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Istl AC, Nudotor R, Greer JB, Gross JM, Meyer CF, Johnston FM. Primary Tumor Resection in Leiomyosarcoma Patients With Synchronous Isolated Lung Metastases: A National Cancer Database Study. J Surg Res 2024; 300:559-566. [PMID: 38925091 DOI: 10.1016/j.jss.2024.03.020] [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: 12/15/2022] [Revised: 02/13/2024] [Accepted: 03/16/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Up to half of patients with leiomyosarcoma (LMS) present with distant metastases, most commonly in the lungs. Despite guidelines around managing metachronous oligometastatic disease, limited evidence exists for synchronous isolated lung metastases (SILMs). Our histology-specific study describes management patterns and outcomes for patients with LMS and SILM across disease sites. METHODS We used the National Cancer Database to analyze patients with LMS of the retroperitoneum, extremity, trunk/chest/abdominal wall, and pelvis with SILM. Patients with extra-pulmonary metastases were excluded. We identified factors associated with primary tumor resection and receipt of metastasectomy. Outcomes included median, 1-year, and 5-year overall survival (OS) across treatment approaches using log-rank tests, Kaplan-Meier curves, and Cox proportional hazard models. RESULTS We identified 629 LMS patients with SILM from 2004 to 2017. Patients were more likely to have resection of their primary tumor or lung metastases if treated at an academic center compared to a community cancer center. Five year OS for patients undergoing both primary tumor resection and metastasectomy was 20.9% versus 9.2% for primary tumor resection alone, and 2.6% for nonsurgical patients. Median OS for all-comers was 15.5 mo. Community treatment site, comorbidity score, and larger primary tumors were associated with worse survival. Chemotherapy, primary resection, and curative intent surgery predicted improved survival on multivariate Cox regression. CONCLUSIONS An aggressive surgical approach to primary LMS with SILM was undertaken for select patients in our population and found to be associated with improved OS. This approach should be considered for suitable patients at high-volume centers.
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Affiliation(s)
- Alexandra C Istl
- Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Richard Nudotor
- Department of Surgery, Anne Arundel Medical Center, Annapolis, Maryland
| | - Jonathan B Greer
- Division of Surgical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John M Gross
- Division of Surgical Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christian F Meyer
- Division of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fabian M Johnston
- Division of Surgical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Matsuda N, Yamamoto H, Habu T, Iwata K, Matsubara K, Tanaka S, Hashimoto K, Shien K, Suzawa K, Miyoshi K, Toji T, Okazaki M, Sugimoto S, Takahashi K, Toyooka S. Prognostic Impact of Tumor-Infiltrating Lymphocytes, Tertiary Lymphoid Structures, and Neutrophil-to-Lymphocyte Ratio in Pulmonary Metastases from Uterine Leiomyosarcoma. Ann Surg Oncol 2023; 30:8727-8734. [PMID: 37658268 PMCID: PMC10625945 DOI: 10.1245/s10434-023-14176-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/31/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND The presence of tumor-infiltrating lymphocytes (TILs) and tertiary lymphoid structures (TLSs) in tumor tissue has been related to the prognosis in various malignancies. Meanwhile, neutrophil-to-lymphocyte ratio (NLR) as a systemic inflammation marker also has been associated with the prognosis in them. However, few reports have investigated the relationship between pulmonary metastases from sarcoma and these biomarkers. METHODS We retrospectively recruited 102 patients undergoing metastasectomy for pulmonary metastases from uterine leiomyosarcoma at Okayama University Hospital from January 2006 to December 2019. TILs and TLSs were evaluated by immunohistochemical staining of surgically resected specimens of pulmonary metastases using anti-CD3/CD8/CD103/Foxp3/CD20 antibodies. NLR was calculated from the blood examination immediately before the most recent pulmonary metastasectomy. We elucidated the relationship between the prognosis and these factors. Because we considered that the status of tumor tissue and systemic inflammation were equally valuable, we also assessed the impact of the combination of TILs or TLSs and NLR on the prognosis. RESULTS As for TILs, CD3-positive cells and CD8-positive cells were correlated with the prognosis. The prognosis was significantly better in patients with CD3-high group, CD8-high group, TLSs-high group, and NLR-low group, respectively. The prognosis of CD8-high/NLR-low group and TLSs-high/NLR-low group was significantly better than that of CD8-low/NLR-high group and TLSs-low/NLR-high group, respectively. CONCLUSIONS CD3-positive TILs, CD8-positive TILs, TLSs, and NLR are correlated with the prognosis, respectively. The combination of CD8-positive TILs or TLSs and NLR may be the indicators to predict the prognosis of patients with pulmonary metastases from uterine leiomyosarcoma.
