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Huerta CT, Quinn K, Saberi RA, Rao KA, Quiroz HJ, Brady AC, Thorson CM, Sola JE, Perez EA. Radical Resection of Pediatric Fibrosarcoma Is Not Associated With Survival Benefit: A Nationwide Database Analysis. J Surg Res 2022; 279:639-647. [PMID: 35930817 DOI: 10.1016/j.jss.2022.06.030] [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: 02/10/2022] [Revised: 05/27/2022] [Accepted: 06/13/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Fibrosarcoma is one of the most common nonrhabdomyosarcoma soft tissue sarcomas in the pediatric population. Surgical resection is the cornerstone of treatment; however, optimal factors regarding the extent of fibrosarcoma resection in localized versus regional disease is poorly understood. METHODS The Surveillance, Epidemiology, and End Results database was queried for patients who are 19 y old or younger with a diagnosis of fibrosarcoma from 1975 to 2016. Kaplan-Meier analyses were performed for disease-specific survival on clinical and pathologic variables. Multivariate analysis was performed based on significant predictors of disease-specific survival. RESULTS There were 1290 patients (median age 13 [7-17] y) identified with fibrosarcoma. The overall survival rate at 20 y was 93%. Radical resection was performed on 22%, 40%, and 52% of patients with localized, regional, and distant Surveillance, Epidemiology, and End Results disease stage, respectively. Chemotherapy (P < 0.001), radiation (P < 0.001), histology (P < 0.001), and stage (P = 0.004) were significant predictors of increased mortality using univariate Kaplan-Meier analysis. Most patients (86%) with localized or regional stage who underwent radiation had fibrosarcomas of nondermatofibrosarcoma histology (P < 0.001). Dermatofibrosarcoma subtype comprised most radical resections (41%). Excluding distant stage, nondermatofibroma histology (hazard ratio 16.94, 95% confidence interval 3.77-76.01) and regional stage (hazard ratio 8.15, 95% confidence interval 2.93-22.69) were independent prognostic factors of mortality (both P < 0.001). Radical resection was not a significant independent prognostic indicator of survival. CONCLUSIONS Nondermatofibrosarcoma subtype is independently associated with increased mortality. Although surgery remains the mainstay of treatment, the extent of resection is not a predictor of survival for patients with the localized and regional stage of disease.
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Affiliation(s)
- Carlos Theodore Huerta
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Kirby Quinn
- University of Miami Miller School of Medicine, Miami, Florida
| | - Rebecca A Saberi
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Krishnamurti A Rao
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Hallie J Quiroz
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Ann-Christina Brady
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Chad M Thorson
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Juan E Sola
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Eduardo A Perez
- DeWitt Daughtry Family Department of Surgery, Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida.
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Sadeghi R, Shojaeian R, Hiradfar M, Mohammadipour A, Azadmand A, Mashhadi MP. Sentinel lymph node biopsy in pediatric Wilms tumor. J Pediatr Surg 2022; 57:1518-1522. [PMID: 35067359 DOI: 10.1016/j.jpedsurg.2021.12.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/05/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Although the sentinel lymph node Biopsy (SLNB) is well stablished in solid tumors among adults but the experience on SLNB in pediatrics is still limited. In this article we report our experience of sentinel lymph node detection that is applied on pediatric solid renal tumors. MATERIAL AND METHODS Twenty 1-16 year old children with non-metastatic primary Wilms tumor regarding the radiological studies were enrolled. Radio tracer injection was carried out after renal vein, artery and ureter ligation, at the time of radical nephrectomy. Sentinel node detection and sampling was performed in every location with radiotracer count of 3 times more than background. Finally lymph node sampling was completed following the standard current discipline in Wilms tumor surgery. RESULTS A single SLN was detected in 16 patients. 4 patients had more than one SLN. The most common site of SLN was inter aortocaval space. Histopathologic studies revealed tumor involvement in 3 sentinel nodes (15%). All other lymph node samples were also studied histologically and LN involvement was not detected in any of the cases with tumor free sentinel lymph node (no false negative case). Multiple LN involvement was reported in two patients with positive SLN in which, other involved lymph nodes were removed with the tumor during radical nephrectomy. CONCLUSION Intraoperative SLNB is a safe and feasible tool to improve the accuracy of staging in pediatric Wilms' tumor. We suggest to ligate renal artery and vein prior to radiotracer injection to diminish the background confounding effect. LEVEL OF EVIDENCE Level II (development of diagnostic criteria in a consecutive series of patients and a universally applied "gold standard") TYPE OF STUDY: Study of Diagnostic Test.
