1
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Cuenin M, Levy A, Peiffert D, Sunyach MP, Ducassou A, Cordoba A, Gillon P, Thibouw D, Lapeyre M, Lerouge D, Helfre S, Leroux A, Salleron J, Sirveaux F, Marchal F, P.Teixeira, Debordes PA, G.Vogin. Local relapse patterns after preoperative radiotherapy of limb and trunk wall soft tissue sarcomas: Prognostic role of imaging and pathologic response factors. Clin Transl Radiat Oncol 2024; 48:100825. [PMID: 39192877 PMCID: PMC11347830 DOI: 10.1016/j.ctro.2024.100825] [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: 07/19/2024] [Accepted: 07/24/2024] [Indexed: 08/29/2024] Open
Abstract
Purpose To retrospectively identify clinical, pathologic, or imaging factors predictive of local relapse (LR) after preoperative radiotherapy (RT) for soft tissue sarcomas (STS). Methods and Materials This is a retrospective multicenter study of patients who underwent preoperative RT and surgery for limb or trunk wall STS between 2007 and 2018 in French Sarcoma Group centers and were enrolled in the "Conticabase". Patterns of LR were investigated taking into account the multimodal response after preoperative RT. Diagnostic and surgical samples were compared after systematic review by expert pathologists and patients were stratified by tumor grade. Log-rank tests and Cox models were used to identify prognostic factors for radiation response and LR. Results 257 patients were included; 17 % had low-grade (LG), 72.5 % had high-grade (HG) sarcomas. In HG group, tumors were larger, mostly undifferentiated, and displayed more necrosis and perilesional edema after RT. Median follow-up was 32 months. Five-year cumulative incidence of LR was 20.3 % in the HG group versus 9.7 % in the LG group (p = 0.026). In multivariate analysis, trunk wall location (HR 6.79, p = 0.012) and proportion of viable tumor cellularity ≥ 20 % (HR 3.15, p = 0.018) were associated with LR. After adjusting for tumor location, combination of histotype and cellularity rate significantly correlated with LR. We described three prognostic subgroups for HG sarcomas, listed from the highest to lowest risk: undifferentiated sarcoma (US) with cellularity rates ≥ 20 %; non-US (NUS) with cellularity rates ≥ 20 % or US with cellularity rates < 20 %; and NUS with cellularity rates < 20 %, which shared similar prognostic risks with LG sarcomas. Conclusions HG and LG tumors have different morphological and biological behaviors in response to RT. Combination of cellularity rate with histotype could be a major prognostic for LR. Patients with undifferentiated HG sarcomas with cellularity rates ≥ 20 % after preoperative RT had the highest risk of LR and disease-specific death.
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Affiliation(s)
- M. Cuenin
- Department of Radiation Oncology, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - A. Levy
- Department of Radiation Oncology, Gustave Roussy, Thoracic Oncology Institute (IOT), Villejuif, France
| | - D. Peiffert
- Department of Radiation Oncology, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - MP. Sunyach
- Department of Radiation Oncology, Centre Léon-Bérard, Lyon, France
| | - A. Ducassou
- Department of Radiation Oncology, IUCT-oncopole, Institut Claudius-Regaud, Toulouse, France
| | - A. Cordoba
- Department of Radiation Oncology, Centre Oscar-Lambret, Lille, France
| | - P. Gillon
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France
| | - D. Thibouw
- Department of Radiation Oncology, Centre Régional De Lutte Contre Le Cancer Georges-François Leclerc C.G.F., Dijon, France
| | - M. Lapeyre
- Department of Radiation Oncology, Centre Jean-Perrin, Clermont-Ferrand, France
| | - D. Lerouge
- Department of Radiation Oncology, Centre François-Baclesse, Caen, France
| | - S. Helfre
- Department of Radiation Oncology, Institut Curie, PSL Research University, Paris, France
| | - A. Leroux
- Department of Pathology, Institut de Cancérologie de Lorraine, Vandoeuvre-les Nancy, France
| | - J. Salleron
- Department of Statistics, Institut de Cancérologie de Lorraine, Vandoeuvre-les Nancy, France
| | - F. Sirveaux
- Department of Orthopedic Surgery, Centre Chirurgical Emile Gallé, University Hospital of Nancy, Nancy, France
| | - F. Marchal
- Department of Surgical Oncology, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - P.Teixeira
- Guilloz Department of Imaging, Central Hospital, Nancy, France
| | - PA. Debordes
- Department of Orthopedic Surgery, Hopitaux universitaires de Strasbourg, Strasbourg, France
| | - G.Vogin
- CNRS, Université de Lorraine, France
- National Center of Radiotherapy, Grand-Duché du Luxembourg, Centre François Baclesse, Esch sur Alzette, Luxembourg