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Affiliation(s)
- Naoki Matsuda
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiromasa Yamamoto
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
| | - Tomohiro Habu
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuma Iwata
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kei Matsubara
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Shin Tanaka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Kohei Hashimoto
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Kazuhiko Shien
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Ken Suzawa
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Kentaroh Miyoshi
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Tomohiro Toji
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Pathology, Okayama University Hospital, Okayama, Japan
| | - Mikio Okazaki
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Seiichiro Sugimoto
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Katsuhito Takahashi
- Department of Sarcoma Medicine, Center for Sarcoma Multidisciplinary Treatment, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
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Guadagni S, Peri A, Palmeri M, Furbetta N, Di Franco G, Filardo M, Comandatore A, Pollina LE, Gaeta R, Sbrana A, Galli L, Mercinelli C, Pietrabissa A, Di Candio G, Morelli L. Surgical treatment of recurrent retroperitoneal sarcoma in its different patterns: A 15-years' two-centers experience. Surgeon 2023; 21:e249-e257. [PMID: 36707317 DOI: 10.1016/j.surge.2023.01.003] [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: 11/26/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION There is limited data available regarding the role of surgery in the treatment of retroperitoneal sarcoma (RPS) recurrences. We herein report the short- and mid-term outcomes of patients who underwent surgical treatment of RPS recurrences at two Italian centers over a 15-years' experience. MATERIALS AND METHODS From January 2005 to January 2020, 33 patients underwent surgical treatment of isolated locally recurrent RPS (LR group), locally recurrent RPS associated with the presence of distant recurrence (LR + DM group), and distant-only recurrent RPS (DM group). Only procedures performed to obtain a macroscopically radical treatment with curative intent were included. Data regarding pre-, intra-, post-operative course, and follow-up, collected in an Institutional database, were retrospectively analyzed, and compared. RESULTS LR-group was composed of 15 patients, LR + DM group of 9 patients, and DM group of 9 patients. During the follow-up, 78.5% of the LR group, 77.8% of the DM group and 100% of the LR + DM group (p = 0.244) experienced a second recurrence. 7/11 (63.6%) patients in the LR group, 2/7 (28.5%) patients in the DM-group, and 0/9 (0.0%) patients in the LR + DM group underwent to almost one further local treatments of their recurrences (p = 0.010). No differences in the mean disease-free survival (p = 0.127), overall survival (OS) (p = 0.165) was reported among the three groups. Repeated surgery was an independent factor affecting survival in multivariate analysis (p = 0.01). CONCLUSIONS A surgical treatment of RPS recurrences should always be taken into consideration, also in metastatic patients and/or in those who have already undergone surgery for previous RPS recurrence, because this approach may offer survival benefits.