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Affiliation(s)
- Ramin Sadeghi
- Department of Nuclear Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Shojaeian
- Department of Pediatric Surgery, Mashhad University of Medical Sciences, Akbar Children's Hospital, Mashhad, Iran.
| | - Mehran Hiradfar
- Department of Pediatric Surgery, Mashhad University of Medical Sciences, Akbar Children's Hospital, Mashhad, Iran
| | - Ahmad Mohammadipour
- Department of Pediatric Surgery, Mashhad University of Medical Sciences, Akbar Children's Hospital, Mashhad, Iran
| | - Ali Azadmand
- Department of Pediatric Surgery, Mashhad University of Medical Sciences, Akbar Children's Hospital, Mashhad, Iran
| | - Mahdi Parvizi Mashhadi
- Department of Pediatric Surgery, Mashhad University of Medical Sciences, Akbar Children's Hospital, Mashhad, Iran
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Li W, Zhou Q, Liu W, Xu C, Tang ZR, Dong S, Wang H, Li W, Zhang K, Li R, Zhang W, Hu Z, Shibin S, Liu Q, Kuang S, Yin C. A Machine Learning-Based Predictive Model for Predicting Lymph Node Metastasis in Patients With Ewing's Sarcoma. Front Med (Lausanne) 2022; 9:832108. [PMID: 35463005 PMCID: PMC9020377 DOI: 10.3389/fmed.2022.832108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objective In order to provide reference for clinicians and bring convenience to clinical work, we seeked to develop and validate a risk prediction model for lymph node metastasis (LNM) of Ewing’s sarcoma (ES) based on machine learning (ML) algorithms. Methods Clinicopathological data of 923 ES patients from the Surveillance, Epidemiology, and End Results (SEER) database and 51 ES patients from multi-center external validation set were retrospectively collected. We applied ML algorithms to establish a risk prediction model. Model performance was checked using 10-fold cross-validation in the training set and receiver operating characteristic (ROC) curve analysis in external validation set. After determining the best model, a web-based calculator was made to promote the clinical application. Results LNM was confirmed or unable to evaluate in 13.86% (135 out of 974) ES patients. In multivariate logistic regression, race, T stage, M stage and lung metastases were independent predictors for LNM in ES. Six prediction models were established using random forest (RF), naive Bayes classifier (NBC), decision tree (DT), xgboost (XGB), gradient boosting machine (GBM), logistic regression (LR). In 10-fold cross-validation, the average area under curve (AUC) ranked from 0.705 to 0.764. In ROC curve analysis, AUC ranged from 0.612 to 0.727. The performance of the RF model ranked best. Accordingly, a web-based calculator was developed (https://share.streamlit.io/liuwencai2/es_lnm/main/es_lnm.py). Conclusion With the help of clinicopathological data, clinicians can better identify LNM in ES patients. Risk prediction models established in this study performed well, especially the RF model.
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Affiliation(s)
- Wenle Li
- Department of Orthopedics, Xianyang Central Hospital, Xianyang, China.,Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Qian Zhou
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Chongqing Liang Jiang New Area, Chongqing, China
| | - Wencai Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chan Xu
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Chongqing Liang Jiang New Area, Chongqing, China.,Department of Dermatology, Xianyang Central Hospital, Xianyang, China
| | - Zhi-Ri Tang
- School of Physics and Technology, Wuhan University, Wuhan, China
| | - Shengtao Dong
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Haosheng Wang
- Department of Orthopaedics, The Second Hospital of Jilin University, Changchun, China
| | - Wanying Li
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Kai Zhang
- Department of Orthopedics, Xianyang Central Hospital, Xianyang, China.,Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Rong Li
- The First Clinical Medical College, Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Wenshi Zhang
- The First Clinical Medical College, Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Zhaohui Hu
- Department of Spinal Surgery, Liuzhou People's Hospital, Liuzhou, China
| | - Su Shibin
- Department of Business Management, Xiamen Bank, Xiamen, China
| | - Qiang Liu
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Sirui Kuang
- Faculty of Medicine, Macau University of Science and Technology, Macau, China
| | - Chengliang Yin
- Faculty of Medicine, Macau University of Science and Technology, Macau, China
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Jeremiasse B, van der Steeg AFW, Fiocco M, Hobbelink MGG, Merks JHM, Godzinski J, Shulkin BL, Wijnen MHWA, Terwisscha van Scheltinga CEJ. Value of the Sentinel Node Procedure in Pediatric Extremity Rhabdomyosarcoma: A Systematic Review and Retrospective Cohort Study. Ann Surg Oncol 2021; 28:9048-9059. [PMID: 34057567 PMCID: PMC8591006 DOI: 10.1245/s10434-021-10035-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/29/2021] [Indexed: 11/23/2022]
Abstract
Background Our aim is to show whether the sentinel node procedure (SNP) is recommendable for pediatric patients with extremity rhabdomyosarcoma (RMS). Lymph node metastases are an important prognostic factor in pediatric patients with extremity RMS. Accurate nodal staging is necessary to treat the patient accordingly. An alternative to the current recommended lymph node sampling is the sentinel node procedure (SNP). Methods A systematic review was performed summarizing all published cases of SNP in addition to 13 cases from our hospital and 8 cases from two other hospitals that have not been published before. Results For all patients (n = 55), at least one SLN was identified, but the SNP technique used was not uniform. The SNP changed the nodal classification of eight patients (17.0%) and had a false-negative rate of 10.5%. Conclusions The SNP is recommendable for pediatric patients with extremity RMS. It can change lymph node status and can be used to sample patients in a more targeted way than nodal sampling alone. Therefore, we recommend use of the SNP in addition to clinical and radiological nodal assessment for pediatric patients with extremity RMS.
