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Zhang BY, Wilson‐Smith AR, Connolly EA, Strach MC, Ussher N, Yan T, Bhadri VA. Extrapleural pneumonectomy for sarcoma: Outcomes of adult patients at a specialized center. Cancer Rep (Hoboken) 2024; 7:e2065. [PMID: 38627902 PMCID: PMC11021620 DOI: 10.1002/cnr2.2065] [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: 08/13/2023] [Revised: 03/21/2024] [Accepted: 03/30/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Extrapleural pneumonectomy (EPP) is a complex surgical procedure involving en-bloc resection of the parietal and visceral pleura, lung, pericardium, and ipsilateral diaphragm. Small case series of pleural-based sarcoma of predominantly pediatric patients suggest EPP may be a life-prolonging surgical option. We aimed to describe the characteristics and outcomes of adults who underwent EPP at a specialized sarcoma center. METHODS Clinicopathologic variables, surgical details, and follow-up information were extracted for patients undergoing EPP for pleural-based sarcoma between August 2017 and December 2020. Primary outcomes were event-free survival (EFS) and overall survival (OS) from the date of EPP. Secondary outcomes were disease-free interval (DFI) prior to EPP, and early and late postoperative complications. RESULTS Eight patients were identified, seven with soft tissue sarcoma and one with bone sarcoma. Patients had either localized disease with a primary thoracic sarcoma, sarcoma recurrent to the thorax, or de novo metastatic disease. All patients underwent resection of their pleural-based sarcoma by an experienced cardiothoracic surgeon, and some patients had pre or postoperative treatment. The perioperative morbidity was comparable with previously published reports of EPP performed in mesothelioma patients. At median follow-up of 22.5 months, median EFS was 6.0 months and OS was 20.7 months. Six patients (75%) had disease recurrence; five (62.5%) died of progressive disease. Two patients (25%) had not recurred: one died of a radiation-related esophageal rupture, and one was alive with no evidence of disease at 37.0 months. Characteristics of those with the longest EFS included low-grade histology and achieving a metabolic response to preoperative chemotherapy. CONCLUSIONS In adults with pleural-based sarcoma, EPP is rarely curative but appears to be a feasible salvage procedure when performed at specialized centers. Patient selection is critical with strong consideration given to multimodal therapy to optimize patient outcomes. In the absence of a confirmed response to neoadjuvant treatment, long term survival is poor and EPP should not be recommended.
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Affiliation(s)
- Betty Y. Zhang
- Department of Medical OncologyChris O'Brien LifehouseSydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Ashley R. Wilson‐Smith
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Department of Cardiothoracic SurgeryRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Elizabeth A. Connolly
- Department of Medical OncologyChris O'Brien LifehouseSydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Madeleine C. Strach
- Department of Medical OncologyChris O'Brien LifehouseSydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Nathan Ussher
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Department of Cardiothoracic SurgeryRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Tristan Yan
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Department of Cardiothoracic SurgeryRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Vivek A. Bhadri
- Department of Medical OncologyChris O'Brien LifehouseSydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
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Huang Q, Li W, He X, He Q, Lai Q, Yuan Q, Deng Z. Prognostic visualization model for primary pulmonary sarcoma: a SEER-based study. Sci Rep 2023; 13:17774. [PMID: 37853232 PMCID: PMC10584923 DOI: 10.1038/s41598-023-45058-7] [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] [Received: 03/17/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023] Open
Abstract
Primary pulmonary sarcoma (PPS) is a rare and poor prognostic malignancy that results from current clinical studies are lacking. Our study aimed to investigate the prognostic factors of PPS and to construct a predictive nomogram that predict the overall survival (OS) rate. We extracted data on patients diagnosed with PPS from 2010 to 2019 in the SEER database. A total of 169 patients were included after screening by inclusion and exclusion criteria. Univariate and multivariate COX regression analyses showed that age, pathological grade, liver metastasis, surgical intervention, and chemotherapy influenced the prognosis. We constructed the prediction model nomogram based on these factors. Moreover, the results of the internal and external ROC curves, calibration curves, and DCA plots confirmed that the model has good discrimination, accuracy, and clinical practice efficacy. The present study is the first population-based study to explore the factors affecting the prognosis of PPS. We established a novel prognostic nomogram to predict the OS rate, which can help to make proper clinical decisions.
