have a poor overall prognosis. However, there may be opportunities in patients with low volume metastatic soft tissue sarcoma to improve outcomes with local therapy including surgery, ablation, embolization, and radiation therapy. Stereotactic body radiation therapy (SBRT) offers a safe, convenient, precise, and non-invasive option for ablation of sites of metastases. In this review article, we explore the limited yet evolving role of radiotherapy to metastatic and primary sites for local control and palliation, particularly in the oligometastatic setting.
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Patterns of Perioperative Treatment and Survival of Localized, Resected, Intermediate- or High-Grade Soft Tissue Sarcoma: A 2000-2017 Netherlands Cancer Registry Database Analysis. Sarcoma 2021; 2021:9976122. [PMID: 34335076 PMCID: PMC8324372 DOI: 10.1155/2021/9976122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/18/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Standard therapy for localized soft tissue sarcoma (STS) is wide, limb-sparing resection. For intermediate- or high-grade tumors, (neo)adjuvant therapies are frequently added to the treatment plan. In this study, data from a Dutch nationwide database are used to (1) assess whether perioperative management of STS follows ESMO guidelines, (2) characterize prognostic factors for overall survival (OS), and (3) assess the association between perioperative treatment and survival. Methods All intermediate- or high-grade, localized STS cases, who have undergone surgery and diagnosed between 2000 and 2017, were identified in the Netherlands Cancer Registry (NCR) database. Variables with demographic, treatment, and survival data were obtained. Survival curves were estimated by Kaplan–Meier's method, and the effect of prognostic factors on OS was assessed in a multivariable Cox regression analysis. Results A total of 4957 patients were identified. There were slightly more males (54.7%). Median age at diagnosis was 64 years, and 53.6% of the tumors were located in the extremities. Radiotherapy (RT) was administered to 2481 (50.1%) patients, and 252 (5.1%) patients were treated with perioperative systemic chemotherapy. The total use of perioperative RT did not significantly change in the last 20 years, but the timing followed clinical guidelines: preoperative RT increased significantly (2000–2008: 3.7%, 2009–2017: 22.3%; p < 0.001), whereas the use of postoperative RT diminished (2000–2008: 45.9%, 2009–2017: 26.1%; p < 0.001). The use of perioperative chemotherapy slightly decreased (2000–2008: 5.9%, 2009–2017: 4.4%; p = 0.015). 5-year OS was 59.6% (95% CI: 58.2–61.0). Sex, age, year of diagnosis, tumor location, tumor size, histological grade, depth, histological subtype, surgical margins, and the use of perioperative RT were identified as independent predictors for OS. Conclusion Preoperative RT is gradually replacing postoperative RT for localized STS in the Netherlands. The use of perioperative chemotherapy is rare and has slightly decreased in recent years. Identified baseline characteristics and treatment factors predicting OS may aid in future treatment decisions.
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Yang G, Yuan Z, Ahmed K, Welsh EA, Fulp WJ, Gonzalez RJ, Mullinax JE, Letson D, Bui M, Harrison LB, Scott JG, Torres-Roca JF, Naghavi AO. Genomic identification of sarcoma radiosensitivity and the clinical implications for radiation dose personalization. Transl Oncol 2021; 14:101165. [PMID: 34246048 PMCID: PMC8274330 DOI: 10.1016/j.tranon.2021.101165] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/14/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022] Open
Abstract
Soft tissue sarcomas have traditionally been treated with a one-size fits all approach, despite a wide range of histologies and clinical outcomes. The radiosensitivity index has demonstrated that soft tissue sarcomas are in general radioresistant, however exhibit a wide range of radiosensitivity. These differences in radiosensitivity are associated with decreased locoregional control in patients with radioresistant histologies. Using the radiosensitivity index we identify specific histologies of soft tissue sarcoma that may be more radioresistant, and suggest a genomic-based radiation dosing framework.