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Affiliation(s)
- Bernadette Jeremiasse
- Pediatric Surgery, Pediatric Solid Tumor Unit, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Alida F W van der Steeg
- Pediatric Surgery, Pediatric Solid Tumor Unit, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Marta Fiocco
- Trial and Data Center, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Institute of Mathematics, Leiden University, Leiden, The Netherlands.,Department of Biomedical Data Science, Section Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique G G Hobbelink
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes H M Merks
- Pediatric Oncology, Pediatric Solid Tumor Unit, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jan Godzinski
- Department of Pediatric Surgery, Marciniak Hospital, Wroclaw, Poland.,Department of Paediatric Traumatology and Emergency Medicine, Medical University, Wroclaw, Poland
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Marc H W A Wijnen
- Pediatric Surgery, Pediatric Solid Tumor Unit, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
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5
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Alternative approaches to retroperitoneal lymph node dissection for paratesticular rhabdomyosarcoma. J Pediatr Surg 2020; 55:2677-2681. [PMID: 32345499 DOI: 10.1016/j.jpedsurg.2020.03.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/21/2020] [Accepted: 03/21/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE The aim of this study was to evaluate outcomes based on surgical approach for retroperitoneal lymph node dissection (RPLND) in patients with paratesticular rhabdomyosarcoma (PT-RMS). METHODS Patients undergoing RPLND for PT-RMS over 10 years at a single institution were retrospectively reviewed. Length of stay (LOS), complications, oral morphine equivalents per kilogram (OME/Kg), lymph node yield, and time to chemotherapy were assessed. The surgical approaches compared were: open transabdominal, open extraperitoneal, laparoscopic, and retroperitoneoscopic. For cases with lymphatic mapping, indocyanine green (ICG) was injected into the spermatic cord. RESULTS Twenty patients were included: five open transabdominal, six open extraperitoneal, three laparoscopic, and six retroperitoneoscopic operations. LOS was shorter in the retroperitoneoscopic group than laparoscopic (p = 0.029) and both open groups (p < 0.001). Mean OME/kg used was lowest in the retroperitoneoscopic (0.13 ± 0.15) group compared to laparoscopic (0.68 ± 0.53, p = 0.043), open transabdominal (14.90 ± 8.87, p = 0.003), and extraperitoneal (10.11 ± 2.44, p < 0.001). Time to chemotherapy was shorter for retroperitoneoscopic patients (0.13 days ± 0.15) compared to open transabdominal (15.6 days±6.5, p = 0.005). There was no difference in lymph node yield between groups. Spermatic cord ICG demonstrated iliac lymph node avidity on near-infrared spectroscopy. CONCLUSIONS Minimally invasive RPLND appears to offer a faster recovery without compromising lymph node yield for patients with PT-RMS. LEVEL OF EVIDENCE III.
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6
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The clinical and radiologic features of paediatric rhabdomyosarcoma. Pediatr Radiol 2019; 49:1516-1523. [PMID: 31620851 DOI: 10.1007/s00247-019-04386-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/01/2019] [Accepted: 03/08/2019] [Indexed: 02/01/2023]
Abstract
Rhabdomyosarcoma is the most common soft-tissue sarcoma in children. The most common sites are head and neck, genitourinary tract and extremities. In this review we outline the clinical and radiologic features of paediatric rhabdomyosarcoma, as well as imaging considerations and imaging of relapse.