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Affiliation(s)
- Qian Huang
- Sichuan North Medical College, Nanchong, 637000, Sichuan Province, China
| | - Wenqiang Li
- Zigong First People's Hospital, Zigong City, 643000, Sichuan Province, China
| | - Xiaoyu He
- Sichuan North Medical College, Nanchong, 637000, Sichuan Province, China
| | - Qian He
- West China Second Hospital of Sichuan University, Chengdu, 610044, Sichuan Province, China
| | - Qun Lai
- The First Hospital of Jilin University, Changchun, 130021, Jilin Province, China
| | - Quan Yuan
- Zigong First People's Hospital, Zigong City, 643000, Sichuan Province, China.
| | - Zhiping Deng
- Zigong First People's Hospital, Zigong City, 643000, Sichuan Province, China.
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3
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Gu H, Song R, Beeraka NM, Li T, Zhao D, Liu J, Fan R. SEER-Based Survival Nomogram (1998-2015) Based on 'Stage, Lymph Node Dissection, Tumor Size and Degree of Differentiation, and Therapies' for Prognosis of Primary Pulmonary Sarcoma. Technol Cancer Res Treat 2023; 22:15330338221150732. [PMID: 36740992 PMCID: PMC9903015 DOI: 10.1177/15330338221150732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: Primary pulmonary sarcoma (PPS) is very rare in terms of incidence, henceforth, the clinical evidence pertinent to the prognosis of PPS is limited. The aim of this study was to construct a nomogram for evaluating the overall survival (OS) of patients diagnosed with PPS based on the stage, lymph node dissection, tumor size and degree of differentiation, and therapies. Methods: A total of 515 patients diagnosed with PPS during the period of 1998 to 2015 were obtained from the surveillance, epidemiology, and end results database and randomly segregated into 'training group' and 'validation group' with a ratio of 7:3. Regression analysis was executed for the training group to obtain the independent factors influencing prognosis of PPS patients. A nomogram was constructed as per the results obtained through multivariate Cox regression analysis subsequently validated using C index, receiver operating characteristic (ROC) curve, and calibration curves. Results: Age, tumor size, histology type, lymph node surgery, summary stage and differentiation grade were independent factors affecting the prognosis. C index was 0.775 and 0.737 for both training group, and validation group, respectively. Areas under the ROC curve of 1-year, 3-year, and 5-year OS were 87.6 (95% CI: 83.8-91.3), 90.1 (95% CI: 86.2-94.0) and 90.6 (95% CI: 85.8-95.4), respectively, in training group. Area under the curve values of 1-year, 3-year, and 5-year OS in the validation group were 83.1 (95% CI: 75.8-90.5), 82.9 (95% CI: 73.2-92.7) and 87.0 (95% CI: 75.9-98.1), respectively. Based on the nomogram, patients were segregated into low-risk group and high-risk group (degree of risk: cutoff score 193). OS of low-risk group was significantly higher when compared to high-risk group (P < .001) in the training group and validation group. Radiotherapy was a risk factor for the low-risk group and adjuvant chemotherapy has not exhibited influence on OS pertinent to low-risk group. However, adjuvant radiotherapy or chemotherapy both significantly improved the prognosis of PPS patients (P < .001) in the high-risk group. Conclusion: Constructed nomogram could have a strong predictive ability with higher accuracy for the prognosis of patients with PPS. Patients at low risk could not benefit from adjuvant radiotherapy or chemotherapy, while the prognosis clearly improved in the high-risk populations treated with either radiotherapy or chemotherapy.
