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Tolstrup J, Loya A, Aggerholm-Pedersen N, Preisler L, Penninga L. Risk factors for recurrent disease after resection of solitary fibrous tumor: a systematic review. Front Surg 2024; 11:1332421. [PMID: 38357190 PMCID: PMC10864472 DOI: 10.3389/fsurg.2024.1332421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/05/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction Solitary fibrous tumor (SFT) is a rare soft tissue tumor found at any site of the body. The treatment of choice is surgical resection, though 10%-30% of patients experience recurrent disease. Multiple risk factors and risk stratification systems have been investigated to predict which patients are at risk of recurrence. The main goal of this systematic review is to create an up-to-date systematic overview of risk factors and risk stratification systems predicting recurrence for patients with surgically resected SFT within torso and extremities. Method We prepared the review following the updated Prisma guidelines for systematic reviews (PRISMA-P). Pubmed, Embase, Cochrane Library, WHO international trial registry platform and ClinicalTrials.gov were systematically searched up to December 2022. All English studies describing risk factors for recurrence after resected SFT were included. We excluded SFT in the central nervous system and the oto-rhino-laryngology region. Results Eighty-one retrospective studies were identified. Different risk factors including age, symptoms, sex, resection margins, anatomic location, mitotic index, pleomorphism, hypercellularity, necrosis, size, dedifferentiation, CD-34 expression, Ki67 index and TP53-expression, APAF1-inactivation, TERT promoter mutation and NAB2::STAT6 fusion variants were investigated in a narrative manner. We found that high mitotic index, Ki67 index and presence of necrosis increased the risk of recurrence after surgically resected SFT, whereas other factors had more varying prognostic value. We also summarized the currently available different risk stratification systems, and found eight different systems with a varying degree of ability to stratify patients into low, intermediate or high recurrence risk. Conclusion Mitotic index, necrosis and Ki67 index are the most solid risk factors for recurrence. TERT promoter mutation seems a promising component in future risk stratification models. The Demicco risk stratification system is the most validated and widely used, however the G-score model may appear to be superior due to longer follow-up time. Systematic Review Registration CRD42023421358.
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Affiliation(s)
- Johan Tolstrup
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen, Denmark
| | - Anand Loya
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | | | - Louise Preisler
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen, Denmark
| | - Luit Penninga
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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2
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Guang-Ping Z, Ying Y, Jian-Yong Z, Zhen-Guo Z. Solitary fibrous tumor of the ilium: A case report. Asian J Surg 2022; 45:2771-2772. [PMID: 35718610 DOI: 10.1016/j.asjsur.2022.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/01/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Zeng Guang-Ping
- Department of Oncology, The First People's Hospital of Guangyuan, Guangyuan, Sichuan, 628017, PR China
| | - Yuan Ying
- Department of Oncology, The First People's Hospital of Guangyuan, Guangyuan, Sichuan, 628017, PR China
| | - Zhang Jian-Yong
- Department of Oncology, The First People's Hospital of Guangyuan, Guangyuan, Sichuan, 628017, PR China
| | - Zhao Zhen-Guo
- Department of Oncology, The First People's Hospital of Guangyuan, Guangyuan, Sichuan, 628017, PR China.
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Georgiesh T, Aggerholm-Pedersen N, Schöffski P, Zhang Y, Napolitano A, Bovée JVMG, Hjelle Å, Tang G, Spalek M, Nannini M, Swanson D, Baad-Hansen T, Sciot R, Hesla AC, Huang P, Dorleijn D, Haugland HK, Lacambra M, Skoczylas J, Pantaleo MA, Haas RL, Meza-Zepeda LA, Haller F, Czarnecka AM, Loong H, Jebsen NL, van de Sande M, Jones RL, Haglund F, Timmermans I, Safwat A, Bjerkehagen B, Boye K. Validation of a novel risk score to predict early and late recurrence in solitary fibrous tumour. Br J Cancer 2022; 127:1793-1798. [PMID: 36030294 PMCID: PMC9643389 DOI: 10.1038/s41416-022-01959-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current risk models in solitary fibrous tumour (SFT) were developed using cohorts with short follow-up and cannot reliably identify low-risk patients. We recently developed a novel risk model (G-score) to account for both early and late recurrences. Here, we aimed to validate the G-score in a large international cohort with long-term follow-up. METHODS Data were collected from nine sarcoma referral centres worldwide. Recurrence-free interval (RFi) was the primary endpoint. RESULTS The cohort comprised 318 patients with localised extrameningeal SFTs. Disease recurrence occurred in 96 patients (33%). The estimated 5-year RFi rate was 72%, and the 10-year RFi rate was 52%. G-score precisely predicted recurrence risk with estimated 10-year RFi rate of 84% in low risk, 54% in intermediate risk and 36% in high risk (p < 0.001; C-index 0.691). The mDemicco (p < 0.001; C-index 0.749) and SalasOS (p < 0.001; C-index 0.674) models also predicted RFi but identified low-risk patients less accurate with 10-year RFi rates of 72% and 70%, respectively. CONCLUSIONS G-score is a highly significant predictor of early and late recurrence in SFT and is superior to other models to predict patients at low risk of relapse. A less intensive follow-up schedule could be considered for patients at low recurrence risk according to G-score.