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Ludmir EB, Paulino AC, Grosshans DR, McAleer MF, McGovern SL, Huh WW, Okcu MF, Harrell LM, Mahajan A. Regional Nodal Control for Head and Neck Alveolar Rhabdomyosarcoma. Int J Radiat Oncol Biol Phys 2018; 101:169-176. [DOI: 10.1016/j.ijrobp.2018.01.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 12/27/2017] [Accepted: 01/16/2018] [Indexed: 12/11/2022]
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8
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Orbach D, Mosseri V, Gallego S, Kelsey A, Devalck C, Brenann B, van Noesel MM, Bergeron C, Merks JHM, Rechnitzer C, Jenney M, Minard-Colin V, Stevens M. Nonparameningeal head and neck rhabdomyosarcoma in children and adolescents: Lessons from the consecutive International Society of Pediatric Oncology Malignant Mesenchymal Tumor studies. Head Neck 2016; 39:24-31. [PMID: 27459057 DOI: 10.1002/hed.24547] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This article reports risk factors and long-term outcome in localized nonparameningeal head and neck rhabdomyosarcomas in children and adolescents from a combined dataset from 3 consecutive international trials. METHODS Data from 140 children (9.3% of total) prospectively enrolled in the International Society of Pediatric Oncology Malignant Mesenchymal Tumor (SIOP-MMT)-84/89/95 studies were analyzed. RESULTS Primary site was: superficial face in 46%; oral cavity (21%); neck (19%); and salivary glands (14%). Local control was achieved in 96%, but 49% relapsed (locoregionally 91%). At median follow-up of 10 years, 5-year overall survival (OS) was 74.7% (67.4% to 81.9%) and event-free survival 48.9% (40.6% to 57.2%), although this improved with successive studies. Radiotherapy (RT) as first-line treatment was independently prognostic for event-free survival (relative risk [RR] = 0.4 [range, 0.2-0.7]; p < .01) even if it did not impact OS (RR = 1 [range, 0.5-2]). CONCLUSION High rates of locoregional relapse were seen in head and neck rhabdomyosarcoma that should be prevented by more frequent use of RT in this primary. © 2016 Wiley Periodicals, Inc. Head Neck 39: 24-31, 2017.
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Affiliation(s)
- Daniel Orbach
- Adolescent and Pediatric Oncology Department, Institut Curie, Paris, France
| | | | - Soledad Gallego
- Paediatric Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Anna Kelsey
- Pathology Department, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Christine Devalck
- Pediatric Haematology Oncology Department, Hopital Universitaire des enfants, Brussels, Belgium
| | - Bernadette Brenann
- Department of Paediatric Oncology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Max M van Noesel
- Center of Pediatric Oncology, Princess Máxima, Utrecht, The Netherlands
| | - Christophe Bergeron
- Department of Pediatric Oncology, Institut d'Hematologie et d'Oncologie Pédiatrique, Lyon, France
| | - Johannes H M Merks
- Department of Pediatric Oncology, Emma Children's Hospital - Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Meriel Jenney
- Department of Pediatric Oncology, Children's Hospital for Wales, Heath Park, Cardiff, United Kingdom
| | | | - Michael Stevens
- School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
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10
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Hotta R, Fujimura T, Shimojima N, Nakahara T, Fuchimoto Y, Hoshino K, Morikawa Y, Matsufuji H, Kuroda T. Application of nuclear medicine to achieve less invasive surgery for malignant solid tumors in children. Pediatr Int 2014; 56:896-901. [PMID: 24773623 DOI: 10.1111/ped.12368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/11/2014] [Accepted: 04/17/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of nuclear medicine for the management of malignant tumor, such as radioguided surgery and sentinel lymph node biopsy (SLNB), has been widely accepted in the adult practice. However, there are very few studies to apply those techniques for pediatric diseases. The aim of this study was to investigate the feasibility of application of nuclear medicine in surgery for neuroblastoma (NB) or rhabdomyosarcoma (RMS) in children. METHODS Radioguided surgery using (123) I-metaiodobenzylguanidine was performed on six children with NB. SLNB using technetium-labeled tin or sulfur colloid was performed on two children with perineal RMS. Histological evaluation of resected specimens was performed to determine the accuracy of intraoperative detection and SLNB. All patients were evaluated for overall survival and complications. RESULTS Intraoperative tumor localization using hand-held gamma probe was helpful in 85.7% of NB patients. Sensitivity and specificity of this technique were 81.8% and 93.3%, respectively. There were no postoperative complications, and four out of five patients with high-risk NB experienced disease-free survival (median follow up, 57 months). Sentinel lymph nodes were easily detected in patients with perineal RMS, and histological assessment revealed complete consistency with regional lymph node status. CONCLUSIONS Nuclear medicine may have a potential application in the use of less invasive surgery for advanced NB or perineal RMS, the two most challenging pediatric malignancies.
