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Song EH, Lee SY, Lee S, Jung JY, Shin SH, Chung YG, Jung CK. Diagnosis of Local Recurrence of Malignant Soft Tissue Tumors after Reconstructive Surgery on MRI. J Clin Med 2023; 12:4369. [PMID: 37445404 DOI: 10.3390/jcm12134369] [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: 05/21/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE Magnetic resonance imaging (MRI) is useful in the diagnosis of local recurrence, but few studies have explored recurrence in MRI in patients after reconstructive surgery. The purpose of this study was to analyze MRI findings of locoregional recurrence following reconstructive surgery after malignant soft tissue tumor resection. METHOD Fifty-three postoperative MRIs from 37 patients who underwent reconstructive surgery after malignant soft tissue tumor resection were retrospectively reviewed. A total of 76 enhancing lesions, including 40 locoregional recurrences and 36 postoperative changes, were analyzed regarding morphology (location on the transplanted tissue, border, and shape) and the signals on T1- and T2-weighted imaging (T1WI, T2WI), fat-suppressed (FS) T2WI, and contrast-enhanced FS T1WI. Diffusion-weighted imaging with an apparent diffusion coefficient was assessed. A chi-squared test and Fisher's exact test were used for statistical analysis. RESULTS The most common site of recurrent tumors and postoperative changes was the peripheral margin on transplanted tissue (63% and 61%, respectively p = 0.907). Recurrent tumors commonly appeared with well-defined borders (75%) as well as nodular appearance (98%), hyperintensity on T2WI (85%) and FS-T2WI (95%), isointensity on T1WI (65%), impeded water diffusion (55%), and intense (50%) or moderate (45%) enhancement. Postoperative changes showed ill-defined borders (75%), nodular appearance (56%), facilitated water diffusion (69%), and moderate (86%) enhancement, which were significantly different from those of recurrent tumors (p ≤ 0.020). CONCLUSIONS Common and partitioning MRI features of locoregional recurrence were well-defined borders, nodular shape, impeded water diffusion, and intense enhancement. Peripheral margins on transplanted tissue were common sites in both recurrent tumors and postoperative changes.
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Affiliation(s)
- Eun-Hee Song
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea
| | - So-Yeon Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Seungeun Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Seung-Han Shin
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Yang-Guk Chung
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Chan-Kwon Jung
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
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Dammerer D, VAN Beeck A, Schneeweiss V, Schwabegger A. Follow-up Strategies for Primary Extremity Soft-tissue Sarcoma in Adults: A Systematic Review of the Published Literature. In Vivo 2021; 34:3057-3068. [PMID: 33144410 DOI: 10.21873/invivo.12140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 01/22/2023]
Abstract
AIM Follow-up strategies for primary extremity soft-tissue sarcomas (eSTS) in adults were evaluated in a systematic review of the published literature. MATERIAL AND METHODS The published literature was reviewed using PubMed. Of 136,646 studies published between 1985 and 2019, 78 original articles met the inclusion criteria. Articles were selected on the basis of the PRISMA guidelines. The selected articles were then cross-searched to identify further publications. August 1, 2019 was used as the concluding date of publication. RESULTS A variety of follow-up schedules have been reported in recently published literature. Two official guidelines have been approved by international societies. The guidelines distinguish between high- and low-grade STS, but mention a wide range of follow-up intervals. Established tools of follow-up include computed tomograph, X-rays of the chest, and magnetic resonance imaging of the primary tumor site in addition to clinical observation and physical examination. CONCLUSION Further research will be needed to establish evidence-based guidelines and schedules for follow-up strategies in patients with eSTS.