- Department of Oncology, Luxembourg Institute of Health, Luxembourg
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Chmiel P, Rutkowski P, Spałek M, Szumera-Ciećkiewicz A, Czarnecka AM. What is the Optimal Treatment Strategy after Sarcoma R2 Surgery? Curr Treat Options Oncol 2024; 25:798-812. [PMID: 38809411 PMCID: PMC11222198 DOI: 10.1007/s11864-024-01218-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 05/30/2024]
Abstract
OPINION STATEMENT Soft tissue sarcomas (STS) are rare tumours of mesenchymal origin, most commonly occurring in the extremity but also in the retroperitoneum. The curative treatment for STS is radical surgery with wide margins, in some cases in combination with perioperative radiotherapy and chemotherapy. Nonradical resection (R2) of STS has been an emerging issue in recent decades, as optimal subsequent management remains debatable. Similarly, there is still no consensus on optimal surgical margins. Combining multiple treatment modalities in adjuvant therapy can achieve local and distant control in patients following surgery with positive margins. Patients who have undergone nonradical resection therefore require additional surgical interventions, and adjuvant radiotherapy resulting in a better prognosis but a higher number of complications. Following non-radical treatment, patients with limb and trunk wall sarcomas and retroperitoneal sarcomas should also undergo increased oncological surveillance. Given the potential issues that may emerge in such clinical situations, it is crucial to up-date the current guidelines to enhance the long-term prognosis of these patients.
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Affiliation(s)
- Paulina Chmiel
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland
- Faculty of Medicine, Medical University of Warsaw, 02-091, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland
| | - Mateusz Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland
- Department of Radiotherapy I, Maria Sklodowska-Curie National Research Institute of Oncology, 02-718, Warsaw, Poland
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland
- Biobank Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland
| | - Anna M Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland.
- Department of Experimental Pharmacology, Mossakowski Medical Research Institute Polish Academy of Sciences, 02-106, Warsaw, Poland.
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3
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Makris EA, Tran TB, Delitto DJ, Lee B, Ethun CG, Grignol V, Harrison Howard J, Bedi M, Clark Gamblin T, Tseng J, Roggin KK, Chouliaras K, Votanopoulos K, Cullinan D, Fields RC, Cardona K, Poultsides G, Kirane A. Natural history of undifferentiated pleomorphic sarcoma: Experience from the US Sarcoma Collaborative. J Surg Oncol 2024; 129:1354-1363. [PMID: 38562002 DOI: 10.1002/jso.27620] [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: 01/10/2024] [Accepted: 02/13/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Undifferentiated pleomorphic sarcoma (UPS) is a relatively rare but aggressive neoplasm. We sought to utilize a multi-institutional US cohort of sarcoma patients to examine predictors of survival and recurrence patterns after resection of UPS. METHODS From 2000 to 2016, patients with primary UPS undergoing curative-intent surgical resection at seven academic institutions were retrospectively reviewed. Epidemiologic and clinicopathologic factors were reviewed by site of origin. Overall survival (OS), recurrence-free survival (RFS), time-to-locoregional (TTLR), time-to-distant recurrence (TTDR), and patterns of recurrence were analyzed. RESULTS Of the 534 UPS patients identified, 53% were female, with a median age of 60 and median tumor size of 8.5 cm. The median OS, RFS, TTLR, and TTDR for the entire cohort were 109, 49, 86, and 46 months, respectively. There were no differences in these survival outcomes between extremity and truncal UPS. Compared with truncal, extremity UPS were more commonly amenable to R0 resection (87% vs. 75%, p = 0.017) and less commonly associated with lymph node metastasis (1% vs. 6%, p = 0.031). R0 resection and radiation treatment, but not site of origin (extremity vs. trunk) were independent predictors of OS and RFS. TTLR recurrence was shorter for UPS resected with a positive margin and for tumors not treated with radiation. CONCLUSION For patients with resected extremity and truncal UPS, tumor size >5 cm and positive resection margin are associated with worse survival OS and RFS, irrespectively the site of origin. R0 surgical resection and radiation treatment may help improve these survival outcomes.