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Affiliation(s)
- Ryo Hotta
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takumi Fujimura
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Shimojima
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tadaki Nakahara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yasushi Fuchimoto
- Department of Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Ken Hoshino
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yasuhide Morikawa
- Department of Pediatric Surgery, International University of Health & Welfare, Tochigi, Japan
| | - Hiroshi Matsufuji
- Department of Pediatric Surgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
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Sherman KL, Kinnier CV, Farina DA, Wayne JD, Laskin WB, Agulnik M, Attar S, Hayes JP, Peabody T, Bilimoria KY. Examination of national lymph node evaluation practices for adult extremity soft tissue sarcoma. J Surg Oncol 2014; 110:682-8. [DOI: 10.1002/jso.23687] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 05/19/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Karen L. Sherman
- Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago Illinois
- Department of Surgery; Surgical Oncology and Quality Improvement Center; Northwestern University; Feinberg School of Medicine; Chicago Illinois
| | - Christine V. Kinnier
- Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago Illinois
- Department of Surgery; Surgical Oncology and Quality Improvement Center; Northwestern University; Feinberg School of Medicine; Chicago Illinois
- Department of Surgery; Massachusetts General Hospital; Boston Massachusetts
| | - Domenico A. Farina
- Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago Illinois
- Department of Surgery; Surgical Oncology and Quality Improvement Center; Northwestern University; Feinberg School of Medicine; Chicago Illinois
| | - Jeffrey D. Wayne
- Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago Illinois
- Department of Surgery; Surgical Oncology and Quality Improvement Center; Northwestern University; Feinberg School of Medicine; Chicago Illinois
| | - William B. Laskin
- Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago Illinois
- Department of Pathology; Northwestern Memorial Hospital; Chicago Illinois
| | - Mark Agulnik
- Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago Illinois
- Department of Medicine; Division of Hematology Oncology; Northwestern Memorial Hospital; Chicago Illinois
| | - Samer Attar
- Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago Illinois
- Department of Orthopedic Surgery; Northwestern Memorial Hospital; Chicago Illinois
| | - John P. Hayes
- Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago Illinois
- Department of Radiation Oncology; Northwestern Memorial Hospital; Chicago Illinois
| | - Terrance Peabody
- Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago Illinois
- Department of Orthopedic Surgery; Northwestern Memorial Hospital; Chicago Illinois
| | - Karl Y. Bilimoria
- Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago Illinois
- Department of Surgery; Surgical Oncology and Quality Improvement Center; Northwestern University; Feinberg School of Medicine; Chicago Illinois
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Terwisscha van Scheltinga CEJ, Spronk P, van Rosmalen J, Wijnen MHWA, Heij HA, van Baren R, Merks JHM, van Noesel MM, Wijnen RMH. Diagnosis and treatment of lymph node metastases in pediatric rhabdomyosarcoma in the Netherlands: a retrospective analysis. J Pediatr Surg 2014; 49:416-9. [PMID: 24650468 DOI: 10.1016/j.jpedsurg.2013.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/09/2013] [Accepted: 08/05/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND In pediatric rhabdomyosarcoma (RMS), evaluation of lymph node involvement (N1) is an important staging aspect, but difficult to assess. The aim of our study was to evaluate the assessment of lymph node infiltration and impact on outcome in N1 RMS patients. METHODS We identified 277 non-metastatic RMS patients diagnosed and treated between 1990 and 2008. Patients with recorded N1 disease were evaluated for their diagnostic procedures and outcome. RESULTS In 13.7% N1 status was reported. In 19 of 34 N1 patients, lymph node biopsies were performed for histologically confirmation. Different treatment modalities were used to treat lymph node metastases. In total 23 of 31 patients received local treatment of the node (11/23 RT, 4/23 surgery, and 8/23 both). All patients received chemotherapy. Lymph node relapse occurred in 7 of 31 patients who were treated with one or two modalities. Only 1 (14%) of 8 patients treated with three modalities relapsed. In N0 patients 10 (4.2%) of 239 had a regional lymph node relapse, and 9 of 10 died. CONCLUSION Lymph node metastases are an essential part of staging. Node positivity contributes to relapse of disease. Nodal relapse is also associated with a high mortality rate. These data imply that nodal assessment needs to be optimal and standardized for improved staging.