Background Soft-tissue sarcomas (STS) are heterogeneous with variable response to radiation therapy (RT). Utilizing the radiosensitivity index (RSI) we estimated the radiobiologic ratio of lethal to sublethal damage (α/β), genomic-adjusted radiation dose(GARD), and in-turn a biological effective radiation dose (BED). Methods Two independent cohorts of patients with soft-tissue sarcoma were identified. The first cohort included 217 genomically-profiled samples from our institutional prospective tissue collection protocol; RSI was calculated for these samples, which were then used to dichotomize the population as either highly radioresistant (HRR) or conventionally radioresistant (CRR). In addition, RSI was used to calculate α/β ratio and GARD, providing ideal dosing based on sarcoma genomic radiosensitivity. A second cohort comprising 399 non-metastatic-STS patients treated with neoadjuvant RT and surgery was used to validate our findings. Results Based on the RSI of the sample cohort, 84% would historically be considered radioresistant. We identified a HRR subset that had a significant difference in the RSI, and clinically a lower tumor response to radiation (2.4% vs. 19.4%), 5-year locoregional-control (76.5% vs. 90.8%), and lower estimated α/β (3.29 vs. 5.98), when compared to CRR sarcoma. Using GARD, the dose required to optimize outcome in the HRR subset is a BEDα/β=3.29 of 97 Gy. Conclusions We demonstrate that on a genomic scale, that although STS is radioresistant overall, they are heterogeneous in terms of radiosensitivity. We validated this clinically and estimated an α/β ratio and dosing that would optimize outcome, personalizing dose.
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Affiliation(s)
- George Yang
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, United States
| | - Zhigang Yuan
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, United States
| | - Kamran Ahmed
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, United States
| | | | | | | | | | | | - Marilyn Bui
- Sarcoma, United States; Pathology, United States
| | - Louis B Harrison
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, United States
| | - Jacob G Scott
- Cleveland Clinic, Translational Hematology and Oncology Research, United States
| | - Javier F Torres-Roca
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, United States
| | - Arash O Naghavi
- H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, United States.
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Levy A, Honoré C, Dumont S, Bourdais R, Cavalcanti A, Faron M, Ngo C, Haddag-Miliani L, Le Cesne A, Mir O, Le Péchoux C. [Preoperative versus postoperative radiotherapy in soft tissue sarcomas: State of the art and perspectives]. Bull Cancer 2021; 108:868-876. [PMID: 34246458 DOI: 10.1016/j.bulcan.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/03/2021] [Accepted: 03/13/2021] [Indexed: 11/26/2022]
Abstract
Radiation therapy is a standard treatment for limbs soft tissue sarcomas. Preoperative versus postoperative radiotherapy has been a controversial topic for years. With preoperative irradiation, the treatment volume is more limited, the delivered dose possibly lower and the tumor volume easier to delimit. Only one randomized trial compared these two irradiation sequences. The results in terms of local control and survival were equivalent but the risk of acute postoperative complications was higher if irradiation was administered before surgery. However, in the latest update of this trial, patients who received adjuvant irradiation exhibited more severe late toxicity than those treated preoperatively. In addition, with modern irradiation techniques such as conformal with image-guided intensity modulated radiotherapy and flap coverage techniques, the incidence of complications after preoperative irradiation were lower than historically published rates. Locally advanced proximal sarcomas and the failure of other neoadjuvant treatments are nowadays classical indications for preoperative irradiation. As with other neoadjuvant treatments, induction radiotherapy must be personalized according to the histological subtype, the tumor site and the benefit/risk ratio, which is best appreciated by a multidisciplinary surgical and oncological team in a specialized center in the management of soft-tissue sarcomas.