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Affiliation(s)
| | - Thuy B Tran
- Surgical Oncology, Stanford University, Stanford, California, USA
| | - Daniel J Delitto
- Surgical Oncology, Stanford University, Stanford, California, USA
| | - Byrne Lee
- Surgical Oncology, Stanford University, Stanford, California, USA
| | - Cecilia G Ethun
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Valerie Grignol
- Surgical Oncology, The Ohio State University, Columbus, Ohio, USA
| | | | - Meena Bedi
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Jennifer Tseng
- Surgical Oncology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Kevin K Roggin
- Surgical Oncology, University of Chicago Medicine, Chicago, Illinois, USA
| | | | | | - Darren Cullinan
- Surgical Oncology, Washington University, St. Louis, Missouri, USA
| | - Ryan C Fields
- Surgical Oncology, Washington University, St. Louis, Missouri, USA
| | - Kenneth Cardona
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | | | - Amanda Kirane
- Surgical Oncology, Stanford University, Stanford, California, USA
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4
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van Ravensteijn SG, Nederkoorn MJL, Wal TCP, Versleijen-Jonkers YMH, Braam PM, Flucke UE, Bonenkamp JJ, Schreuder BHW, van Herpen CML, de Wilt JHW, Desar IME, de Rooy JWJ. The Prognostic Relevance of MRI Characteristics in Myxofibrosarcoma Patients Treated with Neoadjuvant Radiotherapy. Cancers (Basel) 2023; 15:2843. [PMID: 37345181 DOI: 10.3390/cancers15102843] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 06/23/2023] Open
Abstract
To improve local control, neoadjuvant radiotherapy (nRT) followed by surgery is the standard of care in myxofibrosarcoma (MFS) because of its infiltrative growth pattern. Nevertheless, local recurrence rates are high. Data on prognostic factors for poor clinical outcomes are lacking. This retrospective study thus investigates the prognostic relevance of magnetic resonance imaging (MRI) characteristics before and after nRT in 40 MFS patients, as well as their association with disease-free survival (DFS) and overall survival (OS). A vascular pedicle, defined as extra-tumoral vessels at the tumor periphery, was observed in 12 patients (30.0%) pre-nRT and remained present post-nRT in all cases. Patients with a vascular pedicle had worse DFS (HR 5.85; 95% CI 1.56-21.90; p = 0.009) and OS (HR 9.58; 95% CI 1.91-48.00; p = 0.006). An infiltrative growth pattern, referred to as a tail sign, was observed in 22 patients (55.0%) pre-nRT and in 19 patients (47.5%) post-nRT, and was associated with worse DFS post-nRT (HR 6.99; 95% CI 1.39-35.35; p = 0.019). The percentage of tumor necrosis estimated by MRI was increased post-nRT, but was not associated with survival outcomes. The presence of a tail sign or vascular pedicle on MRI could support the identification of patients at risk for poor clinical outcomes after nRT.
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Affiliation(s)
- Stefan G van Ravensteijn
- Department of Medical Oncology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Maikel J L Nederkoorn
- Department of Medical Oncology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Tom C P Wal
- Department of Medical Oncology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | | | - Pètra M Braam
- Department of Radiotherapy, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Uta E Flucke
- Department of Pathology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Johannes J Bonenkamp
- Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Bart H W Schreuder
- Department of Orthopedics, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Carla M L van Herpen
- Department of Medical Oncology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Ingrid M E Desar
- Department of Medical Oncology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Jacky W J de Rooy
- Department of Radiology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
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5
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Dapper H, Diehl C, Knebel C, Mogler C, Borm K, Dobiasch S, Combs SE, Peeken JC. Outcome of patients with soft tissue sarcomas of the extremities and trunk treated by (neo)adjuvant intensity modulated radiation therapy with curative intent. Radiat Oncol 2023; 18:44. [PMID: 36869396 PMCID: PMC9985237 DOI: 10.1186/s13014-023-02238-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/25/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Soft tissue sarcomas (STS) are a relatively rare group of malignant tumors. Currently, there is very little published clinical data, especially in the context of curative multimodal therapy with image-guided, conformal, intensity-modulated radiotherapy. METHODS Patients who received preoperative or postoperative intensity-modulated radiotherapy for STS of the extremities or trunk with curative intent were included in this single centre retrospective analysis. A Kaplan-Meier analysis was performed to evaluate survival endpoints. Multivariable proportional hazard models were used to investigate the association between survival endpoints and tumour-, patient-, and treatment-specific characteristics. RESULTS 86 patients were included in the analysis. The most common histological subtypes were undifferentiated pleomorphic high-grade sarcoma (UPS) (27) and liposarcoma (22). More than two third of the patients received preoperative radiation therapy (72%). During the follow-up period, 39 patients (45%) suffered from some type of relapse, mainly remote (31%). The two-years overall survival rate was 88%. The median DFS was 48 months and the median DMFS was 51 months. Female gender (HR 0.460 (0.217; 0.973)) and histology of liposarcomas compared to UPS proved to be significantly more favorable in terms of DFS (HR 0.327 (0.126; 0.852)). CONCLUSION Conformal, intensity-modulated radiotherapy is an effective treatment modality in the preoperative or postoperative management of STS. Especially for the prevention of distant metastases, the establishment of modern systemic therapies or multimodal therapy approaches is necessary.
