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Lin JS, Coleman L, Voskuil RT, Malik A, Mayerson JL, Scharschmidt TJ. Local recurrence rates of superficial versus deep soft tissue sarcoma. Arch Orthop Trauma Surg 2024; 144:2967-2973. [PMID: 38850420 PMCID: PMC11319495 DOI: 10.1007/s00402-024-05326-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/14/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION Soft tissue sarcomas are a group of malignancies that commonly occur in the extremities. As deep lesions may exist within the confines of the muscular fascia, we postulate that local recurrence rates are higher for superficial soft tissue sarcomas managed by the standard of care. MATERIALS AND METHODS A retrospective review was performed on 90 patients who underwent surgical resection of soft tissue sarcomas of the extremity from 2007 to 2015. Patients with minimum 2-year follow-up and adequate operative, pathologic, and clinical outcomes data were included. RESULTS Mean age was 54 ± 18 years with 49 (54.4%) patients being male. Lesions in 77.8% of cases were deep, and 22.2% were superficial to fascia. Following the index surgical resection, a total of 33 (36.7%) patients had positive margins. A total of 17 (18.9%) patients had a local recurrence. Overall, 3-year survival was 92.7%, and 5-year survival was 79.0%. Five-year recurrence-free survival of deep sarcomas was 91.1% versus 58.2% of superficial lesions (p = 0.006). Patients with higher tumor depth had lower odds of experiencing a local recurrence (HR 0.26 [95% CI 0.09-0.72]). Local recurence rates was also associated with positive surgical margins on initial resection (33.3% versus 12.3%) (p = 0.027). CONCLUSIONS In this series, superficial tumor depth was associated with local recurrence of soft tissue sarcomas of the extremity following surgical resection. Positive surgical margins was also associated with local recurrence.
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Affiliation(s)
- James S Lin
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Lisa Coleman
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Ryan T Voskuil
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Azeem Malik
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Joel L Mayerson
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Thomas J Scharschmidt
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States.
- Department of Orthopaedic Surgery, Division of Musculoskeletal Oncology, The James Cancer Hospital and Solove Research Institute, Division of Musculoskeletal Oncology, The Ohio State University Wexner Medical Center, Nationwide Children's Hospital, Columbus, Ohio, United States.
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Michot A, Lagarde P, Lesluyes T, Darbo E, Neuville A, Baud J, Perot G, Bonomo I, Maire M, Michot M, Coindre JM, Le Loarer F, Chibon F. Analysis of the Peritumoral Tissue Unveils Cellular Changes Associated with a High Risk of Recurrence. Cancers (Basel) 2023; 15:3450. [PMID: 37444560 DOI: 10.3390/cancers15133450] [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: 05/15/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The management of soft-tissue sarcoma (STS) relies on a multidisciplinary approach involving specialized oncological surgery combined with other adjuvant therapies to achieve optimal local disease control. Purpose and Results: Genomic and transcriptomic pseudocapsules of 20 prospective sarcomas were analyzed and revealed to be correlated with a higher risk of recurrence after surgery. CONCLUSIONS A peritumoral environment that has been remodeled and infiltrated by M2 macrophages, and is less expressive of healthy tissue, would pose a significant risk of relapse and require more aggressive treatment strategies.
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Affiliation(s)
- Audrey Michot
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, 33000 Bordeaux, France
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
- Department of Biopathology, Bergonié Institute, Université Victor Segalen Site Carreire, Bordeaux 2, 33076 Bordeaux, France
| | - Pauline Lagarde
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
- Department of Biopathology, Bergonié Institute, Université Victor Segalen Site Carreire, Bordeaux 2, 33076 Bordeaux, France
| | - Tom Lesluyes
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
| | - Elodie Darbo
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, 33000 Bordeaux, France
- Department of Biopathology, Bergonié Institute, Université Victor Segalen Site Carreire, Bordeaux 2, 33076 Bordeaux, France
| | - Agnès Neuville
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
| | - Jessica Baud
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, 33000 Bordeaux, France
| | - Gaëlle Perot
- OncoSarc, INSERM U1037, Cancer Research Center in Toulouse (CRCT), 31000 Toulouse, France
- Department of Pathology, Institut Claudius Régaud, IUCT-Oncopole, 31000 Toulouse, France
| | - Iris Bonomo
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
| | - Mathilde Maire
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
| | - Maxime Michot
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
| | - Jean-Michel Coindre
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
- Department of Biopathology, Bergonié Institute, Université Victor Segalen Site Carreire, Bordeaux 2, 33076 Bordeaux, France
| | - François Le Loarer
- Bordeaux Institute of Oncology, BRIC U1312, INSERM, 33000 Bordeaux, France
- Institut Bergonié, Centre de Lutte Contre le Cancer de Bordeaux, 33076 Bordeaux, France
- Department of Biopathology, Bergonié Institute, Université Victor Segalen Site Carreire, Bordeaux 2, 33076 Bordeaux, France
| | - Frédéric Chibon
- OncoSarc, INSERM U1037, Cancer Research Center in Toulouse (CRCT), 31000 Toulouse, France
- Department of Pathology, Institut Claudius Régaud, IUCT-Oncopole, 31000 Toulouse, France
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Brinkmann EJ, Ahmed SK, Houdek MT. Extremity Soft Tissue Sarcoma: Role of Local Control. Curr Treat Options Oncol 2020; 21:13. [PMID: 32025823 DOI: 10.1007/s11864-020-0703-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OPINION STATEMENT For localized extremity soft tissue sarcoma (eSTS), treatment is individualized and each patient needs to be evaluated by a multidisciplinary team at a referral sarcoma center specialized in the care of sarcoma. For a majority of patients, treatment for eSTS involves limb-salvage surgery, with or without the addition of radiation therapy. Surgery should only be performed by surgeons specifically fellowship trained in the resection of eSTS. Surgery alone may be considered for small, low-grade, and superficial tumors as long a wide (≥ 2 cm) margin can be achieved. In cases where a less than wide negative margin can be achieved, radiation therapy should be utilized to facilitate a planned close margin resection to preserve critical structures (such as nerves, blood vessels, and bone) without a significant impact on oncologic outcomes. Soft tissue sarcomas are rare, and as such patients often present following an inadvertent excision. In these situations, we recommend preoperative radiation and wide tumor bed re-excision, as rates of residual tumor can be high in this scenario. While there is large amount of evidence to support the use of radiotherapy to enhance local tumor control, the evidence to support the use of chemotherapy to enhance local tumor control is lacking, and as such cannot be recommended for all patients.