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Affiliation(s)
- Hao Gu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruixia Song
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Narasimha M. Beeraka
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia,JSS College of Pharmacy, JSS Academy of Higher Education and Research (JSS AHER), Mysuru, Karnataka, India
| | - Tingxuan Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Di Zhao
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junqi Liu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,Junqi Liu, Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou 450000, Henan Province, China.
| | - Ruitai Fan
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China,Ruitai Fan, Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Erqi District, Zhengzhou 450000, Henan Province, China.
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4
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Rodrigues C, Peretz Soroka H, Pierro A, Baertschiger RM, Cypel M, Donahoe L, Tsang DS, Cho J, De Perrot M, Waddell TK, Gupta AA. Extra-Pleural Pneumonectomy (EPP) in Children and Adults with Locally Advanced Sarcoma: A CanSaRCC Study. Curr Oncol 2022; 29:4260-4266. [PMID: 35735449 PMCID: PMC9221731 DOI: 10.3390/curroncol29060340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Extra-pleural pneumonectomy (EPP) involves the removal of the parietal and visceral pleura, ipsilateral lungs, pericardium, and hemi diaphragm. In patients with advanced sarcoma in the pleura, EPP is often the only option for local control. The aim of our study was to review our institutional experience with EPP. Of ten patients in our study, five were alive without disease at last follow-up after multi-modality therapy including EPP. Two patients had local recurrence and died of progressive disease. One patient died of brain metastasis, one patient died of radiation induced sarcoma, and one patient died of surgical complications. Our results suggest that EPP is a feasible option for patients when used in combination with chemotherapy and radiation. Moreover, high-volume cancer centers should discuss the use of EPP during tumor board discussion. Abstract Sarcoma can present as locally advanced disease involving pleura for which extra-pleural pneumonectomy (EPP) may be the only surgical option to ensure adequate local control. Data were collected on patients who underwent EPP between January 2009 and August 2021 at Princess Margret Hospital and SickKids (Toronto) using the CanSaRCC (Canadian Sarcoma Research and Clinical Collaboration). Ten patients with locally advanced sarcoma involving the pleura, aged 4 to 59 years (median 19.5 years) underwent EPP. Nine (90%) received pre-operative chemotherapy and eight (80%) achieved an R0 resection. Hemithoracic radiation was administered preoperatively (n = 6, 60%) or postoperatively (n = 4, 40%). Five (50%) patients were alive without disease at last follow-up (median 34.2 months) and time from EPP to last FU was median 29.2 months (range 2.2–87.5). Two patients (20%) had local recurrence, 4.3 and 5.8 months from EPP, and both died from progressive disease, 13.1 and 8.2 months from EPP, respectively. One patient died from brain metastasis (17 months), one died from radiation associated osteosarcoma (66 months), and one died from surgical complications (heart failure from constrictive pericarditis). EPP offers a feasible and life-prolonging surgical consideration for patients with locally advanced sarcoma involving the pleura in combination with chemotherapy and radiation. Consequently, EPP should be considered during multi-disciplinary tumor board discussions at high-volume centers.
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Affiliation(s)
- Caroline Rodrigues
- Division of Medical Oncology, Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC), Princess Margaret Cancer Centre—University Health Network, Toronto, ON M5G 2C1, Canada; (C.R.); (H.P.S.)
| | - Hagit Peretz Soroka
- Division of Medical Oncology, Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC), Princess Margaret Cancer Centre—University Health Network, Toronto, ON M5G 2C1, Canada; (C.R.); (H.P.S.)
| | - Agostino Pierro
- Division of General Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada; (A.P.); (R.M.B.)
| | - Reto M. Baertschiger
- Division of General Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada; (A.P.); (R.M.B.)
| | - Marcelo Cypel
- Division of Thoracic Surgery, Toronto General Hospital—University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (M.C.); (L.D.); (M.D.P.); (T.K.W.)