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Affiliation(s)
- Hendrik Dapper
- Department of Radiotherapy and Radiation Oncology, Public Hospital of Bielefeld, University Medical Center East Westphalia-Lippe, Bielefeld, Germany. .,Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.
| | - Christian Diehl
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Carolin Knebel
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Carolin Mogler
- Institute of Pathology, Klinikum Rechts der Isar, School of Medicine, Technical University Munich, Munich, Germany
| | - Kai Borm
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Sophie Dobiasch
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.,Deutsches Konsortium Für Translationale Krebsforschung (DKTK), Partner Site , Munich, Germany.,Institute for Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstr. 1, Neuherberg, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.,Deutsches Konsortium Für Translationale Krebsforschung (DKTK), Partner Site , Munich, Germany.,Institute for Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstr. 1, Neuherberg, Germany
| | - Jan C Peeken
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.,Deutsches Konsortium Für Translationale Krebsforschung (DKTK), Partner Site , Munich, Germany.,Institute for Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstr. 1, Neuherberg, Germany
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6
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Gurusamy VM, Al-Hammadi N, Caparrotti P, Divakar SR, Hammoud RW, Shaikh G. Real-world clinical outcomes with daily image-guided IMRT in extremity soft tissue sarcomas. Cancer Treat Res Commun 2022; 33:100655. [PMID: 36356354 DOI: 10.1016/j.ctarc.2022.100655] [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: 09/22/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE We report the clinical outcomes of patients with soft tissue sarcomas (STS) arising in extremities treated with image-guided intensity modulated radiotherapy (IG-IMRT) at our institute. Local control of the tumors treated with RT was the primary end point of this study. Analyzing overall survival and long-term toxicities were the secondary objectives. METHODS AND MATERIALS The database of the patients with STS who received wide local excision and IG-IMRT at our institution from January 2012 to December 2020 was reviewed. Radiation was offered either preoperatively or postoperatively as part of multi-modality treatment. RESULTS Thirty-three consecutive patients were identified and included for analysis. Twenty-eight patients (84.8%) received postoperative adjuvant radiotherapy. Dedicated MRI simulation studies were performed in 31 patients (93.9%) in the treatment position. RapidArc IMRT technique was used in 31 patients (93.9%). A total of 2954 images were acquired during 991 treatment sessions. Errors exceeding 1 mm in the x, y and z directions were corrected online before the treatment. With a median follow-up of 36 months, two patients (6.1%) developed local recurrence. The 3-year local control was 90.9% (95% CI, 0.76 - 0.98), and the 5-year overall survival was 71.7% (95% CI, 0.44 - 0.88). One patient (3.03%) sustained a pathological fracture during the follow-up period. CONCLUSION Our results showed that IMRT with daily imaging offered excellent local control with acceptable long-term toxicity, as well as being feasible and practical to implement in our routine clinical practice.
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Affiliation(s)
- Venkada Manickam Gurusamy
- Department of Radiation Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar.
