1
|
Khan M, Baia M, Fiore M, Colombo C, Callegaro D, Pasquali S, Gronchi A, Radaelli S. Initial local resection versus early referral for spermatic cord sarcoma: Any impact on treatment timelines and oncological outcomes? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108269. [PMID: 38520783 DOI: 10.1016/j.ejso.2024.108269] [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: 01/01/2024] [Revised: 02/27/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES Spermatic cord sarcomas are exceedingly rare, often misdiagnosed and subsequently improperly treated at local hospitals. This retrospective study looked at the oncological outcomes of spermatic cord sarcoma cases managed with curative intent resection at a tertiary referral sarcoma centre. We specifically studied how initial inadequate resections impact the oncologic outcomes compared to primary tumour resections at the reference centre. METHODS One hundred eighteen consecutive patients affected by primary, localized spermatic cord sarcoma surgically managed at our reference centre from January 2001 through January 2021 were included. Primary endpoints were local relapse free (LRFS), distant metastasis free (DMFS) and overall survival (OS). These outcomes were evaluated with multi-nomial logistic regression and Cox proportional hazards regression models for a co-relation to known patient, tumour and treatment-related prognostic factors, including a prior inadequate resection and time from diagnosis to a complete oncologic resection as independent variables. Secondarily, we compared the above variables and treatment intervals among the subgroups of primary versus re-resection surgery. RESULTS Over a median follow-up of 54 months (IQR 25-105), 12 patients (10.2%) developed local recurrence (LR) and 14 (11.6%) had distant metastasis (DM). 5-year local relapse (LRFS) and distant metastasis-free survival (DMFS) were 89.3% and 86.5%, respectively. Higher tumour grade and size were associated with a worse DMFS (p=<0.05). Likewise, marginal (R1) resection correlated with an inferior LRFS (p=< 0.05). Eighty-four patients (71.2%) had their initial diagnosis established on an inadequate surgical excision performed in a local hospital, followed by a re-excision at our centre (Re-resection group). During the same period, 34 (28.8%) were managed primarily with biopsy and treatment at our reference centre (Primary-resection group). The two groups had statistically significant differences in tumour size, histopathology, surgery duration, rate of postoperative complication and R0 resection (p < 0.005). Additionally, the difference in time intervals to achieve the treatment targets was statistically insignificant and did not correlate to the risk of recurrence as an independent variable. Residual disease was present in 51.2 % (n = 43) of the re-excision specimens. However, following a complete R0 resection, this did not correlate with a higher risk of recurrence (p = 0.481). CONCLUSION Prompt referral to a tertiary centre, where multidisciplinary evaluation and sound oncologic resections are the standard of treatment, can align the OS and DFS of patients receiving incomplete surgery elsewhere to those treated primarily in referral centres. The primary determinant of prognosis remains surgical margin, tumour size and grade.
Collapse
Affiliation(s)
| | - Marco Baia
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Fiore
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Colombo
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dario Callegaro
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sandro Pasquali
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Radaelli
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| |
Collapse
|
2
|
Achard G, Charon-Barra C, Carrere S, Bonvalot S, Meeus P, Fau M, Honoré C, Delhorme JB, Tzanis D, Le Loarer F, Karanian-Philippe M, Ngo C, Le Guellec S, Bertaut A, Causeret S, Isambert N. Prognostic factors and outcomes of adult spermatic cord sarcoma. A study from the French Sarcoma Group. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1203-1208. [PMID: 36868941 DOI: 10.1016/j.ejso.2023.02.013] [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: 01/20/2023] [Revised: 02/10/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
