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Boulouta A, Kyriazoglou A, Kotsantis I, Economopoulou P, Anastasiou M, Pantazopoulos A, Kyrkasiadou M, Moutafi M, Gavrielatou N, Zazas E, Caglar C, Nixon I, Tolia M, Kavourakis G, Psyrri A. Pathologic complete response in patients with localized soft tissue sarcoma treated with neoadjuvant therapy and its correlation with clinical outcomes: A systematic review. Cancer Treat Rev 2024; 130:102820. [PMID: 39216184 DOI: 10.1016/j.ctrv.2024.102820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 08/22/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
Soft tissue sarcomas (STS), comprising approximately 1% of adult solid malignancies, are primarily treated with surgery, with the choice of perioperative treatment being a challenging and highly individualized decision. Clinical trials assessing neoadjuvant modalities in STS predominantly use clinical outcomes or radiologic response as endpoints, with pathologic complete response (pCR) not being employed as a designated study endpoint. Our systematic review aimed to assess the rates of pCR in clinical trials of different neoadjuvant modalities for STS and its correlation with patient clinical outcomes. 23 phase I, II and III studies were included, from which data regarding rates of pCR with each treatment, as well as correlation of pCR with clinical outcomes were retrieved. In 16 trials that assessed pCR, the percentage of patients who achieved a pCR ranged from 8 to 58%. Most of these trials did not aim to establish an association between pCR and clinical outcomes. However, among those that did investigate this correlation, a positive association was identified between pCR and both 5-year disease-specific survival (DSS) and 5-year overall survival (OS). While pCR serves as a crucial marker guiding treatment decisions in other neoplasms like triple negative breast cancer and urothelial cancer, it is not yet used in a similar setting for STS. Our findings indicate variability in patients achieving pCR across different neoadjuvant treatments for STS and a possible positive correlation with patient outcomes. Consequently, we propose considering pCR as a surrogate endpoint in future prospective trials for STS.
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Affiliation(s)
- A Boulouta
- Second Department of Internal Medicine, Oncology Unit, Attikon University Hospital, Athens, Greece.
| | - A Kyriazoglou
- Second Department of Internal Medicine, Oncology Unit, Attikon University Hospital, Athens, Greece
| | - I Kotsantis
- Second Department of Internal Medicine, Oncology Unit, Attikon University Hospital, Athens, Greece
| | - P Economopoulou
- Second Department of Internal Medicine, Oncology Unit, Attikon University Hospital, Athens, Greece
| | - M Anastasiou
- Second Department of Internal Medicine, Oncology Unit, Attikon University Hospital, Athens, Greece
| | - A Pantazopoulos
- Second Department of Internal Medicine, Oncology Unit, Attikon University Hospital, Athens, Greece
| | - M Kyrkasiadou
- Second Department of Internal Medicine, Oncology Unit, Attikon University Hospital, Athens, Greece
| | - M Moutafi
- Second Department of Internal Medicine, Oncology Unit, Attikon University Hospital, Athens, Greece
| | - N Gavrielatou
- Second Department of Internal Medicine, Oncology Unit, Attikon University Hospital, Athens, Greece
| | - E Zazas
- Second Department of Internal Medicine, Oncology Unit, Attikon University Hospital, Athens, Greece
| | - C Caglar
- Second Department of Internal Medicine, Oncology Unit, Attikon University Hospital, Athens, Greece
| | - I Nixon
- Department of Clinical Oncology, The Beatson West of Scotland Cancer Center, Glasgow, UK
| | - M Tolia
- Department of Radiotherapy, Faculty of Medicine, School of Health Sciences, University of Crete, Heraklion, Greece
| | - G Kavourakis
- Second Department of Internal Medicine, Oncology Unit, Attikon University Hospital, Athens, Greece
| | - A Psyrri
- Second Department of Internal Medicine, Oncology Unit, Attikon University Hospital, Athens, Greece
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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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Palm RF, Liveringhouse CL, Gonzalez RJ, Bui MM, Binitie O, Yang GQ, Naghavi AO. Effect of Favorable Pathologic Response After Neoadjuvant Radiation Therapy Alone in Soft-tissue Sarcoma. Adv Radiat Oncol 2023; 8:101086. [PMID: 36483058 PMCID: PMC9723307 DOI: 10.1016/j.adro.2022.101086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Whether the therapeutic response of soft-tissue sarcoma to neoadjuvant treatment is predictive for clinical outcomes is unclear. Given the rarity of this disease and the confounding effects of chemotherapy, this study analyzes whether a favorable pathologic response (fPR) after neoadjuvant radiation therapy (RT) alone is associated with clinical benefits. Methods and Materials An institutional review board-approved retrospective review was conducted on a database of patients with primary soft-tissue sarcoma treated at our institution between 1987 and 2015 with neoadjuvant RT alone followed by surgical resection. Time-to-event outcomes estimated with a Kaplan-Meier analysis included overall survival, progression-free survival (PFS), locoregional control, and distant control (DC). Cox regression analyses were performed to determine prognostic variables associated with clinical outcomes. Results Of the overall cohort of 315 patients, 181 patients (57%) were included in the primary analysis with documented pathologic necrosis (PN) rates (mean: 59%) and a median follow up from diagnosis of 48 months (range, 4-170 months). The median neoadjuvant RT dose was 50 Gy (range, 40-60 Gy), and the majority of patients had negative surgical margins (79%). Only 35 patients (19%) achieved a fPR (PN ≥95%), which was associated with a higher R0 resection rate (94% vs. 75%; P = .013), a significant 5-year PFS benefit (74% vs. 43%; P = .014), and a nonsignificant 5-year DC benefit (76% vs. 62%; P = .12) compared with PN <95%. On multivariable analysis, fPR was an independent predictor for PFS (hazard ratio: 0.47; 95% confidence interval, 0.25-0.90; P = .022). Conclusions Achieving fPR with neoadjuvant RT alone is associated with a higher R0 resection rate and possible DC benefit, translating into a significant improvement in PFS. Further studies to improve pathologic response rates and prospectively validate this endpoint are warranted.
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Affiliation(s)
- Russell F. Palm
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa Florida
| | | | | | - Marilyn M. Bui
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa Florida
| | - Odion Binitie
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa Florida
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Rust DJ, Kato T, Yoon SS. Treatment for local control of retroperitoneal and pelvis sarcomas: A review of the literature. Surg Oncol 2022; 43:101814. [PMID: 35834940 DOI: 10.1016/j.suronc.2022.101814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/21/2022] [Accepted: 07/03/2022] [Indexed: 11/29/2022]
Abstract
Retroperitoneal and pelvis sarcomas are uncommon tumors for which complete surgical resection is the mainstay of treatment. However, achieving complete gross resection with microscopically negative margins is challenging, and local recurrence rates can be high. Patients often succumb to uncontrolled local disease. Radiation therapy offers a potential means for sterilizing microscopic residual disease, although its use continues to be controversial. Chemotherapy alone or in combination with radiation continues to be investigated as an adjunct to surgery, along with immunotherapy and targeted therapies. In this review, we discuss the current management of retroperitoneal and pelvis sarcomas, focusing on studies of surgery and radiation therapy to maximize local control.
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Affiliation(s)
- Dylan J Rust
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Division of Surgical Oncology, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Tomoaki Kato
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Division of Abdominal Organ Transplantation, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Sam S Yoon
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Division of Surgical Oncology, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA.
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Istl AC, Gronchi A. Neoadjuvant Therapy for Primary Resectable Retroperitoneal Sarcomas-Looking Forward. Cancers (Basel) 2022; 14:1831. [PMID: 35406603 PMCID: PMC8998126 DOI: 10.3390/cancers14071831] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 01/25/2023] Open
Abstract
The cornerstone of therapy for primary retroperitoneal sarcomas (RPS) is complete surgical resection, best achieved by resecting the tumor en bloc with adherent structures even if not overtly infiltrated. Until recently, trials designed to elucidate the role of neoadjuvant radiation or chemotherapy for RPS have been unable to achieve sufficient enrollment. The completion of the STRASS trial, which explored neoadjuvant radiotherapy for primary resectable RPS, is a major milestone in RPS research, but has prompted further questions about histology-driven treatment paradigms for RPS. Though it was ultimately a negative trial with respect to its primary endpoint of abdominal recurrence-free survival, STRASS produced a signal that suggested improved abdominal recurrence-free survival with neoadjuvant radiotherapy (RT) for patients with liposarcoma (LPS). No effect was seen for leiomyosarcoma (LMS) or high-grade dedifferentiated (DD) LPS, consistent with recent literature suggesting LMS and high-grade DD-LPS have a predominant pattern of distant rather than local failure. These results, along with those from other recent studies conducted at the bench and the bedside, emphasize the importance of a histology-specific approach to RPS research. Recent evidence for patterns of distant failure in LMS and high-grade DD-LPS has prompted the initiation of STRASS2, a study of neoadjuvant chemotherapy for these histologies. As this study unfolds, evidence may emerge for novel systemic therapy options in specific sarcoma histotypes given the explosion in targeted and immunotherapeutic applications over the last decade. This article reviews current and recent evidence around neoadjuvant radiation and chemotherapy as well as avenues for future study to optimize these treatment approaches.
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Affiliation(s)
- Alexandra C. Istl
- Division of Surgical Oncology, Johns Hopkins Hospital, Baltimore, MD 21287, USA;
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
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6
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Oda Y, Tanaka K, Hirose T, Hasegawa T, Hiruta N, Hisaoka M, Yoshimoto M, Otsuka H, Bekki H, Ishii T, Endo M, Kunisada T, Hiruma T, Tsuchiya H, Katagiri H, Matsumoto Y, Kawai A, Nakayama R, Kawashima H, Takenaka S, Emori M, Watanuki M, Yoshida Y, Okamoto T, Mizusawa J, Fukuda H, Ozaki T, Iwamoto Y, Nojima T. Standardization of evaluation method and prognostic significance of histological response to preoperative chemotherapy in high-grade non-round cell soft tissue sarcomas. BMC Cancer 2022; 22:94. [PMID: 35062915 PMCID: PMC8783422 DOI: 10.1186/s12885-022-09195-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 01/12/2022] [Indexed: 12/30/2022] Open
Abstract
Background Preoperative chemotherapy is widely applied to high-grade localized soft tissue sarcomas (STSs); however, the prognostic significance of histological response to chemotherapy remains controversial. This study aimed to standardize evaluation method of histological response to chemotherapy with high agreement score among pathologists, and to establish a cut-off value closely related to prognosis. Methods Using data and specimens from the patients who had registered in the Japan Clinical Oncology Group study, JCOG0304, a phase II trial evaluating the efficacy of perioperative chemotherapy with doxorubicin (DOX) and ifosfamide (IFO), we evaluated histological response to preoperative chemotherapy at the central review board. Results A total of 64 patients were eligible for this study. The percentage of viable tumor area ranged from 0.1% to 97.0%, with median value of 35.7%. Regarding concordance proportion between pathologists, the weighted kappa coefficient (κ) score in all patients was 0.71, indicating that the established evaluation method achieved substantial agreement score. When the cut-off value of the percentage of the residual tumor area was set as 25%, the p-value for the difference in overall survival showed the minimum value. Hazard ratio of the non-responder with percentage of the residual tumor < 25%, to the responder was 4.029 (95% confidence interval 0.893–18.188, p = 0.070). Conclusion The standardized evaluation method of pathological response to preoperative chemotherapy showed a substantial agreement in the weighted κ score. The evaluation method established here was useful for estimating of the prognosis in STS patients who were administered perioperative chemotherapy with DOX and IFO. Trial registration UMIN Clinical Trials Registry C000000096. Registered 30 August, 2005 (retrospectively registered).