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Affiliation(s)
- Tatiana Georgiesh
- Department of Pathology, Oslo University Hospital, Oslo, Norway
- Department of Tumour Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | | | - Patrick Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Yifan Zhang
- Department of Oncology-Pathology, Karolinska Institutet and Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Andrea Napolitano
- Sarcoma Unit, The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Åse Hjelle
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Gordon Tang
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong SAR, China
| | - Mateusz Spalek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Margherita Nannini
- Division of Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - David Swanson
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Thomas Baad-Hansen
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Raf Sciot
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Asle C Hesla
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Clinical Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | - Paul Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Desiree Dorleijn
- Department of Orthopedic Surgery, Bone and Soft Tissue Tumor Unit, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Maribel Lacambra
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jacek Skoczylas
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maria A Pantaleo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Rick L Haas
- Department of Radiotherapy, the Netherlands Cancer Institute, Amsterdam, The Netherlands and Department of Radiotherapy, the Leiden University Medical Center, Leiden, The Netherlands
| | - Leonardo A Meza-Zepeda
- Department of Tumour Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
- Department of Core Facilities, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Florian Haller
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Anna M Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Herbert Loong
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Nina L Jebsen
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Michiel van de Sande
- Department of Orthopedic Surgery, Bone and Soft Tissue Tumor Unit, Leiden University Medical Center, Leiden, The Netherlands
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - Felix Haglund
- Department of Oncology-Pathology, Karolinska Institutet and Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Iris Timmermans
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Akmal Safwat
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Bodil Bjerkehagen
- Department of Pathology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjetil Boye
- Department of Tumour Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.
- Department of Oncology, Oslo University Hospital, Oslo, Norway.
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Zhuang A, Fang Y, Ma L, Lu W, Tong H, Zhang Y. Postoperative Morbidity After Radical Resection of Retroperitoneal Solitary Fibrous Tumor. Front Surg 2022; 9:833296. [PMID: 35419405 PMCID: PMC8995650 DOI: 10.3389/fsurg.2022.833296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background This study aimed to investigate the clinicopathological characteristics of retroperitoneal solitary fibrous tumor (RSFT) and the safety of radical resection. Methods A retrospective analysis was conducted on the data of 32 RSFT patients who received surgery with curative intent from February 2011 and June 2021. Results This cohort included 16 (50%) male and 16 (50%) female patients, with the median age of 52 (29 to 72) years. Tumor burden ranged from 3 to 25 (median, 10) cm. Seven patients received arterial embolization before surgery. 15 (47%) patients received radiotherapy, nine (28%) of which received preoperative radiotherapy. Most of the patients (91%) achieved complete resection with median bleeding of 400 (20 to 5,000) ml. Nine (28%) patients received packed red blood cell (RBC) transfusion, with a median of 5 (2 to 10) U. All patients had the five-year progression-free survival rate and the overall survival rate of 75.8% and 80.0%, respectively. 11 (34%) patients were found with adverse events, and four (12%) patients were found with serious postoperative complications (Clavien-Dindo ≥3), of which one (3.1%) patient died after surgery. The univariate analysis found that tumor burden (p = 0.022), packed RBC transfusion (p = 0.001) and postoperative hospital stays (0.027) were correlated with overall morbidity. The multivariate analysis found packed RBC transfusion as an independent risk factor for postoperative morbidity (HR 381.652, 95% CI, 1.597–91213.029, p = 0.033). Conclusion RSFT was confirmed as an uncommon, slow-growing and recurring tumor, with acceptable postoperative morbidity and mortality after surgical resection.