| | - Noora Al-Hammadi
- Department of Radiation Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Palmira Caparrotti
- Department of Radiation Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Saju Raveendran Divakar
- Department of Radiation Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Rabih Wafiq Hammoud
- Department of Radiation Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Ghazia Shaikh
- Department of Radiation Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
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7
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Haine DL, Pittaway R, Berlato D, Demetriou J. Incomplete histological margins following planned narrow excision of canine appendicular soft tissue sarcomas and mast cell tumors, using the residual tumor classification scheme. Vet Surg 2022; 51:1078-1086. [PMID: 35830150 PMCID: PMC9912198 DOI: 10.1111/vsu.13852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 05/27/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the frequency of incomplete histological margins following planned narrow excision (PNE) of mast cell tumors (MCTs) and soft tissue sarcomas (STSs), and to assess the residual tumor classification (R) scheme for reporting histological margins in clinical cases. STUDY DESIGN Retrospective clinical study. SAMPLE POPULATION Forty-four client-owned dogs with 47 masses. METHODS Medical records of dogs undergoing planned narrow excision of STSs and MCTs were reviewed (2016-2019). Histologic specimens were reviewed by a single pathologist and assigned R scoring (histologically incomplete/R1 margins defined as "tumor on ink"). RESULTS Six out of 23 (26%) MCT PNEs and 10/42 (42%) of STS PNEs resulted in R1 margins. R1 margins were more likely when performing PNE with 6-10 mm lateral measured surgical margins (LMSMs) versus 0-5 mm LMSM for MCTs (1/14 vs 5/9), but not STSs (3/7 vs 7/17) (P = .049). The R scheme resulted in higher retrospective percentage agreement in histological reporting than defining incomplete histological margin as tumor cells within ≤1 mm of the margin (83% vs 68% agreement). Complications occurred in 12/47 surgeries, with none requiring additional surgery. Tumors recurred in 3/18 (17%) STSs and 2/18 (11%) MCTs. CONCLUSION Fewer R1 margins were obtained when PNE with LMSM of 6-10 mm was performed for mast cell tumors. The use of the R scheme increased agreement in histopathological margin assessment. CLINICAL SIGNIFICANCE Planned narrow excision is a viable technique for histopathological diagnosis of appendicular soft tissue sarcomas and mast cell tumors for limb salvage.
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Affiliation(s)
- David L. Haine
- Cave Veterinary Specialists, part of Linnaeus Veterinary Limited
| | | | - Davide Berlato
- AniCura Animal Oncology and Imaging CenterHünenbergSwitzerland
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8
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Evaluation of the efficacy of CT-guided 3D template-assisted 125I seed implantation in the treatment of unresectable STS: a multicenter retrospective study. Sci Rep 2022; 12:3731. [PMID: 35260674 PMCID: PMC8904573 DOI: 10.1038/s41598-022-07729-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/22/2022] [Indexed: 11/09/2022] Open
Abstract
To observe the safety and efficacy of CT-guided 3D template-assisted radioactive 125I seed implantation in the treatment of unresectable advanced soft tissue sarcoma (STS). Sixty-two patients who underwent continuous 3D template-assisted radioactive 125I seed implantation for the treatment of unresectable advanced STS from August 2017 to August 2018 were selected from four tumor treatment centers for retrospective analysis. The postoperative adverse reactions and tumor response were recorded, and the postoperative complications were observed and treated at the same time. The overall survival (OS) rate was determined. All patients successfully completed 125I seed implantation. In practice, the median number of puncture needles used during the operation was 20, and the median number of 125I particles was 88. There were no statistical differences in the relative dosimetry parameters before and after the operation (P > 0.05). Tumor evaluation was performed 6 months after the operation. The effective rate was 61.3%, and the local control rate was 93.5%. As of March 2020, the 1-year survival rate was 85.2%, and the 2-year survival rate was 49.0%. The OS was 23 months. CT-guided 3D template-assisted 125I seed implantation for the treatment of unresectable STS has a high local control rate, thereby further prolonging the OS of patients with unresectable STS.
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9
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Abstract
➤ Soft-tissue sarcomas (STS) in adults comprise a heterogeneous group of tumors of mesenchymal origin that share similar biological patterns of local tumor growth and metastatic dissemination. ➤ The judicious use of imaging studies, biopsy techniques, and pathological evaluations is essential for accurate diagnosis and for planning treatment strategy. ➤ Wide local resection and radiation therapy form the cornerstone of management of high-grade STS. The role of adjuvant radiation therapy is questionable in the management of small (≤5 cm) superficial lesions that can be resected with negative margins. Chemotherapy given to patients who have nonmetastatic, high-grade STS results in varying benefit in terms of local tumor control and overall survival. ➤ Coordinated care by a multidisciplinary team of trained surgeons, medical oncologists, radiologists, radiation oncologists, and pathologists has been documented to improve local tumor control and the overall survival of patients with STS. ➤ Although considerable progress in tumor diagnostics and targeted therapies has been made over the past 2 decades, recommendations and controversies relating to tumor imaging and margins of resection have not changed.