| | - Laura Donahoe
- Division of Thoracic Surgery, Toronto General Hospital—University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (M.C.); (L.D.); (M.D.P.); (T.K.W.)
| | - Derek S. Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C1, Canada; (D.S.T.); (J.C.)
| | - John Cho
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C1, Canada; (D.S.T.); (J.C.)
| | - Marc De Perrot
- Division of Thoracic Surgery, Toronto General Hospital—University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (M.C.); (L.D.); (M.D.P.); (T.K.W.)
| | - Thomas K. Waddell
- Division of Thoracic Surgery, Toronto General Hospital—University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (M.C.); (L.D.); (M.D.P.); (T.K.W.)
| | - Abha A. Gupta
- Division of Medical Oncology, Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC), Princess Margaret Cancer Centre—University Health Network, Toronto, ON M5G 2C1, Canada; (C.R.); (H.P.S.)
- Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
- Correspondence: ; Tel.: +1-416-946-2252; Fax: +1-416-946-6546
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Zöllner SK, Amatruda JF, Bauer S, Collaud S, de Álava E, DuBois SG, Hardes J, Hartmann W, Kovar H, Metzler M, Shulman DS, Streitbürger A, Timmermann B, Toretsky JA, Uhlenbruch Y, Vieth V, Grünewald TGP, Dirksen U. Ewing Sarcoma-Diagnosis, Treatment, Clinical Challenges and Future Perspectives. J Clin Med 2021; 10:1685. [PMID: 33919988 PMCID: PMC8071040 DOI: 10.3390/jcm10081685] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 02/08/2023] Open
Abstract
Ewing sarcoma, a highly aggressive bone and soft-tissue cancer, is considered a prime example of the paradigms of a translocation-positive sarcoma: a genetically rather simple disease with a specific and neomorphic-potential therapeutic target, whose oncogenic role was irrefutably defined decades ago. This is a disease that by definition has micrometastatic disease at diagnosis and a dismal prognosis for patients with macrometastatic or recurrent disease. International collaborations have defined the current standard of care in prospective studies, delivering multiple cycles of systemic therapy combined with local treatment; both are associated with significant morbidity that may result in strong psychological and physical burden for survivors. Nevertheless, the combination of non-directed chemotherapeutics and ever-evolving local modalities nowadays achieve a realistic chance of cure for the majority of patients with Ewing sarcoma. In this review, we focus on the current standard of diagnosis and treatment while attempting to answer some of the most pressing questions in clinical practice. In addition, this review provides scientific answers to clinical phenomena and occasionally defines the resulting translational studies needed to overcome the hurdle of treatment-associated morbidities and, most importantly, non-survival.
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Affiliation(s)
- Stefan K. Zöllner
- Pediatrics III, University Hospital Essen, 45147 Essen, Germany;
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
| | - James F. Amatruda
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA;
| | - Sebastian Bauer
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Medical Oncology, Sarcoma Center, University Hospital Essen, 45147 Essen, Germany
| | - Stéphane Collaud
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Thoracic Surgery, Ruhrlandklinik, University of Essen-Duisburg, 45239 Essen, Germany
| | - Enrique de Álava
- Institute of Biomedicine of Sevilla (IbiS), Virgen del Rocio University Hospital, CSIC, University of Sevilla, CIBERONC, 41013 Seville, Spain;
- Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, 41009 Seville, Spain
| | - Steven G. DuBois
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA 02215, USA; (S.G.D.); (D.S.S.)
| | - Jendrik Hardes
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Musculoskeletal Oncology, Sarcoma Center, 45147 Essen, Germany
| | - Wolfgang Hartmann
- Division of Translational Pathology, Gerhard-Domagk Institute of Pathology, University Hospital Münster, 48149 Münster, Germany;
- West German Cancer Center (WTZ), Network Partner Site, University Hospital Münster, 48149 Münster, Germany
| | - Heinrich Kovar
- St. Anna Children’s Cancer Research Institute and Medical University Vienna, 1090 Vienna, Austria;
| | - Markus Metzler
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, 91054 Erlangen, Germany;
| | - David S. Shulman
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA 02215, USA; (S.G.D.); (D.S.S.)