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Affiliation(s)
- Aobo Zhuang
- Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yuan Fang
- Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Lijie Ma
- Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Weiqi Lu
- Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hanxing Tong
- Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Zhang
- Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Georgiesh T, Boye K, Bjerkehagen B. A novel risk score to predict early and late recurrence in solitary fibrous tumour. Histopathology 2021; 77:123-132. [PMID: 31991494 DOI: 10.1111/his.14078] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/03/2020] [Accepted: 01/24/2020] [Indexed: 12/13/2022]
Abstract
AIMS Solitary fibrous tumours (SFTs) are rare mesenchymal neoplasms with recurrence rates of 10-30%. Current risk stratification systems for extrameningeal SFTs are based on cohorts with limited follow-up and are not suitable for prediction of late recurrences. In this study we aimed to develop a prognostic model accounting for both early and late recurrences using a relatively large patient cohort with long-term follow-up. METHODS AND RESULTS Clinicopathological factors were analysed in a cohort of 100 extrameningeal, STAT6-positive SFTs. Median follow-up for overall survival (OS) and recurrence-free interval (RFi) were 121 and 84 months, respectively. Disease relapse occurred in 31% of patients and median time to recurrence was 63 months. In univariate analysis mitotic count, necrosis, male gender and presence of severe atypia and pleomorphism were associated with inferior RFi. Mitotic count, necrosis and male gender were independent predictors of recurrence in multivariate analysis. Previously published risk models were also statistically associated with RFi in our cohort, but failed to reliably identify low-risk patients due to poor prediction of late recurrences. A novel risk score based on mitotic count, necrosis and gender was able to stratify patients into low-, intermediate- and high-risk groups for both early and late recurrences. CONCLUSIONS In this cohort of patients with extrameningeal SFT and long-term follow-up mitotic count, necrosis and gender were independent prognostic markers of recurrence. We propose a novel risk score based on these factors and accounting for late recurrences, which should be validated in external cohorts with sufficient follow-up time.
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Affiliation(s)
- Tatiana Georgiesh
- Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,Department of Tumour Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Kjetil Boye
- Department of Tumour Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Bodil Bjerkehagen
- Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine and Institute of Oral Biology, University of Oslo, Oslo, Norway
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Georgiesh T, Namløs HM, Sharma N, Lorenz S, Myklebost O, Bjerkehagen B, Meza-Zepeda LA, Boye K. Clinical and molecular implications of NAB2-STAT6 fusion variants in solitary fibrous tumour. Pathology 2021; 53:713-719. [PMID: 33745702 DOI: 10.1016/j.pathol.2020.11.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023]
Abstract
Solitary fibrous tumour (SFT) is a mesenchymal neoplasm characterised by pathognomonic NAB2-STAT6 gene fusions. The clinical implications and prognostic value of different fusion variants has not been clarified. In the current study, we explore the clinicopathological, prognostic and molecular differences between tumours with different fusions. Thirty-nine patients with localised, extrameningeal SFT were included, of whom 20 developed distant recurrence and 19 were without recurrence after long term follow-up. Capture-based RNA sequencing identified 12 breakpoint variants, which were categorised into two groups based on the STAT6 domain composition in the predicted chimeric proteins. Twenty-one of 34 (62%) sequenced tumours had fusions with most of the STAT6 domains intact and were classified as STAT6-Full. Thirteen tumours (38%) contained only the transactivation domain of STAT6 and were classified as STAT6-TAD. Tumours with STAT6-TAD fusions had a higher mitotic count (p=0.016) and were associated with inferior recurrence-free interval (p=0.004) and overall survival (p=0.012). Estimated 10-year recurrence-free survival was 25% for patients with STAT6-TAD tumours compared to 78% for the STAT6-Full group. Distinct transcriptional signatures between the fusion groups were identified, including higher expression of FGF2 in the STAT6-TAD group and IGF2, EGR2, PDGFRB, STAT6 and several extracellular matrix genes in STAT6-Full tumours. In summary, we demonstrate that NAB2-STAT6 fusion variants are associated with distinct clinicopathological and molecular characteristics and have prognostic significance in extrameningeal SFT.