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7
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Squires MH, Ethun CG, Donahue EE, Benbow JH, Anderson CJ, Jagosky MH, Salo JC, Hill JS, Ahrens W, Prabhu RS, Livingston MB, Gower NL, Needham M, Trufan SJ, Fields RC, Krasnick BA, Bedi M, Abbott DE, Schwartz P, Votanopoulos K, Chouliaras K, Grignol V, Roggin KK, Tseng J, Poultsides G, Tran TB, Cardona K, Howard JH. A multi-institutional validation study of prognostic nomograms for retroperitoneal sarcoma. J Surg Oncol 2021; 124:829-837. [PMID: 34254691 DOI: 10.1002/jso.26586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Prognostic nomograms for patients undergoing resection of retroperitoneal sarcoma (RPS) include the Sarculator and Memorial Sloan Kettering (MSK) sarcoma nomograms. We sought to validate the Sarculator and MSK nomograms within a large, modern multi-institutional cohort of patients with primary RPS undergoing resection. METHODS Patients who underwent resection of primary RPS between 2000 and 2017 across nine high-volume US institutions were identified. Predicted 7-year disease-free (DFS) and overall survival (OS) and 4-, 8-, and 12-year disease-specific survival (DSS) were calculated from the Sarculator and MSK nomograms, respectively. Nomogram-predicted survival probabilities were stratified in quintiles and compared in calibration plots to observed survival outcomes assessed by Kaplan-Meier estimates. Discriminative ability of nomograms was quantified by Harrell's concordance index (C-index). RESULTS Five hundred and two patients underwent resection of primary RPS. Histologies included leiomyosarcoma (30%), dedifferentiated liposarcoma (23%), and well-differentiated liposarcoma (15%). Median tumor size was 14.0 cm (interquartile range [IQR], 8.5-21.0 cm). Tumor grade distribution was: Grade 1 (27%), Grade 2 (17%), and Grade 3 (56%). Median DFS was 31.5 months; 7-year DFS was 29%. Median OS was 93.8 months; 7-year OS was 51%. C-indices for 7-year DFS, and OS by the Sarculator nomogram were 0.65 (95% confidence interval [CI]: 0.62-0.69) and 0.69 (95%CI: 0.65-0.73); plots demonstrated good calibration for predicting 7-year outcomes. The C-index for 4-, 8-, and 12-year DSS by the MSK nomogram was 0.71 (95%CI: 0.67-0.75); plots demonstrated similarly good calibration ability. CONCLUSIONS In a diverse, modern validation cohort of patients with resected primary RPS, both Sarculator and MSK nomograms demonstrated good prognostic ability, supporting their ongoing adoption into clinical practice.
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Affiliation(s)
- Malcolm H Squires
- Division of Surgical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Cecilia G Ethun
- Division of Surgical Oncology, Emory University, Atlanta, Georgia, USA
| | - Erin E Donahue
- Department of Cancer Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Jennifer H Benbow
- Department of Cancer Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Colin J Anderson
- Department of Orthopedic Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA.,Musculoskeletal Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Megan H Jagosky
- Department of Medical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Jonathan C Salo
- Division of Surgical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Joshua S Hill
- Division of Surgical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - William Ahrens
- Department of Pathology, Atrium Health, Charlotte, North Carolina, USA
| | - Roshan S Prabhu
- Department of Radiation Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Michael B Livingston
- Department of Medical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Nicole L Gower
- Department of Cancer Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Mckenzie Needham
- Department of Cancer Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Sally J Trufan
- Department of Cancer Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Ryan C Fields
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bradley A Krasnick
- Department of Surgery, School of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Meena Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Daniel E Abbott
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Patrick Schwartz
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | | | | | - Valerie Grignol
- Division of Surgical Oncology, The Ohio State University, Columbus, OH, USA
| | - Kevin K Roggin
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Jennifer Tseng
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - George Poultsides
- Department of Surgery, Stanford University, Palo Alto, California, USA
| | - Thuy B Tran
- Department of Surgery, Stanford University, Palo Alto, California, USA
| | - Kenneth Cardona
- Division of Surgical Oncology, Emory University, Atlanta, Georgia, USA
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Impact of histological subtype on radiological and pathological response after neoadjuvant radiotherapy in soft tissue sarcoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:2995-3003. [PMID: 34281731 DOI: 10.1016/j.ejso.2021.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/01/2021] [Accepted: 07/10/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Evaluation of response to neoadjuvant radiotherapy (NART) does not consider soft tissue sarcoma (STS) heterogeneity. We aimed to investigate radiological and pathological response of 4 major histotypes. METHODS Extremity or trunk STS patients who received 50 Gy NART between 2009 and 2020 were retrospectively included. Relative variation in tumor size (RVTS) and pathological response were reported in the overall population and in undifferentiated pleomorphic sarcoma (UPS), myxofibrosarcoma (MFS), myxoid liposarcoma (MLS) and synovial sarcoma (SS) patients to identify response modalities of each histotype. RESULTS Among the 121 included patients, 49, 19, 13 and 11 presented UPS, MFS, MLS and SS. Median RVTS were 0% (IQR -18-+18), +8% (IQR 0-+24), -12% (IQR -20-3) and -11% (IQR -15-9), respectively (p = 0.001). Median viable cells were 10%, 60%, 20% and 70% (p = 0.007). In overall population, pathological complete response and median necrosis were 27.7% and 10% without significant correlation to histotype (p = 0.18 and 0.06). Nineteen (38.8%) UPS specimens presented cysts that were emptied during the sampling process and distorted the microscopic response evaluation. Infiltrative growth pattern was observed in 28% and 38.9% UPS and MFS patients. Five (38.5%) MLS presented mature adipocytes without proven prognostic value. Cysts were observed in 36% of SS specimens. In the absence of initial tumor limits, the great viable cellularity of SS may be overestimated by their nodular aspect. CONCLUSION After NART, we highlighted disparate response of UPS, frequent progression of MFS, and confirmed MLS and SS radiosensitivity. Response must be interpreted with caution and consider the histotype-specific patterns.
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9
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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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Vujanić GM, D'Hooghe E, Graf N, Vokuhl C, Al-Saadi R, Chowdhury T, Pritchard-Jones K, Furtwängler R. Prognostic significance of histopathological response to preoperative chemotherapy in unilateral Wilms' tumor: An analysis of 899 patients treated on the SIOP WT 2001 protocol in the UK-CCLG and GPOH studies. Int J Cancer 2021; 149:1332-1340. [PMID: 34109628 DOI: 10.1002/ijc.33707] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 11/12/2022]
Abstract
In the SIOP Wilms' tumor (WT) studies, preoperative chemotherapy is used as primary treatment, and tumors are classified thereafter by pathologists. Completely necrotic WTs (CN-WTs) are classified as low-risk tumors. The aim of the study was to evaluate whether a subset of regressive type WTs (RT-WTs) (67%-99% chemotherapy-induced changes [CIC]) showing an exceptionally good response to preoperative chemotherapy had comparably excellent survivals as CN-WTs, and to establish a cut-off point of CIC that could define this subset. The study included 2117 patients with unilateral, nonanaplastic WTs from the UK-CCLG and GPOH-WT studies (2001-2020) treated according to the SIOP-WT-2001 protocol. There were 126 patients with CN-WTs and 773 with RT-WTs, stages I-IV. RT-WTs were subdivided into subtotally necrotic WTs (>95% CIC) (STN-WT96-99) (124 patients) and the remaining of RT-WT (RR-WT67-95) (649 patients). The 5-year event-free survival (EFS) and overall survival (OS) for CN-WTs were 95.3% (±2.1% SE) and 97.3% (±1.5% SE), and for RT-WTs 85.7% (±1.14% SE, P < .01) and 95.2% (±0.01% SE, P = .59), respectively. CN-WT and STN-WT96-99 groups showed significantly better EFS than RR-WT67-95 (P = .003 and P = .02, respectively), which remained significantly superior when adjusted for age, local stage and metastasis at diagnosis, in multivariate analysis, whereas OS were superimposable (97.3 ± 1.5% SE for CN-WT; 97.8 ± 1.5% SE for STN-WT96-99; 94.7 ± 1.0% SE for RR-WT67-95). Patients with STN-WT96-99 share the same excellent EFS and OS as patients with CN-WTs, and although this was achieved by more treatment for patients with STN-WT96-99 than for patients with CN-WT, reduction in postoperative treatment of these patients may be justified.
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Affiliation(s)
- Gordan M Vujanić
- Department of Pathology, Sidra Medicine and Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Ellen D'Hooghe
- Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Norbert Graf
- Department of Hematology and Oncology, University of Saarland, Homburg, Germany
| | | | - Reem Al-Saadi
- Developmental Biology and Cancer Programme, UCL Great Ormond Street of Child Health, University College London, London, UK
| | - Tanzina Chowdhury
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Kathy Pritchard-Jones
- Developmental Biology and Cancer Programme, UCL Great Ormond Street of Child Health, University College London, London, UK
| | - Rhoikos Furtwängler
- Department of Hematology and Oncology, University of Saarland, Homburg, Germany
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Gennaro N, Reijers S, Bruining A, Messiou C, Haas R, Colombo P, Bodalal Z, Beets-Tan R, van Houdt W, van der Graaf WTA. Imaging response evaluation after neoadjuvant treatment in soft tissue sarcomas: Where do we stand? Crit Rev Oncol Hematol 2021; 160:103309. [PMID: 33757836 DOI: 10.1016/j.critrevonc.2021.103309] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/15/2021] [Accepted: 03/03/2021] [Indexed: 12/16/2022] Open
Abstract
Soft tissue sarcomas (STS) represent a broad family of rare tumours for which surgery with radiotherapy represents first-line treatment. Recently, neoadjuvant chemo-radiotherapy has been increasingly used in high-risk patients in an effort to reduce surgical morbidity and improve clinical outcomes. An adequate understanding of the efficacy of neoadjuvant therapies would optimise patient care, allowing a tailored approach. Although response evaluation criteria in solid tumours (RECIST) is the most common imaging method to assess tumour response, Choi criteria and functional and molecular imaging (DWI, DCE-MRI and 18F-FDG-PET) seem to outperform it in the discrimination between responders and non-responders. Moreover, the radiologic-pathology correlation of treatment-related changes remains poorly understood. In this review, we provide an overview of the imaging assessment of tumour response in STS undergoing neoadjuvant treatment, including conventional imaging (CT, MRI, PET) and advanced imaging analysis. Future directions will be presented to shed light on potential advances in pre-surgical imaging assessments that have clinical implications for sarcoma patients.
