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Sah SP, Regmi A, Niraula BB, Sehrawat A, Bhagat SK, Dhingra M. Interferons as Neoadjuvant Chemotherapy for Giant Cell Tumor: A Hospital-Based Prospective Pilot Study. Indian J Med Paediatr Oncol 2024. [DOI: 10.1055/s-0043-1775817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Abstract
Introduction Neoadjuvant chemotherapy is now considered an effective way to treat Campanacci grade 2 and 3 giant cell tumors (GCTs). Assessment of these drugs is essential clinically, radiologically, and pathologically. This study analyzes the early results of angiogenesis inhibitors (interferons) in the aggressive GCT of bone.
Methodology A prospective pilot study was conducted from January 2021 to July 2022 including eight biopsy-proven GCT patients subjected to interferon therapy. Radiological assessment was done with changes on plain radiograph, computerized tomography scan, and magnetic resonance imaging. Histopathological examination was done by changes in the biopsy and resected segment.
Results Out of the eight patients included in the study, 26% (n = 3) were males and 62% (n = 5) were females, with mean age of the patients being 24.6 ± 8.48 years (range: 22–38). There was significant reduction of the size of swelling (p-value: 0.049), significant reduction in Visual Analog Scale score (p-value: 0.011), significant decrease in swelling size on radiograph (p-value: 0.012), significant marginal sclerosis (p-value: 0.001), significant neocortex formation on radiographs (p-value: 0.001), significant result in and osteoid formation (p-value: 0.001) on histology. Whereas Campanacci grade on plain radiographs, number of viable cells, and number of viable stromal cell were not statistically different in comparison with pretherapy and posttherapy status.
Conclusion Interferon therapy in a GCT has potential beneficiary effect in terms of clinical, radiological, and pathological outcomes. It might prove to be an effective alternative to standard neoadjuvant chemotherapy in the management of aggressive GCT of bones.
Level of Evidence III.
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Affiliation(s)
- Saroj Prasad Sah
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Rishikesh, Uttarakhand, India
| | - Anil Regmi
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Rishikesh, Uttarakhand, India
| | - Bishwa Bandhu Niraula
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Rishikesh, Uttarakhand, India
| | - Amit Sehrawat
- Department of Medical Oncology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, Uttarakhand, India
| | - Saroj Kumar Bhagat
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Rishikesh, Uttarakhand, India
| | - Mohit Dhingra
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Rishikesh, Uttarakhand, India
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Tortorello GN, Li EH, Sharon CE, Ma KL, Maki RG, Miura JT, Fraker DL, DeMatteo RP, Karakousis GC. Neoadjuvant Chemotherapy in Retroperitoneal Sarcoma: A National Cohort Study. Ann Surg Oncol 2023; 30:6886-6893. [PMID: 37488394 DOI: 10.1245/s10434-023-13933-2] [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: 03/20/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Management of retroperitoneal sarcoma (RPS) remains controversial, with the mainstay of treatment being surgery. While neoadjuvant radiation demonstrated no improvement in recurrence-free survival in a prospective randomized trial (STRASS), the role of neoadjuvant chemotherapy (NCT) remains unknown and is the subject of ongoing study (STRASS2). METHODS Patients who underwent surgical resection of high-grade RP leiomyosarcoma (LMS) or dedifferentiated liposarcoma (DDLS) were identified from the National Cancer Database (2006-2019). Predictors of NCT were analyzed using univariate and multivariate logistic regression analyses. Differences in 5-year survival were examined using the Kaplan-Meier (KM) method and by Cox proportional hazard modeling. RESULTS A total of 2656 patients met inclusion criteria. Fifty-seven percent of patients had DDLS and 43.5% had LMS. Six percent of patients underwent NCT. Patients who received NCT were younger (median age 60 vs 64 years, p < 0.001) and more likely to have LMS (OR 1.4, p = 0.04). In comparing NCT with no-NCT patients, there was no difference in 5-year overall survival (OS) on KM analysis (57.3% vs 52.8%, p = 0.38), nor was any difference seen after propensity matching (54.9% vs 49.1%, p = 0.48, N = 144 per group). When stratified by histology, there was no difference in OS based on receipt of NCT (LMS: 59.8% for NCT group, 56.6% for no-NCT, p = 0.34; DDLS: 54.2% for NCT group, 50.1% for no-NCT, p = 0.99). CONCLUSION In patients undergoing surgical resection of RP LMS or DDLS, NCT does not appear to confer an OS advantage. Prospective randomized data from STRASS2 will confirm or refute these retrospective data.
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Affiliation(s)
- Gabriella N Tortorello
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Eric H Li
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Cimarron E Sharon
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin L Ma
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert G Maki
- Division of Hematology and Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - John T Miura
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas L Fraker
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ronald P DeMatteo
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Giorgos C Karakousis
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Delisle M, Gyorki D, Bonvalot S, Nessim C. Landmark Series: A Review of Landmark Studies in the Treatment of Primary Localized Retroperitoneal Sarcoma. Ann Surg Oncol 2022; 29:7297-7311. [DOI: 10.1245/s10434-022-12517-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022]
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The Implications of an Unplanned Sarcoma Excision (the “Whoops” Operation). Surg Clin North Am 2022; 102:529-538. [DOI: 10.1016/j.suc.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Role of Radiation Therapy for Newly Diagnosed Retroperitoneal Sarcoma. Curr Treat Options Oncol 2021; 22:75. [PMID: 34213610 DOI: 10.1007/s11864-021-00877-6] [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] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
OPINION STATEMENT Soft tissue sarcomas (STS) are rare, aggressive, and heterogenous tumors, comprising approximately 1% of adult cancers with over 50 different subtypes. The mainstay of treatment for retroperitoneal sarcomas (RPS) includes surgical resection. The addition of radiation therapy (RT), either preoperatively or postoperatively, has been used to potentially decrease the risk of local recurrence. The recently published results from STRASS (EORTC-STBSG 62092-22092), which randomized patients to receive or not receive preoperative radiation, indicate no abdominal recurrence-free survival benefit (primary endpoint) nor overall survival benefit to date from the addition of preoperative RT prior to surgical resection in patients with RPS. Keeping in mind caveats of subgroup analyses, the data show a significant reduction in local recurrence with radiation therapy in resected patients and non-significant trends toward improved abdominal recurrence-free survival in all patients and improved local control and abdominal recurrence-free survival in patients with liposarcoma and low-grade sarcoma. Given the high rate of local failure with surgery alone, it is possible that higher RT dose and/or selective RT dose painting may improve outcomes. Prior to treatment, the authors encourage multidisciplinary review and discussion of management options at a sarcoma center for patients with RPS. Selective use of RT may be considered for patients at high risk of local recurrence.
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6
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Yokoyama Y, Nishida Y, Ikuta K, Nagino M. A case of retroperitoneal dedifferentiated liposarcoma successfully treated by neoadjuvant chemotherapy and subsequent surgery. Surg Case Rep 2020; 6:105. [PMID: 32448975 PMCID: PMC7246274 DOI: 10.1186/s40792-020-00865-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/07/2020] [Indexed: 12/25/2022] Open
Abstract
Background Retroperitoneal liposarcoma (RPLS) is the most commonly observed soft tissue sarcoma in the retroperitoneal space. Although the beneficial effect of chemotherapy for RPLS is controversial, there are some reports that have shown a considerable tumor-suppressive effect of chemotherapy in RPLS. We demonstrate a case of dedifferentiated RPLS, which was initially considered inoperable but was successfully treated by neoadjuvant chemotherapy and subsequent curative resection. Case presentation A 59-year-old female was referred to our hospital with a chief complaint of right lower quadrant abdominal pain. Abdominal computed tomography revealed a large retroperitoneal tumor with a maximum diameter of 11 cm. The tumor involved retroperitoneal major vasculatures, such as the right common iliac vein and artery, as well as the right psoas muscle and femoral nerve. The right ureter was also involved and obstructed by the tumor. A biopsy was performed through the retroperitoneal route, and the tumor was diagnosed as a dedifferentiated liposarcoma with the Fédération Nationale des Centres de Lutte Contre le Cancer grade 3. Because the tumor was highly invasive and complete resection was not feasible, we decided to administer neoadjuvant chemotherapy with doxorubicin and ifosfamide (AI). After completing 6 courses of AI, the tumor size was considerably reduced, and we decided to perform surgery with curative intent. Before laparotomy, femoro-femoral arterial bypass was performed to prepare for the right common iliac artery resection. Thereafter, the patient underwent laparotomy and tumor resection combined with right nephrectomy, resection of the right common iliac artery and vein, and resection of the right psoas muscle and femoral nerve. The postoperative course was uneventful, although the patient needed a walking brace to support her gait. The pathological findings indicated a 99% disappearance of tumor cells. The patient was healthy without any complaints after 1 year of surgery, and a follow-up CT scan revealed no tumor recurrence. Conclusions To the best of our knowledge, this is the first report that showed a nearly complete pathological response to AI in dedifferentiated RPLS, which was subsequently completely resected.