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Affiliation(s)
- Dietmar Dammerer
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Viktoria Schneeweiss
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anton Schwabegger
- Department of Plastic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Noebauer-Huhmann IM, Chaudhary SR, Papakonstantinou O, Panotopoulos J, Weber MA, Lalam RK, Albtoush OM, Fueger BJ, Szomolanyi P, Grieser T, Bloem JL. Soft Tissue Sarcoma Follow-up Imaging: Strategies to Distinguish Post-treatment Changes from Recurrence. Semin Musculoskelet Radiol 2020; 24:627-644. [PMID: 33307581 DOI: 10.1055/s-0040-1721464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Soft tissue sarcomas encompass multiple entities with differing recurrence rates and follow-up intervals. The detection of recurrences and their differentiation from post-therapeutic changes is therefore complex, with a central role for the clinical radiologist. This article describes approved recommendations. Prerequisite is a precise knowledge of the current clinical management and surgical techniques. We review recurrence rates and treatment modalities. An adequate imaging technique is paramount, and comparison with previous imaging is highly recommended. We describe time-dependent therapy-related complications on magnetic resonance imaging compared with the spectrum of regular post-therapeutic changes. Early complications such as seromas, hematomas, and infections, late complications such as edema and fibrosis, and inflammatory pseudotumors are elucidated. The appearance of recurrences and radiation-associated sarcomas is contrasted with these changes. This systematic approach in follow-up imaging of soft tissue sarcoma patients will facilitate the differentiation of post-therapeutic changes from recurrences.
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Affiliation(s)
- Iris-M Noebauer-Huhmann
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Snehansh R Chaudhary
- Department of Clinical Radiology, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Joannis Panotopoulos
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Radhesh K Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - Omar M Albtoush
- Department of Radiology, University of Jordan, and Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Barbara J Fueger
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pavol Szomolanyi
- High Field MR Center, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Grieser
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Johan L Bloem
- Department of radiology, Leiden University Medical Center, Leiden, The Netherlands
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What Is the Success of Repeat Surgical Treatment of a Local Recurrence After Initial Wide Resection of Soft Tissue Sarcomas? Clin Orthop Relat Res 2018; 476:1791-1800. [PMID: 30794216 PMCID: PMC6259807 DOI: 10.1007/s11999.0000000000000158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment for patients with locally recurrent soft tissue sarcomas after wide resection is challenging, and few studies have examined the results of treating these patients. In treatment of recurrent tumors, it has been reported that positive margins are correlated to local rerecurrence, but the relationship between surgical margin and survival remains controversial and risk factors for local recurrences after wide resection of soft tissue sarcomas are not well established. This study examined clinical outcomes and factors associated with survival and local rerecurrence in patients with local recurrence after initial surgical treatment who underwent another resection with a goal of negative margins. QUESTIONS/PURPOSES The purpose of this study was to determine (1) oncologic outcomes (survival rates and local rerecurrence-free rates) of surgical treatment for patients with local recurrence after wide resection; (2) whether factors associated with survival and local rerecurrence-free rates can be determined; and (3) the proportion of patients treated by amputation at final followup. METHODS Between 1992 and 2013, we treated 530 patients with soft tissue sarcoma without metastasis. Of those, 26 (5%) were lost before 3 years of followup but were not known to have died. Of the remainder, 59 have had a local recurrence. Of those with a local recurrence, 34 (58%) were treated with wide resection, whereas 25 (42%) were treated with nonsurgical treatment including chemotherapy and radiotherapy. During that period, our general indications for wide resection were patients (1) without distant metastasis; or (2) without distant lymph node metastasis, and contraindications were distant organ metastasis and/or distant lymph node metastasis. Of those treated with wide resection, 30 (88%) were available for followup. We conducted a retrospective analysis of these 30 patients with local recurrence (17 men, 13 women) who had previously undergone wide resection. Patient followup ranged from 1 to 12 years (median, 5 