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Affiliation(s)
- Nicolò Gennaro
- Humanitas Research and Cancer Center, Dept. of Radiology, Rozzano, Italy; Humanitas University, Dept. of Biomedical Sciences, Pieve Emanuele, Italy; The Netherlands Cancer Institute, Dept. of Radiology, Amsterdam, the Netherlands.
| | - Sophie Reijers
- The Netherlands Cancer Institute, Dept. of Surgical Oncology, Amsterdam, the Netherlands
| | - Annemarie Bruining
- The Netherlands Cancer Institute, Dept. of Radiology, Amsterdam, the Netherlands
| | - Christina Messiou
- The Royal Marsden NHS Foundation Trust, Dept. Of Radiology Sarcoma Unit, Sutton, United Kingdom; The Institute of Cancer Research, Sutton, United Kingdom
| | - Rick Haas
- The Netherlands Cancer Institute, Dept. of Radiation Oncology, Amsterdam, the Netherlands; Leiden University Medical Center, Dept. of Radiation Oncology, the Netherlands
| | | | - Zuhir Bodalal
- The Netherlands Cancer Institute, Dept. of Radiology, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Regina Beets-Tan
- The Netherlands Cancer Institute, Dept. of Radiology, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands; Danish Colorectal Cancer Center South, Vejle University Hospital, Institute of Regional Health Research, University of Southern Denmark, Denmark
| | - Winan van Houdt
- The Netherlands Cancer Institute, Dept. of Surgical Oncology, Amsterdam, the Netherlands
| | - Winette T A van der Graaf
- The Netherlands Cancer Institute, Dept. of Medical Oncology, Amsterdam, the Netherlands; Erasmus MC Cancer Institute, Dept. of Medical Oncology, Erasmus University Medical Center, Rotterdam, the Netherlands
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12
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Llacer-Moscardo C, Terlizzi M, Bonvalot S, Le Loarer F, Carrère S, Tetrau R, D'ascoli A, Lerouge D, Le Péchoux C, Thariat J. Pre- or postoperative radiotherapy for soft tissue sarcomas. Cancer Radiother 2020; 24:501-512. [PMID: 32807685 DOI: 10.1016/j.canrad.2020.05.007] [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: 05/12/2020] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 11/17/2022]
Abstract
Sarcomas are rare tumours arising from mesenchymal tissue. A multimodal management in an expert centre combining surgery and radiotherapy is the current standard of care for localized soft-tissue sarcomas of the extremities, to enable limb-sparing strategies. The delivery of pre- radiotherapy or postoperative radiotherapy offers similar local control and survival rates but the toxicity profile is quite different: preoperative radiotherapy increases the risk of wound complications and postoperative radiotherapy affects long-term functional outcomes. While postoperative radiotherapy has long been the rule, especially in Europe, technical improvements with image-guided- and intensity-modulated radiotherapy associated with a better management of postoperative wounds has tended to change practices with more frequent preoperative radiotherapy. More recently the possibilities of a hypofractionated regimen or potentiation by nanoparticles to increase the therapeutic index plead in favour of a preoperative delivery of radiotherapy. The aim of this paper is to report pros and cons of pre- and post-operative radiotherapy for soft-tissue sarcomas.
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Affiliation(s)
- C Llacer-Moscardo
- Radiation Oncology Department, institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France.
| | - M Terlizzi
- Radiation Oncology Department, hôpital Haut-Lévêque, CHU de Bordeaux, 1, avenue Magellan, 33600 Pessac, France
| | - S Bonvalot
- Department of Surgical Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - F Le Loarer
- Department of Pathology, institut Bergonié, 229, cours de l'Argonne, CS 61283, 33076 Bordeaux cedex, France
| | - S Carrère
- Department of Surgical Oncology, institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France
| | - R Tetrau
- Radiology Department, institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France
| | - A D'ascoli
- Department of Orthopaedics and Sports Surgery, hôpital Pasteur 2, Institut universitaire locomoteur et sports (IULS), 30, voie Romaine, 06000 Nice, France
| | - D Lerouge
- Radiation Oncology Department, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France; Association Advance Resource Centre for Hadrontherapy in Europe (Archade), 3, avenue General-Harris, 14000 Caen, France
| | - C Le Péchoux
- Radiation Oncology Department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - J Thariat
- Radiation Oncology Department, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France; Association Advance Resource Centre for Hadrontherapy in Europe (Archade), 3, avenue General-Harris, 14000 Caen, France
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13
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Montero A, Nuñez M, Hernando O, Vicente E, Ciervide R, Zucca D, Sanchez E, López M, Quijano Y, Garcia-Aranda M, Alonso R, Valero J, Chen X, Alvarez B, Fernandez-Leton P, Rubio C. Retroperitoneal soft-tissue sarcomas: Radiotherapy experience from a tertiary cancer center and review of current evidence. Rep Pract Oncol Radiother 2020; 25:643-655. [PMID: 32565743 PMCID: PMC7292898 DOI: 10.1016/j.rpor.2020.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/14/2020] [Accepted: 05/25/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Surgery remains to be the main therapeutic approach for retroperitoneal sarcomas (RPS) although evidence supports that complementary radiotherapy increases local-control and survival. We present a multidisciplinary management and experience of a tertiary cancer center in the treatment of RPS and analyze current evidence of radiotherapy efficacy. PATIENTS AND METHODS We retrospectively reviewed 19 patients with primary or relapsed RPS treated between November 2009 and October 2018. Multidisciplinary approach comprised complete resection in 15 patients (79%) achieving resection R0 in 11 patients (58%), R1 in 4 patients (21%) and R2 in 2 patients (10%). Seven patients (37%) underwent a preoperative radiation (PRORT), 10 patients (53%), post-operative radiation (PORT) and 2 patients (10%), received radiotherapy exclusively. Ten patients (53%) received adjuvant chemotherapy. RESULTS With a median follow-up of 24 months (2-114 months), actuarial rates of loco-regional relapse free survival (LRFS) at 1, 2 and 3 years were 77%, 77% and 67%, respectively. Actuarial rates of distant-metastases-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) at 1, 2 and 3 years were 100%, 100% and 80% for DMFS; 94%, 77% and 67% for DFS and 100%, 91% and 91% for OS, respectively. Only surgical margins (negative vs. positive) showed significance for 3y-LRFS: 100% vs. 34.3%, p = 0.018. Treatment tolerance was acceptable with no acute or late toxicity higher than grade 2. CONCLUSIONS Complementary radiotherapy appears to be useful and well tolerated for the multidisciplinary management of RPS. Presence of positive surgical margins seems to be the most relevant prognostic factor through the follow-up.
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Affiliation(s)
- A. Montero
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - M. Nuñez
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - O. Hernando
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - E. Vicente
- Department of General Surgery, University Hospital HM Sanchinarro, Madrid, Spain
| | - R. Ciervide
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - D. Zucca
- Department of Medical Physics, University Hospital HM Sanchinarro, Madrid, Spain
| | - E. Sanchez
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - M. López
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - Y. Quijano
- Department of General Surgery, University Hospital HM Sanchinarro, Madrid, Spain
| | - M. Garcia-Aranda
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - R. Alonso
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - J. Valero
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - X. Chen
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - B. Alvarez
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - P. Fernandez-Leton
- Department of Medical Physics, University Hospital HM Sanchinarro, Madrid, Spain
| | - C. Rubio
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
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Ahmed AK, Pennington Z, Molina CA, Xia Y, Goodwin CR, Sciubba DM. Multidisciplinary surgical planning for en bloc resection of malignant primary cervical spine tumors involving 3D-printed models and neoadjuvant therapies: report of 2 cases. J Neurosurg Spine 2019; 30:424-431. [PMID: 30660123 DOI: 10.3171/2018.9.spine18607] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/26/2018] [Indexed: 12/14/2022]
Abstract
Effective en bloc resection of primary spinal tumors necessitates careful consideration of adjacent anatomical structures in order to achieve negative margins and reduce surgical morbidity. This can be particularly challenging in the cervical spine, where vital neurovascular and connective tissues are present in the region. Early multidisciplinary surgical planning that includes clinicians and engineers can both optimize surgical planning and enable a more feasible resection with oncological margins. The aim of the current work was to demonstrate two cases that involved multidisciplinary surgical planning for en bloc resection of primary cervical spine tumors, successfully utilizing 3D-printed patient models and neoadjuvant therapies.
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Affiliation(s)
- A Karim Ahmed
- 1Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, Maryland; and
| | - Zachary Pennington
- 1Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, Maryland; and
| | - Camilo A Molina
- 1Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, Maryland; and
| | - Yuanxuan Xia
- 1Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, Maryland; and
| | - C Rory Goodwin
- 2Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Daniel M Sciubba
- 1Department of Neurosurgery, The Johns Hopkins School of Medicine, Baltimore, Maryland; and
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15
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Tanaka K, Ogawa G, Mizusawa J, Naka N, Kawai A, Takahashi M, Hiruma T, Matsumoto Y, Tsuchiya H, Nakayama R, Hatano H, Emori M, Hosaka M, Yoshida Y, Toguchida J, Abe S, Asanuma K, Yokoyama R, Hiraga H, Yonemoto T, Morii T, Matsumoto S, Nagano A, Yoshikawa H, Fukuda H, Ozaki T, Iwamoto Y. Prospective comparison of various radiological response criteria and pathological response to preoperative chemotherapy and survival in operable high-grade soft tissue sarcomas in the Japan Clinical Oncology Group study JCOG0304. World J Surg Oncol 2018; 16:162. [PMID: 30097070 PMCID: PMC6086997 DOI: 10.1186/s12957-018-1462-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 08/01/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Soft tissue sarcomas (STS) are rare malignant tumors. The efficacy of preoperative chemotherapy for STS is evaluated using various tumor size-based radiological response criteria. However, it is still unclear which set of criteria would show the best association with pathological response and survival of the patients with STS. METHODS We compared radiological responses to preoperative chemotherapy for operable STS by the Response Evaluation Criteria in Solid Tumors (RECIST), modified RECIST, World Health Organization criteria, Japanese Orthopaedic Association criteria, and modified Choi criteria and analyzed the association with pathological response and survival using the data from the Japan Clinical Oncology Group (JCOG) study JCOG0304, a phase II clinical trial evaluating the efficacy of perioperative chemotherapy for STS in the extremities. RESULTS Seventy eligible patients in JCOG0304 were analyzed. The results demonstrated that none of the size-based radiological response criteria showed significant association with pathological response to preoperative chemotherapy for STS. The difference between overall survival of the patients assessed as partial response and stable disease/progressive disease by RECIST was not significant (hazard ratio 1.37, p = 0.63), and calculated C-index was 0.50. All other response criteria also could not exhibit significant association between radiological responses and survival. CONCLUSION In the present study, none of the radiological response criteria analyzed demonstrated association of response to preoperative chemotherapy with pathological response or survival of the patients with operable STS. Further prospective investigation is required to develop criteria to evaluate not only tumor shrinkage but biological effects of preoperative chemotherapy for the patients with localized STS. TRIAL REGISTRATION UMIN Clinical Trials Registry C000000096. Registered 30 August, 2005 (retrospectively registered).