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Affiliation(s)
- Yukihiro Yokoyama
- Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Yoshihiro Nishida
- Department of Orthopedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kunihiro Ikuta
- Department of Orthopedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Masato Nagino
- Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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7
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Gamboa AC, Gronchi A, Cardona K. Soft-tissue sarcoma in adults: An update on the current state of histiotype-specific management in an era of personalized medicine. CA Cancer J Clin 2020; 70:200-229. [PMID: 32275330 DOI: 10.3322/caac.21605] [Citation(s) in RCA: 278] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 12/13/2022] Open
Abstract
Soft-tissue sarcomas (STS) are rare tumors that account for 1% of all adult malignancies, with over 100 different histologic subtypes occurring predominately in the trunk, extremity, and retroperitoneum. This low incidence is further complicated by their variable presentation, behavior, and long-term outcomes, which emphasize the importance of centralized care in specialized centers with a multidisciplinary team approach. In the last decade, there has been an effort to improve the quality of care for patients with STS based on anatomic site and histology, and multiple ongoing clinical trials are focusing on tailoring therapy to histologic subtype. This report summarizes the latest evidence guiding the histiotype-specific management of extremity/truncal and retroperitoneal STS with regard to surgery, radiation, and chemotherapy.
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Affiliation(s)
- Adriana C Gamboa
- Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, Georgia
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Kenneth Cardona
- Division of Surgical Oncology, Winship Cancer Institute, Emory University Hospital Midtown, Atlanta, Georgia
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8
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Pak LM, Kwon NK, Baldini EH, Learn PA, Koehlmoos T, Haider AH, Raut CP. Racial Differences in Extremity Soft Tissue Sarcoma Treatment in a Universally Insured Population. J Surg Res 2020; 250:125-134. [PMID: 32044509 DOI: 10.1016/j.jss.2020.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 11/05/2019] [Accepted: 01/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND In prior reports from population-based databases, black patients with extremity soft tissue sarcoma (ESTS) have lower reported rates of limb-sparing surgery and adjuvant treatment. The objective of this study was to compare the multimodality treatment of ESTS between black and white patients within a universally insured and equal-access health care system. METHODS Claims data from TRICARE, the US Department of Defense insurance plan that provides health care coverage for 9 million active-duty personnel, retirees, and dependents, were queried for patients younger than 65 y with ESTS who underwent limb-sparing surgery or amputation between 2006 and 2014 and identified as black or white race. Multivariable logistic regression analysis was used to evaluate the impact of race on the utilization of surgery, chemotherapy, and radiation. RESULTS Of the 719 patients included for analysis, 605 patients (84%) were white and 114 (16%) were black. Compared with whites, blacks had the same likelihood of receiving limb-sparing surgery (odds ratio [OR], 0.861; 95% confidence interval [95% CI], 0.284-2.611; P = 0.79), neoadjuvant radiation (OR, 1.177; 95% CI, 0.204-1.319; P = 0.34), and neoadjuvant (OR, 0.852; 95% CI, 0.554-1.311; P = 0.47) and adjuvant (OR, 1.211; 95% CI, 0.911-1.611; P = 0.19) chemotherapy; blacks more likely to receive adjuvant radiation (OR, 1.917; 95% CI, 1.162-3.162; P = 0.011). CONCLUSIONS In a universally insured population, racial differences in the rates of limb-sparing surgery for ESTS are significantly mitigated compared with prior reports. Biologic or disease factors that could not be accounted for in this study may contribute to the increased use of adjuvant radiation among black patients.
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Affiliation(s)
- Linda M Pak
- Department of Surgery, Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Nicollette K Kwon
- Department of Surgery, Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elizabeth H Baldini
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts; Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Peter A Learn
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Tracey Koehlmoos
- Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Adil H Haider
- Department of Surgery, Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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9
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Chowdhary M, Chowdhary A, Sen N, Zaorsky NG, Patel KR, Wang D. Does the addition of chemotherapy to neoadjuvant radiotherapy impact survival in high-risk extremity/trunk soft-tissue sarcoma? Cancer 2019; 125:3801-3809. [PMID: 31490546 DOI: 10.1002/cncr.32386] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/14/2019] [Accepted: 06/15/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND The role of chemotherapy in extremity/trunk soft-tissue sarcoma (ET-STS) is controversial, even for patients at high risk for distant recurrence and death (those with high-grade tumors ≥5 cm in size). This study examines the impact of integrating chemotherapy with neoadjuvant radiotherapy (RT) on overall survival (OS) for patients with high-risk ET-STS. METHODS The National Cancer Data Base was queried for adult patients with high-risk ET-STS who received neoadjuvant RT and limb salvage surgery between 2006 and 2014. Patients were stratified into RT and chemoradiotherapy (CRT) cohorts. OS for the RT and CRT cohorts was analyzed with the Kaplan-Meier method, log-rank tests, and Cox proportional hazards models. Propensity score matching (PSM) analysis was used to account for a potential treatment selection bias between the cohorts. RESULTS A total of 884 patients were identified: 639 (72.3%) in the RT cohort and 245 (27.7%) in the CRT cohort. The unadjusted 5-year Kaplan-Meier OS rate was significantly higher in the CRT cohort: 72.0% versus 56.1% (P < .001). Neoadjuvant chemotherapy was associated with improved OS in univariate and multivariable analyses (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.41-0.78; P < .001). PSM identified 2 evenly matched cohorts of 212 patients each. The 5-year matched Kaplan-Meier OS rates were 69.8% and 55.4% for the CRT and RT cohorts, respectively (P = .002). The addition of neoadjuvant chemotherapy remained prognostic for OS on PSM (HR, 0.56; 95% CI, 0.39-0.83; P = .003). CONCLUSIONS The addition of chemotherapy to neoadjuvant RT was associated with improved OS for patients with high-risk ET-STS. In the absence of randomized data evaluating CRT versus RT, these findings warrant further investigation.
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Affiliation(s)
- Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Akansha Chowdhary
- Division of Hematology and Medical Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Neilayan Sen
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hersey, Pennsylvania
| | - Kirtesh R Patel
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Dian Wang
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
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10
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Lindner LH. [Multimodal treatment of sarcomas: standards and new aspects in pharmacological and radio-oncological treatment]. Chirurg 2019; 90:457-461. [PMID: 31053897 DOI: 10.1007/s00104-019-0958-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with localized high-risk soft tissue sarcoma are at high risk for both local recurrence and distant metastases despite optimal surgical treatment. OBJECTIVE Importance of preoperative or postoperative chemotherapy and hyperthermia. METHODS Evaluation and overview of published study results. RESULTS Preoperative or postoperative radiotherapy is considered as standard for patients with localized high-risk soft tissue sarcoma. The results of two randomized studies on neoadjuvant chemotherapy showed a survival benefit. As both studies did not have a control arm without chemotherapy but in one case the superiority of anthracycline/ifosfamide-based chemotherapy in combination with hyperthermia over chemotherapy alone and in the other case the superiority of anthracycline/ifosfamide-based chemotherapy over histology-specific chemotherapy were shown, the formal proof of the superiority of this treatment is still missing. Stratifying the patients treated in the so far largest randomized adjuvant chemotherapy trial according to current risk criteria ( http://www.sarculator.com ) revealed a significant survival benefit for patients at high risk of recurrence. CONCLUSION For high-risk soft tissue sarcomas, multimodal treatment strategies involving perioperative chemotherapy, radiotherapy and, if possible, hyperthermia should be considered in addition to tumor resection. Preoperative chemotherapy should be given preference over postoperative chemotherapy based on available data.
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Affiliation(s)
- L H Lindner
- Medizinische Klinik und Poliklinik III, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
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Wang GY, Lucas DR. Dedifferentiated Liposarcoma With Myofibroblastic Differentiation. Arch Pathol Lab Med 2019; 142:1159-1163. [PMID: 30281365 DOI: 10.5858/arpa.2018-0205-ra] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Liposarcoma is divided into myxoid, pleomorphic, well-differentiated, and dedifferentiated subtypes. Dedifferentiated liposarcoma displays the greatest histomorphologic diversity, including a subset with myofibroblastic differentiation that shares similarities with a spectrum of reactive, benign, and malignant soft tissue lesions. Misdiagnosis may lead to deleterious consequences, as dedifferentiated liposarcoma differs significantly in its prognosis and treatment from its mimics. OBJECTIVE.— To review the clinicopathologic, immunohistochemical, and molecular features of the myofibroblastic variant of dedifferentiated liposarcoma as well as the key distinguishing features from its mimics. DATA SOURCES.— Review of pertinent literature on major features and current understanding of dedifferentiated liposarcoma with myofibroblastic differentiation. CONCLUSIONS.— The myofibroblastic variant of dedifferentiated liposarcoma is an uncommon and underrecognized sarcoma with several important differential diagnoses, and likely represents the major subset of aggressive retroperitoneal tumors that may have been misdiagnosed as desmoid-type fibromatosis, inflammatory myofibroblastic tumor, or another type of sarcoma in the past.