PURPOSE To evaluate the outcomes of adult patients with spermatic cord sarcoma (SCS). METHODS All consecutive patients with SCS managed by the French Sarcoma Group from 1980 to 2017 were analysed retrospectively. Multivariate analysis (MVA) was used to identify independent correlates of overall survival (OS), metastasis-free survival (MFS), and local relapse-free survival (LRFS). RESULTS A total of 224 patients were recorded. The median age was 65.1 years. Forty-one (20.1%) SCSs were discovered unexpectedly during inguinal hernia surgery. The most common subtypes were liposarcoma (LPS) (73%) and leiomyosarcoma (LMS) (12.5%). The initial treatment was surgery for 218 (97.3%) patients. Forty-two patients (18.8%) received radiotherapy, 17 patients (7.6%) received chemotherapy. The median follow-up was 5.1 years. The median OS was 13.9 years. In MVA, OS decreased significantly with histology (HR, well-differentiated LPS versus others = 0.096; p = 0.0224), high grade (HR, 3 versus 1-2 = 2.7; p = 0.0111), previous cancer and metastasis at diagnosis (HR = 6.8; p = 0.0006). The five-year MFS was 85.9% [95% CI: 79.3-90.6]. In MVA, significant factors associated with MFS were LMS subtype (HR = 4.517; p < 10-4) and grade 3 (HR = 3.664; p < 10-3). The five-year LRFS survival rate was 67.9% [95% CI: 59.6-74.9]. In MVA, significant factors associated with local relapse were margins and wide reresection (WRR) after incomplete resection. OS was not significantly different between patients with initial R0/R1 resection and R2 patients who underwent WRR. CONCLUSIONS Unplanned surgery affected 20.1% of SCSs. A nonreducible painless inguinal lump should suggest a sarcoma. WRR with R0 resection achieved similar OS to patients with correct surgery upfront.
Collapse
Affiliation(s)
- Gilles Achard
- Department of Pathology, Centre Georges-François Leclerc, 1 Rue du Professeur Marion, 21000, Dijon, France
| | - Céline Charon-Barra
- Department of Pathology, Centre Georges-François Leclerc, 1 Rue du Professeur Marion, 21000, Dijon, France
| | - Sebastien Carrere
- Department of Surgery, Institut du Cancer de Montpellier, 208 rue des Apothicaires, 34298, Montpellier, France
| | - Sylvie Bonvalot
- Department of Surgery, Institut Curie, 26 Rue d'Ulm, 75005, Paris, France.
| | - Pierre Meeus
- Department of Surgery, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Magali Fau
- Department of Surgery, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France
| | - Charles Honoré
- Department of Surgery, Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Jean-Baptiste Delhorme
- Department of Surgery, Centre Hospitalier Universitaire hautepierre, 1 Avenue Moliere, 67000, Strasbourg, France
| | - Dimitri Tzanis
- Department of Surgery, Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
| | - François Le Loarer
- Department of Pathology, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France
| | - Marie Karanian-Philippe
- Department of Pathology, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Carine Ngo
- Department of Pathology, Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Sophie Le Guellec
- Department of Pathology, Institut Universitaire de Cancer de Toulouse Oncopole, avenue Irène Joliot-Curie, 31059, Toulouse, France
| | - Aurélie Bertaut
- Department of Biostatistics, Centre Georges-François Leclerc, 1 Rue du Professeur Marion, 21000, Dijon, France
| | - Sylvain Causeret
- Department of Surgery, Centre Georges-François Leclerc, 1 Rue du Professeur Marion, 21000, Dijon, France
| | - Nicolas Isambert
- Department of Medical Oncology, Centre Georges-François Leclerc, 1 Rue du Professeur Marion, 21000, Dijon, France
| |
Collapse
|
3
|
Gupta A, Kulshrestha R, Kishore K, Micke O, Kumar R, Garg K, Sharma D, Pandey R. Identifying Patterns of Failure and Risk Factors for Recurrence in Patients of Paratesticular Sarcomas: Protocol of a Systematic Review and Meta-Analysis. Int J Surg Protoc 2021; 25:84-91. [PMID: 34113745 PMCID: PMC8162288 DOI: 10.29337/ijsp.145] [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: 11/24/2022] Open
Abstract