years). Survivorship (including overall survival and survival free from repeat recurrence) was ascertained by the Kaplan-Meier method. Factors associated with survival were evaluated by the log-rank test. Amputations were performed when limb-sparing surgery was deemed unsuitable because of extensive involvement of the limb by tumor, including invasion of multiple muscle compartments and neurovascular components. Survivorship free from amputation was ascertained by the Kaplan-Meier method. RESULTS Overall 5- and 10-year Kaplan-Meier survival rates after resection were 70% (95% confidence interval [CI], 50%-91%) and 44% (95% CI, 12%-76%), respectively, and 12 patients (40%) developed distant metastases after the second operation. Ten patients (33%) had additional local recurrences, and overall 5- and 10-year local rerecurrence-free rates were 66% (95% CI, 48%-85%) and 50% (95% CI, 18%-81%), respectively. A positive margin was associated with further recurrence (5-year local rerecurrence-free rates of positive margin: 20% [95% CI, 0%-52%], negative margin: 89% [95% CI, 74%-100%], p < 0.01) and with survival (5-year survival rates of positive margin: 36% [95% CI, 0%-75%], negative margin: 91% [95% CI, 74%-100%], p < 0.01). The survival rate was lower in patients with recurrence developing after 2 years (5-year survival rates of within 2 years: 46% [95% CI, 2%-90%], after 2 years: 83% [95% CI, 62%-100%], p = 0.01). The overall 5- and 10-year amputation-free rates were 86% (95% CI, 74%-99%) and 81% (95% CI, 67%-96%), respectively. CONCLUSIONS A surgical procedure with negative margins appears to be important for reducing the likelihood of local recurrences and improving survival of patients with rerecurrence after wide resection of soft tissue sarcomas. Although these findings need to be confirmed in larger studies, it appears that when tumor recurrence is evident within 2 years from the primary surgery, it is associated with a poor prognosis. Local recurrence within 2 years after wide resection may also be an indicator of aggressive tumor biology. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Weichteilsarkome: Wie lassen sich posttherapeutische Veränderungen von Rezidiven unterscheiden? Radiologe 2017; 57:923-937. [DOI: 10.1007/s00117-017-0310-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Müller DA, Beltrami G, Scoccianti G, Frenos F, Capanna R. Combining limb-sparing surgery with radiation therapy in high-grade soft tissue sarcoma of extremities - Is it effective? Eur J Surg Oncol 2016; 42:1057-63. [PMID: 26924784 DOI: 10.1016/j.ejso.2016.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 01/17/2016] [Accepted: 02/02/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Limb-sparing surgery in combination with radiation therapy is a well-established treatment for high-grade soft tissue sarcomas of the extremities. But selection of cases and optimal sequence of irradiation and surgery still remain controversial. METHODS 769 patients with a high-grade soft tissue sarcoma of the extremities, who underwent a limb-sparing surgery, were retrospectively reviewed. Group 1 (N = 89) was treated with neo-adjuvant radiation therapy, group 2 (N = 315) with adjuvant irradiation and group 3 (N = 365) with surgery alone. RESULTS After a mean follow up of 45 months 95 local recurrences occurred resulting in a local recurrence-free survival of 83.2% after 5 years and 75.9% after 10 years. Contaminated surgical margins (Odds ratio: 2.42) and previous inadequate surgeries (Odds ratio: 1.89) were identified as risk factors for failed local control. Neo-adjuvant radiation therapy provides the best local recurrence-free rate for 5 years (90.0%), whereas after 10 years (78.3%) adjuvant irradiation showed better local control. The metastatic-free rate was independent from achieved surgical margins (p = 0.179). Group 1 showed the highest rate of revision surgery (9.0%), followed by group 3 (5.5%) and group 2 (4.4%) (p = 0.085). However, the rate of irradiation-correlated side effects was higher in group 2 (15.2%) than in group 1 (11.2%) (p = 0.221). CONCLUSION Surgery has to be effective for successful local control and remains the mainstay of the treatment in combination with neo-adjuvant as well as adjuvant irradiation. In really wide or even radical resections the benefit of radiation therapy can be discussed as the irradiation induced side effects are not negligible.
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Affiliation(s)
- D A Müller
- Department of Orthopedic Surgery, University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland.
| | - G Beltrami
- Department of Orthopedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Firenze, Italy.
| | - G Scoccianti
- Department of Orthopedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Firenze, Italy.
| | - F Frenos
- Department of Orthopedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Firenze, Italy.
| | - R Capanna
- Department of Orthopedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Firenze, Italy.