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Affiliation(s)
- Simone Guadagni
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Andrea Peri
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Palmeri
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
| | - Niccolò Furbetta
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gregorio Di Franco
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Matteo Filardo
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Annalisa Comandatore
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Raffaele Gaeta
- Second Division of Surgical Pathology, University Hospital of Pisa, Italy
| | - Andrea Sbrana
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Luca Galli
- Unit of Oncology 2, University Hospital of Pisa, Italy
| | | | - Andrea Pietrabissa
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulio Di Candio
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Luca Morelli
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Mittal S, Kadamberi IP, Chang H, Wang F, Kumar S, Tsaih SW, Walker CJ, Chaluvally-Raghavan P, Charlson J, Landesman Y, Pradeep S. Preclinical activity of selinexor in combination with eribulin in uterine leiomyosarcoma. Exp Hematol Oncol 2023; 12:78. [PMID: 37715291 PMCID: PMC10503035 DOI: 10.1186/s40164-023-00443-w] [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: 06/23/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023] Open
Abstract
Leiomyosarcoma (LMS) is a rare soft tissue sarcoma (STS) that begins in smooth muscle tissue and most often initiates in the abdomen or uterus. Compared with other uterine cancers, uterine LMS (ULMS) is an aggressive tumor with poor prognosis and a high risk of recurrence and death, regardless of the stage at presentation. Selinexor is a first-in-class selective inhibitor of nuclear export (SINE) compound that reversibly binds to exportin 1 (XPO1), thereby reactivating tumor suppressor proteins and downregulating the expression of oncogenes and DNA damage repair (DDR) proteins. In this study, we evaluated the effects of selinexor in combination with doxorubicin and eribulin in the LMS tumor model in vitro and in vivo. Treatment of selinexor combined with eribulin showed synergistic effects on tumor growth inhibition in SK-UT1 LMS-derived xenografts. Immunohistochemical assessment of the tumor tissues showed a significantly reduced expression of proliferation (Ki67) and XPO1 markers following combination therapy compared to the control group. Global transcriptome analyses on tumor tissue revealed that the combination therapy regulates genes from several key cancer-related pathways that are differentially expressed in ULMS tumors. To our knowledge, this is the first preclinical study demonstrating the anti-cancer therapeutic potential of using a combination of selinexor and eribulin in vivo. Results from this study further warrant clinical testing a combination of chemotherapy agents with selinexor to reduce the morbidity and mortality from ULMS.
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Affiliation(s)
- Sonam Mittal
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Hua Chang
- Karyopharm Therapeutics, Inc, Newton, MA, USA
| | - Feng Wang
- Karyopharm Therapeutics, Inc, Newton, MA, USA
| | - Sudhir Kumar
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shirng-Wern Tsaih
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Pradeep Chaluvally-Raghavan
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin-Cancer Center, Milwaukee, WI, USA
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John Charlson
- Medical Oncology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | | | - Sunila Pradeep
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA.
- Medical College of Wisconsin-Cancer Center, Milwaukee, WI, USA.
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, USA.
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Hardy NL, Canakis A, Staats PN, Darwin P, Legesse T. Cytologic features of metastatic epithelioid uterine leiomyosarcoma to the pancreas. Diagn Cytopathol 2023; 51:E21-E24. [PMID: 36082519 DOI: 10.1002/dc.25051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 12/13/2022]
Abstract
Although uterine leiomyosarcoma (ULMS) is a rare disease, it accounts for a significant proportion uterine cancer-related deaths due to frequent metastasis and chemoresistance. The WHO currently recognizes the conventional (spindle), myxoid, and epithelioid variants of ULMS, the latter of which is the rarest, least understood, and cited as clinically more aggressive than the other variants. Descriptions of the histologic features of epithelioid ULMS are extremely limited, and are absent from the cytology literature which has only published descriptions of conventional ULMS or epithelioid variants of other LMS primaries. Therefore, we present a unique case of metastatic epithelioid ULMS to an unusual location, the pancreas, along with its cytologic features on endoscopic ultrasound-guided fine needle aspiration not previously described including pseudoglandular arrangements, scant cytoplasm, and frequent molding.
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Affiliation(s)
- Naomi L Hardy
- Department of Pathology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Paul N Staats
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Peter Darwin
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Teklu Legesse
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Hennon M. Sarcoma Pulmonary Metastatic Disease: Still a Chance for Cure. Surg Clin North Am 2022; 102:615-624. [PMID: 35952691 DOI: 10.1016/j.suc.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Tumors of soft tissue origin are not common but are increasing in incidence. Given the rare and heterogeneous nature of the disease, deciding on an effective treatment approach to the patient can be challenging. Approximately 20-50% of patients with sarcoma will develop metastases to the lung via hematogenous spread. Despite improvements in systemic therapy options for patients with metastatic disease to the lung, surgical resection of metastases is often the preferred option in patients who are safe surgical candidates. Clearance of metastatic disease with surgical resection has been proven to be cost-effective and can improve chances for long term survival. Deciding on who may benefit from surgical resection is best achieved in a multidisciplinary setting.