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Affiliation(s)
- Tatiana Georgiesh
- Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway; Department of Tumour Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Heidi Maria Namløs
- Department of Tumour Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Nitin Sharma
- Department of Tumour Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Susanne Lorenz
- Department of Tumour Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Ola Myklebost
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bodil Bjerkehagen
- Department of Pathology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine and Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Leonardo A Meza-Zepeda
- Department of Tumour Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Kjetil Boye
- Department of Tumour Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway; Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
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Haas RL, Walraven I, Lecointe-Artzner E, van Houdt WJ, Scholten AN, Strauss D, Schrage Y, Hayes AJ, Raut CP, Fairweather M, Baldini EH, Gronchi A, De Rosa L, Griffin AM, Ferguson PC, Wunder J, van de Sande MAJ, Krol ADG, Skoczylas J, Brandsma D, Doglietto F, Sangalli C, Stacchiotti S. Management of meningeal solitary fibrous tumors/hemangiopericytoma; surgery alone or surgery plus postoperative radiotherapy? Acta Oncol 2021; 60:35-41. [PMID: 32988268 DOI: 10.1080/0284186x.2020.1826574] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION A meningeal solitary fibrous tumor (SFT), also called hemangiopericytoma, is a rare mesenchymal malignancy. Due to anatomic constrains, even after macroscopic complete surgery with curative intent, the local relapse risk is still relatively high, thus increasing the risk of dedifferentiation and metastatic spread. This study aims to better define the role of postoperative radiotherapy (RT) in meningeal SFTs. PATIENTS AND METHODS A retrospective study was performed across seven sarcoma centers. Clinical information was retrieved from all adult patients with meningeal primary localized SFT treated between 1990 and 2018 with surgery alone (S) compared to those that also received postoperative RT (S + RT). Differences in treatment characteristics between subgroups were tested using independent samples t-test for continuous variables and chi-square tests for proportions. Local control (LC) and overall survival (OS) rates were calculated as time from start of treatment until progression or death from any cause. LC and OS in groups receiving S or S + RT were compared using Kaplan-Meier survival curves. RESULTS Among a total of 48 patients, 7 (15%) underwent S and 41 (85%) underwent S + RT. Median FU was 65 months. LC was significantly associated with treatment. LC after S at 60 months was 60% versus 90% after S + RT (p = 0.052). Furthermore, R1 resection status was significantly associated with worse LC (HR 4.08, p = 0.038). OS was predominantly associated with the mitotic count (HR 3.10, p = 0.011). CONCLUSION This retrospective study, investigating postoperative RT in primary localized meningeal SFT patients, suggests that combining RT to surgery in the management of this patient population may reduce the risk for local failures.
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Affiliation(s)
- R. L. Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Radiation Oncology, The Leiden University Medical Center, Leiden, The Netherlands
| | - I. Walraven
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - W. J. van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A. N. Scholten
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - D. Strauss
- Sarcoma Unit, Department of Surgery, The Royal Marsden Hospital, London, UK
| | - Y. Schrage
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Sarcoma Unit, Department of Surgery, The Royal Marsden Hospital, London, UK
- Department of Surgical Oncology, The Leiden University Medical Center, Leiden, The Netherlands
| | - A. J. Hayes
- Sarcoma Unit, Department of Surgery, The Royal Marsden Hospital, London, UK
| | - C. P. Raut
- Division of Surgical Oncology, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - M. Fairweather
- Division of Surgical Oncology, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - E. H. Baldini
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, USA
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - A. Gronchi
- Department of Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L. De Rosa
- Department of Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A. M. Griffin
- Department of Orthopedic Surgery, Sarcoma Unit, Mount Sinai Hospital, Toronto, ON, Canada
| | - P. C. Ferguson
- Department of Orthopedic Surgery, Sarcoma Unit, Mount Sinai Hospital, Toronto, ON, Canada
| | - J. Wunder
- Department of Orthopedic Surgery, Sarcoma Unit, Mount Sinai Hospital, Toronto, ON, Canada
| | - M. A. J. van de Sande
- Department of Orthopedic Oncology, The Leiden University Medical Center, Leiden, The Netherlands
| | - A. D. G. Krol
- Department of Radiation Oncology, The Leiden University Medical Center, Leiden, The Netherlands
| | - J. Skoczylas
- Department of Surgical Oncology, The Maria Sklodowska-Curie Institute – Oncology Center, Warsaw, Poland