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Affiliation(s)
- Elyse J Brinkmann
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Safia K Ahmed
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Abstract
OPINION STATEMENT The proper diagnosis and treatment planning for subcutaneous soft tissue sarcoma is very important. Soft tissue tumors can occur anywhere in the body, but if they occur subcutaneously, patients can easily notice a subcutaneous soft tissue mass. Therefore, it is possible to determine through recording, the growth speed of the mass, which is often difficult to obtain with deep-situated soft tissue masses. Palpation can also provide information about the firmness and mobility of the mass. Thus, history taking and physical examinations are informative for subcutaneous soft tissue tumors, compared to tumors that occur deeply. Because subcutaneous soft tissue tumors are easily recognized, they are often resected, without sufficient imaging analyses or thorough treatment planning. An operation performed based on such an inadequate preoperative plan is called a "whoops surgery." In the case of "whoops surgeries," subsequent radical surgery is required to remove additional areas, including hematomas that result from the initial surgery, that require a wider range of resection and soft tissue reconstruction. Therefore, as with deep-seated soft tissue tumors, it is important to conduct careful imaging examinations and make appropriate preoperative plans for subcutaneous soft tissue tumors. Subcutaneous soft tissue sarcomas often show an invasive pattern, and such tumors require a more careful assessment to prevent local recurrence after surgery. During surgery, it is necessary to remove the entire infiltration area along the fascia. Sometimes, an adequately wide excision is necessary, which is considered the minimum necessary procedure to eradicate the lesion. As noted above, clinicians who see patients with subcutaneous soft tissue tumors are encouraged to have sufficient knowledge and experience regarding the diagnosis and treatment. This article is intended for all doctors who deal with subcutaneous soft tissue tumors and focuses on essential points regarding their diagnosis and management.
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Surgery alone is sufficient therapy for children and adolescents with low-risk synovial sarcoma: A joint analysis from the European paediatric soft tissue sarcoma Study Group and the Children's Oncology Group. Eur J Cancer 2017; 78:1-6. [PMID: 28391003 DOI: 10.1016/j.ejca.2017.03.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/07/2017] [Accepted: 03/09/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Multimodal risk-adapted treatment is used in paediatric protocols for synovial sarcoma (SS). Retrospective analyses suggest that low-risk SS patients can be safely treated with surgery alone, but no prospective studies have confirmed the safety of this approach. This analysis pooled data from the two prospective clinical trials to assess outcomes in SS patients treated with a surgery-only approach and to identify predictors of treatment failure. METHODS Patients with localised SS enrolled on the European paediatric Soft tissue sarcoma Study Group (EpSSG) NRSTS2005 and on the Children Oncology Group (COG) ARST0332 trials, treated with surgery alone were eligible for this analysis. Patients must have undergone initial complete resection with histologically free margins, with a grade 2 tumour of any size or a grade 3 tumour ≤5 cm. RESULTS Sixty patients under 21 years of age were eligible for the analysis; 36 enrolled in the COG (from 2007 to 2012) and 24 in the EpSSG study (from 2005 to 2012). The 3-year event-free survival was 90% (median follow-up 5.2 years, range 1.9-9.1). All eight events were local tumour recurrence, whereas no metastatic recurrences were seen. All patients with recurrence were effectively salvaged, resulting in 100% overall survival. CONCLUSION This joint prospective analysis showed that patients with adequately resected ≤5 cm SS, regardless of grade, can be safely treated with a surgery-only approach. Avoiding the use of adjuvant chemotherapy and radiotherapy in this low-risk patient population may decrease both short- and long-term morbidity and mortality.
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Tiong SS, Dickie C, Haas RL, O'Sullivan B. The role of radiotherapy in the management of localized soft tissue sarcomas. Cancer Biol Med 2016; 13:373-383. [PMID: 27807504 PMCID: PMC5069839 DOI: 10.20892/j.issn.2095-3941.2016.0028] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The combination of radiotherapy (RT) and function-preserving surgery is the most usual contemporary approach in the management of soft tissue sarcomas (STS). Pre- and postoperative RT result in similar local control rates, as shown by a landmark trial in extremity STS. In this review, the role of RT in the management of extremity STS will be discussed, but STS in other sites, including retroperitoneal STS, will also be addressed. The focus will consider various aspects of RT including strategies to reduce the volume of tissue being irradiated, dose, scheduling, and the possible of omission of RT in selected cases. Finally, technology advances through the use of intensity-modulated radiotherapy (IMRT), image-guided IMRT, intraoperative radiotherapy (IORT) and particle therapy will also be discussed.
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Affiliation(s)
- Siaw Sze Tiong
- Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto M5G 2M9, ON, Canada
| | - Colleen Dickie
- Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto M5G 2M9, ON, Canada
| | - Rick L Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam 1066, CX, The Netherlands
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto M5G 2M9, ON, Canada
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