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Affiliation(s)
- Mark Hennon
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA; Department of Surgery, Jacobs School of Medicine, State University of New York at Buffalo, 100 High Street, Buffalo, NY 14203, USA.
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Metastasectomy in Leiomyosarcoma: A Systematic Review and Pooled Survival Analysis. Cancers (Basel) 2022; 14:cancers14133055. [PMID: 35804827 PMCID: PMC9264936 DOI: 10.3390/cancers14133055] [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: 05/28/2022] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Leiomyosarcoma (LMS) is an aggressive soft tissue sarcoma with a poor prognosis. Approximately 40% of patients will develop metastatic disease. The optimal treatment for patients with metastatic LMS is not well established, and there are no randomized controlled trials regarding metastasectomy. This systematic review and pooled survival analysis aims to assess the survival in patients undergoing a metastasectomy for LMS and compare the outcomes based on the site of metastasectomy. We identified that patients with LMS metastases in the lungs, liver, spine, and brain can undergo metastasectomy with acceptable survival. Two studies have compared survival outcomes between patients treated and not treated with metastasectomy; despite their low quality, these studies support a survival benefit associated with metastasectomy. Abstract This study assesses the survival in patients undergoing metastasectomy for leiomyosarcoma (LMS) and compares the outcomes by the site of metastasectomy. We conducted a systematic review and pooled survival analysis of patients undergoing metastasectomy for LMS. Survival was compared between sites of metastasectomy. We identified 23 studies including 573 patients undergoing metastasectomy for LMS. The pooled median survival was 59.6 months (95% CI 33.3 to 66.0). The pooled median survival was longest for lung metastasectomy (72.8 months 95% CI 63.0 to 82.5), followed by liver (34.8 months 95% CI 22.3 to 47.2), spine (14.1 months 95% CI 8.6 to 19.7), and brain (14 months 95% CI 6.7 to 21.3). Two studies compared the survival outcomes between patients who did, versus who did not undergo metastasectomy; both demonstrated a significantly improved survival with metastasectomy. We conclude that surgery is currently being utilized for LMS metastases to the lung, liver, spine, and brain with acceptable survival. Although low quality, comparative studies support a survival benefit with metastasectomy. In the absence of randomized studies, it is impossible to determine whether the survival benefit associated with metastasectomy is due to careful patient selection rather than a surgical advantage; limited data were included about patient selection.
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Stork T, Hegedüs B, Guder W, Hamacher R, Hardes J, Kaths M, Plönes T, Pöttgen C, Schildhaus HU, Streitbürger A, Treckmann J, Bauer S, Aigner C, Collaud S. Prognostic Factors for Leiomyosarcoma with Isolated Metastases to the Lungs: Impact of Metastasectomy. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11806-8. [PMID: 35552929 PMCID: PMC9174305 DOI: 10.1245/s10434-022-11806-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/06/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Leiomyosarcoma (LMS) most frequently metastasizes to the lung. Metastatic LMS is considered incurable. Selected patients may benefit from pulmonary metastasectomy (PM) within multimodal therapy. This study analyzed the prognostic relevance of clinicopathologic factors in these patients. METHODS Patients with metastatic LMS to the lung treated in our center from 2004 to 2020 were included in this single-center retrospective study. Overall survival (OS), progression-free survival (PFS), and prognostic factors were analyzed. RESULTS The study had 64 patients (33 males, 52%) with metastatic LMS to the lung. The 5-year OS was 55% after the diagnosis of pulmonary metastases. Age older than 60 years at the primary tumor diagnosis, primary tumor larger than 70 mm, and five or more lung metastases were associated with poorer OS. Of the 64 patients, 44 underwent PM. The postoperative mortality rate was 0%. The patients selected for PM were younger and had smaller primary tumors, fewer metastases, and metastases that more often were metachronous. Metastasis grade (G1 vs. G2/3) and size (20-mm cutoff) were significant prognostic factors for OS (p = 0.05) and PFS (p = 0.028) after PM, respectively. The 44 patients who underwent PM had a survival benefit compared with the patients who were selected but did not undergo PM (n = 6) and the patients who were not selected for PM (n = 14). Three patients (7%) were alive and free of disease at the last follow-up visit respectively 5.5, 9, and 12 years after PM. CONCLUSIONS For patients with leiomyosarcoma, PM is safe. Despite aggressive multimodal treatment, most patients will experience recurrence and eventually die of their disease. However, a small subgroup of patients could potentially be cured after PM.