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Affiliation(s)
| | - David R Lucas
- From the Department of Pathology, University of Michigan, Ann Arbor
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Mastoraki A, Schizas D, Papanikolaou IS, Bagias G, Machairas N, Agrogiannis G, Liakakos T, Arkadopoulos N. Management of primary retroperitoneal synovial sarcoma: A case report and review of literature. World J Gastrointest Surg 2019; 11:27-33. [PMID: 30705737 PMCID: PMC6354068 DOI: 10.4240/wjgs.v11.i1.27] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/11/2018] [Accepted: 12/30/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Synovial sarcoma (SS) is a rare type of soft tissue sarcoma that is usually developed from areas where synovial tissue exists, especially at the extremities. Nevertheless, several cases of retroperitoneal SS (RSS) have been described. We herein report a case of RSS presented in our institution.
CASE SUMMARY A 69-year-old female patient was admitted with a large, palpable, firm mass in the right abdominal space SS. Computerized tomography scan depicted a concentric, sharply marinated retro-peritoneal lesion which was displacing the right kidney and the lower edge of the liver. Subsequently, the patient underwent surgical excision of the mass with additional right nephrectomy and resection of the right adrenal gland and a part of the diaphragm. The final histological diagnosis of the tumour was grade II monophasic RSS.
CONCLUSION RSS is encountered in the biphasic type, the monophasic fibrous, and the monophasic epithelial category as well. Relevant clinical manifestations are not always documented at early stages. Therefore, the final diagnosis is posed after complete histological examination taking into consideration the results of immunochemistry and genetic analysis. Therapeutic approach happens often late when metastases at the lungs and the liver are apparent. Thus, 5-year survival rates remain low.
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Affiliation(s)
- Aikaterini Mastoraki
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens 12462, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens 11527, Greece
| | - Ioannis S Papanikolaou
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens 12462, Greece
| | - George Bagias
- Hannover Medical School, Clinic for General, Visceral and Transplant Surgery, Hannover 30625, Germany
| | - Nikolaos Machairas
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens 12462, Greece
| | - George Agrogiannis
- 1st Department of Pathology, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Theodore Liakakos
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens 11527, Greece
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens 12462, Greece
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Neoadjuvant Interdigitated Chemoradiotherapy Using Mesna, Doxorubicin, and Ifosfamide for Large, High-grade, Soft Tissue Sarcomas of the Extremity. Am J Clin Oncol 2019; 42:1-5. [DOI: 10.1097/coc.0000000000000467] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Smolle MA, Andreou D, Tunn PU, Szkandera J, Liegl-Atzwanger B, Leithner A. Diagnosis and treatment of soft-tissue sarcomas of the extremities and trunk. EFORT Open Rev 2017; 2:421-431. [PMID: 29209518 PMCID: PMC5702952 DOI: 10.1302/2058-5241.2.170005] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The relatively low incidence and often atypical clinical presentation of soft-tissue sarcomas (STS) impedes early and adequate diagnosis. Patients may report on recently enlarged soft-tissue swellings, infrequently complain of painful lesions, or even have no symptoms at all. A thorough diagnostic work-up is essential in order to distinguish between benign soft-tissue tumours and STSs. Patient history, clinical features and radiological findings all help in assessing the underlying pathology. ‘Worrying’ features such as recent increase in size, deep location relative to the fascia, a tumour exceeding 4 cm in size, and invasive growth patterns seen on imaging should prompt verification by biopsy. Even though acquisition of biopsy material may be incomplete, one should bear in mind some essential rules. Regardless of the biopsy technique applied, the most direct route to the lump in question should be identified, contamination of adjacent structures should be avoided and a sufficient amount of tissue acquired. Treatment of STS is best planned by a multidisciplinary team, involving experts from various medical specialities. The benchmark therapy consists of en bloc resection of the tumour, covered by a safety margin of healthy tissue. Depending on tumour histology, grade, local extent and anatomical stage, radiotherapy, chemotherapy and isolated hyperthermic limb perfusion may be employed. Due to the complexity of treatment, any soft-tissue swelling suspected of malignancy is best referred directly to a sarcoma centre, where therapeutic management is carefully planned by an experienced multidisciplinary team.
Cite this article: EFORT Open Rev 2017;2:421-431. DOI: 10.1302/2058-5241.2.170005
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Affiliation(s)
| | | | - Per-Ulf Tunn
- Sarcoma Center Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Germany
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Maurice MJ, Yih JM, Ammori JB, Abouassaly R. Predictors of surgical quality for retroperitoneal sarcoma: Volume matters. J Surg Oncol 2017; 116:766-774. [DOI: 10.1002/jso.24710] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/13/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Matthew J. Maurice
- Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland Ohio
| | - Jessica M. Yih
- Urology Institute; University Hospitals Cleveland Medical Center; Cleveland Ohio
| | - John B. Ammori
- Department of Surgery; University Hospitals Cleveland Medical Center; Cleveland Ohio
| | - Robert Abouassaly
- Urology Institute; University Hospitals Cleveland Medical Center; Cleveland Ohio
- Division of Urology; Louis Stokes Cleveland VA Medical Center; Cleveland Ohio
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Can Abdominal Computed Tomography Imaging Help Accurately Identify a Dedifferentiated Component in a Well-Differentiated Liposarcoma? J Comput Assist Tomogr 2017; 40:872-879. [PMID: 27454788 DOI: 10.1097/rct.0000000000000462] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the ability of computed tomography (CT) to differentiate an atypical lipomatous tumor/well-differentiated liposarcoma (WDLPS) from a WDLPS with a dedifferentiated component (DDLPS) within it. MATERIALS AND METHODS Forty-nine untreated patients with abdominal atypical lipomatous tumors/well-differentiated liposarcomas who had undergone contrast-enhanced CT were identified using an institutional database. Three radiologists who were blinded to the pathology findings evaluated all the images independently to determine whether a dedifferentiated component was present within the WDLPS. The CT images were evaluated for fat content (≤25% or >25%); presence of ground-glass density, enhancing and/or necrotic nodules; presence of a capsule surrounding the mass; septations; and presence and pattern of calcifications. A multivariate logistic regression model with generalized estimating equations was used to correlate imaging features with pathology findings. Kappa statistics were calculated to assess agreement between the three radiologists. RESULTS On the basis of pathological findings, 12 patients had been diagnosed with DDLPS within a WDLPS and 37 had been diagnosed with WDLPS. The presence of an enhancing or a centrally necrotic nodule within the atypical lipomatous tumor was associated with dedifferentiated liposarcoma (P = 0.02 and P = 0.0003, respectively). The three readers showed almost perfect agreement in overall diagnosis (κ r = 0.83; 95% confidence interval, 0.67-0.99). CONCLUSIONS An enhancing or centrally necrotic nodule may be indicative of a dedifferentiated component in well-differentiated liposarcoma. Ground-glass density nodules may not be indicative of dedifferentiation.
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Nathenson MJ, Sausville E. Looking for answers: the current status of neoadjuvant treatment in localized soft tissue sarcomas. Cancer Chemother Pharmacol 2016; 78:895-919. [PMID: 27206640 PMCID: PMC7577379 DOI: 10.1007/s00280-016-3055-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 05/04/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE Sarcomas are a rare and heterogeneous variant of cancer. The standard of care treatment involves surgical resection with radiation in high-risk patients. Despite appropriate treatment approximately 50 % of patients will suffer and die from recurrent disease. The purpose of this article is to review the current evidence concerning the use of neoadjuvant chemotherapy with or without radiation in soft tissue sarcomas. METHODS An in-depth literature search was conducted using Ovid Medline and PubMed. RESULTS The most active chemotherapeutic agents in sarcoma are anthracyclines and ifosfamide. Adjuvant chemotherapy trials show only minimal benefit. Neoadjuvant chemotherapy offers the potential advantage of reducing the extent of surgery, increasing the limb salvage rate, early exposure of micrometastatic disease to chemotherapy, and assessment of tumor response to chemotherapy. Some retrospective and phase II trials suggest a benefit to neoadjuvant chemotherapy. Unfortunately, no clearly positive phase III prospectively randomized trials exist for neoadjuvant therapy in soft tissue sarcomas. CONCLUSIONS The current neoadjuvant chemotherapy trials that do exist are heterogeneous resulting in conflicting results. However, neoadjuvant chemotherapy with or without radiation can be considered in patients with high-risk disease in an attempt to improve long-term outcomes.