| | - D. Brandsma
- Department of Neuro-Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - F. Doglietto
- Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - C. Sangalli
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - S. Stacchiotti
- Adult Mesenchymal and Rare Tumor Unit, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Afzal A, Maldonado-Vital M, Khan S, Farooque U, Luo W. Solitary Fibrous Tumor of Pancreas With Unusual Features: A Case Report. Cureus 2020; 12:e10833. [PMID: 33173639 PMCID: PMC7647364 DOI: 10.7759/cureus.10833] [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: 11/06/2022] Open
Abstract
Solitary fibrous tumor (SFT) is an uncommon fibroblastic neoplasm that is most commonly associated with the pleura but has also been reported in almost all anatomic sites. Although the majority of SFTs are benign, few cases follow a malignant clinical course and may recur and/or metastasize after several years of their original occurrence. Only 16 cases of pancreatic SFTs are reported so far, and only one has metastasized to lung and subcutis. Pancreatic SFT resembles more common neuroendocrine tumor and gastrointestinal stromal tumor (GIST) radiographically and is at times almost indistinguishable from GIST histologically. Diagnosis of SFTs particularly, if attempted on biopsied specimens, can be very challenging due to its rare occurrence and nondescript morphology. It is imperative to understand the pathological spectrum of this entity to avoid misdiagnosis. We report a case of pancreatic SFT in a 43-year-old male with some unusual morphologic and immunohistochemical features including pseudoangiomatous growth pattern, a hypercellular area demonstrating nuclear pleomorphism, and only focal positivity for cluster of differentiation (CD)34. These atypical features can pose even more diagnostic challenge by causing additional confusion with other malignancies like dedifferentiated liposarcoma and vascular tumors. The potential diagnostic pitfalls are discussed.
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Affiliation(s)
- Anoshia Afzal
- Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | | | - Shahbaz Khan
- Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Umar Farooque
- Neurology, Dow University of Health Sciences, Karachi, PAK
| | - Wenyi Luo
- Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
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9
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Haas RL, Walraven I, Lecointe-Artzner E, van Houdt WJ, Strauss D, Schrage Y, Hayes AJ, Raut CP, Fairweather M, Baldini EH, Gronchi A, De Rosa L, Griffin AM, Ferguson PC, Wunder J, van de Sande MAJ, Krol ADG, Skoczylas J, Sangalli C, Stacchiotti S. Extrameningeal solitary fibrous tumors-surgery alone or surgery plus perioperative radiotherapy: A retrospective study from the global solitary fibrous tumor initiative in collaboration with the Sarcoma Patients EuroNet. Cancer 2020; 126:3002-3012. [PMID: 32315454 PMCID: PMC7318349 DOI: 10.1002/cncr.32911] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 12/19/2022]
Abstract
Background Solitary fibrous tumor (SFT) is a rare mesenchymal malignancy. Although surgery is potentially curative, the local relapse risk is high after marginal resections. Given the lack of prospective clinical trial data, the objective of the current study was to better define the role of perioperative radiotherapy (RT) in various SFT presentations by location. Methods This was retrospective study performed across 7 sarcoma centers. Clinical information was retrieved from all adult patients with extrameningeal, primary, localized SFT who were treated between 1990 and 2018 with surgery alone (S) compared with those who also received perioperative RT (S+RT). Differences in treatment characteristics between subgroups were tested using analysis of variance statistics and propensity score matching. Local control and overall survival rates were calculated from the start of treatment until progression or death from any cause. Results Of all 549 patients, 428 (78%) underwent S, and 121 (22%) underwent S+RT. The median follow‐up was 52 months. After correction for mitotic count and surgical margins, S+RT was significantly associated with a lower risk of local progression (hazard ratio, 0.19: P = .029), an observation further confirmed by propensity score matching (P = .012); however, this association did not translate into an overall survival benefit. Conclusions The results from this retrospective study investigating perioperative RT in patients with primary extrameningeal SFT suggest that combining RT with surgery in the management of this patient population is significantly associated with a reduced risk of local failures, especially in patients who have less favorable resection margins and in those who have tumors with a high mitotic count. This retrospective study of perioperative radiotherapy in patients with primary extrameningeal solitary fibrous tumors suggests that combining radiotherapy with surgery in the management of this population significantly reduces the risk of local failures, especially in patients who have less favorable resection margins or tumors with a high mitotic count.