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Affiliation(s)
- Antonin Levy
- Gustave-Roussy, département d'oncologie radiothérapie, 94805 Villejuif, France; Université Paris-Saclay, 94270 Le-Kremlin-Bicêtre, France; Université Paris-Saclay, Inserm U1030, radiothérapie moléculaire, 94805 Villejuif, France.
| | - Charles Honoré
- Gustave-Roussy, département de chirurgie, 94805 Villejuif, France
| | - Sarah Dumont
- Gustave-Roussy, département d'oncologie médicale, 94805 Villejuif, France
| | - Rémi Bourdais
- Gustave-Roussy, département d'oncologie radiothérapie, 94805 Villejuif, France
| | | | - Matthieu Faron
- Gustave-Roussy, département de chirurgie, 94805 Villejuif, France
| | - Carine Ngo
- Gustave-Roussy, département d'anatomopathologie, 94805 Villejuif, France
| | | | - Axel Le Cesne
- Gustave-Roussy, département d'oncologie médicale, 94805 Villejuif, France
| | - Olivier Mir
- Gustave-Roussy, département d'oncologie médicale, 94805 Villejuif, France
| | - Cécile Le Péchoux
- Gustave-Roussy, département d'oncologie radiothérapie, 94805 Villejuif, France
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A moderate dose of preoperative radiotherapy may improve resectability in myxoid liposarcoma. Eur J Surg Oncol 2021; 47:2633-2639. [PMID: 34233858 DOI: 10.1016/j.ejso.2021.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/31/2021] [Accepted: 06/16/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Histotype specific neoadjuvant therapy response data is scarce in soft tissue sarcomas. This study aimed to assess the impact of a moderate radiotherapy (RT) dose on resectability and to correlate MRI parameters to pathological treatment response in Myxoid Liposarcoma (MLS). METHODS This prospective, multicenter, single-arm, phase 2 trial assessed the radiological effects of 36 Gy of preoperative radiotherapy in primary non-metastatic MLS (n=34). Distance of the tumor to the neurovascular bundle, tumor dimensions, fat fraction, enhancing fraction were determined on MRI scans at baseline, after 8 and 16 fractions, and preoperatively. Pathological response was established by central pathology review. RESULTS Preoperative radiotherapy resulted in a median increase of 2 mm (IQR 0 to 6) of the distance of the tumor to the neurovascular bundle. As compared to baseline, the median change of the tumor volume, craniocaudal diameter and axial diameter at preoperative MRI were -60% (IQR -74 to -41), -19% (IQR -23 to -7) and -20% (IQR -29 to -12), respectively. The median fat fraction of 0.1 (IQR 0.0-0.1) and enhancing fraction of 0.8 (IQR 0.6 to 0.9) at baseline, changed to 0.2 (IQR 0.1 to 0.5) and to 0.5(IQR 0.4 to 0.9) preoperatively, respectively. Radiological signs of response in terms of volume, enhancing fraction and fat fraction were correlated with specific pathological signs of response like hyalinization, necrosis and fatty maturation. CONCLUSIONS A moderate dose of preoperative radiotherapy may improve resectability in MLS and could facilitate achievement of clear margins and function preservation. MRI features which were predictive for expressions of pathological response, can play a role in further personalization of neoadjuvant treatment strategies in order to improve outcome in MLS.
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Flucke U, van Noesel MM, Siozopoulou V, Creytens D, Tops BBJ, van Gorp JM, Hiemcke-Jiwa LS. EWSR1-The Most Common Rearranged Gene in Soft Tissue Lesions, Which Also Occurs in Different Bone Lesions: An Updated Review. Diagnostics (Basel) 2021; 11:diagnostics11061093. [PMID: 34203801 PMCID: PMC8232650 DOI: 10.3390/diagnostics11061093] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 01/09/2023] Open
Abstract
EWSR1 belongs to the FET family of RNA-binding proteins including also Fused in Sarcoma (FUS), and TATA-box binding protein Associated Factor 15 (TAF15). As consequence of the multifunctional role of EWSR1 leading to a high frequency of transcription of the chromosomal region where the gene is located, EWSR1 is exposed to aberrations such as rearrangements. Consecutive binding to other genes leads to chimeric proteins inducing oncogenesis. The other TET family members are homologous. With the advent of widely used modern molecular techniques during the last decades, it has become obvious that EWSR1 is involved in the development of diverse benign and malignant tumors with mesenchymal, neuroectodermal, and epithelial/myoepithelial features. As oncogenic transformation mediated by EWSR1-fusion proteins leads to such diverse tumor types, there must be a selection on the multipotent stem cell level. In this review, we will focus on the wide variety of soft tissue and bone entities, including benign and malignant lesions, harboring EWSR1 rearrangement. Fusion gene analysis is the diagnostic gold standard in most of these tumors. We present clinicopathologic, immunohistochemical, and molecular features and discuss differential diagnoses.