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Affiliation(s)
- Michael J Nathenson
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA.
| | - Edward Sausville
- Department of Medicine, University of Maryland Medical Center, 22 South Greene Street Suite 9d10, Baltimore, MD, 21201, USA
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Voudouri K, Nikitovic D, Berdiaki A, Papachristou DJ, Tsiaoussis J, Spandidos DA, Tsatsakis AM, Tzanakakis GN. Heparin regulates B6FS cell motility through a FAK/actin cytoskeleton axis. Oncol Rep 2016; 36:2471-2480. [PMID: 27572115 PMCID: PMC5055209 DOI: 10.3892/or.2016.5057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/11/2016] [Indexed: 02/06/2023] Open
Abstract
Soft tissue sarcomas are rare, heterogeneous tumors of mesenchymal origin with an aggressive behavior. Heparin is a mixture of heavily sulfated, linear glycosaminoglycan (GAG) chains, which participate in the regulation of various cell biological functions. Heparin is considered to have significant anticancer capabilities, although the mechanisms involved have not been fully defined. In the present study, the effects of unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) on B6FS fibrosarcoma cell motility were examined. Both preparations of heparin were shown to both enhance B6FS cell adhesion (p<0.01 and p<0.05), and migration (p<0.05), the maximal effect being evident at the concentration of 10 µg/ml. The utilization of FAK-deficient cells demonstrated that the participation of FAK was obligatory for heparin-dependent fibrosarcoma cell adhesion (p<0.05). The results of confocal microscopy indicated that heparin was taken up by the B6FS cells, and that UFH and LMWH induced F-actin polymerization. Heparitinase digestion demonstrated that the endogenous heparan sulfate (HS) chains did not affect the motility of the B6FS cells (p>0.05, not significant). In conclusion, both UFH and LMWH, through a FAK/actin cytoskeleton axis, promoted the adhesion and migration of B6FS fibrosarcoma cells. Thus, our findings indicate that the responsiveness of fibrosarcoma cells to the exogenous heparin/HS content of the cancer microenvironment may play a role in their ability to become mobile and metastasize.
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Affiliation(s)
- Kallirroi Voudouri
- Laboratory of Anatomy‑Histology‑Embryology, School of Medicine, University of Crete, Heraklion 71003, Greece
| | - Dragana Nikitovic
- Laboratory of Anatomy‑Histology‑Embryology, School of Medicine, University of Crete, Heraklion 71003, Greece
| | - Aikaterini Berdiaki
- Laboratory of Anatomy‑Histology‑Embryology, School of Medicine, University of Crete, Heraklion 71003, Greece
| | - Dionysios J Papachristou
- Laboratory of Anatomy‑Histology‑Embryology, School of Medicine, University of Patras, Patras 23001, Greece
| | - John Tsiaoussis
- Laboratory of Anatomy‑Histology‑Embryology, School of Medicine, University of Crete, Heraklion 71003, Greece
| | - Demetrios A Spandidos
- Laboratory of Virology, School of Medicine, University of Crete, Heraklion 71003, Greece
| | - Aristides M Tsatsakis
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion 71003, Greece
| | - George N Tzanakakis
- Laboratory of Anatomy‑Histology‑Embryology, School of Medicine, University of Crete, Heraklion 71003, Greece
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Pham V, Henderson-Jackson E, Doepker MP, Caracciolo JT, Gonzalez RJ, Druta M, Ding Y, Bui MM. Practical Issues for Retroperitoneal Sarcoma. Cancer Control 2016; 23:249-64. [DOI: 10.1177/107327481602300308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Retroperitoneal sarcoma is rare. Using initial specimens on biopsy, a definitive diagnosis of histological subtypes is ideal but not always achievable. Methods A retrospective institutional review was performed for all cases of adult retroperitoneal sarcoma from 1996 to 2015. A review of the literature was also performed related to the distribution of retroperitoneal sarcoma subtypes. A meta-analysis was performed. Results Liposarcoma is the most common subtype (45%), followed by leiomyosarcoma (21%), not otherwise specified (8%), and undifferentiated pleomorphic sarcoma (6%) by literature review. Data from Moffitt Cancer Center demonstrate the same general distribution for subtypes of retroperitoneal sarcoma. A pathology-based algorithm for the diagnosis of retroperitoneal sarcoma is illustrated, and common pitfalls in the pathology of retroperitoneal sarcoma are discussed. Conclusions An informative diagnosis of retroperitoneal sarcoma via specimens on biopsy is achievable and meaningful to guide effective therapy. A practical and multidisciplinary algorithm focused on the histopathology is helpful for the management of retroperitoneal sarcoma.
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Affiliation(s)
- Vicky Pham
- University of South Florida Morsani College of Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Evita Henderson-Jackson
- Departments of Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Sarcoma, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Matthew P. Doepker
- Sarcoma, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Surgical Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Jamie T. Caracciolo
- Sarcoma, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Diagnostic Imaging, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Ricardo J. Gonzalez
- University of South Florida Morsani College of Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Mihaela Druta
- Sarcoma, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Yi Ding
- Department of Pathology, JiShuiTan Hospital, Beijing, China
| | - Marilyn M. Bui
- Departments of Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Sarcoma, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Doepker MP, Hanna KH, Thompson ZJ, Binitie OT, Letson DG, Gonzalez RJ. Recurrence and survival analysis of resected soft tissue sarcomas of pelvic retroperitoneal structures. J Surg Oncol 2016; 113:103-7. [PMID: 26744131 DOI: 10.1002/jso.24090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/28/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose is to determine the clinicopathologic factors related to survival and recurrence of primary resected pelvic soft tissue sarcomas (STS). METHODS Demographic/clinical variables were recorded. RESULTS Thirty-five pts were identified. Median follow-up was 24.2 months. There were 23 (65.7%) high/intermediate-grade and 12 (34.3%) low-grade tumors included in the final analysis. Eight patients (22.9%) received neoadjuvant therapy. Margins were grossly negative in 27 (77.1%, 17-R0, 10-R1) and grossly positive (R2) in 8 (22.9%). Adjuvant therapy was used in 13 patients (37.1%). The 2- and 3-year RFS was 56.5% and 51.3%, with 14 patients recurring at a median time of 16 months (6-local, 8-distant). All distant recurrences were in high-grade tumors. There were no differences in RFS for margins (R0 vs. R1), neoadjuvant/adjuvant therapy, size (≥10 vs. <10 cm) or gender. High/intermediate-grade tumors had worse RFS (P < 0.008). The 2- and 3-year OS was 80.9%. OS was improved for R0/R1 resection (P < 0.001). Resection to R0/R1 margin was a significant predictor of improved OS (P = 0.001). CONCLUSIONS High/intermediate-grade lesions were associated with worse OS and RFS. Resection to gross negative margins was the only independent predictor of OS. Adjuvant therapy may be reserved for high-grade lesions due to increased metastatic potential. J
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Affiliation(s)
| | - Karim H Hanna
- University of South Florida Medical School, Tampa, Florida
| | | | - Odion T Binitie
- Department of Sarcoma, Moffitt Cancer Center, Tampa, Florida
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21
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Biopsy techniques for soft tissue and bowel sarcomas. J Surg Oncol 2015; 111:504-12. [DOI: 10.1002/jso.23870] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 11/08/2014] [Indexed: 11/07/2022]
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Jai SR, Farah RH, Hamdaoui B, Boufettal R, Chehab F. Pleomorphous leiomyosarcoma of the mesocolon: a case report. Pan Afr Med J 2015; 22:322. [PMID: 26977231 PMCID: PMC4769802 DOI: 10.11604/pamj.2015.22.322.8050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 11/05/2015] [Indexed: 11/11/2022] Open
Abstract
Leiomyosarcoma is a rare tumor of the smooth muscle, but relatively frequent in the stomach and the small intestine. The mesocolic site is rare. Globally, leiomyosarcoma represents less than 0, 1% of the malignant tumors found in the colon and the anus. Because of the similarities with other digestive tumors, namely mesenchymatous or benign tumors of the smooth muscle, the diagnosis of a pleomorphic sarcoma remains difficult even at the histological stage. Surgery is the mainstay of the therapy. We report a case of leiomyosarcoma of the mesocolon and discuss about its main characteristics in the view of the current literature about this pathological condition.