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Affiliation(s)
- Jacob Bickels
- Unit of Orthopedic Oncology, Orthopedic Division, Hillel-Yaffe Medical Center, Hadera, Israel, affiliated with the Rappaport Faculty of Medicine, The Technion, Haifa, Israel
| | - Martin M Malawer
- Department of Orthopedic Surgery, Georgetown University School of Medicine, Washington, DC
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10
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Salerno KE, Alektiar KM, Baldini EH, Bedi M, Bishop AJ, Bradfield L, Chung P, DeLaney TF, Folpe A, Kane JM, Li XA, Petersen I, Powell J, Stolten M, Thorpe S, Trent JC, Voermans M, Guadagnolo BA. Radiation Therapy for Treatment of Soft Tissue Sarcoma in Adults: Executive Summary of an ASTRO Clinical Practice Guideline. Pract Radiat Oncol 2021; 11:339-351. [PMID: 34326023 DOI: 10.1016/j.prro.2021.04.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE This guideline provides evidence-based recommendations addressing the indications for radiation therapy (RT), sequencing of local therapies, and appropriate dose and planning techniques for management of primary, operable, localized, soft tissue sarcoma (STS) in adults. METHODS The American Society for Radiation Oncology convened a task force to address 5 key questions focused on the use of RT for management of STS. These questions included indications for RT for STS of the extremity and superficial trunk; considerations for sequencing of RT with respect to surgery, dose of RT, appropriate treatment volumes and techniques; and the role of RT in management of retroperitoneal sarcoma. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS Multidisciplinary evaluation and decision making are recommended for all cases of STS. RT is recommended for patients in whom there is increased risk of local recurrence of resected STS, particularly if close or microscopically positive margins are anticipated or have occurred. When RT is indicated, preoperative RT is strongly recommended over postoperative RT. Postoperative RT is conditionally recommended in specific clinical circumstances (eg, uncontrolled pain or bleeding) or when the risk of wound complications outweighs that of late toxicity from RT. Routine use of RT in addition to oncologic resection for retroperitoneal sarcoma is conditionally not recommended. When RT is used for retroperitoneal sarcoma, preoperative RT is recommended, whereas postoperative RT is not recommended. CONCLUSIONS Based on currently published data, the American Society for Radiation Oncology task force has proposed evidence-based recommendations regarding the use of RT for STS in adults. Future studies will ascertain whether alterations in dosing and sequencing may optimize outcomes and quality of life.
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Affiliation(s)
- Kilian E Salerno
- Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland.
| | - Kaled M Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Elizabeth H Baldini
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Manpreet Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrew J Bishop
- Department of Radiation Oncology, UT-MD Anderson Cancer Center, Houston, Texas
| | - Lisa Bradfield
- American Society for Radiation Oncology, Arlington, Virginia
| | - Peter Chung
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew Folpe
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota
| | - John M Kane
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ivy Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - John Powell
- Department of Radiation Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Michael Stolten
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Steven Thorpe
- Department of Orthopedic Surgery, UC Davis Medical Center, Sacramento, California
| | - Jonathan C Trent
- Division of Medical Oncology, Sylvester Comprehensive Cancer Center, The University of Miami Health System, Miami, Florida
| | - Maria Voermans
- Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin
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Sambri A, Caldari E, Fiore M, Zucchini R, Giannini C, Pirini MG, Spinnato P, Cappelli A, Donati DM, De Paolis M. Margin Assessment in Soft Tissue Sarcomas: Review of the Literature. Cancers (Basel) 2021; 13:cancers13071687. [PMID: 33918457 PMCID: PMC8038240 DOI: 10.3390/cancers13071687] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Many classifications to assess margins status for soft tissue sarcomas are reported in the literature. Most of the series are heterogeneous and variable in size, making it difficult to compare results from study to study. Thus, which is the best way to assess margins in order to predict the risk of local recurrence is still debated. The aim of this narrative review is to provide a comprehensive assessment of the literature on margins, and to highlight the need for a uniform description of the margin status for patients with soft tissue sarcomas (STS). Abstract Adequacy of margins must take into consideration both the resection margin width (quantity) and anatomic barrier (quality). There are several classification schemes for reporting surgical resection margin status for soft tissue sarcomas (STS). Most of the studies regarding treatment outcomes in STS included all histologic grades and histological subtypes, which include infiltrative and non-infiltrative subtypes and are very heterogeneous in terms of both histologic characteristics and treatment modalities (adjuvant treatments or not). This lack of consistency makes it difficult to compare results from study to study. Therefore, there is a great need for evidence-based standardization concerning the width of resection margins. The aim of this narrative review is to provide a comprehensive assessment of the literature on margins, and to highlight the need for a uniform description of the margin status for patients with STS. Patient cases should be discussed at multidisciplinary tumor boards and treatments should be individualized to clinical and demographic characteristics, which must include also a deep knowledge of specific histotypes behaviors, particularly infiltrative ones.
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Affiliation(s)
- Andrea Sambri
- Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy;
- IRCCS Policlinico di Sant’Orsola, 40138 Bologna, Italy; (E.C.); (M.G.P.); (A.C.); (M.D.P.)