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Affiliation(s)
- Uta Flucke
- Department of Pathology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.M.v.N.); (B.B.J.T.); (L.S.H.-J.)
- Correspondence: ; Tel.: +31-24-36-14387; Fax: +31-24-36-68750
| | - Max M. van Noesel
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.M.v.N.); (B.B.J.T.); (L.S.H.-J.)
- Division Cancer & Imaging, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | | | - David Creytens
- Department of Pathology, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium;
| | - Bastiaan B. J. Tops
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.M.v.N.); (B.B.J.T.); (L.S.H.-J.)
| | - Joost M. van Gorp
- Department of Pathology, St Antonius Hospital, 3435 CM Nieuwegein, The Netherlands;
| | - Laura S. Hiemcke-Jiwa
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.M.v.N.); (B.B.J.T.); (L.S.H.-J.)
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Tfayli Y, Baydoun A, Naja AS, Saghieh S. Management of myxoid liposarcoma of the extremity. Oncol Lett 2021; 22:596. [PMID: 34188698 PMCID: PMC8228380 DOI: 10.3892/ol.2021.12857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/15/2021] [Indexed: 11/18/2022] Open
Abstract
Myxoid liposarcoma (MLPS) is the second most common type of LPS after the well differentiated LPS. MLPS is primarily localized to the extremities. The incidence of LPS is ~2 per million worldwide. MLPS accounts for ~30% of all LPS cases. MLPS is usually encountered in adults, but can also occur in younger individuals more than other types of LPS. MLPS can be divided into low- and high-grade subtypes, which present with differences in patient prognosis and outcome. Methods of tumor management include surgery, radiotherapy and chemotherapy; however, there is no unified treatment based on tumor characteristics alone. The present manuscript reviews the surgical management, radiotherapeutic and chemotherapeutic approaches reported in the literature for different types of MLPS in the extremities, as well as the post-treatment outcomes. In addition, the present review provides an evidence-based management plan for MLPS in the form of an organogram based on specific tumor and patient parameters.
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Affiliation(s)
- Yehia Tfayli
- Division of Orthopedic Surgery, Department of Surgery, American University of Beirut Medical Center, 11-0236 Beirut, Lebanon
| | - Ahmad Baydoun
- Department of Surgery, Saint George Hospital University Medical Center, University of Balamand, 11-0236 Beirut, Lebanon
| | - Ahmad Salaheddine Naja
- Division of Orthopedic Surgery, Department of Surgery, American University of Beirut Medical Center, 11-0236 Beirut, Lebanon
| | - Said Saghieh
- Division of Orthopedic Surgery, Department of Surgery, American University of Beirut Medical Center, 11-0236 Beirut, Lebanon
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Cammelli S, Cortesi A, Buwenge M, Zamagni A, Ferioli M, Ghigi G, Romeo A, Morganti AG. The role of radiotherapy in adult soft tissues sarcoma of the extremities. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1583-1596. [PMID: 33954820 PMCID: PMC8702420 DOI: 10.1007/s00590-021-02990-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/18/2021] [Indexed: 01/19/2023]
Abstract
Local management of adult soft tissue sarcoma of the extremities has evolved over the past decades. Until the 1970s, radical surgery (amputations) was the standard therapeutic procedure resulting in significant physical and psychological morbidity for the patients. In the present era, limb sparing surgery combined with radiotherapy represents the current standard of care for high grade and > 5 cm STSs. This approach guarantees high local control rate and function preservation. The aim of this paper is to summarize the current evidence for RT in STSs of the extremities. Outcomes, technical details (techniques, timing, dose, volumes of treatment) and the emerging role of RT in the management of oligometastatic disease will be analysed. Finally, results of the recent clinical trials testing new scenarios in RT of STSs will be described.