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Affiliation(s)
- Kazuhiro Tanaka
- Department of Orthopaedic Surgery, Oita University, Idaigaoka 1-1, Hasama, Yufu City, Oita, 879-5593, Japan.
| | - Gakuto Ogawa
- JCOG Data Center, National Cancer Center Hospital, Tokyo, 104-0045, Japan
| | - Junki Mizusawa
- JCOG Data Center, National Cancer Center Hospital, Tokyo, 104-0045, Japan
| | - Norifumi Naka
- Musculoskeletal Oncology Service, Osaka International Cancer Institute, Osaka, 541-8567, Japan
| | - Akira Kawai
- Department of Orthopaedic Surgery, National Cancer Center, Tokyo, 104-0045, Japan
| | - Mitsuru Takahashi
- Department of Orthopaedic Surgery, Shizuoka Cancer Center, Shizuoka, 411-0934, Japan
| | - Toru Hiruma
- Department of Orthopaedic Surgery, Kanagawa Cancer Center, Kanagawa, 241-0815, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, 812-8582, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University, Ishikawa, 920-8641, Japan
| | - Robert Nakayama
- Department of Orthopaedic Surgery, Keio University, Tokyo, 160-0016, Japan
| | - Hiroshi Hatano
- Department of Orthopaedic Surgery, Niigata Cancer Center Hospital, Niigata, 951-8133, Japan
| | - Makoto Emori
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, 060-8556, Japan
| | - Masami Hosaka
- Department of Orthopaedic Surgery, Tohoku University, Sendai, 980-8575, Japan
| | - Yukihiro Yoshida
- Department of Orthopaedic Surgery, Nihon University, Tokyo, 173-8610, Japan
| | - Junya Toguchida
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, 606-8501, Japan
| | - Satoshi Abe
- Department of Orthopaedic Surgery, Teikyo University, Tokyo, 173-8606, Japan
| | - Kunihiro Asanuma
- Department of Orthopaedic Surgery, Mie University, Mie, 514-8507, Japan
| | - Ryohei Yokoyama
- Department of Orthopaedic Surgery, National Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Hiroaki Hiraga
- Department of Orthopaedic Surgery, Hokkaido Cancer Center, Sapporo, 003-0804, Japan
| | - Tsukasa Yonemoto
- Department of Orthopaedic Surgery, Chiba Cancer Center, Chiba, 260-8717, Japan
| | - Takeshi Morii
- Department of Orthopaedic Surgery, Kyorin University, Tokyo, 181-8611, Japan
| | - Seiichi Matsumoto
- Department of Orthopaedic Surgery, Cancer Institute Hospital, Tokyo, 135-8550, Japan
| | - Akihito Nagano
- Department of Orthopaedic Surgery, Gifu University, Gifu, 501-1194, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University, Osaka, 565-0871, Japan
| | - Haruhiko Fukuda
- JCOG Data Center, National Cancer Center Hospital, Tokyo, 104-0045, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University, Okayama, 700-0914, Japan
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16
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Salah S, Lewin J, Amir E, Abdul Razak A. Tumor necrosis and clinical outcomes following neoadjuvant therapy in soft tissue sarcoma: A systematic review and meta-analysis. Cancer Treat Rev 2018; 69:1-10. [PMID: 29843049 DOI: 10.1016/j.ctrv.2018.05.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/10/2018] [Accepted: 05/12/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prognostic role of tumor necrosis following neoadjuvant therapy is established in bone sarcomas but remains unclear in soft tissue sarcomas (STS). METHODS We searched MEDLINE, MEDLINE in progress, EMBASE and Cochrane to identify studies that investigated neoadjuvant therapy in STS. Studies were required to report survival data based on extent of necrosis, or provided individual patient data allowing estimation thereof. Hazard ratios (HR) for relapse-free (RFS) and overall survival (OS) and odds ratios (OR) for recurrence at 3 years and for death at 5 years were pooled in a random effect meta-analysis. Associations between patient characteristics and attainment of ≥90% necrosis were explored. RESULTS 21 studies comprising 1663 patients were included. Extremity tumors were most common (n = 1554; 93%). Induction regimens included chemotherapy with radiotherapy (n = 924; 56%), chemotherapy alone (n = 412; 25%), radiotherapy alone (n = 78; 5%), isolated limb perfusion (ILP) (n = 231; 14%), and targeted therapy/radiotherapy (n = 18; 1%). Patients with <90% necrosis had higher hazard of recurrence (hazard ratio [HR] 1.47; 95% CI: 1.06-2.04; p = 0.02) and death (HR 1.86; 95% CI: 1.41-2.46; p < 0.001). Risk of recurrence at 3 years (OR = 3.35; 95% CI: 2.27-4.92; p < 0.001) and of death at 5 years (OR 2.60; 95% CI: 1.59-4.26; p < 0.001) were similarly increased. Compared to other modalities, ILP was associated with higher odds of achieving ≥90% necrosis (OR 12.1; 95% CI: 3.69-39.88; p < 0.001). CONCLUSION Tumour necrosis <90% following neoadjuvant therapy is associated with increased recurrence risk and inferior OS in patients with STS.
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Affiliation(s)
- Samer Salah
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Medical Oncology, King Hussein Cancer Centre, Queen Rania Al Abdullah St 202, Amman, Jordan.
| | - Jeremy Lewin
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
| | - Eitan Amir
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
| | - Albiruni Abdul Razak
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
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17
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Goumard C, Marcal LP, Wang WL, Somaiah N, Okuno M, Roland CL, Tzeng CWD, Chun YS, Feig BW, Vauthey JN, Conrad C. Long-Term Survival According to Histology and Radiologic Response to Preoperative Chemotherapy in 126 Patients Undergoing Resection of Non-GIST Sarcoma Liver Metastases. Ann Surg Oncol 2018; 25:107-116. [PMID: 29116489 DOI: 10.1245/s10434-017-6144-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Non-gastrointestinal stromal tumor sarcomas (NGSs) have heterogeneous histology, and this heterogeneity may lead to uncertainty regarding the prognosis of patients with liver metastases from NGS (NGSLM) and decision regarding their surgical management. Furthermore, the role of preoperative chemotherapy in treatment of NGSLM remains poorly defined. We investigated long-term survival and its correlation to response to preoperative chemotherapy in patients with NGSLM. PATIENTS AND METHOD Patients who underwent liver resection for NGSLM during 1998-2015 were identified. Clinical, histopathologic, and survival data were analyzed. Multivariate analysis was performed using a Cox proportional hazards model. RESULTS 126 patients [62 (49%) with leiomyosarcoma] were included. Five-year overall survival (OS) and recurrence-free survival (RFS) rates were 49.3 and 14.9%, respectively. Survival did not differ by histologic subtype, primary tumor location, or use of preoperative or postoperative chemotherapy. NGSLM ≥ 10 cm and extrahepatic metastases at NGSLM diagnosis were the only independent risk factors for OS. In the 83 (66%) patients with metachronous NSGLM, disease-free interval > 6 months was associated with improved OS and RFS. Among the 65 patients (52%) who received preoperative chemotherapy, radiologic response according to Choi criteria specifically was associated with improved OS (p = 0.04), but radiologic response according to RECIST 1.1 criteria was not. CONCLUSIONS Resection of NGSLM led to a 5-year OS rate of 49%, independent of histologic subtype and primary tumor location. Choi criteria (which take into account tumor density) are superior to RECIST 1.1 in assessing radiologic response and should be used to assess response to preoperative chemotherapy.
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Affiliation(s)
- Claire Goumard
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Leonardo P Marcal
- Division of Diagnostic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei-Lien Wang
- Division of Pathology/Laboratory Medicine, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Neeta Somaiah
- Division of Cancer Medicine, Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Masayuki Okuno
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christina L Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yun Shin Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Barry W Feig
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Claudius Conrad
- Department of Surgical Oncology, Hepato-Pancreato-Biliary Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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18
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File D, Grilley-Olson JE. Can we predict the response to therapy in soft tissue sarcoma? Future Oncol 2017; 14:101-104. [PMID: 29219624 DOI: 10.2217/fon-2017-0497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Danielle File
- Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Juneko E Grilley-Olson
- Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA
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19
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Russell TA, Eckardt MA, Murakami T, Elliott IA, Kawaguchi K, Kiyuna T, Igarashi K, Li Y, Crompton JG, Graham DS, Dry SM, Bernthal N, Yanagawa J, Kalbasi A, Federman N, Chmielowski B, Singh AS, Hoffman RM, Eilber FC. Clinical Factors That Affect the Establishment of Soft Tissue Sarcoma Patient-Derived Orthotopic Xenografts: A University of California, Los Angeles, Sarcoma Program Prospective Clinical Trial. JCO Precis Oncol 2017; 2017. [PMID: 30613825 DOI: 10.1200/po.17.00071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose Given the diverse and aggressive nature of soft tissue sarcomas (STSs), a need exists for more-precise therapy. Patient-derived orthotopic xenografts (PDOXs) provide a unique platform for personalized treatment. Thus, identification of patient and treatment factors that predict PDOX establishment is important. This study assessed the feasibility of incorporating PDOXs into the clinical setting and identifying factors associated with PDOX establishment. Patients and Methods From May 2015 to May 2016, 107 patients with biopsy-proven or potential STS were enrolled. Tumor samples were obtained intraoperatively and orthotopically implanted into nude mice in the corresponding anatomic location. PDOXs were considered established after engraftment and serial passage. Factors associated with establishment were analyzed by logistic regression and time to establishment by time-to-event analysis. Results Only high-grade tumors established (32 of 72 [44.4%]). The establishment rate (ER) varied by neoadjuvant therapy and treatment response, with the highest ER among untreated high-grade tumors (26 of 42 [61.9%]). Tumors exposed to radiation preoperatively did not establish (zero of 11 [0%]), and tumors exposed to neoadjuvant chemotherapy had a lower ER(31.9%) than untreated tumors. Only STSs with minimal pathologic response to neoadjuvant treatment (≤ 30%) established a PDOX (six of 18 [33.3%]). Median establishment time was 54 days, which varied by neoadjuvant therapy but was not statistically significant (P = .180). Conclusion To our knowledge, in the largest STS PDOX study to date, we demonstrate a 62% ER among untreated high-grade tumors with a median establishment time of 54 days. Neoadjuvant therapy, particularly radiation, and pathologic response to treatment were associated with a reduced rate of PDOX establishment.