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Affiliation(s)
| | - Pauline Spronk
- Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - Marc H W A Wijnen
- Department of Pediatric Surgery, UMCN, Nijmegen and AMC, Amsterdam, the Netherlands; Department of Pediatric Surgery, AMC, Amsterdam, the Netherlands
| | - Hugo A Heij
- Department of Pediatric Surgery, UMCN, Nijmegen and AMC, Amsterdam, the Netherlands
| | | | | | - Max M van Noesel
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - Rene M H Wijnen
- Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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13
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Hinkle NM, Malkan AD, Sandoval JA. The Application and Indications for Sentinel Lymph Node Biopsy in Pediatric Solid Tumors: Current Status and Future Directions. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ijcm.2014.518145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Alcorn KM, Deans KJ, Congeni A, Sulkowski JP, Bagatell R, Mattei P, Minneci PC. Sentinel lymph node biopsy in pediatric soft tissue sarcoma patients: utility and concordance with imaging. J Pediatr Surg 2013; 48:1903-6. [PMID: 24074665 DOI: 10.1016/j.jpedsurg.2013.04.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 04/25/2013] [Accepted: 04/26/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND The purpose of this study was to report our experience with sentinel lymph node biopsy (SLNB) for pediatric soft tissue sarcomas to add to the limited literature about its feasibility, utility, and concordance with pre-operative imaging, including CT and (18)F-FDG PET (PET) scanning. METHODS Medical records of patients with a sarcoma who underwent SLNB as part of their treatment for a soft tissue sarcoma at our institution from 2000 to 2011 were identified and reviewed. RESULTS Eight patients underwent SLNB for soft tissue sarcoma during the study period. Two patients had positive SLNBs; both of these patients had rhabdomyosarcoma. Three patients with pathologically enlarged lymph nodes on CT scan underwent PET functional imaging prior to SLNB. The PET suggested the presence of nodal disease in all three patients; however, only one of these patients had a positive SLNB. CONCLUSIONS Our series confirms that SLNB is feasible in pediatric sarcoma patients. Small numbers preclude definitive conclusions regarding the utility of SLNB compared with PET, however our data suggest functional imaging alone may not be sufficient to definitively determine lymph node status in these patients. Surgical lymph node sampling may still need to be performed to accurately identify nodal status in pediatric patients with soft tissue sarcoma.
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Bachmann S, Panzica M, Brunnemer U, Stueber V, Länger F, Kaltenborn A, Schrem H, Bektaş H. Diagnostik und Therapie von Weichteilsarkomen der Extremitäten. Chirurg 2013; 84:566-71. [DOI: 10.1007/s00104-012-2410-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Optimal management of rhabdomyosarcoma requires establishing the correct pathologic diagnosis, histologic sub-type, primary site, extent of disease (Stage), and extent of resection (Group). Based on these features, cooperative groups in North America and Europe have defined risk-adapted treatments that include surgery, chemotherapy, and usually radiotherapy. This article focuses on recent findings that can impact or have already impacted rhabdomyosarcoma treatment guidelines and highlights controversies that should be addressed in order to improve outcome for children with rhabdomyosarcoma. Rhabdomyosarcoma is currently sub-classified in children based on histology into the favorable embryonal/botryoid/spindle cell types and the unfavorable alveolar form. Risk group assignment depends in part on histologic sub-type. Alveolar rhabdomyosarcoma is sometimes associated with chromosomal translocations, which impact clinical behavior. An important ongoing debate is whether molecular diagnostic tools to identify chromosomal translocations and/or define gene expression profiles should be used to sub-classify rhabdomyosarcoma rather than histology. Clinical trials continue to evaluate retrospective as well as prospective cohorts in order to carefully determine the impact of histology versus biologic features on outcome in the context of specific therapeutic regimens. Most rhabdomyosarcoma recurrences involve the primary site or adjacent region. Cooperative groups continue to investigate new approaches to local control in order to reduce local recurrences and sequelae associated with local therapy. Delaying primary resection until after chemotherapy has started appears to increase the number of tumors that can be completely resected with acceptable morbidity in some primary sites. Radiation dose reductions following delayed primary resection have been investigated. Although outcomes appear similar to the conventional approach of full-dose radiotherapy without delayed primary resection, long-term effects of the two approaches have not been rigorously compared. Early evidence suggests that newer methods of delivering radiotherapy, including intensity-modulated radiotherapy (IMRT), proton beam radiotherapy, and brachytherapy maintain efficacy but may reduce long-term sequelae compared with 3-dimensional conformal radiotherapy. Chemotherapy regimens defined by the cooperative groups vary by risk group. The most commonly used regimens include vincristine and dactinomycin in combination with an alkylating agent, either cyclophosphamide or ifosfamide. In order to improve outcomes, recent clinical trials have introduced new chemotherapeutic agents (e.g. topotecan, carboplatin, or epirubicin) into the treatment regimens. However, outcomes have not been significantly impacted. Novel chemotherapy administration schedules have been tested in patients with metastatic rhabdomyosarcoma, including interval compressed dosing or maintenance therapy, and may be promising. Molecularly targeted agents are currently under investigation in combination with chemotherapy for patients with recurrent or metastatic rhabdomyosarcoma. It is hoped that these novel agents will benefit all patients with rhabdomyosarcoma in the future.