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Cambeiro M, Aristu JJ, Jimenez MM, Arbea L, Ramos L, San Julian M, Azinovic I, Calvo FA, Martínez-Monge R. Salvage wide resection with intraoperative electron beam therapy or HDR brachytherapy in the management of isolated local recurrences of soft tissue sarcomas of the extremities and the superficial trunk. Brachytherapy 2015; 14:62-70. [DOI: 10.1016/j.brachy.2014.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 09/03/2014] [Accepted: 09/09/2014] [Indexed: 11/15/2022]
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8
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Tseng WW, Amini B, Madewell JE. Follow-up of the soft tissue sarcoma patient. J Surg Oncol 2014; 111:641-5. [PMID: 25322963 DOI: 10.1002/jso.23814] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 09/14/2014] [Indexed: 12/16/2022]
Abstract
Despite optimal treatment, patients with soft tissue sarcoma are at risk for recurrence and therefore appropriate surveillance is critical. At minimum, regularly scheduled clinical assessments and chest X-rays are necessary. Consensus guidelines are available; however, surveillance strategies must be personalized based on the risk for recurrence and inherent disease biology. Further research is needed on a number of issues, including the impact of surveillance on clinical outcome and the utility of molecular surveillance.
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Affiliation(s)
- William W Tseng
- Department of Surgery, Division of Upper GI/General Surgery, Section of Surgical Oncology, University of Southern California, Los Angeles, California; Hoag Family Cancer Institute, Hoag Memorial Hospital Presbyterian, Newport Beach, California
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9
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Surgical procedures and prognostic factors for local recurrence of soft tissue sarcomas. J Orthop Sci 2014; 19:141-9. [PMID: 24081391 DOI: 10.1007/s00776-013-0469-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 08/28/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Patients with local recurrence of soft tissue sarcomas are predisposed to future recurrences because treatment is challenging and complicated by prior therapy. This study investigated clinical outcomes following surgical procedures for locally recurrent soft tissue sarcomas and risk factors for re-recurrence and metastasis. METHODS A retrospective analysis was conducted with 105 patients (52 males, 53 females) who underwent surgical procedures for local recurrence without distant metastasis of soft tissue sarcoma between 1987 and 2009. Patient follow-up ranged from 1 to 12 years (mean 4.9 years). RESULTS Overall 5- and 10-year survival rates were 83.4 and 67.7%, respectively. Twenty-one patients (20.0%) had additional local recurrences, and 23 (21.9%) had distant metastases. Amputation rate was 10.5% at the time of surgical procedures and 17.1% at final follow-up. Locations deep within muscles in the upper limb or trunk and surgical margins <1 cm wide were risk factors for further local recurrence. Locations deep within muscles, tumor sizes >10 cm, high-grade malignancy, and local recurrence after radical surgery were risk factors for distant metastasis. CONCLUSIONS Surgical margin and location were independent prognostic factors for local control, and a wider margin was especially important for recurrent tumors located in the trunk and upper extremity. For high-grade sarcomas with local recurrence after radical surgery, new approaches are needed to prevent distant metastases.
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Fontanesi J, Mott MP, Lucas DR, Miller PR, Kraut MJ. The role of irradiation in the management of locally recurrent non-metastatic soft tissue sarcoma of extremity/trunkal locations. Sarcoma 2011; 8:57-61. [PMID: 18521396 PMCID: PMC2395609 DOI: 10.1080/13577140412331332785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Patients who have had initial curative intent therapy for non-metastatic soft tissue sarcoma, and who
subsequently relapse at the initial site without evidence of metastatic disease, have various options regarding local treatment.