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Affiliation(s)
- Theresa Stork
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Center Essen, Germany
| | - Balazs Hegedüs
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Center Essen, Germany
| | - Wiebke Guder
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Rainer Hamacher
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jendrik Hardes
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Moritz Kaths
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Till Plönes
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Center Essen, Germany
| | - Christoph Pöttgen
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Radiation Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hans-Ulrich Schildhaus
- German Cancer Consortium (DKTK), Center Essen, Germany
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Arne Streitbürger
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Juergen Treckmann
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Sebastian Bauer
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany.
- German Cancer Consortium (DKTK), Center Essen, Germany.
| | - Stéphane Collaud
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Center Essen, Germany
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LiBrizzi CL, Vankara A, Meyer CF, Levin AS, Morris CD. Bone Metastases in Patients with Leiomyosarcoma: A Retrospective Analysis of Survival and Surgical Management. Sarcoma 2022; 2022:6806932. [PMID: 35570847 PMCID: PMC9106492 DOI: 10.1155/2022/6806932] [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: 01/21/2022] [Revised: 03/14/2022] [Accepted: 04/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Leiomyosarcomas (LMS) are malignancies with smooth muscle differentiation. Metastasis to the bone is not uncommon. The literature on the clinical course and management of such metastases is limited. Our study describes the clinical course of LMS to the bone, including survival rates, prognostic factors, and surgical management. Methods We retrospectively reviewed 396 LMS patients presenting at an academic center between 1995 and 2020. We included LMS patients diagnosed with bone metastases and excluded patients with primary LMS of bone. We evaluated survival time with the Kaplan-Meier survival method and used Cox's proportional hazards regression analysis to determine factors associated with survival. Results Forty-five patients with LMS (11%) had bone metastases. The most common LMS subtypes with bone metastases were uterine (N = 18, 40%) and retroperitoneal (N = 15, 33%). Bone metastasis was not an independent predictor of mortality by Cox regression analysis (HR 1.0, 95% CI: 0.67-1.5). Patients more frequently metastasized to the axial (N = 29, 64%) than to the appendicular (N = 5, 11%) skeleton. Bone was the first site of metastasis in 13 patients (29%). Patients presented with bone metastases at a median of 32.7 months (IQR: 5.2, 62.6) after initial LMS diagnosis. Twelve patients (27%) sustained a pathologic fracture. Twenty (44%) required surgical management, with 30 surgeries total. Three (15%) had a failure of reconstructive constructs. The median overall survival time was 69.7 months (IQR: 43.2, 124.5). There were no associations between the LMS subtype and survival. Pathologic fracture was an independent predictor of mortality by Cox regression analysis (HR 5.4, 95% CI: 1.8-16). Conclusion The majority of patients with metastatic LMS to bone survive greater than 5 years and frequently require surgical intervention. Extended survival in this patient population should inform fixation and implant choice. No anatomic subtype was associated with risk for bone metastases. Pathologic fracture was associated with worse survival.