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Affiliation(s)
- Yasmin Gosiengfiao
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Division of Hematology/Oncology/Stem Cell Transplant, Chicago, IL, USA
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17
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Wright S, Armeson K, Hill EG, Streck C, Leddy L, Cole D, Esnaola N, Camp ER. The role of sentinel lymph node biopsy in select sarcoma patients: a meta-analysis. Am J Surg 2012; 204:428-33. [DOI: 10.1016/j.amjsurg.2011.12.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 12/16/2011] [Accepted: 12/16/2011] [Indexed: 01/19/2023]
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18
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Van Gaal JC, De Bont ES, Kaal SE, Versleijen-Jonkers Y, van der Graaf WT. Building the bridge between rhabdomyosarcoma in children, adolescents and young adults: The road ahead. Crit Rev Oncol Hematol 2012; 82:259-79. [DOI: 10.1016/j.critrevonc.2011.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 06/29/2011] [Accepted: 06/30/2011] [Indexed: 01/02/2023] Open
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19
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Parida L, Morrisson GT, Shammas A, Hossain AKMM, McCarville MB, Gerstle JT, Charron M, Rao BN, Shulkin BL. Role of lymphoscintigraphy and sentinel lymph node biopsy in the management of pediatric melanoma and sarcoma. Pediatr Surg Int 2012; 28:571-8. [PMID: 22526545 PMCID: PMC3608674 DOI: 10.1007/s00383-012-3066-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2012] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this study was to describe the use of lymphoscintigraphy and sentinel lymph-node biopsy (SLNB) for the management of children with melanoma and sarcomas. We report the experience of two children's hospitals that utilize this technique to identify sentinel lymph nodes for lymph-node biopsy and dissection. METHODS We identified 56 patients (median age 10.8 years) who underwent 58 lymphoscintigraphy procedures. There were 33 patients with melanoma and melanocytic lesions, and 23 with sarcomas. RESULTS Of 58 lymphoscintigraphy procedures, sentinel lymph nodes were identified in 52 (90% success rate). Using the combination of intraoperative blue dye injection and lymphoscintigraphy, the success rate was 95% (55/58). Metastatic disease was found in 14 sentinel lymph nodes (13 patients with melanoma and melanocytic lesions, and 1 patient with rhabdomyosarcoma). CONCLUSION We have found that lymphoscintigraphy with SLNB is an effective method to identify patients who may benefit from more extensive lymph-node dissection and to identify those patients who are unlikely to benefit from further lymph-node exploration.
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Affiliation(s)
- Lalit Parida
- Department of Surgery, St Jude Children's Research Hospital, Memphis, TN, USA
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20
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Abstract
Rhabdomyosarcoma (RMS) is a malignant childhood tumor of mesenchymal origin that currently has a greater than 70% overall 5-year survival. Multimodality treatment is determined by risk stratification according to pretreatment stage, postoperative group, histology, and site of the primary tumor. Pretreatment staging is dependent on primary tumor site, size, regional lymph node status, and presence of metastases. Unique to RMS is the concept of postoperative clinical grouping that assesses the completeness of disease resection and takes into account lymph node evaluation. At all tumor sites, the clinical grouping, and therefore completeness of resection, is an independent predictor of outcome. Overall, the prognosis for RMS is dependent on primary tumor site, patient age, completeness of resection, extent of disease, including the presence and number of metastatic sites and histology and biology of the tumor cells. Therefore, the surgeon plays a vital role in RMS by contributing to risk stratification for treatment, local control of the primary tumor, and outcome. The current state-of-the-art treatment is determined by treatment protocols developed by the Soft Tissue Sarcoma Committee of the children's Oncology Group.
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Affiliation(s)
- Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
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21
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Nishida Y, Tsukushi S, Urakawa H, Arai E, Ishiguro N. Difficulties to Detect In-Transit Lymphatic Metastasis in Patients With Rhabdomyosarcoma of the Extremity: In Regard to La et al. (Int J Radiat Oncol Biol Phys 2011; 80: 1151-1157.). Int J Radiat Oncol Biol Phys 2011; 81:606; author reply 606. [DOI: 10.1016/j.ijrobp.2011.04.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 04/25/2011] [Indexed: 01/13/2023]
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22
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Weiss BD, Dasgupta R, Gelfand MJ, Laor T, Yin H, Breneman JC, Lavigne R, Elluru RG, Wagner LM. Use of sentinel node biopsy for staging parameningeal rhabdomyosarcoma. Pediatr Blood Cancer 2011; 57:520-3. [PMID: 21744475 DOI: 10.1002/pbc.23052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 01/04/2011] [Indexed: 01/13/2023]
Abstract
Identification of nodal involvement is important for treatment planning in patients with rhabdomyosarcoma, and is facilitated by sentinel node biopsy. Although it is employed primarily for extremity tumors, we report using sentinel node biopsy in a patient with parameningeal rhabdomyosarcoma arising in the ethmoid sinus. Lymphoscintigraphy with single photon emission computed tomography following injection of tracer at the tumor site helped identify contralateral cervical node involvement not previously recognized by physical exam, cross sectional imaging, or other functional imaging. This case demonstrates how information from sentinel node identification and biopsy can change therapy recommendations in patients with parameningeal rhabdomyosarcoma.