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Affiliation(s)
- Tara A Russell
- Tara A. Russell, Irmina A. Elliott, Yungfeng Li, Joseph G. Crompton, Danielle S. Graham, Sarah M. Dry, Nicholas Bernthal, Jane Yanagawa, Anusha Kalbasi, Noah Federman, Bartosz Chmielowski, Arun S. Singh, and Fritz C. Eilber, University of California, Los Angeles; Tara A. Russell, Veterans Affairs Los Angeles Health Services Research & Development Center of Innovation, Los Angeles, CA; Mark A. Eckardt, Yale School of Medicine, New Haven, CT; Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, AntiCancer; and Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, University of California, San Diego, San Diego, CA
| | - Mark A Eckardt
- Tara A. Russell, Irmina A. Elliott, Yungfeng Li, Joseph G. Crompton, Danielle S. Graham, Sarah M. Dry, Nicholas Bernthal, Jane Yanagawa, Anusha Kalbasi, Noah Federman, Bartosz Chmielowski, Arun S. Singh, and Fritz C. Eilber, University of California, Los Angeles; Tara A. Russell, Veterans Affairs Los Angeles Health Services Research & Development Center of Innovation, Los Angeles, CA; Mark A. Eckardt, Yale School of Medicine, New Haven, CT; Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, AntiCancer; and Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, University of California, San Diego, San Diego, CA
| | - Takashi Murakami
- Tara A. Russell, Irmina A. Elliott, Yungfeng Li, Joseph G. Crompton, Danielle S. Graham, Sarah M. Dry, Nicholas Bernthal, Jane Yanagawa, Anusha Kalbasi, Noah Federman, Bartosz Chmielowski, Arun S. Singh, and Fritz C. Eilber, University of California, Los Angeles; Tara A. Russell, Veterans Affairs Los Angeles Health Services Research & Development Center of Innovation, Los Angeles, CA; Mark A. Eckardt, Yale School of Medicine, New Haven, CT; Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, AntiCancer; and Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, University of California, San Diego, San Diego, CA
| | - Irmina A Elliott
- Tara A. Russell, Irmina A. Elliott, Yungfeng Li, Joseph G. Crompton, Danielle S. Graham, Sarah M. Dry, Nicholas Bernthal, Jane Yanagawa, Anusha Kalbasi, Noah Federman, Bartosz Chmielowski, Arun S. Singh, and Fritz C. Eilber, University of California, Los Angeles; Tara A. Russell, Veterans Affairs Los Angeles Health Services Research & Development Center of Innovation, Los Angeles, CA; Mark A. Eckardt, Yale School of Medicine, New Haven, CT; Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, AntiCancer; and Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, University of California, San Diego, San Diego, CA
| | - Kei Kawaguchi
- Tara A. Russell, Irmina A. Elliott, Yungfeng Li, Joseph G. Crompton, Danielle S. Graham, Sarah M. Dry, Nicholas Bernthal, Jane Yanagawa, Anusha Kalbasi, Noah Federman, Bartosz Chmielowski, Arun S. Singh, and Fritz C. Eilber, University of California, Los Angeles; Tara A. Russell, Veterans Affairs Los Angeles Health Services Research & Development Center of Innovation, Los Angeles, CA; Mark A. Eckardt, Yale School of Medicine, New Haven, CT; Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, AntiCancer; and Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, University of California, San Diego, San Diego, CA
| | - Tasuku Kiyuna
- Tara A. Russell, Irmina A. Elliott, Yungfeng Li, Joseph G. Crompton, Danielle S. Graham, Sarah M. Dry, Nicholas Bernthal, Jane Yanagawa, Anusha Kalbasi, Noah Federman, Bartosz Chmielowski, Arun S. Singh, and Fritz C. Eilber, University of California, Los Angeles; Tara A. Russell, Veterans Affairs Los Angeles Health Services Research & Development Center of Innovation, Los Angeles, CA; Mark A. Eckardt, Yale School of Medicine, New Haven, CT; Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, AntiCancer; and Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, University of California, San Diego, San Diego, CA
| | - Kentaro Igarashi
- Tara A. Russell, Irmina A. Elliott, Yungfeng Li, Joseph G. Crompton, Danielle S. Graham, Sarah M. Dry, Nicholas Bernthal, Jane Yanagawa, Anusha Kalbasi, Noah Federman, Bartosz Chmielowski, Arun S. Singh, and Fritz C. Eilber, University of California, Los Angeles; Tara A. Russell, Veterans Affairs Los Angeles Health Services Research & Development Center of Innovation, Los Angeles, CA; Mark A. Eckardt, Yale School of Medicine, New Haven, CT; Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, AntiCancer; and Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, University of California, San Diego, San Diego, CA
| | - Yungfeng Li
- Tara A. Russell, Irmina A. Elliott, Yungfeng Li, Joseph G. Crompton, Danielle S. Graham, Sarah M. Dry, Nicholas Bernthal, Jane Yanagawa, Anusha Kalbasi, Noah Federman, Bartosz Chmielowski, Arun S. Singh, and Fritz C. Eilber, University of California, Los Angeles; Tara A. Russell, Veterans Affairs Los Angeles Health Services Research & Development Center of Innovation, Los Angeles, CA; Mark A. Eckardt, Yale School of Medicine, New Haven, CT; Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, AntiCancer; and Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, University of California, San Diego, San Diego, CA
| | - Joseph G Crompton
- Tara A. Russell, Irmina A. Elliott, Yungfeng Li, Joseph G. Crompton, Danielle S. Graham, Sarah M. Dry, Nicholas Bernthal, Jane Yanagawa, Anusha Kalbasi, Noah Federman, Bartosz Chmielowski, Arun S. Singh, and Fritz C. Eilber, University of California, Los Angeles; Tara A. Russell, Veterans Affairs Los Angeles Health Services Research & Development Center of Innovation, Los Angeles, CA; Mark A. Eckardt, Yale School of Medicine, New Haven, CT; Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, AntiCancer; and Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, University of California, San Diego, San Diego, CA
| | - Danielle S Graham
- Tara A. Russell, Irmina A. Elliott, Yungfeng Li, Joseph G. Crompton, Danielle S. Graham, Sarah M. Dry, Nicholas Bernthal, Jane Yanagawa, Anusha Kalbasi, Noah Federman, Bartosz Chmielowski, Arun S. Singh, and Fritz C. Eilber, University of California, Los Angeles; Tara A. Russell, Veterans Affairs Los Angeles Health Services Research & Development Center of Innovation, Los Angeles, CA; Mark A. Eckardt, Yale School of Medicine, New Haven, CT; Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, AntiCancer; and Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, University of California, San Diego, San Diego, CA
| | - Sarah M Dry
- Tara A. Russell, Irmina A. Elliott, Yungfeng Li, Joseph G. Crompton, Danielle S. Graham, Sarah M. Dry, Nicholas Bernthal, Jane Yanagawa, Anusha Kalbasi, Noah Federman, Bartosz Chmielowski, Arun S. Singh, and Fritz C. Eilber, University of California, Los Angeles; Tara A. Russell, Veterans Affairs Los Angeles Health Services Research & Development Center of Innovation, Los Angeles, CA; Mark A. Eckardt, Yale School of Medicine, New Haven, CT; Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, AntiCancer; and Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, University of California, San Diego, San Diego, CA
| | - Nicholas Bernthal
- Tara A. Russell, Irmina A. Elliott, Yungfeng Li, Joseph G. Crompton, Danielle S. Graham, Sarah M. Dry, Nicholas Bernthal, Jane Yanagawa, Anusha Kalbasi, Noah Federman, Bartosz Chmielowski, Arun S. Singh, and Fritz C. Eilber, University of California, Los Angeles; Tara A. Russell, Veterans Affairs Los Angeles Health Services Research & Development Center of Innovation, Los Angeles, CA; Mark A. Eckardt, Yale School of Medicine, New Haven, CT; Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, AntiCancer; and Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, University of California, San Diego, San Diego, CA
| | - Jane Yanagawa
- Tara A. Russell, Irmina A. Elliott, Yungfeng Li, Joseph G. Crompton, Danielle S. Graham, Sarah M. Dry, Nicholas Bernthal, Jane Yanagawa, Anusha Kalbasi, Noah Federman, Bartosz Chmielowski, Arun S. Singh, and Fritz C. Eilber, University of California, Los Angeles; Tara A. Russell, Veterans Affairs Los Angeles Health Services Research & Development Center of Innovation, Los Angeles, CA; Mark A. Eckardt, Yale School of Medicine, New Haven, CT; Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, AntiCancer; and Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, University of California, San Diego, San Diego, CA
| | - Anusha Kalbasi
- Tara A. Russell, Irmina A. Elliott, Yungfeng Li, Joseph G. Crompton, Danielle S. Graham, Sarah M. Dry, Nicholas Bernthal, Jane Yanagawa, Anusha Kalbasi, Noah Federman, Bartosz Chmielowski, Arun S. Singh, and Fritz C. Eilber, University of California, Los Angeles; Tara A. Russell, Veterans Affairs Los Angeles Health Services Research & Development Center of Innovation, Los Angeles, CA; Mark A. Eckardt, Yale School of Medicine, New Haven, CT; Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, AntiCancer; and Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, University of California, San Diego, San Diego, CA
| | - Noah Federman
- Tara A. Russell, Irmina A. Elliott, Yungfeng Li, Joseph G. Crompton, Danielle S. Graham, Sarah M. Dry, Nicholas Bernthal, Jane Yanagawa, Anusha Kalbasi, Noah Federman, Bartosz Chmielowski, Arun S. Singh, and Fritz C. Eilber, University of California, Los Angeles; Tara A. Russell, Veterans Affairs Los Angeles Health Services Research & Development Center of Innovation, Los Angeles, CA; Mark A. Eckardt, Yale School of Medicine, New Haven, CT; Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, AntiCancer; and Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, University of California, San Diego, San Diego, CA
| | - Bartosz Chmielowski
- Tara A. Russell, Irmina A. Elliott, Yungfeng Li, Joseph G. Crompton, Danielle S. Graham, Sarah M. Dry, Nicholas Bernthal, Jane Yanagawa, Anusha Kalbasi, Noah Federman, Bartosz Chmielowski, Arun S. Singh, and Fritz C. Eilber, University of California, Los Angeles; Tara A. Russell, Veterans Affairs Los Angeles Health Services Research & Development Center of Innovation, Los Angeles, CA; Mark A. Eckardt, Yale School of Medicine, New Haven, CT; Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, AntiCancer; and Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, University of California, San Diego, San Diego, CA
| | - Arun S Singh
- Tara A. Russell, Irmina A. Elliott, Yungfeng Li, Joseph G. Crompton, Danielle S. Graham, Sarah M. Dry, Nicholas Bernthal, Jane Yanagawa, Anusha Kalbasi, Noah Federman, Bartosz Chmielowski, Arun S. Singh, and Fritz C. Eilber, University of California, Los Angeles; Tara A. Russell, Veterans Affairs Los Angeles Health Services Research & Development Center of Innovation, Los Angeles, CA; Mark A. Eckardt, Yale School of Medicine, New Haven, CT; Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, AntiCancer; and Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, University of California, San Diego, San Diego, CA
| | - Robert M Hoffman
- Tara A. Russell, Irmina A. Elliott, Yungfeng Li, Joseph G. Crompton, Danielle S. Graham, Sarah M. Dry, Nicholas Bernthal, Jane Yanagawa, Anusha Kalbasi, Noah Federman, Bartosz Chmielowski, Arun S. Singh, and Fritz C. Eilber, University of California, Los Angeles; Tara A. Russell, Veterans Affairs Los Angeles Health Services Research & Development Center of Innovation, Los Angeles, CA; Mark A. Eckardt, Yale School of Medicine, New Haven, CT; Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, AntiCancer; and Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, University of California, San Diego, San Diego, CA
| | - Fritz C Eilber
- Tara A. Russell, Irmina A. Elliott, Yungfeng Li, Joseph G. Crompton, Danielle S. Graham, Sarah M. Dry, Nicholas Bernthal, Jane Yanagawa, Anusha Kalbasi, Noah Federman, Bartosz Chmielowski, Arun S. Singh, and Fritz C. Eilber, University of California, Los Angeles; Tara A. Russell, Veterans Affairs Los Angeles Health Services Research & Development Center of Innovation, Los Angeles, CA; Mark A. Eckardt, Yale School of Medicine, New Haven, CT; Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, AntiCancer; and Takashi Murakami, Kei Kawaguchi, Tasuku Kiyuna, Kentaro Igarashi, and Robert M. Hoffman, University of California, San Diego, San Diego, CA
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20
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Pasquali S, Gronchi A. Neoadjuvant chemotherapy in soft tissue sarcomas: latest evidence and clinical implications. Ther Adv Med Oncol 2017; 9:415-429. [PMID: 28607580 PMCID: PMC5455882 DOI: 10.1177/1758834017705588] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/27/2017] [Indexed: 12/20/2022] Open
Abstract
Soft tissue sarcomas are a rare and multifaceted group of solid tumours. Neoadjuvant chemotherapy is increasingly used to limit loss of function after wide surgical excision with the ultimate aim of improving patient survival. Recently, advances in the identification of effective treatment strategies and improvements in patient risk stratification have been reached. A randomized trial demonstrated that neoadjuvant epirubicin and ifosfamide improves survival of patients affected by five high-risk soft tissue sarcoma histologies of trunk and extremities, including undifferentiated pleomorphic sarcoma, myxoid liposarcoma, synovial sarcoma, malignant peripheral nerve sheath tumours, and leiomyosarcoma. Selection of patients for these treatments is expected to be improved by the eighth edition of the American Joint Committee on Cancer (AJCC) TNM staging system, as it tailors T-stage categories on primary tumour site and considers a prognostic nomogram for retroperitoneal sarcoma, which also includes soft tissue sarcoma histology and other patient and tumour features not directly included in the TNM staging. Within this framework, this article will present neoadjuvant treatment strategies for high-risk soft tissue sarcoma, emphasizing the most recent advances and discussing the need for further research to improve the effectiveness of neoadjuvant treatments.