Introduction: Para testicular sarcomas are rare mesenchymal tumors that affect patients of all ages. Unlike other sites of sarcoma, they tend to be of lower grade and have a higher propensity for lymphatic spread. Management is hampered by the small number of patients who differ in terms of tumor grade and histology. Current treatment approaches are based on case reports, small case series and literature reviews, resulting in a number of unresolved issues. The consensus on the type of surgery and adjuvant treatment is yet to be determined. The local relapse rates in the scrotum and groin after orchidectomy comes out to be 25%–37%, indicating the need for either aggressive surgery or adjuvant treatment. There is a paucity of data identifying the patterns of failure and risk factors for recurrence, which will help clinicians tailor appropriate treatment. Methods: We aim to perform a systematic review and meta-analysis of the available data in the last 50 years in a methodologically rigorous and transparent manner to identify patterns of failure and high-risk factors for recurrence. The protocol is prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA-P) 2015 guidelines. The protocol is registered in the International Prospective Register of Systematic Reviews (CRD42021237134). Highlights Para testicular sarcomas are rare mesenchymal tumors that affects patients of all ages. Current treatment approaches are based on case reports, small case series and literature reviews, resulting in a number of unresolved issues. A systemic review was performed in 2013 based on survival rates, prognostic factors, and relapse sites on paratesticular sarcomas. However, it lacks a comprehensive review that can guide radiation oncologists to select in which patient’s postoperative radiotherapy is warranted and define the target volume based on histopathological type, stage, and grade of the tumor. After 2013, new case series with improved methodology and sample size are published, which adds new information to the literature. In one case series, 22 patients with spermatic cord sarcoma were discussed, while in another study, long-term outcome analysis of 51 patients was discussed, and another study discussed eight patients.
Collapse
Affiliation(s)
- Anil Gupta
- Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, IN
| | - Rashi Kulshrestha
- Clinical Radiation Oncology fellowship program, Department of Radiation Oncology, BC Cancer Agency, Abbotsford, BC, CA
| | - Kamal Kishore
- Department of Biostatistics, Post Graduate Institute of Medical Education and Research, Chandigarh, IN
| | - Oliver Micke
- Prof. Dr. med, Klinik für Strahlentherapie und Radioonkologie, Franziskus Hospital, Kiskerstrasse, Bielefeld, DE
| | - Rishabh Kumar
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, IN
| | - Kanika Garg
- Department of Anaesthesiology, Employee's State Insurance Corporation, Noida, IN
| | - Dayanand Sharma
- Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi & National Cancer Institute, Jhajjar, Haryana, IN
| | - Rambha Pandey
- Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, IN
| |
Collapse
|
4
|
Abstract
PURPOSE OF REVIEW Spermatic cord tumors (SCT) are very rare. The present review discusses the most recent literature regarding clinical presentation, pathological characteristics, diagnosis, and management of SCT. RECENT FINDINGS Although the majority of SCT are benign, when malignant almost all SCT are sarcomas. Liposarcomas are the most common; whereas rhabdomyosarcomas recorded the highest tendency of develop distant metastases. The clinical presentation is usually a unilateral solid slow-growing mass at the level of the inguinal canal and of the scrotum. Surgical excision represents the most common used treatment, and considering the risk in developing local recurrence, radical inguinal orchiectomy and resection of the tumor with negative microscopic surgical margins is mandatory. Adjuvant therapies such as radiotherapy and chemotherapy have been suggested in selected patients, but clear data to demonstrate any improvement in survival are not available. SUMMARY SCT are rare tumors with high risk of misdiagnosis or mistreatment. The majority are benign, but when malignant almost all are sarcomas. A surgical excision is the treatment of choice; however, no clear data exists documenting the efficacy of a multimodal treatment in reducing high local recurrence rates after surgery.