- Correspondence:
| | - Emilia Caldari
- IRCCS Policlinico di Sant’Orsola, 40138 Bologna, Italy; (E.C.); (M.G.P.); (A.C.); (M.D.P.)
| | - Michele Fiore
- IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.F.); (R.Z.); (C.G.); (P.S.)
| | - Riccardo Zucchini
- IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.F.); (R.Z.); (C.G.); (P.S.)
| | - Claudio Giannini
- IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.F.); (R.Z.); (C.G.); (P.S.)
| | - Maria Giulia Pirini
- IRCCS Policlinico di Sant’Orsola, 40138 Bologna, Italy; (E.C.); (M.G.P.); (A.C.); (M.D.P.)
| | - Paolo Spinnato
- IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.F.); (R.Z.); (C.G.); (P.S.)
| | - Alberta Cappelli
- IRCCS Policlinico di Sant’Orsola, 40138 Bologna, Italy; (E.C.); (M.G.P.); (A.C.); (M.D.P.)
| | - Davide Maria Donati
- Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy;
- IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.F.); (R.Z.); (C.G.); (P.S.)
| | - Massimiliano De Paolis
- IRCCS Policlinico di Sant’Orsola, 40138 Bologna, Italy; (E.C.); (M.G.P.); (A.C.); (M.D.P.)
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12
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Pathologic Response Rates after Neoadjuvant Therapy for Sarcoma: A Single Institution Study. Cancers (Basel) 2021; 13:cancers13051074. [PMID: 33802383 PMCID: PMC7959282 DOI: 10.3390/cancers13051074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/12/2021] [Accepted: 02/25/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Pathologic necrosis of soft tissue sarcomas (STS) has been used to determine treatment response, but its relationship to neoadjuvant treatments remains indeterminate. In this retrospective, single institution study, we hypothesized that neoadjuvant chemoradiation (NA-CRT) yields higher rates of pathologic complete response (pCR) than neoadjuvant radiation (NA-XRT) or chemotherapy (NA-CT) alone. (2) Methods: Patients with extremity STS between 2011-2020 who received neoadjuvant treatment were included. pCR was defined as percent necrosis of the surgical specimen greater than or equal to 90%. (3) Results: 79 patients were analyzed. 51.9% of the population were male with a mean age of 58.4 years. 49.4% identified as Non-Hispanic White. Twenty-six (32.9%) patients achieved pCR while 53 (67.1%) did not. NA-CT (OR 15.82, 95% CI = 2.58-96.9, p = 0.003 in univariate (UVA) and OR 24.7, 95% CI = 2.88-211.2, p = 0.003 in multivariate (MVA), respectively) and NA-XRT (OR 5.73, 95% CI = 1.51-21.8, p = 0.010 in UVA and OR 7.95, 95% CI = 1.87-33.7, p = 0.005 in MVA, respectively) was significantly associated with non- pCR when compared to NA-CRT. The analysis also demonstrated that grade 3 tumors, when using grade 2 as reference, also had significantly higher odds of achieving pCR (OR 0.23, 95% CI = 0.06-0.80, p = 0.022 in UVA and OR 0.16, 95% CI = 0.04-0.70, p = 0.015 in MVA, respectively). (4) Conclusion: NA-CRT yields superior pCR compared to other neoadjuvant regimens. This extends to higher grade tumors.