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Affiliation(s)
- Sandro Pasquali
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alessandro Gronchi
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G Venezian 1, 20013 Milano, Italy
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21
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Spencer RM, Aguiar Junior S, Ferreira FO, Stevanato Filho PR, Kupper BE, Silva ML, Mello CA, Bezerra TS, Lopes A. Neoadjuvant Hypofractionated Radiotherapy and Chemotherapy in High-Grade Extremity Soft Tissue Sarcomas: Phase 2 Clinical Trial Protocol. JMIR Res Protoc 2017; 6:e97. [PMID: 28546135 PMCID: PMC5465377 DOI: 10.2196/resprot.6806] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/22/2017] [Accepted: 03/17/2017] [Indexed: 11/18/2022] Open
Abstract
Background Neoadjuvant radiotherapy (RT) and chemotherapy are applied to large, high-grade extremity soft tissue sarcomas to treat metastatic disease earlier and sterilize margins to perform R0 surgery. However, preoperative RT increases wound complication rates (rWC), delaying adjuvant chemotherapy or preventing it from being administered altogether. Hypofractionated neoadjuvant RT can be offered in this situation, concomitant to chemotherapy, allowing patients to receive chemotherapy as a preoperative treatment in less time with an acceptable rWC. Objective The objectives of this protocol are to maintain low rates of morbidity and mortality compared to literature data, improving survival rates and avoiding poor responders from receiving unnecessary adjuvant chemotherapy. Methods This noncontrolled, single-arm, phase 2 clinical trial recruited patients aged over 18 years with high-grade soft tissue sarcomas in the girdles or extremities. Three neoadjuvant chemotherapy (ifosfamide and doxorubicin) cycles were administered with 5 days of hypofractionated RT (25 Gy in 5 fractions) in the second cycle of doxorubicin only. Viable cell counts in the surgical specimen were measured, and patients in whom this value was less than 30% continued to receive an additional 3 full chemotherapy cycles as adjuvant treatment. Results Primary endpoint will be disease-specific survival measured by the evaluation of local and distant recurrence after neoadjuvant treatment. The secondary endpoints will be wound complication and amputation rates and chemotherapy toxicity. We also will record the viable cell rates after the schema and correlate this with survival. Conclusions As seems with other solid tumors, hypofractionated RT has comparable efficacy and safety as conventional fractionation. This modality of treatment combined with chemotherapy could increase the pathological response rates and improve the outcomes of select patients. Trial Registration ClinicalTrials.gov NCT02812654; https://clinicaltrials.gov/ct2/show/NCT02812654 (Archived by WebCite at http://www.webcitation.org/6qC3puBOy)
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Affiliation(s)
- Ranyell Msb Spencer
- Sarcoma and Colorectal Tumors, Pelvic Surgery Department, AC Camargo Cancer Center, São Paulo, Brazil
| | - Samuel Aguiar Junior
- Sarcoma and Colorectal Tumors, Pelvic Surgery Department, AC Camargo Cancer Center, São Paulo, Brazil
| | - Fabio O Ferreira
- Sarcoma and Colorectal Tumors, Pelvic Surgery Department, AC Camargo Cancer Center, São Paulo, Brazil
| | - Paulo R Stevanato Filho
- Sarcoma and Colorectal Tumors, Pelvic Surgery Department, AC Camargo Cancer Center, São Paulo, Brazil
| | - Bruna Ec Kupper
- Sarcoma and Colorectal Tumors, Pelvic Surgery Department, AC Camargo Cancer Center, São Paulo, Brazil
| | - Maria Lg Silva
- Sarcoma and Colorectal Tumors, Radiation Therapy Department, AC Camargo Cancer Center, São Paulo, Brazil
| | - Celso A Mello
- Sarcoma and Colorectal Tumors, Clinical Oncology Department, AC Camargo Cancer Center, São Paulo, Brazil
| | - Tiago S Bezerra
- Sarcoma and Colorectal Tumors, Pelvic Surgery Department, AC Camargo Cancer Center, São Paulo, Brazil
| | - Ademar Lopes
- Sarcoma and Colorectal Tumors, Pelvic Surgery Department, AC Camargo Cancer Center, São Paulo, Brazil
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22
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Messiou C, Moskovic E, Vanel D, Morosi C, Benchimol R, Strauss D, Miah A, Douis H, van Houdt W, Bonvalot S. Primary retroperitoneal soft tissue sarcoma: Imaging appearances, pitfalls and diagnostic algorithm. Eur J Surg Oncol 2016; 43:1191-1198. [PMID: 28057392 DOI: 10.1016/j.ejso.2016.10.032] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/19/2016] [Accepted: 10/24/2016] [Indexed: 02/07/2023] Open
Abstract
Although retroperitoneal sarcomas are rare tumours, they can be encountered by a wide variety of clinicians as they can be incidental findings on imaging or present with non specific symptoms and signs. Surgical resection can offer hope of cure and patient outcomes are improved when patients are managed in high-volume specialist centers. Failure to recognize retroperitoneal sarcomas on imaging can lead to inappropriate management in inexperienced centers. Therefore it is critical that a diagnosis of retroperitoneal sarcoma should be considered in the differential diagnosis of a retroperitoneal mass with prompt referral to a soft tissue sarcoma unit. In particular, the most common retroperitoneal sarcoma subtypes, liposarcoma and leiomyosarcoma, have characteristic imaging appearances which are discussed. This review therefore aims to set the context and guide clinicians through a diagnostic pathway for retroperitoneal masses in adults which arise extrinsic to the solid abdominal viscera.
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Affiliation(s)
- C Messiou
- Department of Radiology, The Royal Marsden Hospital and The Institute of Cancer Research, London, UK.
| | - E Moskovic
- Department of Radiology, The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - D Vanel
- Department of Radiology, The Rizzoli Institute, Bologna, Italy
| | - C Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - R Benchimol
- Department of Radiology, Institut Curie, Paris, France
| | - D Strauss
- Department of Academic Surgery, The Royal Marsden Hospital, London, UK
| | - A Miah
- Department of Radiotherapy and Physics, Sarcoma Unit, The Royal Marsden Hospital, London, UK
| | - H Douis
- Department of Radiology, University Hospital, Birmingham, UK
| | - W van Houdt
- Department of Academic Surgery, The Royal Marsden Hospital, London, UK
| | - S Bonvalot
- Department of Surgery, Institut Curie, Paris, France
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23
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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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24
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Sargos P, Stoeckle E, Henriques de Figueiredo B, Antoine M, Delannes M, Mervoyer A, Kantor G. [Radiotherapy for retroperitoneal sarcomas]. Cancer Radiother 2016; 20:677-84. [PMID: 27568294 DOI: 10.1016/j.canrad.2016.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/27/2016] [Accepted: 07/02/2016] [Indexed: 10/21/2022]
Abstract
The management of retroperitoneal sarcoma can be very challenging, and the quality of initial treatment strategy appears to be a crucial prognostic factor. En bloc surgery is currently the standard of care for these rare tumours and perioperative treatments such as chemotherapy or radiotherapy have not been validated yet. However, local-regional relapse constitutes the most common disease course. While adjuvant radiotherapy is less and less common due to gastrointestinal toxicities, preoperative radiation therapy offers numerous advantages and is being evaluated as part of a national multicentre phase II study (TOMOREP trial) and is the subject of a European randomized phase III study (STRASS trial). The objective of this article is to present data on preoperative irradiation in terms of dose, volumes and optimal radiotherapy techniques for the treatment of this rare disease.
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Affiliation(s)
- P Sargos
- Département de radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France.
| | - E Stoeckle
- Département de chirurgie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - B Henriques de Figueiredo
- Département de radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - M Antoine
- Unité de physique médicale, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - M Delannes
- Département de radiothérapie, institut Claudius-Regaud, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - A Mervoyer
- Département de radiothérapie, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain, France
| | - G Kantor
- Département de radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
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25
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Fan W, Niu L, Wang Y, Zhang Y, Yao X, Tan G, Yang J, Li J. Percutaneous computed tomography-guided cryoablation for recurrent retroperitoneal soft tissue sarcoma: a study of safety and efficacy. Oncotarget 2016; 7:42639-42649. [PMID: 27223071 PMCID: PMC5173163 DOI: 10.18632/oncotarget.9476] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 04/16/2016] [Indexed: 12/17/2022] Open
Abstract
AIMS To evaluate the use of computed tomography image-guided percutaneous cryoablation for recurrent retroperitoneal soft tissue sarcomas (RPSs). RESULTS Adverse events were limited to grades 1 and 2, included fever (n = 19), local pain (n = 11), emesis (n = 10), frostbite (n = 6), and nerve injury (n = 1). Fever was more frequent in the large tumor group (15.8%) than in small tumor group (1.9%) (P = 0.008). Median PFS and OS were 37.0 ± 7.7 months (range, 4-39 months) and 43.0 ± 5.9 months (range, 6-54 months), respectively. PFS and OS were significantly longer in the small tumor group than in the large tumor group (P = 0.011 and P = 0.015, respectively), but the response rate (82.7% vs. 72.8%, P = 0.240) did not differ significantly. On univariate analysis, tumor size, tumor invasion grade, and distant metastasis were significant prognostic factors for PFS and OS. On multivariate analysis, a tumor size ≥10 cm was an independent negative prognostic factor for PFS and OS after cryoablation (HR: 3.98, 95% CI: 1.27-12.50, P = 0.018 and HR: 4.33, 95% CI: 1.41-13.26, P = 0.010, respectively). MATERIALS AND METHODS Data from 72 patients with recurrent RPSs who underwent percutaneous cryoablation were reviewed retrospectively. The prognostic factors for progression-free survival (PFS), overall survival (OS), and efficacy based on mRECIST criteria were analysis. Adverse events were compared according to tumor size (<10 and ≥10 cm). CONCLUSION Minimally invasive percutaneous cryoablation was safe and efficacious for recurrent RPSs.