| | - Arne Streitbürger
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Musculoskeletal Oncology, Sarcoma Center, 45147 Essen, Germany
| | - Beate Timmermann
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre, 45147 Essen, Germany
| | - Jeffrey A. Toretsky
- Departments of Oncology and Pediatrics, Georgetown University, Washington, DC 20057, USA;
| | - Yasmin Uhlenbruch
- St. Josefs Hospital Bochum, University Hospital, 44791 Bochum, Germany;
| | - Volker Vieth
- Department of Radiology, Klinikum Ibbenbüren, 49477 Ibbenbühren, Germany;
| | - Thomas G. P. Grünewald
- Division of Translational Pediatric Sarcoma Research, Hopp-Children’s Cancer Center Heidelberg (KiTZ), 69120 Heidelberg, Germany;
- Division of Translational Pediatric Sarcoma Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Core Center, 69120 Heidelberg, Germany
| | - Uta Dirksen
- Pediatrics III, University Hospital Essen, 45147 Essen, Germany;
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
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6
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Stork T, Boemans R, Hardes J, Streitbürger A, Dirksen U, Pöttgen C, Schildhaus HU, Bauer S, Collaud S, Aigner C. Number of metastases and their response to chemotherapy impact survival of patients with isolated lung metastases from bone-derived sarcoma. BMC Cancer 2021; 21:375. [PMID: 33827467 PMCID: PMC8028220 DOI: 10.1186/s12885-021-08073-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background Pulmonary metastasectomy (PM) is an established treatment for selected patients with metastatic sarcomas. The aim of this study was to examine our institutional experience and evaluate factors predicting outcome. Methods We retrospectively reviewed all patients undergoing PM for bone sarcoma in our center from 2001 to 2019. Survival was calculated from the date of PM. Impact on survival of clinical parameters was assessed. Results Thirty-eight patients (27 males, 71%) were included. Histology was osteosarcoma (n = 20, 53%), Ewing sarcoma (n = 13, 34%) and chondrosarcoma (n = 5, 13%). Twelve patients (31.5%) had synchronous metastases, all received chemotherapy before PM. Median number of metastases was 3 (1 to 29). Twenty (53%) patients had mediastinal lymph node sampling. One patient had positive lymph nodes. Ninety-day mortality was 0%. Three and 5-year PFS were 24.5 and 21%, respectively. Three and 5-year OS were 64.5 and 38.5%, respectively. More than three metastases and progression under chemotherapy were significant independent predictors for OS. Conclusion PM is a safe procedure and encouraging long-term outcome can be achieved. Patients with progression of pulmonary metastases under chemotherapy as well as patients with more than three metastases had significantly worse OS.
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Affiliation(s)
- Theresa Stork
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Rebecca Boemans
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Jendrik Hardes
- German Cancer Consortium (DKTK), Center Essen, Essen, Germany.,Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Arne Streitbürger
- German Cancer Consortium (DKTK), Center Essen, Essen, Germany.,Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Uta Dirksen
- German Cancer Consortium (DKTK), Center Essen, Essen, Germany.,Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christoph Pöttgen
- German Cancer Consortium (DKTK), Center Essen, Essen, Germany.,Department of Radiation Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hans-Ulrich Schildhaus
- German Cancer Consortium (DKTK), Center Essen, Essen, Germany.,Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sebastian Bauer
- German Cancer Consortium (DKTK), Center Essen, Essen, Germany.,Department of Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stéphane Collaud
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany. .,German Cancer Consortium (DKTK), Center Essen, Essen, Germany.