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Affiliation(s)
- Brian D Weiss
- Division of Pediatric Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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23
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Bandino JP, Norton SA, Aldrich SL, Wisco OJ, Hodson DS, Murchland MR, Grande DJ. Low-grade myxofibrosarcoma presenting at the site of prior high-grade disease. J Cutan Pathol 2011; 38:808-13. [PMID: 21752050 DOI: 10.1111/j.1600-0560.2011.01740.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Myxofibrosarcoma is one of the most common soft tissue sarcomas occurring in older adults. It can arise de novo or can be radiation induced, and the term myxofibrosarcoma was originally devised to encompass a spectrum of myxoid tumors with characteristics similar to malignant fibrous histiocytoma (MFH). Confusion exists, however, regarding the distinction between microscopic grade and characteristics of myxofibrosarcoma and MFH. Correct classification is vital to prognosis, as the degree of myxoid change is inversely related to the incidence of metastasis. We present a case of a 76-year-old man with a history of high-grade MFH of the left lower extremity, status post excision and radiation therapy, who presented 2 years later with a regional metastatic recurrence of high-grade MFH to the left groin as well as new nodules adjacent to and within his prior excision and radiation site. These new nodules were determined to represent low-grade myxofibrosarcoma. These new low-grade lesions either represent a low-grade recurrence of high-grade sarcoma or a new, radiation-induced soft tissue sarcoma occurring at the same site. Radiotherapy, however, is an unlikely cause; specific postradiation sarcoma criteria have not been fulfilled. This article discusses both the nosology and histopathological spectrum of these important soft tissue sarcomas, their aggressive and recurrent nature and their association with radiation therapy.
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Affiliation(s)
- Justin P Bandino
- San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, USA.
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Casanova M, Meazza C, Favini F, Fiore M, Morosi C, Ferrari A. Rhabdomyosarcoma of the extremities: a focus on tumors arising in the hand and foot. Pediatr Hematol Oncol 2009; 26:321-31. [PMID: 19579078 DOI: 10.1080/08880010902964367] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Extremities are peculiar sites of origin for rhabdomyosarcomas (RMS) and are usually associated with an unfavorable outcome. METHODS The authors reviewed the clinical data on 60 patients <21 years old with limb RMS treated at the Pediatric Oncology Unit of the Istituto Nazionale Tumori of Milan, in Italy, over a 30-year period. Twelve patients had tumors arising in the hand and foot. RESULTS Complete tumor resection was achieved in 21 patients (but in only 1 case of hand/foot RMS); all patients received chemotherapy and 43 also had radiotherapy. The alveolar subtype was identified in 62% of cases. Half of the hand/foot cases had metastatic disease at onset. Overall survival at 5 years was 33% among the hand/foot cases and 56% for the others. Most of the relapsing cases had distant metastases. CONCLUSIONS A particularly poor survival was observed for RMS of the hand/foot due its marked tendency to spread. Surgical resection is particularly difficult in such cases and a multimodality treatment approach seems crucial to improving their outcome.
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Affiliation(s)
- Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
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25
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Povoski SP, Neff RL, Mojzisik CM, O'Malley DM, Hinkle GH, Hall NC, Murrey DA, Knopp MV, Martin EW. A comprehensive overview of radioguided surgery using gamma detection probe technology. World J Surg Oncol 2009; 7:11. [PMID: 19173715 PMCID: PMC2653072 DOI: 10.1186/1477-7819-7-11] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Accepted: 01/27/2009] [Indexed: 02/08/2023] Open
Abstract
The concept of radioguided surgery, which was first developed some 60 years ago, involves the use of a radiation detection probe system for the intraoperative detection of radionuclides. The use of gamma detection probe technology in radioguided surgery has tremendously expanded and has evolved into what is now considered an established discipline within the practice of surgery, revolutionizing the surgical management of many malignancies, including breast cancer, melanoma, and colorectal cancer, as well as the surgical management of parathyroid disease. The impact of radioguided surgery on the surgical management of cancer patients includes providing vital and real-time information to the surgeon regarding the location and extent of disease, as well as regarding the assessment of surgical resection margins. Additionally, it has allowed the surgeon to minimize the surgical invasiveness of many diagnostic and therapeutic procedures, while still maintaining maximum benefit to the cancer patient. In the current review, we have attempted to comprehensively evaluate the history, technical aspects, and clinical applications of radioguided surgery using gamma detection probe technology.
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Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA
| | - Ryan L Neff
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA
| | - Cathy M Mojzisik
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA
- Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA
| | - David M O'Malley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA
| | - George H Hinkle
- Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA
- College of Pharmacy, The Ohio State University, Columbus, OH, 43210, USA
| | - Nathan C Hall
- Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA
| | - Douglas A Murrey
- Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA
| | - Michael V Knopp
- Department of Radiology, The Ohio State University, Columbus, OH, 43210, USA
| | - Edward W Martin
- Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University, Columbus, OH, 43210, USA
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