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Affiliation(s)
- Saad Rifki Jai
- Service de Chirurgie Viscérale Aile 3, Centre Hospitalier Universitaire Ibn Rochd, Université Hassan II, Casablanca, Maroc
| | - Robleh Hassan Farah
- Service de Chirurgie Viscérale Aile 3, Centre Hospitalier Universitaire Ibn Rochd, Université Hassan II, Casablanca, Maroc
| | - Brahim Hamdaoui
- Service de Chirurgie Viscérale Aile 3, Centre Hospitalier Universitaire Ibn Rochd, Université Hassan II, Casablanca, Maroc
| | - Rachid Boufettal
- Service de Chirurgie Viscérale Aile 3, Centre Hospitalier Universitaire Ibn Rochd, Université Hassan II, Casablanca, Maroc
| | - Farid Chehab
- Service de Chirurgie Viscérale Aile 3, Centre Hospitalier Universitaire Ibn Rochd, Université Hassan II, Casablanca, Maroc
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23
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Tan MCB, Yoon SS. Surgical management of retroperitoneal and pelvic sarcomas. J Surg Oncol 2014; 111:553-61. [PMID: 25482329 DOI: 10.1002/jso.23840] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 10/09/2014] [Indexed: 02/04/2023]
Abstract
Management of retroperitoneal sarcomas presents technical and oncological challenges. Imaging is crucial for diagnosis and to define local tumor extent. Complete gross resection at initial presentation is the best chance for cure, but there is controversy as to how this can be best achieved. There is a long-term risk of local recurrence, which is best treated with repeat resection if feasible. The roles of radiation and chemotherapy remain undefined.
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Affiliation(s)
- Marcus C B Tan
- Department of Surgery, University of South Alabama and Mitchell Cancer Institute, Mobile, Alabama
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24
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Kneisl JS, Coleman MM, Raut CP. Outcomes in the management of adult soft tissue sarcomas. J Surg Oncol 2014; 110:527-38. [PMID: 24965077 DOI: 10.1002/jso.23685] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 05/02/2014] [Indexed: 12/14/2022]
Abstract
Adult soft tissue sarcomas (STSs) are heterogeneous neoplasms that account for 11,410 new diagnoses and 4,390 deaths per year. This article summarizes recent NCCN guidelines for diagnosis and management of STSs of the extremities and retroperitoneum, as well as gastrointestinal stromal tumors (GIST). AJCC staging and recently reported NCDB data regarding outcomes are reviewed. Currently accepted STS prognostic variables are presented, as are future directions regarding the utility of molecular prognosticators and nomograms.
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Affiliation(s)
- Jeffrey S Kneisl
- Department of Orthopaedic Surgery, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina
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25
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Lindner LH, Angele M, Dürr HR, Rauch J, Bruns C. [Systemic therapy and hyperthermia for locally advanced soft tissue sarcoma]. Chirurg 2014; 85:398-403. [PMID: 24740176 DOI: 10.1007/s00104-013-2687-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Patients with high-risk soft tissue sarcomas (FNCLCC grades 2-3, > 5 cm and deep lying) are at a high risk of local recurrence or distant metastases despite optimal surgical tumor resection. Therefore, multimodal treatment should be considered for this difficult to treat patient group. Besides surgery, radiation therapy and chemotherapy, hyperthermia has become a valid, complementary treatment option within multimodal treatment concepts. Hyperthermia in this context means the selective heating of the tumor region to temperatures of 40-43 °C for 60 min by microwave radiation in addition to simultaneous chemotherapy or radiation therapy. A randomized phase III study demonstrated that the addition of hyperthermia to neoadjuvant chemotherapy improved tumor response and was associated with a minimal risk of early disease progression as compared to chemotherapy alone. The addition of hyperthermia to a multimodal treatment regimen for high-risk soft tissue sarcoma consisting of surgery, radiation therapy and chemotherapy, either in the neoadjuvant or adjuvant setting after incomplete or marginal tumor resection, significantly improved local progression-free and disease-free survival. Based on these results and due to the generally good tolerability of hyperthermia, this treatment method in combination with chemotherapy should be considered as a standard treatment option within multimodal treatment approaches for locally advanced high-risk soft tissue sarcoma.
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Affiliation(s)
- L H Lindner
- Medizinische Klinik III, Klinikum der Universität München - Campus Grosshadern, Marchioninistr. 15, 81377, München, Deutschland,
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Ghadimi MPH, Rehders A, Knoefel WT. [Multimodal management in soft tissue sarcoma of the trunk and extremities]. Chirurg 2014; 85:378-82. [PMID: 24733613 DOI: 10.1007/s00104-013-2690-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Soft tissue sarcoma (STS) is a rare, extremely heterogeneous group of malignant tumors of mesodermal origin. With an incidence of 1-5 per 100,000/year they account for only 1 % of all human malignancies. The STSs occur predominantly in the lower extremities and the trunk. To date 100 different histopathological subentities can be defined. The prognosis varies substantially depending on the localization and histology. Whereas local recurrence rates and overall survival of sarcomas of the extremities have benefited from the introduction of multimodal therapies, only marginal progress has been made in the management of trunk STSs. This manuscript gives an overview of preoperative diagnostics, pathology and neoadjuvant as well as adjuvant therapeutic options for soft tissue sarcoma.
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Affiliation(s)
- M P H Ghadimi
- Chirurgische Klinik (A), Allgemein-, Thorax-, Viszeral- und Kinderchirurgie, Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
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Katz MHG, Choi EA, Pollock RE. Current concepts in multimodality therapy for retroperitoneal sarcoma. Expert Rev Anticancer Ther 2014; 7:159-68. [PMID: 17288527 DOI: 10.1586/14737140.7.2.159] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Radical surgical resection currently represents the most effective therapy for patients with retroperitoneal sarcoma. Unfortunately, margin-negative resection often mandates extirpation of multiple retroperitoneal viscera, and such operations are nonetheless fraught with high rates of locoregional recurrence. In an attempt to improve local control and ultimately survival, adjuvant strategies of radiation and chemotherapy have been increasingly employed, with promising results. To date, however, the rarity of the disease has limited large, prospective studies investigating the efficacy of these adjuvant modalities. In this article, we review the current literature pertaining to the diagnosis, staging and treatment of retroperitoneal sarcoma and demonstrate the critical need for future large, multi-institutional studies to advance our knowledge of this uncommon disease.
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Affiliation(s)
- Matthew H G Katz
- The University of Texas, MD Anderson Cancer Center, Department of Surgical Oncology, Houston, TX 77030, USA.
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Gronchi A, Olmi P, Casali PG. Combined modalities approach for localized adult extremity soft-tissue sarcoma. Expert Rev Anticancer Ther 2014; 7:1135-44. [DOI: 10.1586/14737140.7.8.1135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Chen Y, Yang Y, Wang C, Shi Y. Radiographic response to neoadjuvant therapy and its impact on scope of surgery and prognosis in stage IIB/III soft tissue sarcomas. BMC Cancer 2013; 13:591. [PMID: 24325569 PMCID: PMC4028883 DOI: 10.1186/1471-2407-13-591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 12/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy has been newly included in the NCCN guidelines as a treatment option for stage IIB/III soft tissue sarcomas. Whether radiographic response to neoadjuvant therapy correlates with improved quality of resection and prognosis remains unproven. METHODS Data from 120 consecutive patients who were treated with neoadjuvant chemoradiotherapy followed by surgical resection for their locally aggressive limb sarcomas were retrospectively reviewed. Radiographic response was evaluated after neoadjuvant therapy according to Response Evaluation Criteria In Solid Tumors, and data was analyzed for overall survival (OS), local recurrence free survival (LRFS) and metastasis free survival (MFS). Surgical complications and toxicities, as well as functional outcomes, were also analysed. RESULTS After neoadjuvant chemoradiotherapy, 25 patients (20.8%) had a partial response, 75 patients (62.5%) had stable disease, and 20 patients (16.7%) showed disease progression. Radiographic response to neoadjuvant therapy correlated significantly with improved OS (P = 0.002) and MFS (P < 0.001). Patients with partial response (PR) had a significantly decreased rate of R2 resection as compared with stable disease (SD) and progressive disease (PD) patients (4.0% Vs 21.4%, P < 0.001). CONCLUSIONS Radiographic response to neoadjuvant chemoradiotherapy correlates with improved quality of resection and prognosis in extremity STS patients.