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Affiliation(s)
- Wenzhe Fan
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Lizhi Niu
- Fuda Cancer Hospital, Guangzhou, China
- Fuda Institute of Cryosurgery for Cancer, Guangzhou, China
| | - Yu Wang
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yingqiang Zhang
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xuehua Yao
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Guosheng Tan
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jianyong Yang
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Department of Medical Imaging, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jiaping Li
- Department of Interventional Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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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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Mor N, Wu G, Aylward A, Christos PJ, Sulica L. Predictors for Permanent Medialization Laryngoplasty in Unilateral Vocal Fold Paralysis. Otolaryngol Head Neck Surg 2016; 155:443-53. [PMID: 27143710 DOI: 10.1177/0194599816644716] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 03/25/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Early differentiation of patients with unilateral vocal fold paralysis (VFP) who recover from those who do not and consequently require permanent medialization laryngoplasty (ML) remains a challenge. The goal of this study is to identify factors that predict the need for ML. STUDY DESIGN Case series with chart review. SETTING Academic center. SUBJECTS AND METHODS A total of 507 records of patients with VFP were analyzed, of which 252 met criteria and were stratified according to whether or not they obtained ML. Demographic information and clinical features were analyzed to determine predictors of ML. A nomogram was generated according to the significance and utility of these parameters. RESULTS Of 252 patients, 86 underwent ML, and 166 did not. No differences in age or sex were observed between the ML and non-ML patients (P = .27 and P = .35, respectively). The most common cause of VFP was iatrogenic injury (62.79%, ML; 49.40%, non-ML). ML correlated with VFP secondary to neoplastic disease (odds ratio [OR], 2.14; 95% confidence interval [95% CI], 1.01-4.53) and iatrogenic injury (OR 1.73; 95% CI 1.01-2.94). ML had an inverse correlation with idiopathic VFP (OR, 0.40; 95% CI, 0.20-0.79). Patients in the ML group were more likely to have left-sided VFP, to have a history of aspiration, and to present ≥90 days from onset and less likely to have had temporary injection augmentation. CONCLUSION Clinical features may be used to predict the likelihood of a patient obtaining ML. Nomograms may be useful to counsel patients who would benefit from early definitive surgery.
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Affiliation(s)
- Niv Mor
- Voice and Swallowing Disorders, Division of Otolaryngology-Head and Neck Surgery, Maimonides Medical Center, Brooklyn, New York, USA Department of Otolaryngology-Head and Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, USA
| | - Guojiao Wu
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Alana Aylward
- College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Paul J Christos
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Lucian Sulica
- Department of Otolaryngology-Head and Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, USA
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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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Wardelmann E, Haas R, Bovée J, Terrier P, Lazar A, Messiou C, LePechoux C, Hartmann W, Collin F, Fisher C, Mechtersheimer G, DeiTos A, Stacchiotti S, Jones R, Gronchi A, Bonvalot S. Evaluation of response after neoadjuvant treatment in soft tissue sarcomas; the European Organization for Research and Treatment of Cancer–Soft Tissue and Bone Sarcoma Group (EORTC–STBSG) recommendations for pathological examination and reporting. Eur J Cancer 2016; 53:84-95. [DOI: 10.1016/j.ejca.2015.09.021] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/14/2015] [Accepted: 09/16/2015] [Indexed: 12/25/2022]
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Abstract
Functional MR imaging is the technique of choice to evaluate and manage malignant musculoskeletal masses. Advanced MR imaging sequences include chemical shift MR imaging, diffusion-weighted imaging with apparent diffusion coefficient mapping, MR spectroscopy imaging, and dynamic contrast-enhanced perfusion imaging. Functional MR imaging adds value to morphologic sequences in the detection, characterization, staging, and posttherapy assessment of malignant musculoskeletal malignancies. This article reviews the technical role of each functional sequence and their clinical applications to allow more confident decisions to be made. Multiparametric analysis of functional and anatomic MR sequences allows musculoskeletal tumors analysis to be improved.
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Abstract
Retroperitoneal liposarcomas are rare mesenchymal tumors of the retroperitoneum that typically present with advanced disease and often carry a poor prognosis. Because of their rarity and anatomic location, these malignant tumors can cause a diagnostic dilemma and present several therapeutic challenges. They are usually associated with a high rate of recurrence despite grossly complete resection, thus requiring long-term and often indefinite follow-up. Relevant data on this topic was procured and synthesized with the aid of a comprehensive Medline search in addition to oncologic, pathologic, urologic, radiologic, and surgical literature review on retroperitoneal sarcomas. This article provides an in-depth review into the natural history, pathology, clinical manifestations, and prognostic features of retroperitoneal liposarcomas. It also discusses the reliability of diagnostic procedures and novel curative approaches that are currently being evaluated for the disease.
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Effectiveness of regional hyperthermia with chemotherapy for high-risk retroperitoneal and abdominal soft-tissue sarcoma after complete surgical resection: a subgroup analysis of a randomized phase-III multicenter study. Ann Surg 2015; 260:749-54; discussion 754-6. [PMID: 25379845 DOI: 10.1097/sla.0000000000000978] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether regional hyperthermia (RHT) in addition to chemotherapy improves local tumor control after macroscopically complete resection of abdominal or retroperitoneal high-risk sarcomas. BACKGROUND Within the prospectively randomized EORTC 62961 phase-III trial, RHT and systemic chemotherapy significantly improved local progression-free survival (LPFS) and disease-free survival (DFS) in patients with abdominal and extremity sarcomas. That trial included macroscopically complete and R2 resections. METHODS A subgroup analysis of the EORTC trial was performed and long-term survival determined. From 341 patients, 149 (median age 52 years, 18-69) were identified with macroscopic complete resection (R0, R1) of abdominal and retroperitoneal soft-tissue sarcomas (median diameter 10 cm, G2 48.3%, G3 51.7%). Seventy-six patients were treated with EIA (etoposide, ifosfamide, doxorubicin)+RHT (≥5 cycles: 69.7%) versus 73 patients receiving EIA alone (≥5 cycles: 52.1%, P=0.027). LPFS and DFS as well as overall survival were determined. RESULTS RHT and systemic chemotherapy significantly improved LPFS (56% vs 45% after 5 years, P=0.044) and DFS (34% vs 27% after 5 years, P=0.040). Overall survival was not significantly improved in the RHT group (57% vs 55% after 5 years, P=0.82). Perioperative morbidity and mortality were not significantly different between groups. CONCLUSIONS In patients with macroscopically complete tumor resection, RHT in addition to chemotherapy resulted in significantly improved local tumor control and DFS without increasing surgical complications. Within a multimodal therapeutic concept for abdominal and retroperitoneal high-risk sarcomas, RHT is a treatment option beside radical surgery and should be further evaluated in future trials.
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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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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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A case of myxoid liposarcoma of the retroperitoneum: a challenging tumour for diagnosis and treatment. Case Rep Surg 2014; 2014:572805. [PMID: 25024863 PMCID: PMC4082922 DOI: 10.1155/2014/572805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 05/20/2014] [Indexed: 12/27/2022] Open
Abstract
Retroperitoneal sarcomas are rare neoplasms that account for only 1%-2% of all solid tumors and liposarcomas represent the most frequent histological type. We describe the case of a 44-year-old female with a retroperitoneal myxoid liposarcoma of 22 × 19 × 8 cm in size. The only symptoms were persistent pain and progressive tenderness of the abdomen lasting for two months. The mass was radically excised during laparotomy. CT and MRI were useful to clarify the site of origin of the tumor, relationships with other organs, and planning surgery but final diagnosis was based on histological findings. Here we review the literature about the challenging diagnosis, treatment, and prognostic factors of this disease.
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Mohindra P, Neuman HB, Kozak KR. The role of radiation in retroperitoneal sarcomas. Curr Treat Options Oncol 2014; 14:425-41. [PMID: 23649911 DOI: 10.1007/s11864-013-0236-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OPINION STATEMENT Retroperitoneal sarcomas form a group of rare malignancies that require expertise in every aspect of management. Patients benefit from referral to cancer centers that can provide comprehensive, multidisciplinary, oncologic management. The role of radiation in retroperitoneal sarcoma management is, appropriately, the subject of considerable controversy due to the absence of high-level evidence proving its efficacy. Nonetheless, the preponderance of available data suggests that radiation therapy likely improves local control and, in some settings, may favorably impact resectability and survival. These outcome observations coupled with the lower doses (45-54 Gy) and normal tissue displacement characteristic of preoperative radiation therapy leads us to favor preoperative radiotherapy followed by oncologic resection for most retroperitoneal sarcomas. This strategy appears to provide the highest chance of safe and successful delivery of multimodal therapy, which can otherwise be hindered by postoperative complications as a result of technically challenging surgery and normal tissue radiation dose tolerances. Dose-escalation and selective integrative boosts to "at-risk" margins are attractive strategies that merit, and arguably require, further clinical evaluation. We believe that postoperative radiotherapy should be reserved for very high-risk cases and should be treated to a dose of ≥60 Gy respecting normal tissue dose tolerances. An additional approach that we consider in the postoperative setting is close surveillance with consideration of preoperative radiotherapy at recurrence before repeat surgical resection. Highly conformal radiotherapy techniques, such as IMRT with image guidance, should be employed to minimize dose to normal tissues and thereby allow delivery of efficacious radiation doses. If feasible, referral to a treatment facility with proton beam therapy should be discussed with the patient, especially if normal tissue dose constraints cannot be met using IMRT/IGRT. Participation in prospective studies should be highly encouraged.
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Affiliation(s)
- Pranshu Mohindra
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, K4/B100, Madison, WI, 53792, USA,
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Miah AB, Hannay J, Benson C, Thway K, Messiou C, Hayes AJ, Strauss DC. Optimal management of primary retroperitoneal sarcoma: an update. Expert Rev Anticancer Ther 2014; 14:565-79. [DOI: 10.1586/14737140.2014.883279] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hwang SY, Warrier S, Thompson S, Davidson T, Yang JL, Crowe P. Safety and accuracy of core biopsy in retroperitoneal sarcomas. Asia Pac J Clin Oncol 2013; 12:e174-8. [DOI: 10.1111/ajco.12125] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sang Yun Hwang
- Prince of Wales Hospital Clinical School; University of New South Wales; Sydney New South Wales Australia
- Department of Surgery; Prince of Wales Hospital; Sydney New South Wales Australia
| | - Sanjay Warrier
- Prince of Wales Hospital Clinical School; University of New South Wales; Sydney New South Wales Australia
- Department of Surgery; Prince of Wales Hospital; Sydney New South Wales Australia
| | - Stephen Thompson
- Prince of Wales Hospital Clinical School; University of New South Wales; Sydney New South Wales Australia
- Department of Radiation Oncology; Prince of Wales Hospital; Sydney New South Wales Australia
- Sydney Sarcoma Unit; Prince of Wales Hospital; Sydney New South Wales Australia
| | - Trent Davidson
- Prince of Wales Hospital Clinical School; University of New South Wales; Sydney New South Wales Australia
- Sydney Sarcoma Unit; Prince of Wales Hospital; Sydney New South Wales Australia
- Department of Anatomical Pathology; South Eastern Sydney Laboratory Services; Prince of Wales Hospital; Sydney New South Wales Australia
| | - Jia Lin Yang
- Prince of Wales Hospital Clinical School; University of New South Wales; Sydney New South Wales Australia
- Sydney Sarcoma Unit; Prince of Wales Hospital; Sydney New South Wales Australia
| | - Philip Crowe
- Prince of Wales Hospital Clinical School; University of New South Wales; Sydney New South Wales Australia
- Department of Radiation Oncology; Prince of Wales Hospital; Sydney New South Wales Australia
- Sydney Sarcoma Unit; Prince of Wales Hospital; Sydney New South Wales Australia
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Gyorki DE, Brennan MF. Management of recurrent retroperitoneal sarcoma. J Surg Oncol 2013; 109:53-9. [PMID: 24155163 DOI: 10.1002/jso.23463] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 09/10/2013] [Indexed: 01/01/2023]
Abstract
Approximately 15% of soft tissue sarcomas are retroperitoneal. The occult location and anatomic complexity results in local recurrences in the majority of patients. Predictors of recurrence include histological subtype, completeness of resection, and the hospital case volume. The most significant predictor of outcome following local recurrence is the resectability of the recurrent disease. An understanding of the implication of tumor biology on outcomes is essential in determining optimal management for patients with recurrent retroperitoneal sarcoma.