Collapse
|
5
|
Cerda T, Martin É, Truc G, Créhange G, Maingon P. Safety and efficacy of intensity-modulated radiotherapy in the management of spermatic cord sarcoma. Cancer Radiother 2016; 21:16-20. [PMID: 28041814 DOI: 10.1016/j.canrad.2016.07.102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/04/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE Spermatic cord sarcoma is a rare disease, which management remains controversial due to the lack of guidelines. The standard therapeutic approach is surgical: wide soft-tissue resection with radical inguinal orchidectomy, The diagnosis is made during the analysis of the specimen. The high rate of local recurrence indicates adjuvant radiotherapy of the tumor bed. The aim of this series is to determine the efficacy and safety of postoperative intensity-modulated radiotherapy for spermatic cord sarcomas. PATIENTS AND METHODS Our series included five consecutive cases of spermatic cord sarcoma treated between 2011 and 2014. The indications for radiotherapy were: R1 status after initial surgery, R1 status after wide en bloc resection and orchiectomy, high French federation of cancer centers (FNCLCC) grade, tumor size over 5cm, tumor resection during surgery. RESULTS Median age at diagnosis was 66years (range 46-84years). Median follow-up was 18months (range 6-28months). Four patients had repeat surgery after incomplete removal. All surgeries were orchidectomy with primary ligation of testicular vessels. One patient did not have an in sano margin after the second surgical procedure. The median tumor size was 60mm (range 30-150mm). No recurrence was observed during the follow-up. CONCLUSION No grade 4 toxicities were reported and the most frequent acute toxicity was dermatitis. No recurrence was reported after adjuvant intensity-modulated radiotherapy. The treatment is feasible and well tolerated and seems to provide encouraging results regarding locoregional control of the disease. Dynamic or rotational intensity-modulated radiotherapy is now recommended to decrease acute toxicities while improving the efficacy of this approach.
Collapse
Affiliation(s)
- T Cerda
- Department of Radiation Oncology, CHU de Besançon, 3, boulevard Fleming, 25030 Besançon, France.
| | - É Martin
- Department of Radiation Oncology, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - G Truc
- Department of Radiation Oncology, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - G Créhange
- Department of Radiation Oncology, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France; Medical Imaging group, laboratoire électronique, informatique et image (Le2I) UMR 6306, CNRS, allée Alain-Savary, 21000 Dijon, France; Le2I UMR 6306, Arts et Métiers, allée Alain-Savary, 21000 Dijon, France; Le2I UMR 6306, UFR Sciences et Techniques, université de Bourgogne-Franche-Comté, allée Alain-Savary, 21000 Dijon, France
| | - P Maingon
- Department of Radiation Oncology, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| |
Collapse
|
6
|
Unal OU, Oztop I, Menekse S, Urakci Z, Bozkurt O, Ozcelik M, Gunaydin Y, Yasar N, Yazilitas D, Kodaz H, Taskoylu BY, Aksoy A, Demirci U, Araz M, Tonyali O, Sevinc A, Yilmaz AU, Benekli M. Adult Urological Soft Tissue Sarcomas: A Multicenter Study of the Anatolian Society of Medical Oncology (ASMO). Asian Pac J Cancer Prev 2015; 16:4777-80. [PMID: 26107239 DOI: 10.7314/apjcp.2015.16.11.4777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To analyze clinicopathological characteristics, prognostic factors and survival rates of the patients with urological soft tissue sarcomas treated and followed up in Turkey. MATERIALS AND METHODS For overall survival analyses the Kaplan-Meier method was used. From medical records, nine prognostic factors on overall survival were analysed. RESULTS For the 53 patients (34 males, 19 females) whose charts were reviewed, the median age was 53 (range 22 to 83) years. Most frequently renal location (n=30; 56.6%) was evident and leiomyosarcoma (n=20, 37.7%) was the most frequently encountered histological type. Median survival time of all patients was 40.3 (95% CI, 14.2-66.3) months. In univariate analysis, male gender, advanced age (≥50 years), metastatic stage, unresectability, grade 3, renal location were determined as worse prognostic factors. In multivariate analysis, metastatic stage, unresectability and grade 3 were determined as indicators of worse prognosis. CONCLUSIONS Urological soft tissue sarcomas are rarely seen tumours in adults. The most important factors in survival are surgical resection, stage of the tumour at onset, grade and location of the tumour, gender and age of the patients.
Collapse
Affiliation(s)
- Olcun Umit Unal
- Division of Medical Oncology, Department of Internal Medicine, Dokuz Eylul University Medical Faculty, Izmir, Turkey E-mail :
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|