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Affiliation(s)
- Silvia Cammelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. .,Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Annalisa Cortesi
- Radiotherapy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Milly Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alice Zamagni
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Martina Ferioli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulia Ghigi
- Radiotherapy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Antonino Romeo
- Radiotherapy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Alessio G Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Lansu J, van Houdt WJ, van Langevelde K, van den Ende PLA, van der Graaf WTA, Schrage Y, van Boven H, Scholten AN, Haas RL. Local control and postponement of systemic therapy after modest dose radiotherapy in oligometastatic myxoid liposarcomas. Radiother Oncol 2021; 158:33-39. [PMID: 33610624 DOI: 10.1016/j.radonc.2021.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Oligometastatic disease and/or oligoprogression in myxoid liposarcoma(oMLS) triggers discussions on local treatment options and delay of systemic treatments. We hypothesized that satisfactory local control and postponement of systemic therapy could be achieved with a modest radiotherapy(RT) dose in oMLS. METHODS The DOREMY trial is a multicenter, phase 2 trial evaluating efficacy and toxicity of a modest RT dose in both localized and oMLS; this report presents the data of the oMLS cohort treated with 36 Gy in 12-18 fractions with optional subsequent metastasectomy. The primary endpoint was local progression free survival(LPFS). Secondary endpoints included postponement of systemic therapy, symptom reduction, radiological objective response, and toxicity. RESULTS Nine patients with a total of 25 lesions were included, with a median follow-up of 23 months. The median number of lesions per patient was three and the trunk wall and bone were the most frequently affected sites. In lesions treated with definitive RT(n = 21), LPFS rates at 1, 2, and 3 years were respectively 73%, 61%, and 40%. Radiological objective response and clinical symptom reduction were achieved in 8/15(53%) and 9/10(90%) of the evaluable lesions, respectively. No local recurrences occurred in lesions treated with RT and metastasectomy(n = 4). For the entire study population, the median postponement of systemic therapy was 10 months. Grade ≥ 2 toxicity was observed in 2/9(22%) of patients. CONCLUSIONS This trial suggests that 36 Gy could possibly be effective to achieve local control, postpone systemic therapy and reduce symptoms in oMLS. Given the minimal toxicity this treatment could be reasonably considered in oMLS.
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Affiliation(s)
- Jules Lansu
- Department of Radiotherapy, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Winan J van Houdt
- Department of Surgical Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | | | - Yvonne Schrage
- Department of Surgical Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hester van Boven
- Department of Pathology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Astrid N Scholten
- Department of Radiotherapy, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rick L Haas
- Department of Radiotherapy, the Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiotherapy, Leiden University Medical Center, The Netherlands.
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Lafontaine J, Cardin GB, Malaquin N, Boisvert JS, Rodier F, Wong P. Senolytic Targeting of Bcl-2 Anti-Apoptotic Family Increases Cell Death in Irradiated Sarcoma Cells. Cancers (Basel) 2021; 13:cancers13030386. [PMID: 33494434 PMCID: PMC7866159 DOI: 10.3390/cancers13030386] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary Limited volumetric change after pre-operative radiotherapy (RT) suggests that sarcomas generally do not undergo cell death. Senolytic drugs represent a highly promising field as a new therapy approach to drive senescent cancer cells towards cell death to enhance treatment response. Here, we demonstrate that the Bcl-2 family of anti-apoptotic proteins in irradiated senescent sarcoma cells represents a senotherapeutic target to improve the cell death response in RT. This study paves the way for new treatment options in soft tissue sarcoma management. Abstract Radiotherapy (RT) is a key component of cancer treatment. Most of the time, radiation is given after surgery but for soft-tissue sarcomas (STS), pre-surgical radiation is commonly utilized. However, despite improvements in RT accuracy, the rate of local recurrence remains high and is the major cause of death for patients with STS. A better understanding of cell fates in response to RT could provide new therapeutic options to enhance tumour cell killing by RT and facilitate surgical resection. Here, we showed that irradiated STS cell cultures do not die but instead undergo therapy-induced senescence (TIS), which is characterized by proliferation arrest, senescence-associated β-galactosidase activity, secretion of inflammatory cytokines and persistent DNA damage. STS-TIS was also associated with increased levels of the anti-apoptotic Bcl-2 family of proteins which rendered cells targetable using senolytic Bcl-2 inhibitors. As oppose to radiation alone, the addition of senolytic agents Venetoclax (ABT-199) or Navitoclax (ABT-263) after irradiation induced a rapid apoptotic cell death in STS monolayer cultures and in a more complex three-dimensional culture model. Together, these data suggest a new promising therapeutic approach for sarcoma patients who receive neoadjuvant RT. The addition of senolytic agents to radiation treatments may significantly reduce tumour volume prior to surgery and thereby improve the clinical outcome of patients.