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Affiliation(s)
- David E Gyorki
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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Shiraev T, Pasricha SS, Choong P, Schlicht S, van Rijswijk CSP, Dimmick S, Stuckey S, Anderson SE. Retroperitoneal sarcomas: A review of disease spectrum, radiological features, characterisation and management. J Med Imaging Radiat Oncol 2013; 57:687-700. [DOI: 10.1111/1754-9485.12123] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 09/02/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Timothy Shiraev
- School of Medicine; University of Notre Dame; Sydney New South Wales Australia
| | - Sundeep Singh Pasricha
- Southern Health; Department of Diagnostic Imaging; Monash Medical Centre; Melbourne Victoria Australia
| | - Peter Choong
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
- Department of Orthopaedics; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
- Bone and Soft Tissue Tumour Unit; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Stephen Schlicht
- Department of Medical Imaging; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
| | | | - Simon Dimmick
- School of Medicine; University of Notre Dame; Sydney New South Wales Australia
- Department of Radiology; Royal North Shore Hospital; Sydney New South Wales Australia
| | - Stephen Stuckey
- Southern Health; Department of Diagnostic Imaging; Monash Medical Centre; Melbourne Victoria Australia
- Southern Clinical School; Faculty of Medicine; Nursing and Health Sciences; Monash University; Melbourne Victoria Australia
| | - Suzanne E Anderson
- School of Medicine; University of Notre Dame; Sydney New South Wales Australia
- Southern Health; Department of Diagnostic Imaging; Monash Medical Centre; Melbourne Victoria Australia
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Technical innovation in dynamic contrast-enhanced magnetic resonance imaging of musculoskeletal tumors: an MR angiographic sequence using a sparse k-space sampling strategy. Skeletal Radiol 2013; 42:993-1000. [PMID: 23558650 DOI: 10.1007/s00256-013-1604-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 03/07/2013] [Accepted: 03/10/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We demonstrate the clinical use of an MR angiography sequence performed with sparse k-space sampling (MRA), as a method for dynamic contrast-enhanced (DCE)-MRI, and apply it to the assessment of sarcomas for treatment response. MATERIALS AND METHODS Three subjects with sarcomas (2 with osteosarcoma, 1 with high-grade soft tissue sarcomas) underwent MRI after neoadjuvant therapy/prior to surgery, with conventional MRI (T1-weighted, fluid-sensitive, static post-contrast T1-weighted sequences) and DCE-MRI (MRA, time resolution = 7-10 s, TR/TE 2.4/0.9 ms, FOV 40 cm(2)). Images were reviewed by two observers in consensus who recorded image quality (1 = diagnostic, no significant artifacts, 2 = diagnostic, <25 % artifacts, 3 = nondiagnostic) and contrast enhancement characteristics by static MRI (presence/absence of contrast enhancement, percentage of enhancement) and DCE-MRI (presence/absence of arterial enhancement with time-intensity curves). Results were compared with histological response (defined as <5 % viable tumor [soft tissue sarcoma] or <10 % [bone sarcoma] following resection). RESULTS Diagnostic quality for all conventional and DCE-MRI sequences was rated as 1. In 2 of the 3 sarcomas, there was good histological response (≤5 % viable tumor); in 1 there was poor response (50 % viable tumor). By static post-contrast T1-weighted sequences, there was enhancement in all sarcomas, regardless of response (up to >75 % with good response, >75 % with poor response). DCE-MRI findings were concordant with histological response (arterial enhancement with poor response, no arterial enhancement with good response). CONCLUSION Unlike conventional DCE-MRI sequences, an MRA sequence with sparse k-space sampling is easily integrated into a routine musculoskeletal tumor MRI protocol, with high diagnostic quality. In this preliminary work, tumor enhancement characteristics by DCE-MRI were used to assess treatment response.
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Gronchi A, Miceli R, Shurell E, Eilber FC, Eilber FR, Anaya DA, Kattan MW, Honoré C, Lev DC, Colombo C, Bonvalot S, Mariani L, Pollock RE. Outcome prediction in primary resected retroperitoneal soft tissue sarcoma: histology-specific overall survival and disease-free survival nomograms built on major sarcoma center data sets. J Clin Oncol 2013; 31:1649-55. [PMID: 23530096 DOI: 10.1200/jco.2012.44.3747] [Citation(s) in RCA: 249] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Integration of numerous prognostic variables not included in the conventional staging of retroperitoneal soft tissue sarcomas (RPS) is essential in providing effective treatment. The purpose of this study was to build a specific nomogram for predicting postoperative overall survival (OS) and disease-free survival (DFS) in patients with primary RPS. PATIENTS AND METHODS Data registered in three institutional prospective sarcoma databases were used. We included patients with primary localized RPS resected between 1999 and 2009. Univariate (Kaplan and Meier plots) and multivariate (Cox model) analyses were carried out. The a priori chosen prognostic covariates were age, tumor size, grade, histologic subtype, multifocality, quality of surgery, and radiation therapy. External validation was performed by applying the nomograms to the patients of an external cohort. The model's discriminative ability was estimated by means of the bootstrap-corrected Harrell C statistic. RESULTS In all, 523 patients were identified at the three institutions (developing set). At a median follow-up of 45 months (interquartile range, 22 to 72 months), 171 deaths were recorded. Five- and 7-year OS rates were 56.8% (95% CI, 51.4% to 62.6%) and 46.7% (95% CI, 39.9% to 54.6%. Two hundred twenty-one patients had disease recurrence. Five- and 7-year DFS rates were 39.4% (95% CI, 34.5% to 45.0%) and 35.7% (95% CI, 30.3% to 42.1%). The validation set consisted of 135 patients who were identified at the fourth institution for external validation. The bootstrap-corrected Harrell C statistics for OS and DFS were 0.74 and 0.71 in the developing set and 0.68 and 0.69 in the validating set. CONCLUSION These nomograms accurately predict OS and DFS. They should be used for patient counseling in clinical practice and stratification in clinical trials.
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Affiliation(s)
- Alessandro Gronchi
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy.
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Fayad LM, Jacobs MA, Wang X, Carrino JA, Bluemke DA. Musculoskeletal tumors: how to use anatomic, functional, and metabolic MR techniques. Radiology 2013; 265:340-56. [PMID: 23093707 DOI: 10.1148/radiol.12111740] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although the function of magnetic resonance (MR) imaging in the evaluation of musculoskeletal tumors has traditionally been to help identify the extent of disease prior to treatment, its role continues to evolve as new techniques emerge. Conventional pulse sequences remain heavily used and useful, but with the advent of chemical shift imaging, diffusion-weighted imaging, perfusion imaging and MR spectroscopy, additional quantitative metrics have become available that may help expand the role of MR imaging to include detection, characterization, and reliable assessment of treatment response. This review discusses a multiparametric approach to the evaluation of musculoskeletal tumors, with a focus on the utility and potential added value of various pulse sequences in helping establish a diagnosis, assess pretreatment extent, and evaluate a tumor in the posttreatment setting for recurrence and treatment response.
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Affiliation(s)
- Laura M Fayad
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N Wolfe St, Baltimore, MD 21287, USA.
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Schmitt T, Lehner B, Kasper B, Bischof M, Roeder F, Dietrich S, Dimitrakopoulou-Strauss A, Strauss LG, Mechtersheimer G, Wuchter P, Ho AD, Egerer G. A phase II study evaluating neo-/adjuvant EIA chemotherapy, surgical resection and radiotherapy in high-risk soft tissue sarcoma. BMC Cancer 2011; 11:510. [PMID: 22152120 PMCID: PMC3248452 DOI: 10.1186/1471-2407-11-510] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 12/07/2011] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The role of chemotherapy in high-risk soft tissue sarcoma is controversial. Though many patients undergo initial curative resection, distant metastasis is a frequent event, resulting in 5-year overall survival rates of only 50-60%. Neo-adjuvant and adjuvant chemotherapy (CTX) has been applied to achieve pre-operative cytoreduction, assess chemosensitivity, and to eliminate occult metastasis. Here we report on the results of our non-randomized phase II study on neo-adjuvant treatment for high-risk STS. METHOD Patients with potentially curative high-risk STS (size ≥ 5 cm, deep/extracompartimental localization, tumor grades II-III [FNCLCC]) were included. The protocol comprised 4 cycles of neo-adjuvant chemotherapy (EIA, etoposide 125 mg/m(2) iv days 1 and 4, ifosfamide 1500 mg/m2 iv days 1 - 4, doxorubicin 50 mg/m(2) day 1, pegfilgrastim 6 mg sc day 5), definitive surgery with intra-operative radiotherapy, adjuvant radiotherapy and 4 adjuvant cycles of EIA. RESULT Between 06/2005 and 03/2010 a total of 50 subjects (male = 33, female = 17, median age 50.1 years) were enrolled. Median follow-up was 30.5 months. The majority of primary tumors were located in the extremities or trunk (92%), 6% originated in the abdomen/retroperitoneum. Response by RECIST criteria to neo-adjuvant CTX was 6% CR (n = 3), 24% PR (n = 12), 62% SD (n = 31) and 8% PD (n = 4). Local recurrence occurred in 3 subjects (6%). Distant metastasis was observed in 12 patients (24%). Overall survival (OS) and disease-free survival (DFS) at 2 years was 83% and 68%, respectively. Multivariate analysis failed to prove influence of resection status or grade of histological necrosis on OS or DFS. Severe toxicities included neutropenic fever (4/50), cardiac toxicity (2/50), and CNS toxicity (4/50) leading to CTX dose reductions in 4 subjects. No cases of secondary leukemias were observed so far. CONCLUSION The current protocol is feasible for achieving local control rates, as well as OS and DFS comparable to previously published data on neo-/adjuvant chemotherapy in this setting. However, the definitive role of chemotherapy remains unclear in the absence of large, randomized trials. Therefore, the current regimen can only be recommended within a clinical study, and a possibly increased risk of secondary leukemias has to be taken into account. TRIAL REGISTRATION ClinicalTrials.gov NCT01382030, EudraCT 2004-002501-72.
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Affiliation(s)
- Thomas Schmitt
- Department of Hematology, Oncology, and Rheumatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
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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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Bibliography. Supportive care. Current world literature. Curr Opin Oncol 2011; 23:415-6. [PMID: 21654394 DOI: 10.1097/cco.0b013e328348d4f4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The Royal College of Pathologists of Australasia is developing a series of protocols as an educational tool to assist pathologists in the reporting of relevant information for specific cancer specimens. The protocol for the management of soft tissue tumour resections has recently been released, and this document elaborates the relevant literature on which that protocol drew. Sarcoma is uncommon but is associated with significant morbidity and mortality, and its management is complex. Diagnostic errors are not uncommon and these can have disastrous effects on patient outcome. Sophisticated ancillary testing is often an important adjunct to diagnosis and prognostication. Referral to a specialist sarcoma unit is indicated for both adult and paediatric sarcoma.
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