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Affiliation(s)
- Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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14
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The Effect of Resection Margin on Local Recurrence and Survival in High Grade Soft Tissue Sarcoma of the Extremities: How Far Is Far Enough? Cancers (Basel) 2020; 12:cancers12092560. [PMID: 32911853 PMCID: PMC7563962 DOI: 10.3390/cancers12092560] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/30/2020] [Accepted: 09/05/2020] [Indexed: 12/20/2022] Open
Abstract
Simple Summary In soft tissue sarcomas the width of surgical margins after resection determines the extent of surgery and the function after resection. But how far is really necessary? 305 patients with deep-seated, G2/3 soft tissue sarcomas of the extremity, the trunk wall, or the pelvis were reviewed. The 5-year local recurrence-free survival (LRFS) was 82%. Overall survival (OS) at 5 years was 66%. Positive (contaminated) margins worsened LRFS and OS. A margin of >10 mm did not improve LRFS and OS as compared to one of >5 mm. A resection margin of <1 mm showed a trend but not significantly better LRFS or OS compared to a contaminated margin. In conclusion the margin should at least be free of tumor, in sound tissue. A margin of >5 mm sound tissue seems to be sufficient. Resecting more tissue does not benefit the patient. Abstract Background: The significance of surgical margins after resection of soft tissue sarcomas in respect to local-recurrence-free survival and overall survival is evaluated. Methods: A total of 305 patients with deep-seated, G2/3 soft tissue sarcomas (STS) of the extremity, the trunk wall, or the pelvis were reviewed. The margin was defined according to the Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) classification system (R0-2), the Union Internationale Contre le Cancer (UICC) classification (R + 1 mm) for which a margin <1 mm is included into the R1 group, and in groups of <1 mm, 1–5 mm, >5 mm, or >10 mm. Results: Of these patients, 31 (10.2%) had a contaminated margin, 64 (21%) a margin of <1 mm, 123 (40.3%) a margin of 1–5 mm, 47 (15.4%) a margin of >5 mm, and 40 (13.1%) a margin of >10 mm. The 5-year local recurrence-free survival (LRFS) was 81.6%. Overall survival (OS) at 5 years was 65.9%. Positive margins worsened LRFS and OS. A margin of >10 mm did not improve LRFS and OS as compared to one of >5 mm. Conclusions: A resection margin of <1 mm showed a trend but not significantly better LRFS or OS compared to a contaminated margin. This finding supports use of the UICC classification. A margin of more than 10 mm did not improve LRFS or OS.
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Cha HG, Kang MK, Kim W, Lee JS, Hong JP, Suh HP. Oncologic safety of propeller flap and free flap in reconstruction after soft tissue sarcoma resection. J Surg Oncol 2020; 122:787-794. [PMID: 32596810 DOI: 10.1002/jso.26076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/20/2020] [Accepted: 06/08/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES The propeller flap is a reliable option for reconstruction after soft tissue sarcoma resection. However, some parts of the resection margin may move away from its original position during flap rotation and thus can be excluded from the clinical target volume of adjuvant radiotherapy. This study aimed to evaluate local recurrence after soft tissue sarcoma resection with propeller flap or free flap reconstruction. METHODS Patients who underwent resection of soft tissue sarcoma followed by a free flap or propeller flap reconstruction and adjuvant radiotherapy at a single institution were retrospectively reviewed. RESULTS The 1- and 3-year local control rates were 94.6% and 88.6% in the free flap group vs 90.6% and 87.5% in the propeller flap group, without statistical significance. There were no statistically significant differences in 5-year local recurrence-free survival (88.6% vs 87.5%) and disease-free survival (82.5% vs 74.8%) between the groups. CONCLUSIONS Although there was no significant difference in local control and disease-free survival rates between propeller flap and free flap reconstruction after soft tissue sarcoma resection, a multidisciplinary approach is needed to obtain surgical information for determining the accurate clinical target volume of adjuvant radiotherapy and the area for meticulous follow-up postoperatively.
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Affiliation(s)
- Han Gyu Cha
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Korea
| | - Min Kyu Kang
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wanlim Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Seok Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Pio Hong
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyunsuk Peter Suh
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Rath B, Hardes J, Tingart M, Braunschweig T, Eschweiler J, Migliorini F. [Resection margins in soft tissue sarcomas]. DER ORTHOPADE 2019; 48:768-775. [PMID: 31463543 DOI: 10.1007/s00132-019-03795-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Soft tissue sarcomas (STS) are a rare and heterogeneous group of malignant tumors that arise from the mesenchymal tissue. STS can form anywhere in the human body, with the extremities being preferred sites of predilection. TREATMENT A fundamental pillar of treatment is the surgical resection of soft tissue sarcomas. The goal is always an R0 resection with a safety margin. There is no consensus in the literature about the desired tumor-free resection margin. The decisive factors for these resection margins are histopathology, presence of anatomical barriers (capsule, tendon, fascia, cartilage, periosteum) and possibilities of (neo-) adjuvant therapy. DISCUSSION References in the literature support the role of resection margins as a predictor of local recurrence. Regarding the role of resection margins in overall survival, available data is divergent. There are known prognostic factors that influence overall survival, such as histological subtype, tumor size, tumor grading, and presence of metastases. So far, several studies have attempted to quantify the margins of resection, but no consensus has been reached, and debates are ongoing. When analyzing all the results of the data in the literature, it seems appropriate to aim for a negative resection margin >1 mm including an anatomical border structure, if possible.
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Affiliation(s)
- B Rath
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - J Hardes
- Abteilung für Tumororthopädie und Sarkomchirurgie, Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Essen, Deutschland
| | - M Tingart
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - T Braunschweig
- Institut für Pathologie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - J Eschweiler
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - F Migliorini
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
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