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Affiliation(s)
- Rick L Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Radiation Oncology, The Leiden University Medical Center, Leiden, The Netherlands
| | - Iris Walraven
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dirk Strauss
- Sarcoma Unit, Department of Surgery, The Royal Marsden Hospital, London, United Kingdom
| | - Yvonne Schrage
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Sarcoma Unit, Department of Surgery, The Royal Marsden Hospital, London, United Kingdom.,Department of Surgical Oncology, The Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew J Hayes
- Sarcoma Unit, Department of Surgery, The Royal Marsden Hospital, London, United Kingdom
| | - Chandrajit P Raut
- Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Mark Fairweather
- Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Elizabeth H Baldini
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alessandro Gronchi
- Department of Surgical Oncology, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Laura De Rosa
- Department of Surgical Oncology, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Anthony M Griffin
- Department of Orthopedic Surgery, Sarcoma Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Peter C Ferguson
- Department of Orthopedic Surgery, Sarcoma Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jay Wunder
- Department of Orthopedic Surgery, Sarcoma Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Michiel A J van de Sande
- Department of Orthopedic Oncology, The Leiden University Medical Center, Leiden, The Netherlands
| | - Augustinus D G Krol
- Department of Radiation Oncology, The Leiden University Medical Center, Leiden, The Netherlands
| | - Jacus Skoczylas
- Department of Surgical Oncology, The Maria Sklodowska-Curie Institute Oncology Center, Warsaw, Poland
| | - Claudia Sangalli
- Radiation Oncology, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Silvia Stacchiotti
- Adult Mesenchymal and Rare Tumor Unit, Medical Oncology, IRCCS Foundation, National Cancer Institute, Milan, Italy
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10
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Haas RL, Walraven I, Lecointe-Artzner E, Scholten AN, van Houdt WJ, Griffin AM, Ferguson PC, Miah AB, Zaidi S, DeLaney TF, Chen YL, Spalek M, Krol SDG, Moeri-Schimmel RG, van de Sande MAJ, Sangalli C, Stacchiotti S. Radiation Therapy as Sole Management for Solitary Fibrous Tumors (SFT): A Retrospective Study From the Global SFT Initiative in Collaboration With the Sarcoma Patients EuroNet. Int J Radiat Oncol Biol Phys 2018; 101:1226-1233. [PMID: 29859795 DOI: 10.1016/j.ijrobp.2018.04.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/03/2018] [Accepted: 04/10/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE Solitary fibrous tumors (SFTs) are extremely rare mesenchymal malignancies. Given the lack of large prospective studies on radiation therapy (RT) with definitive and/or palliative intent in SFT patients, this retrospective study aimed to better define the benefit of RT in this disease. METHODS AND MATERIALS A retrospective observational study was performed across 7 sarcoma centers. Clinical information was retrieved from all patients receiving RT without surgery over the course of their locally advanced and/or metastatic disease. Differences in treatment characteristics between subgroups were tested using analysis-of-variance tests. Local control (LC) and overall survival (OS) rates were calculated as time from the start of RT until local progression and death from any cause, respectively. RESULTS Since 1990, a total of 40 patients were identified. RT was applied with definitive intent in 16 patients and with palliative intent in 24. The median follow-up period was 62 months. In patients treated with definitive RT (receiving approximately 60 Gy), the objective response rate was 67%. At 5 years, the LC rate was 81.3%, and the OS rate was 87.5%. In the case of palliative RT (typically 39 Gy), the objective response rate was 38%. The LC and OS rates at 5 years were 62.5% and 54.2%, respectively. In both subgroups, RT-associated toxicities were mild with predominantly grade 1 acute and late side effects. CONCLUSIONS This retrospective study suggests a clinically meaningful benefit for RT given with either definitive or palliative intent without surgery in SFT management. Prospective registries potentially in collaboration with patient advocacy groups are warranted to further assess the role of RT in patients with this rare malignancy.
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Affiliation(s)
- Rick L Haas
- Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Iris Walraven
- Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Astrid N Scholten
- Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Winan J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anthony M Griffin
- Division of Orthopedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Peter C Ferguson
- Division of Orthopedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Aisha B Miah
- Department of Radiotherapy and Physics, Sarcoma Unit, Royal Marsden Hospital, London, UK
| | - Shaine Zaidi
- Department of Radiotherapy and Physics, Sarcoma Unit, Royal Marsden Hospital, London, UK
| | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Yen-Lin Chen
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Mateusz Spalek
- Department of Radiation Oncology, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland
| | - Stijn D G Krol
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Claudia Sangalli
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Stacchiotti
- Adult Mesenchymal and Rare Tumor Unit, Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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11
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Abstract
Solitary fibrous tumor is a rare mesenchymal neoplasm that usually originates from the pleura, but has been reported in other extrapleural locations. We report a rare case of a solitary fibrous tumor of the stomach, which was successfully treated with endoscopic mucosal resection.
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