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Affiliation(s)
- Christa L. LiBrizzi
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ashish Vankara
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christian F. Meyer
- Department of Medical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adam S. Levin
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carol D. Morris
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Hamaji M, Miyata R, Miyahara S. Two Decades of Pulmonary Metastasectomy for Leiomyosarcoma in Essen. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11810-y. [PMID: 35471747 DOI: 10.1245/s10434-022-11810-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/11/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Masatsugu Hamaji
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Ryo Miyata
- Department of Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - So Miyahara
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan
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Impact of Surgery and Chemotherapy on Metastatic Extrauterine Leiomyosarcoma. Curr Oncol 2022; 29:2301-2311. [PMID: 35448161 PMCID: PMC9029669 DOI: 10.3390/curroncol29040187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 01/21/2023] Open
Abstract
Background: Few studies have described the characteristics and prognostic factors of patients with metastatic extrauterine leiomyosarcoma (euLMS). Therefore, we retrospectively investigated the clinicopathological features, clinical outcomes, and prognostic factors of patients with euLMS. Methods: We recruited 61 patients with metastatic euLMS treated from 2006 to 2020 and collected and statistically analyzed information on patient-, tumor-, and treatment-related factors. The median follow-up period was 21.1 months. Results: Sixty-one patients with euLMS and a median age of 59 years were included. Furthermore, their five-year overall survival (OS) rate was 38.3%. Univariate analysis revealed that primary tumor size >10 cm, synchronous metastasis, initial metastatic sites >1, and no metastasectomy with curative intent were significantly associated with poor OS rate. Multivariate analysis identified primary tumor size >10 cm as an independent prognostic factor for poor OS. Among 24 patients who received metastasectomy with curative intent, the interval from the initial diagnosis to development of metastasis ≤6 months was significantly correlated with unfavorable OS. Among 37 patients who did not receive metastasectomy, chemotherapy after metastasis development was significantly related to better OS. Conclusions: Complete metastasectomy should be considered for metastatic euLMS treatment. Moreover, chemotherapy could prolong survival in patients with metastasis who are ineligible for metastasectomy.
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New Aspects of Sarcomas of Uterine Corpus-A Brief Narrative Review. Clin Pract 2021; 11:878-900. [PMID: 34842646 PMCID: PMC8628735 DOI: 10.3390/clinpract11040103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/11/2021] [Accepted: 11/16/2021] [Indexed: 02/04/2023] Open
Abstract
Sarcomas of the uterine corpus are rare malignant neoplasms, which are further classified into mesenchymal tumors, and mixed (epithelial plus mesenchymal) tumors. The main issues concerning these neoplasms are the small number of clinical trials, insufficient data from evidence-based medicine, insignificant interest from the pharmaceutical industry, all of which close a vicious circle. The low frequency of these malignancies implies insufficient experience in the diagnosis, hence incomplete surgical and complex treatment. Additionally, the rarity of these sarcomas makes it very difficult to develop clinical practice guidelines. Preoperative diagnosis, neoadjuvant and adjuvant chemoradiation, target and hormone therapies still raise many controversies. Disagreements about the role and type of surgical treatment are also often observed in medical literature. There are still insufficient data about the role of pelvic lymph node dissection and fertility-sparing surgery. Pathologists’ experience is of paramount importance for an accurate diagnosis. Additionally, genetics examinations become part of diagnosis in some sarcomas of the uterine corpus. Some gene mutations observed in uterine sarcomas are associated with different outcomes. Therefore, a development of molecular classification of uterine sarcomas should be considered in the future. In this review, we focus on the epidemiology, pathogenesis, pathology, diagnosis and treatment of the following sarcomas of the uterine corpus: leiomyosarcoma, low- and high-grade endometrial stromal sarcomas, undifferentiated sarcoma and adenosarcoma. Uterine carcinosarcomas are excluded as they represent an epithelial tumor rather than a true sarcoma.
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Gusho CA, Seder CW, Lopez-Hisijos N, Blank AT, Batus M. Pulmonary metastasectomy in bone and soft tissue sarcoma with metastasis to the lung. Interact Cardiovasc Thorac Surg 2021; 33:879-884. [PMID: 34516633 PMCID: PMC8632785 DOI: 10.1093/icvts/ivab178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/06/2021] [Accepted: 05/16/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES This study investigated the outcomes of sarcoma patients with lung metastases who underwent pulmonary metastasectomy (PM), compared to patients who underwent medical management alone. The secondary objective was to compare survival after PM between variables of interest. METHODS This was a retrospective review of 565 sarcoma patients with confirmed, isolated pulmonary metastasis identified from the Surveillance, Epidemiology and End Results database between 2010 and 2015. 1:4 propensity score matching was used to select PM and non-PM groups. The multivariable Cox proportional hazards model was used to analyse prognostic factors of disease-free survival (DFS). RESULTS Of the eligible 565 patients, 59 PM patients were matched to 202 non-PM patients in a final ratio of 3.4. After propensity matching, there were no significant differences in baseline characteristics between PM and non-PM patients. The median DFS after PM was 32 months (interquartile range 18–59), compared to 20 months (interquartile range 7–40) in patients without PM (P = 0.032). Using a multivariable Cox proportional hazards model, metastasectomy (hazard ratio 0.536, 95% confidence interval 0.33–0.85; P = 0.008) was associated with improved DFS. In a subset analysis of patients who underwent PM only, the median DFS was longer in males compared to females (P = 0.021), as well as in bone sarcoma compared to soft tissue sarcoma (P = 0.014). CONCLUSIONS For sarcoma patients with metastatic lung disease, PM appears to improve the prognosis compared to medical management. Furthermore, there may be a survival association with gender and tumour origin in patients who underwent PM. These data may be used to inform the surgical indications and eligibility criteria for metastasectomy in this setting.