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Affiliation(s)
- Yong Chen
- Department of Gastric Cancer and Soft Tissue Tumors, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
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Meyer JM, Perlewitz KS, Hayden JB, Doung YC, Hung AY, Vetto JT, Pommier RF, Mansoor A, Beckett BR, Tudorica A, Mori M, Holtorf ML, Afzal A, Woodward WJ, Rodler ET, Jones RL, Huang W, Ryan CW. Phase I trial of preoperative chemoradiation plus sorafenib for high-risk extremity soft tissue sarcomas with dynamic contrast-enhanced MRI correlates. Clin Cancer Res 2013; 19:6902-11. [PMID: 24132922 DOI: 10.1158/1078-0432.ccr-13-1594] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We conducted a phase I trial of the addition of sorafenib to a chemoradiotherapy regimen in patients with high-risk (intermediate/high grade, >5 cm) extremity soft tissue sarcoma undergoing limb salvage surgery. We conducted a correlative study of quantitative dynamic contrast-enhanced MRI (DCE-MRI) to assess response to treatment. EXPERIMENTAL DESIGN Patients were treated at increasing dose levels of sorafenib (200 mg daily, 400 mg daily, 400 mg twice daily) initiated 14 days before three preoperative and three postoperative cycles of epirubicin/ifosfamide. Radiation (28 Gy) was administered during cycle 2 with epirubicin omitted. The primary objective was to determine the maximum tolerated dose (MTD) of sorafenib. DCE-MRI was conducted at baseline, after 2 weeks of sorafenib, and before surgery. The imaging data were subjected to quantitative pharmacokinetic analyses. RESULTS Eighteen subjects were enrolled, of which 16 were evaluable. The MTD of sorafenib was 400 mg daily. Common grade 3-4 adverse events included neutropenia (94%), hypophosphatemia (75%), anemia (69%), thrombocytopenia (50%), and neutropenic fever/infection (50%). Of note, 38% developed wound complications requiring surgical intervention. The rate of ≥95% histopathologic tumor necrosis was 44%. Changes in DCE-MRI biomarker ΔK(trans) after 2 weeks of sorafenib correlated with histologic response (R(2) = 0.67, P = 0.012) at surgery. CONCLUSION The addition of sorafenib to preoperative chemoradiotherapy is feasible and warrants further investigation in a larger trial. DCE-MRI detected changes in tumor perfusion after 2 weeks of sorafenib and may be a minimally invasive tool for rapid assessment of drug effect in soft tissue sarcoma.
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Affiliation(s)
- Janelle M Meyer
- Authors' Affiliations: Loyola University Chicago, Maywood, Illinois; Providence Cancer Center, Newberg; Oregon Health and Science University; Oregon Health and Science University Knight Cancer Institute; Oregon Health and Science University Advanced Imaging Research Center, Portland, Oregon; and Seattle Cancer Care Alliance, Seattle, Washington
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Yamamoto N, Tsuchiya H. Chemotherapy for osteosarcoma – Where does it come from? What is it? Where is it going? Expert Opin Pharmacother 2013; 14:2183-93. [DOI: 10.1517/14656566.2013.827171] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Sarcomas are cancers arising from the mesenchymal layer that affect children, adolescents, young adults, and adults. Although most sarcomas are localized, many display a remarkable predilection for metastasis to the lungs, liver, bones, subcutaneous tissue, and lymph nodes. Additionally, many sarcoma patients presenting initially with localized disease may relapse at metastatic sites. While localized sarcomas can often be cured through surgery and often radiation, controversies exist over optimal management of patients with metastatic sarcoma. Combinations of chemotherapy are the most effective in many settings, and many promising new agents are under active investigation or are being explored in preclinical models. Metastatic sarcomas are excellent candidates for novel approaches with additional agents as they have demonstrated chemosensitivity and affect a portion of the population that is motivated toward curative therapy. In this paper, we provide an overview on the common sarcomas of childhood (rhabdomyosarcoma), adolescence, and young adults (osteosarcoma, Ewing sarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumor) and older adults (leiomyosarcoma, liposarcoma, and undifferentiated high grade sarcoma) in terms of the epidemiology, current therapy, promising therapeutic directions and outcome with a focus on metastatic disease. Potential advances in terms of promising therapy and biologic insights may lead to more effective and safer therapies; however, more clinical trials and research are needed for patients with metastatic sarcoma.
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Affiliation(s)
- Ernest K Amankwah
- Department of Cancer Epidemiology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Anthony P Conley
- Sarcoma Department, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Damon R Reed
- Sarcoma Department, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Takeuchi A, Yamamoto Y, Munesue S, Harashima A, Watanabe T, Yonekura H, Yamamoto H, Tsuchiya H. Low molecular weight heparin suppresses receptor for advanced glycation end products-mediated expression of malignant phenotype in human fibrosarcoma cells. Cancer Sci 2013; 104:740-9. [PMID: 23421467 DOI: 10.1111/cas.12133] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 02/11/2013] [Accepted: 02/15/2013] [Indexed: 01/26/2023] Open
Abstract
The receptor for advanced glycation end products (RAGE) is a pattern-recognition receptor and its engagement by ligands such as high mobility group box 1 (HMGB1) is implicated in tumor growth and metastasis. Low molecular weight heparin (LMWH) has an antagonistic effect on the RAGE axis and is also reported to exert an antitumor effect beyond the known activity of anticoagulation. However, the link between the anti-RAGE and antitumor activities of LMWH has not yet to be fully elucidated. In this study, we investigated whether LMWH could inhibit tumor cell proliferation, invasion, and metastasis by blocking the RAGE axis using in vitro and in vivo assay systems. Stably transformed HT1080 human fibrosarcoma cell lines were obtained, including human full-length RAGE-overexpressing (HT1080(RAGE)), RAGE dominant-negative, intracellular tail-deleted RAGE-overexpressing (HT1080(dnRAGE)), and mock-transfected control (HT1080(mock)) cells. Confocal microscopy showed the expression of HMGB1 and RAGE in HT1080 cells. The LMWH significantly inhibited HMGB1-induced NFκB activation through RAGE using an NFκB-dependent luciferase reporter assay and the HT1080 cell lines. Overexpression of RAGE significantly accelerated, but dnRAGE expression attenuated HT1080 cell proliferation and invasion in vitro, along with similar effects on local tumor mass growth and lung metastasis in vivo. Treatment with LMWH significantly inhibited the migration, invasion, tumor formation, and lung metastasis of HT1080(RAGE) cells, but not of HT1080(mock) or HT1080(dnRAGE) cells. In conclusion, this study revealed that RAGE exacerbated the malignant phenotype of human fibrosarcoma cells, and that this exacerbation could be ameliorated by LMWH. It is suggested that LMWH has therapeutic potential in patients with certain types of malignant tumors.
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Affiliation(s)
- Akihiko Takeuchi
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
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Kumar V, Misra S, Chaturvedi A. Retroperitoneal sarcomas- a challenging problem. Indian J Surg Oncol 2012; 3:215-21. [PMID: 23997509 PMCID: PMC3444574 DOI: 10.1007/s13193-012-0152-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 04/25/2012] [Indexed: 02/07/2023] Open
Abstract
Retroperitoneal sarcomas are relatively rare tumours and usually present in a locally advanced stage. Liposarcoma is the most common histopathology. If operable, surgery is the treatment of choice. The role of adjuvant chemotherapy or radiotherapy is not yet defined. Advanced cases are treated by chemotherapy. The prognosis is poor in patients with positive resection margins, high-grade tumours and recurrent tumours.
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Affiliation(s)
- Vijay Kumar
- Department of Surgical Oncology, CSM Medical University, Lucknow, 226003 India
| | - Sanjeev Misra
- Department of Surgical Oncology, CSM Medical University, Lucknow, 226003 India
| | - Arun Chaturvedi
- Surgical Oncology, Sahara Hospital, Sahara India Medical Institute Ltd., Lucknow, India
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Grabellus F, Stylianou E, Umutlu L, Sheu SY, Lehmann N, Taeger G, Lauenstein TC. Size-based clinical response evaluation is insufficient to assess clinical response of sarcomas treated with isolated limb perfusion with TNF-α and melphalan. Ann Surg Oncol 2012; 19:3375-85. [PMID: 22622472 DOI: 10.1245/s10434-012-2408-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND The clinical assessment of the response of sarcomas to preoperative treatment is usually defined using size-based evaluation standards. For nonresectable sarcomas, hyperthermic isolated limb perfusion with TNF-α and melphalan (TM-ILP) yields high response rates. Based on our experience, we assume that anatomic radiological response criteria are insufficient to assess the degree of regression after TM-ILP. METHODS The clinical response of 35 sarcomas to TM-ILP was assessed by unidimensional, bidimensional, and tridimensional size-based anatomical criteria, and responders were identified according to the established thresholds. The same tumors were investigated for pathological response according to the Salzer-Kuntschik regression scale (>90% devitalization) and reviewed for cystic degeneration, hemorrhage, and predominant necrotic or fibrosclerotic regression phenotype. RESULTS None of the clinical response criteria were able to reliably identify the pathologic responders. The extent of size changes showed no association with the pathological degree of regression. The number of clinical responders was low compared with the number of pathological responders (RECIST N = 1, WHO N = 3, volumetry N = 3, pathology N = 19). The occurrence of hemorrhage and/or cystic degeneration was more frequently observed in predominant necrotic sarcomas and was associated with an increase in tumor size after TM-ILP. Furthermore, we identified the fibrosclerotic phenotype of regression to be more significantly strongly associated with posttherapeutic shrinkage than necrosis. CONCLUSIONS Size-based clinical response evaluation is insufficient to assess clinical response in TM-ILP-treated sarcomas. The size changes of tumors after therapy reflect the type of regression rather than the extent of destruction.
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Affiliation(s)
- Florian Grabellus
- Institute of Pathology and Neuropathology, University Hospital of Essen and Sarcoma Center at the West German Cancer Center, University of Duisburg-Essen, Essen, Germany.