The treatment options available will be determined by the extent of relapse, previous therapy rendered, and patient
characteristics. We reported on a series of 31 patients treated initially with only surgery for extremity/trunkal high-grade soft
tissue sarcoma and then seen for recurrence at our institution between 1980 and 1999. Local re-treatment consisted
of combined modality therapy, most often aggressive surgical debulking/resection and irradiation, in an effort to reduce
the need for amputation and, where anatomically allowable, to maintain a functional limb. We report our results in
re-establishing local control, subsequent survival, and complication rates. Methods: Thirty-one patients with locally recurrent, non-metastatic high-grade soft tissue sarcoma, (excluding extraabdominal
desmoid) were retrospectively reviewed to determine local control, survival, and complication rates associated
with the relapsed disease. All patients had multimodality re-treatment most often utilizing aggressive surgical debulking and
irradiation. The irradiation consisted of either external beam alone, brachytherapy alone, or a combination of external beam
and brachytherapy. Nine patients also received multi-agent, multi-cycle chemotherapy using various regimens. In addition,
the impact of surgical margin at the time of re-resection (gross versus microscopic disease), radiation treatment type, total
radiation dose delivered, size of relapse, histological sub-type, sex and age, were evaluated to determine if they had any
impact on the re-establishment of local control and subsequent survival. Results: Local control was re-established in 25 of 31 (80.6%) patients. Two additional patients with isolated local relapse
after irradiation were salvaged with amputation and remain NED at last follow-up. With these patients a total of 27/31 (87%)
are now with local control. At last follow-up, which ranged from 23 to 192 months, 23 of 31 (74%) remained alive. Of the
eight patients who have died, four had evidence of local and distant failure. Two additional patients died of distant failure
while the treated sites remained in local control and two patients, both NED, died of intracurrent processes. Follow-up for
those patients who had re-established local control has ranged from 23 to 192 months (median=60.5 months). Time to
local failure following re-treatment ranged between 3 and 72 months following re-treatment (median=12 months). Five
patients had significant treatment related complications. Included are two patients in which amputation was required due to
local recurrences. Two patients developed a soft tissue necrosis and one patient had a wound healing problem that resolved
with conservative management. No statistical significance in the development of local control could be found based on
surgical margin status, total dose of irradiation (greater or less than 60 Gy), size of recurrence (greater than 5 cm),
histological sub-type, sex, or age (greater than 50 years). There was a trend for negative impact for those patients receiving
only external beam irradiation. Conclusion: Selective locally recurrent, non-metastatic soft tissue sarcoma of the extremity/trunkal regions should still be
considered eligible for aggressive limb-sparing therapy. Our experience suggests that a majority of patients re-establish local
control following aggressive surgical resection/debulking and irradiation and this appears to be durable in its nature. The role
of chemotherapy in this group of patients remains investigational. In a surprising finding, one patient re-relapsed in the
re-treatment site at 72 months, thus justifying continued strict surveillance not only in the primary site but also for
subsequent metastatic disease.
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Affiliation(s)
- James Fontanesi
- Department of Radiation Oncology Barbara Ann Karmanos Cancer Institute Wayne State University School of Medicine Detroit MI USA
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Kane JM, Finley JW, Driscoll D, Kraybill WG, Gibbs JF. The treatment and outcome of patients with soft tissue sarcomas and synchronous metastases. Sarcoma 2011; 6:69-73. [PMID: 18521331 PMCID: PMC2395477 DOI: 10.1080/1357714021000022168] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction: There is a strong association between poor overall survival and a short disease-free interval for patients with
soft tissue sarcomas (STS) and metastatic disease. Patients with STS and synchronous metastases should have a very dismal
prognosis.The role of surgery in this subgroup of patients with STS has not been defined. Patients and Methods: A single-institution retrospective review was performed of 48 patients with STS and synchronous
metastases in regard to patient demographics, presentation, tumor characteristics, metastatic sites, treatment, follow-up, and
survival over a 27-year period. Results: Most primary tumors were ≥10 cm (58%), high-grade histology (77%), and located on the extremity (60%).The
most frequent site of metastatic disease was the lung (63%); 27% of patients had metastases to ≥2 organ sites. Surgery to
the primary tumor was performed in 94% of patients (n = 45) and 68% had additional radiation therapy (n = 32). Thirty-
five percent of patients underwent at least one metastastectomy (n = 17). Chemotherapy was administered to 90% of patients
(n = 43); 31% received ≥3 different regimens (n = 15) and 25% were given intra-arterial or intracavitary therapy (n = 12).