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7
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Ropp AM, Burke AP, Kligerman SJ, Leb JS, Frazier AA. Intimal Sarcoma of the Great Vessels. Radiographics 2021; 41:361-379. [PMID: 33646906 DOI: 10.1148/rg.2021200184] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Intimal sarcomas of the pulmonary artery and aorta are rare entities with a poor prognosis. In many instances, pulmonary artery sarcomas are misinterpreted as acute or chronic pulmonary thromboembolism, whereas aortic intimal sarcomas are often misdiagnosed as protuberant atherosclerotic disease or intimal thrombus. Discernment of intimal sarcomas from these and other common benign entities is essential for the timely initiation of aggressive therapy. The most useful imaging modalities for assessment of a suspected intimal sarcoma include CT angiography, fluorine 18-fluorodeoxyglucose PET, and MRI. The authors discuss the clinical features, current treatment options, characteristic imaging findings, and underlying pathologic features of intimal sarcomas. The authors emphasize imaging discernment of intimal sarcomas and how their differential diagnosis is informed by knowledge of radiologic-pathologic correlation. The most reliable distinguishing imaging features are also emphasized to improve accurate and timely diagnosis. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Alan M Ropp
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA 22903 (A.M.R.); Departments of Pathology (A.P.B.) and Diagnostic Radiology and Nuclear Medicine (A.A.F.), University of Maryland School of Medicine, Baltimore, Md; Department of Diagnostic Radiology, University of California San Diego School of Medicine, San Diego, Calif (S.J.K.); Department of Diagnostic Radiology, Columbia University Medical Center, New York, NY (J.S.L.); and American Institute for Radiologic Pathology Program (AIRP), American College of Radiology, Silver Spring, Md, and Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Md (A.A.F.)
| | - Allen P Burke
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA 22903 (A.M.R.); Departments of Pathology (A.P.B.) and Diagnostic Radiology and Nuclear Medicine (A.A.F.), University of Maryland School of Medicine, Baltimore, Md; Department of Diagnostic Radiology, University of California San Diego School of Medicine, San Diego, Calif (S.J.K.); Department of Diagnostic Radiology, Columbia University Medical Center, New York, NY (J.S.L.); and American Institute for Radiologic Pathology Program (AIRP), American College of Radiology, Silver Spring, Md, and Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Md (A.A.F.)
| | - Seth J Kligerman
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA 22903 (A.M.R.); Departments of Pathology (A.P.B.) and Diagnostic Radiology and Nuclear Medicine (A.A.F.), University of Maryland School of Medicine, Baltimore, Md; Department of Diagnostic Radiology, University of California San Diego School of Medicine, San Diego, Calif (S.J.K.); Department of Diagnostic Radiology, Columbia University Medical Center, New York, NY (J.S.L.); and American Institute for Radiologic Pathology Program (AIRP), American College of Radiology, Silver Spring, Md, and Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Md (A.A.F.)
| | - Jay S Leb
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA 22903 (A.M.R.); Departments of Pathology (A.P.B.) and Diagnostic Radiology and Nuclear Medicine (A.A.F.), University of Maryland School of Medicine, Baltimore, Md; Department of Diagnostic Radiology, University of California San Diego School of Medicine, San Diego, Calif (S.J.K.); Department of Diagnostic Radiology, Columbia University Medical Center, New York, NY (J.S.L.); and American Institute for Radiologic Pathology Program (AIRP), American College of Radiology, Silver Spring, Md, and Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Md (A.A.F.)
| | - Aletta A Frazier
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, 1215 Lee St, Charlottesville, VA 22903 (A.M.R.); Departments of Pathology (A.P.B.) and Diagnostic Radiology and Nuclear Medicine (A.A.F.), University of Maryland School of Medicine, Baltimore, Md; Department of Diagnostic Radiology, University of California San Diego School of Medicine, San Diego, Calif (S.J.K.); Department of Diagnostic Radiology, Columbia University Medical Center, New York, NY (J.S.L.); and American Institute for Radiologic Pathology Program (AIRP), American College of Radiology, Silver Spring, Md, and Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Md (A.A.F.)
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