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Neoadjuvant and adjuvant chemotherapy with modified mesna, adriamycin, ifosfamide, and dacarbazine (MAID) regimen for adult high-grade non-small round cell soft tissue sarcomas. Int J Clin Oncol 2011; 18:170-6. [DOI: 10.1007/s10147-011-0360-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 12/02/2011] [Indexed: 10/14/2022]
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Lehnhardt M, Schmitt T, Bischof M, Daigeler A, Egerer G. [Current state of neoadjuvant therapy of soft tissue sarcoma]. Chirurg 2011; 82:995-1000. [PMID: 22008846 DOI: 10.1007/s00104-011-2132-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The treatment of soft tissue sarcoma is clinically challenging. Referral to an experienced center with an interdisciplinary team is strongly recommended. Neoadjuvant therapy, including irradiation and chemotherapy, has been applied to improve local control rates, eradicate micrometastases and assess chemosensitivity. However, the role of neoadjuvant therapy remains controversial, especially for systemic therapy, as the only available randomized trial failed to prove a benefit for survival. Nevertheless, on the basis of the current body of literature, neoadjuvant therapy can be considered on an individual basis for patients with high-risk tumors. Whenever possible, patients should be included in a clinical trial.
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Affiliation(s)
- M Lehnhardt
- Klinik für Hand-, Plastische- und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie der Ruprecht-Karls-Universität Heidelberg, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
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Mullinax JE, Zager JS, Gonzalez RJ. Current diagnosis and management of retroperitoneal sarcoma. Cancer Control 2011; 18:177-87. [PMID: 21666580 DOI: 10.1177/107327481101800305] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Retroperitoneal sarcomas are rare neoplasms that often present with multivisceral involvement. Treatment for these tumors requires careful decision making requiring a combination of surgery, chemotherapy, and radiation therapy. METHODS We reviewed the scientific literature pertaining to the diagnosis and management of retroperitoneal sarcomas. We also identify recent developments in treatment and discuss future trends in the care of patients with this disease. RESULTS Retroperitoneal tumors often present as large, locally advanced lesions. Evaluation of these tumors requires careful consideration of a multimodality approach. Retrospective data and historical prospective series have demonstrated the survival benefit of radical resection for these tumors with en bloc resection of involved structures. Compartmental resections in the retroperitoneum along with debulking of high-grade disease and regional therapy are controversial approaches with significant morbidity that can lead to long-term survival. The application of neoadjuvant and adjuvant therapies in select tumor histologies may improve local control and survival. CONCLUSIONS The management of retroperitoneal sarcomas requires a multidisciplinary approach and is best accomplished at high-volume centers specializing in the care of patients with these complex malignancies. Current data suggest that radical resection remains the only chance for cure and that chemotherapy and radiation therapy may confer a survival benefit.
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Affiliation(s)
- John E Mullinax
- Department of Surgery at The University of South Florida College of Medicine, Tampa, Florida, USA
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PET/CT allows stratification of responders to neoadjuvant chemotherapy for high-grade sarcoma: a prospective study. Clin Nucl Med 2011; 36:526-32. [PMID: 21637052 DOI: 10.1097/rlu.0b013e3182175856] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE The aim of the present study was to determine whether metabolic reduction is capable of reflecting the histopathologic response and outcome after neoadjuvant chemotherapy in patients with high-grade sarcoma. PATIENTS AND METHODS Forty-two patients with histologically proven high-grade sarcoma underwent neoadjuvant chemotherapy followed by surgical resection. Quantitative F-18 fluorodeoxyglucose (F-18-FDG) positron emission tomography (PET)/computed tomography scans were acquired before and after the first cycle and after completion of neoadjuvant chemotherapy. Standardized uptake values (SUVs) and metabolic reduction rates were compared with histopathologic response, progression-free survival, and overall survival. RESULTS Baseline SUVmax was 10.9 ± 3.6 (range, 3.8-19.6). Therapeutic effect resulted in 10 patients (24%) with a satisfactory response and in 32 patients (76%) with an unsatisfactory response after completion of neoadjuvant chemotherapy. The SUV decreased to 7.8 ± 3.4 after the first cycle (t1) of chemotherapy and to 5.2 ± 3.4 after completion (t2) of chemotherapy. Histopathologic response and percentage SUV (t2) reduction rate were independent predictors of progression-free survival and overall survival in the multivariate analyses. CONCLUSION Metabolic reduction after neoadjuvant chemotherapy evaluated by F-18 FDG PET or computed tomography can be used for stratification of the histopathologic response in patients with high-grade sarcoma.
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Yamamoto N, Tsuchiya H. Clinical Observations of Caffeine-Potentiated Chemotherapy. JOURNAL OF CAFFEINE RESEARCH 2011. [DOI: 10.1089/jcr.2011.0007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Norio Yamamoto
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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Bartlett E, Yoon SS. Current treatment for the local control of retroperitoneal sarcomas. J Am Coll Surg 2011; 213:436-46. [PMID: 21723153 DOI: 10.1016/j.jamcollsurg.2011.05.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 05/25/2011] [Accepted: 05/25/2011] [Indexed: 01/17/2023]
Affiliation(s)
- Edmund Bartlett
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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García Del Muro X, Martín J, Maurel J, Cubedo R, Bagué S, de Álava E, Pousa AL, Narváez JA, Ortiz E, Pomés J, Poveda A, Romasanta LP, Tendero O, Viñals JM. [Soft tissue sarcomas: clinical practice guidelines]. Med Clin (Barc) 2011; 136:408.e1-8. [PMID: 21411112 DOI: 10.1016/j.medcli.2011.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 02/03/2011] [Accepted: 02/08/2011] [Indexed: 10/18/2022]
Abstract
Soft tissue sarcomas (STS) constitute a rare heterogeneous group of tumours that include a wide variety of histological subtypes, which require a multidisciplinary and, frequently specialized and complex management. Despite advances in our understanding of the pathophysiology of the disease, there are no consensus multidisciplinary recommendations about its diagnosis and treatment in our country. The objective of these guidelines is to provide practical therapeutic recommendations that may contribute to improve the therapeutic results of this disease in our environment. With this purpose, the Spanish Group for Research in Sarcomas (GEIS) held a meeting with a multidisciplinary group of experts for the study and management of sarcomas. The results of this meeting are compiled in this document, in which recommendations on diagnosis, treatment and monitoring of soft tissue sarcomas are included. In summary, these guidelines aim to facilitate the identification and management of STS for clinical practice in Spain.
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Affiliation(s)
- Xavier García Del Muro
- Servicio de Oncología Médica, Instituto Catalán de Oncología L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, España.
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Miki Y, Ngan S, Clark JCM, Akiyama T, Choong PFM. The significance of size change of soft tissue sarcoma during preoperative radiotherapy. Eur J Surg Oncol 2010; 36:678-83. [PMID: 20547446 DOI: 10.1016/j.ejso.2010.05.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 04/30/2010] [Accepted: 05/17/2010] [Indexed: 11/19/2022] Open
Abstract
AIM To assess the significance of change in tumour size during preoperative radiotherapy in patients with soft tissue sarcoma (STS). METHODS A retrospective review of 91 cases with STS was performed. Inclusion criteria were localised extremity and truncal STS with measurable disease, older than 18 years, treated with preoperative radiotherapy and wide local excision, in the period between January 1966 and December 2005. Patients with head and neck STS, or who received neoadjuvant chemotherapy were excluded. A difference in excess of 10% of the greatest tumour diameter of the pre-radiotherapy and the post-radiotherapy MRI scans was considered as change in tumour size. RESULTS Increase in tumour size was noted in 28 patients (31%) (Group 1). No change or decrease in size was observed in 63 patients (Group 2). There were no significance differences in local control or overall survival rates between the 2 groups. The estimated overall actuarial local recurrence free, event-free and overall survival rates were 90.5%, 64.4%, 62.9% in Group 1, and 85.7%, 60.8%, 68.9% in Group 2 respectively. CONCLUSION Increase in tumour size during preoperative radiotherapy for soft tissue sarcoma does not seem to associate with inferior local tumour control or compromise survival. Lack of reduction in tumour size is not necessarily a sign of lack of response to preoperative radiotherapy.
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Affiliation(s)
- Y Miki
- Department of Orthopaedics, St. Vincent's Hospital, 41 Victoria Parade, Fitzroy 3065, Victoria, Melbourne, Australia.