Median overall survival was 15 months with a 21% 2-year survival. Local control of the primary tumor was achieved in 54%
(n = 26), and metastastectomy was performed in 35% (n = 17). No analyzed factors were associated with an improvement
in overall survival Conclusions: Despite multiple poor prognostic factors, the survival of patients with STS and metastases is comparable to
those who develop delayed metastatic disease. However, unlike patients who present with metachronous disease, there was
no improved survival observed for patients treated with metastastectomy. Consequently, treatment for patients with STS
and synchronous metastases should be approached with caution. Surgical management of STS with synchronous metastases
must be considered palliative and should be reserved for patients requiring palliation of symptoms. Patients must also
be well informed of the noncurative nature of the procedure.
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Affiliation(s)
- John M Kane
- Division of Surgical Oncology Roswell Park Cancer Institute Elm & Carlton Streets Buffalo NY 14263 USA
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12
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Abatzoglou S, Turcotte RE, Adoubali A, Isler MH, Roberge D. Local recurrence after initial multidisciplinary management of soft tissue sarcoma: is there a way out? Clin Orthop Relat Res 2010; 468:3012-8. [PMID: 20700676 PMCID: PMC2947683 DOI: 10.1007/s11999-010-1481-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Multimodality treatment of primary soft tissue sarcoma by expert teams reportedly affords a low incidence of local recurrence. Despite advances, treatment of local recurrence remains difficult and is not standardized. QUESTIONS/PURPOSES We (1) determined the incidence of local recurrence from soft tissue sarcoma; (2) compared characteristics of the recurrent tumors with those of the primary ones; (3) evaluated local recurrences, metastases and death according to treatments; and (4) explored the relationship between the diagnosis of local recurrence and the occurrence of metastases. METHODS From our prospective database, we identified 618 soft tissue sarcomas. Thirty-seven of the 618 patients (6%) had local recurrence. Leiomyosarcoma was the most frequent diagnosis (eight of 37). The mean delay from original surgery was 22 months (range, 2-75 months). Mean size was 4.8 cm (range, 0.4-28.0 cm). Median followup after local recurrence was 16 months (range, 0-98 months). RESULTS Recurrent tumors had a tendency toward becoming deeper seated and higher graded. Nineteen of the 37 patients with recurrence underwent limb salvage (nine free flaps) and six had an amputation. Twenty-two (59%) had metastases, including 10 occurring after the local recurrence event at an average delay of 21 months (range, 1-34 months). Six patients developed additional local recurrences, with no apparent difference in risk between amputation (two of six) and limb salvage (four of 19). CONCLUSIONS Patients with a local recurrence of a soft tissue sarcoma have a poor prognosis. Limb salvage and additional radiotherapy remain possible but with substantial complications. Amputation did not prevent additional local recurrence or death.