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Affiliation(s)
- Julie Lafontaine
- Institut du Cancer de Montréal (ICM), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), 900 St. Denis Street, Montreal, QC H2X 0A9, Canada; (J.L.); (G.B.C.); (N.M.); (J.-S.B.); (F.R.)
| | - Guillaume B. Cardin
- Institut du Cancer de Montréal (ICM), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), 900 St. Denis Street, Montreal, QC H2X 0A9, Canada; (J.L.); (G.B.C.); (N.M.); (J.-S.B.); (F.R.)
| | - Nicolas Malaquin
- Institut du Cancer de Montréal (ICM), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), 900 St. Denis Street, Montreal, QC H2X 0A9, Canada; (J.L.); (G.B.C.); (N.M.); (J.-S.B.); (F.R.)
| | - Jean-Sébastien Boisvert
- Institut du Cancer de Montréal (ICM), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), 900 St. Denis Street, Montreal, QC H2X 0A9, Canada; (J.L.); (G.B.C.); (N.M.); (J.-S.B.); (F.R.)
- Plasma Processing Laboratory, Department of Chemical Engineering, McGill University, 3610 University Street, Montreal, QC H3A 0C5, Canada
| | - Francis Rodier
- Institut du Cancer de Montréal (ICM), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), 900 St. Denis Street, Montreal, QC H2X 0A9, Canada; (J.L.); (G.B.C.); (N.M.); (J.-S.B.); (F.R.)
- Département de Radiologie, Radio-Oncologie et Médicine Nucléaire, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montreal, QC H3C 3J7, Canada
| | - Philip Wong
- Institut du Cancer de Montréal (ICM), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), 900 St. Denis Street, Montreal, QC H2X 0A9, Canada; (J.L.); (G.B.C.); (N.M.); (J.-S.B.); (F.R.)
- Département de Radio-Oncologie, Centre Hospitalier de l’Université de Montréal (CHUM), 1051 Sanguinet Street, Montreal, QC H2X 3E4, Canada
- Department of Radiation Oncology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, 149 College Street, Suite 504, Toronto, ON M5T 1P5, Canada
- Correspondence: ; Tel.: +1-416-946-4483
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Abstract
Liposarcomas are a common subfamily of soft tissue sarcoma with several subtypes recognized by the World Health Organization: atypical lipomatous tumors (ALT)/well-differentiated liposarcoma (WDLPS), dedifferentiated liposarcoma (DDLPS), myxoid liposarcoma (MLPS), pleomorphic liposarcoma (PLPS), and myxoid pleomorphic liposarcoma (MPLPS). Despite shared adipocytic features among liposarcomas, the clinical approach to each subtype differs based on histology, location, clinical behavior, and specific oncogenic drivers. In this review, we highlight subtype-specific molecular features with the potential to generate novel therapies. We discuss recent clinical trials investigating the use of preoperative radiation therapy for retroperitoneal liposarcoma, chemotherapy, small molecule inhibitors, and innovative immunotherapy approaches and describe how we incorporate these advancements into the management of liposarcoma.
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Affiliation(s)
- Candace L Haddox
- Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA
| | - Richard F Riedel
- Division of Medical Oncology, Duke University Medical Center, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
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