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Neo-adjuvant chemotherapy alone or with regional hyperthermia for localised high-risk soft-tissue sarcoma: a randomised phase 3 multicentre study. Lancet Oncol 2010; 11:561-70. [PMID: 20434400 DOI: 10.1016/s1470-2045(10)70071-1] [Citation(s) in RCA: 433] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The optimum treatment for high-risk soft-tissue sarcoma (STS) in adults is unclear. Regional hyperthermia concentrates the action of chemotherapy within the heated tumour region. Phase 2 studies have shown that chemotherapy with regional hyperthermia improves local control compared with chemotherapy alone. We designed a parallel-group randomised controlled trial to assess the safety and efficacy of regional hyperthermia with chemotherapy. METHODS Patients were recruited to the trial between July 21, 1997, and November 30, 2006, at nine centres in Europe and North America. Patients with localised high-risk STS (> or = 5 cm, Fédération Nationale des Centres de Lutte Contre le Cancer [FNCLCC] grade 2 or 3, deep to the fascia) were randomly assigned to receive either neo-adjuvant chemotherapy consisting of etoposide, ifosfamide, and doxorubicin (EIA) alone, or combined with regional hyperthermia (EIA plus regional hyperthermia) in addition to local therapy. Local progression-free survival (LPFS) was the primary endpoint. Efficacy analyses were done by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT 00003052. FINDINGS 341 patients were enrolled, with 169 randomly assigned to EIA plus regional hyperthermia and 172 to EIA alone. All patients were included in the analysis of the primary endpoint, and 332 patients who received at least one cycle of chemotherapy were included in the safety analysis. After a median follow-up of 34 months (IQR 20-67), 132 patients had local progression (56 EIA plus regional hyperthermia vs 76 EIA). Patients were more likely to experience local progression or death in the EIA-alone group compared with the EIA plus regional hyperthermia group (relative hazard [RH] 0.58, 95% CI 0.41-0.83; p=0.003), with an absolute difference in LPFS at 2 years of 15% (95% CI 6-26; 76% EIA plus regional hyperthermia vs 61% EIA). For disease-free survival the relative hazard was 0.70 (95% CI 0.54-0.92, p=0.011) for EIA plus regional hyperthermia compared with EIA alone. The treatment response rate in the group that received regional hyperthermia was 28.8%, compared with 12.7% in the group who received chemotherapy alone (p=0.002). In a pre-specified per-protocol analysis of patients who completed EIA plus regional hyperthermia induction therapy compared with those who completed EIA alone, overall survival was better in the combined therapy group (HR 0.66, 95% CI 0.45-0.98, p=0.038). Leucopenia (grade 3 or 4) was more frequent in the EIA plus regional hyperthermia group compared with the EIA-alone group (128 of 165 vs 106 of 167, p=0.005). Hyperthermia-related adverse events were pain, bolus pressure, and skin burn, which were mild to moderate in 66 (40.5%), 43 (26.4%), and 29 patients (17.8%), and severe in seven (4.3%), eight (4.9%), and one patient (0.6%), respectively. Two deaths were attributable to treatment in the combined treatment group, and one death was attributable to treatment in the EIA-alone group. INTERPRETATION To our knowledge, this is the first randomised phase 3 trial to show that regional hyperthermia increases the benefit of chemotherapy. Adding regional hyperthermia to chemotherapy is a new effective treatment strategy for patients with high-risk STS, including STS with an abdominal or retroperitoneal location. FUNDING Deutsche Krebshilfe, Helmholtz Association (HGF), European Organisation of Research and Treatment of Cancer (EORTC), European Society for Hyperthermic Oncology (ESHO), and US National Institute of Health (NIH).
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Krikelis D, Judson I. Role of chemotherapy in the management of soft tissue sarcomas. Expert Rev Anticancer Ther 2010; 10:249-60. [PMID: 20132000 DOI: 10.1586/era.09.176] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Soft tissue sarcomas are a diverse group of rare tumors that comprise 1% of all cancers. Few randomized trials of chemotherapy have been performed but there is a clear role for agents such as doxorubicin and ifosfamide in the palliation of advanced disease. There is uncertainty as to whether sequential single-agent treatment is equivalent to combination chemotherapy. For the majority of histological subtypes adjuvant chemotherapy is not of proven value, although there may be situations where it is advantageous. However, there are other subtypes, such as the Ewing's sarcoma family tumors, for which chemotherapy is an essential part of primary management and has definitely improved survival. Apart from Ewing's sarcoma family tumor and rhabdomyosarcoma, there is increasing specialization of chemotherapy according to histological subtype, such as the use of taxanes for angiosarcoma, gemcitabine and docetaxel for leiomyosarcoma, and trabectedin for leiomyosarcoma and liposarcoma, especially the myxoid/round cell variant. Nevertheless, there are serious limitations to existing treatment and novel therapies need to be developed.
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Affiliation(s)
- Dimitrios Krikelis
- University Hospital of Ioannina, Stavros Niarchos Avenue, 45500, Ioannina, Greece.
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Daab LJ, Cook P, Woo K, Hye R, Paluch T, Plecha E. Management of a catecholamine-secreting paraganglioma requiring aortic reconstruction. Vasc Endovascular Surg 2009; 44:150-4. [PMID: 20034938 DOI: 10.1177/1538574409351991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Retroperitoneal paragangliomas are rare extraadrenal pheochromocytomas that can involve major vascular structures. RESULTS AND DISCUSSION A case of periaortic catecholamine-secreting paraganglioma was reviewed and literature search performed to summarize the current surgical management of this disease process. CONCLUSION Resection for cure of retroperitoneal paragangliomas with vascular reconstruction can be performed with acceptable morbidity and mortality with the use of current vascular techniques.
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Affiliation(s)
- Leo J Daab
- Department of Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA.
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Abstract
The current standard in local treatment of soft tissue sarcomas has shifted from amputation and similar mutilating resections to more organ- and function-preserving surgery. This was possible through multidisciplinary treatment approaches, particularly those including adjuvant radiation therapy. Adjuvant radiation showed significant improvement in local tumour control after resection with tight margins and in high-risk sarcomas. Unfortunately adjuvant radiation failed to improve overall survival. Perioperative chemotherapies also have not contributed to improvement in the overall prognosis worldwide. Progress may occur when the pathogenesis and molecular profile of specific sarcoma subtypes are better understood, allowing more effective new drugs. One example is the treatment of advanced gastrointestinal stromal tumour with imatinib, a small molecular kinase inhibitor of the c-kit receptor. Presently the most effective measure to improve the prognosis with soft tissue sarcomas is early patient referral to expert centres, where diagnostic workup and therapy decisions are made on a multidisciplinary basis and updated according to the newest guidelines and study results.
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Affiliation(s)
- F Lordick
- Nationales Centrum für Tumorerkrankungen Medizinische Onkologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 350, Heidelberg, Germany.
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Taeger G, Grabellus F, Taeger G, Grabellus F, Podleska LE, Müller S, Ruchholtz S. Effectiveness of regional chemotherapy with TNF-α/Melphalan in advanced soft tissue sarcoma of the extremities. Int J Hyperthermia 2009; 24:193-203. [DOI: 10.1080/02656730701868387] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Takeuchi A, Tsuchiya H, Shirai T, Hayashi K, Nishida H, Tomita K. Occlusive dressing for large soft tissue defects following soft tissue tumor excision. J Orthop Sci 2009; 14:385-90. [PMID: 19662471 DOI: 10.1007/s00776-009-1353-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 03/13/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Reconstructive surgery using pedicles or free muscle-skin flaps and skin grafting reduces wound complications and promotes favorable limb function; however, the sacrifice of normal tissue remains problematic and complicated. Occlusive dressings are widely employed for management of injuries, burns, and surgical wounds. However, their effectiveness for treating soft tissue defects following a soft tissue tumor excision has not been fully elucidated. The purpose of this study was to evaluate the effectiveness and safety of an occlusive dressing treatment method for soft tissue defects following soft tissue tumor excisions. METHODS We retrospectively reviewed eight patients (three men, five women) whose wounds were treated with polyurethane foam occlusive dressings to allow reconstruction of the soft tissue defect following soft tissue tumor excision. Their mean age was 64.5 years (range 23-83 years), and the mean size of the defect was 60.1 cm(2) (range 20-144 cm(2)). The wound was covered with a hydrophilic polyurethane dressing material. The treatment periods, incidence of complications, and ultimate outcomes were evaluated. RESULTS Seven defects were completely healed by secondary intention without the requirement of any additional surgery. Mean treatment periods were 21.6 weeks (range 13.5-44.0 weeks). Mean follow-up periods were 33.1 months (range 15.8-48.6 months). One patient with a recurrent malignant fibrous histiocytoma (MFH) who had a history of radiotherapy required a posterior thigh flap 44 weeks after the surgery. Recurrence due to a positive surgical margin was observed in only one patient with recurrent MFH. None of the patients exhibited clinical evidence of superficial or deep infection. CONCLUSIONS This treatment method is simple, safe, and reliable. We concluded that the highly favorable indications of this treatment are ideal for patients who wish to avoid sacrificing their normal tissue, have no history of radiotherapy before surgery, and do not require chemotherapy or radiotherapy after the operation.
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Affiliation(s)
- Akihiko Takeuchi
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa, Japan
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