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Affiliation(s)
- Sarantis Abatzoglou
- McGill University Health Centre, 1650 Cedar Avenue, Room B5 159.6, Montreal, QC H3G 1A4 Canada
| | - Robert E. Turcotte
- McGill University Health Centre, 1650 Cedar Avenue, Room B5 159.6, Montreal, QC H3G 1A4 Canada
| | | | | | - David Roberge
- McGill University Health Centre, 1650 Cedar Avenue, Room B5 159.6, Montreal, QC H3G 1A4 Canada
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Innocenti M, Abed YY, Beltrami G, Delcroix L, Balatri A, Capanna R. Quadriceps muscle reconstruction with free functioning latissimus dorsi muscle flap after oncological resection. Microsurgery 2009; 29:189-98. [PMID: 19097058 DOI: 10.1002/micr.20607] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The concept of limb salvage led to increased demand for more complex and sophisticated reconstructive options to achieve better functional and cosmetic outcome. Reconstruction of the total or partial loss of quadriceps muscle after soft tissue sarcomas excision with free functioning latissimus dorsi muscle transfer had become more popular in the last years. PATIENTS AND METHODS Between November 1993 and October 2004, 11 patients with average age 45.5 years underwent excision of quadriceps muscle followed by simultaneous reconstruction with free functioning latissimus dorsi muscle. There were six men and five women. The tumors were high grade in 90.9% of patients and were >10 cm in 81.8% of patients. The tumor extension required the resection of the entire quadriceps in four cases, of three heads in six cases, of only two heads in one case. RESULTS The average follow up was 69 months. The average time of recovery of the contractile activity of the muscle was 8.3 months after operation. The musculoskeletal tumor society rating score (MTSRS) scored excellent or good in 73% of patients. Three patients (27.3%) died of metastatic disease. Local recurrence occurred in one patient (9.1%). Limb salvage was achieved in all the patients (100%). CONCLUSION This method of reconstruction is a reliable technique not only to fill the defect resulting from oncological resection but also to provide better function. Microsurgical reconstruction of soft tissue sarcoma helps to expand the indications of limb salvage by allowing better local control and achieving adequate function and coverage.
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Affiliation(s)
- Marco Innocenti
- Department of Orthopaedics, Reconstructive Microsurgery Unit, Azienda Ospedaliera Careggi, C.T.O., Florence, Italy.
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Sarcoma de partes blandas: ¿existe posibilidad de rescate cuando la primera cirugía no fue resolutiva? Rev Esp Cir Ortop Traumatol (Engl Ed) 2008. [DOI: 10.1016/s1888-4415(08)74789-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Duart-Clemente J, San-Julián M, Martínez-Monge R, Martín-Algarra S. Soft Tissue Sarcoma: Can a Rescue Procedure be Performed when the First Surgery was Unsuccessful? Rev Esp Cir Ortop Traumatol (Engl Ed) 2008. [DOI: 10.1016/s1988-8856(08)70064-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Moureau-Zabotto L, Thomas L, Bui BN, Chevreau C, Stockle E, Martel P, Bonneviale P, Marques B, Coindre JM, Kantor G, Matsuda T, Delannes M. Management of soft tissue sarcomas (STS) in first isolated local recurrence: a retrospective study of 83 cases. Radiother Oncol 2004; 73:313-9. [PMID: 15588876 DOI: 10.1016/j.radonc.2004.05.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2003] [Revised: 04/27/2004] [Accepted: 05/27/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE To analyze the management and clinical outcome of patients treated for a first isolated local recurrence of soft tissue sarcomas (trunk or extremities) and to identify prognosis factors. METHODS AND MATERIAL Between 1980 and 1999, 83 adult patients were included in the study. Mean age was 61 years. Mean tumor size was 6 cm. Most sarcomas were located in extremities (n=74), were deep (n=60), and proximal (n=53); 30 involved nerves or vessels. Histologic subtypes were mainly grade 2 (42%) or 3 (36%) histiocytofibrosarcomas (49%) and liposarcomas (20%). Surgical treatment of recurrences consisted in wide excision (29 cases), marginal resection (43 cases), 5 patients requiring amputation. Final results were R0 (n=33), R1 (n=47) or R2 (n=3) resection. Besides surgery, 6 patients received neo-adjuvant and 7 others adjuvant chemotherapy. Twenty three patients received post-operative external beam radiotherapy (EBRT) (mean dose 55 Gy) and 26 interstitial 192Ir low dose rate brachytherapy (BCT) (mean dose 45 Gy for BCT alone, 22 Gy when associated with EBRT), 19 patients being re-irradiated. RESULTS Mean follow up was 13 years. Thirty-seven (45%) patients relapsed, 62% of whom presenting an isolated local recurrence. Nineteen patients developed distant metastases. Multivariate analysis showed only tumor depth (P=0.05) and re-resection for primary R1 resection (P=0.018) being independent prognosis factors for tumor control, radiotherapy (EBRT and/or BCT) being significant in univariate analysis (P=0.05). Overall survival rate was 73%, 54%, and 47% at, respectively, 3.5 and 10 years, and was 65%, 35% and 32% after a further local recurrence. Multivariate analysis showed trunk (P=0.0001) or inferior extremity locations (P=0.023), symptomatic (P=0.001), high grade (P=0.01), deep (P=0.01) tumors, and the occurrence of a further local failure (P=0.004) as unfavorable characteristics for overall survival. CONCLUSIONS A first isolated local recurrence of STS increases mainly the risk of a subsequent local relapse. Quality of local treatment is decisive. When a conservative treatment is feasible, it should combine surgical resection and radiotherapy, BCT being the best suited in previously irradiated patients. Efforts have to be pursued to increase quality of the treatment of primary tumors, at best performed in centers that have expertise in this field.
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Moureau-Zabotto L, Thomas L, Bui BN, Chevreau C, Stockle E, Martel P, Bonneviale P, Marques B, Coindre JM, Kantor G, Matsuda T, Delannes M. Prise en charge des sarcomes des tissus mous en première rechute locale isolée : étude rétrospective de 83 cas. Cancer Radiother 2004; 8:279-87. [PMID: 15561593 DOI: 10.1016/j.canrad.2004.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2004] [Revised: 09/13/2004] [Accepted: 09/15/2004] [Indexed: 11/18/2022]
Abstract
PURPOSE To analyse the management and clinical outcome of patients treated for a first isolated local recurrence of soft tissue sarcoma (trunk or extremities) and to identify prognosis factors. PATIENTS AND MATERIAL This is a retrospective study of 83 adult patients treated between 1980 and 1999. Mean tumor size was 6 cm. Most sarcomas were located in extremities (N =74), were deep (N =60), and proximal (N =53). Thirty involved nerves or vessels. Histologic subtypes were mainly grade 2 (42%) or 3 (36%) histocytofibrosarcomas (49%) and liposarcomas (20%). Surgical treatment of recurrences consisted in wide excision (32 cases), marginal resection (46 cases), five patients requiring amputation. Final results were R0 (N =33), R1 (N =47) or R2 (N =3) resection. Beside surgery, six patients received neoadjuvant and seven others adjuvant chemotherapy. Twenty-three patients received postoperative external beam radiotherapy (EBRT) (mean dose 55 Gy) and 26 interstitial (192)Ir low dose rate brachytherapy (BCT) (mean dose 45 Gy for BCT alone, 22 Gy when associated with EBRT), 19 patients being re-irradiated. RESULTS Mean follow up was 59 months. Thirty-seven (45%) tumors relapsed, 62% locally as first event. Nineteen patients developed secondary distant metastases. Multivariate analysis showed only tumour depth (P =0.05) and re-resection for primary R1 resection for the recurrence (P =0.018) being independent prognosis factors for tumour control, radiotherapy (EBRT and/or BCT) being significant in univariate analysis (P =0.05). Overall survival rate was 73, 54, and 47% at respectively 3, 5 and 10 years, and was 65, 35 and 32% after a further local recurrence. Multivariate analysis showed trunk (P =0.0001) or inferior extremity locations (P =0.023), symptomatic (P =0.001), high grade (P =0.01), deep (P = 0.01) tumours, and the occurrence of a further local failure (P =0.004) as unfavourable characteristics for overall survival. CONCLUSION Because of the high relapse rate in this series, a first isolated local recurrence of STS increases mainly the risk of a subsequent local relapse. Quality of local treatment for the first local relapse is decisive. When a conservative treatment is feasible, it should combine surgical resection and radiotherapy, brachytherapy being the best suited in previously irradiated patients. Efforts have to be pursued to increase quality of the treatment of primary tumours, at best performed in centers that have expertise in this field.
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Affiliation(s)
- L Moureau-Zabotto
- Département d'oncologie radiothérapie, institut Clandius-Regaud, Toulouse, France.
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