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Affiliation(s)
- Charles A Gusho
- Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Christopher W Seder
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Alan T Blank
- Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Marta Batus
- Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
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Multidisciplinary Management of Retroperitoneal Sarcoma: Diagnosis, Prognostic Factors and Treatment. Cancers (Basel) 2021; 13:cancers13164016. [PMID: 34439171 PMCID: PMC8392612 DOI: 10.3390/cancers13164016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/06/2021] [Indexed: 01/07/2023] Open
Abstract
Simple Summary The management of retroperitoneal sarcomas can be challenging due to the variety of their presentation, histopathological types, and behaviours. This literature review provides a comprehensive and practical overview of the management of retroperitoneal sarcomas, focusing on diagnostic challenges, prognostic factors, multidisciplinary aspects of treatment and new research perspectives. Abstract Retroperitoneal sarcomas (RPS) are rare cancers whose management can be challenging due to various presentation patterns, multiple organ involvement, and a high local and distant recurrence rate. Histopathology and prognostic factors analysis are essential to predict the behaviour of the disease and plan the best therapeutic strategy. To date, surgery is still the main therapeutic option that guarantees a chance of cure from the primary disease. While chemotherapy and radiotherapy seem to be good options for controlling metastatic and recurrent irresectable disease, their role in the treatment of primary RPS remains unclear. This literature review aims to provide a comprehensive overview of the multidisciplinary aspects of RPS management in high-volume centres, summarising the diagnostic path, the prognostic factors, and the most suitable therapeutic options.
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15
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Stamenovic D, Hohenberger P, Roessner E. Pulmonary metastasectomy in soft tissue sarcomas: a systematic review. J Thorac Dis 2021; 13:2649-2660. [PMID: 34012614 PMCID: PMC8107546 DOI: 10.21037/jtd-2019-pm-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Soft tissue sarcoma (STS) tend to metastasis to the lungs. Pulmonary metastasectomy seems to be a common practice always when plausible. The objective of this article was to review systematically the results of a literature search on pulmonary metastasectomy for STSs published in the last ten years and to offer a brief overview about the current practice as well. Methods Eight retrospective studies published in the period 2010–2020, which included patients with pulmonary metastases and metastasectomy were selected. Indication for surgery, survival rate and factors influencing survival were the primary outcomes, while further interesting findings in the studies were also collected and evaluated. Results Cumulative 1,004 patients participated in these studies. The most common histological types were leiomyosarcoma, malignant fibrous histiocytoma (MFH) and synovial sarcoma, being present together at 60% of the study population. Five-year survival was reported to be in the range from 20–58%, better survival going along with a fewer (preferably one) metastases, longer disease free interval (DFI) and R0 resection in most of the cases. Conclusions Complete resection of the metastatic lesions seems to be the most effective treatment for long-term survival, or even achieving cure in selected patients. At selection of the patients amenable for surgery, a high probability of R0 resection, as well as a disease free period of at least 12 months should perhaps bear a higher specific value.
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Affiliation(s)
- Davor Stamenovic
- Mainz University Thoracic Center, Thoracic Surgery and Pulmonary Medicine, Mainz, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center, Mannheim, Germany
| | - Eric Roessner
- Mainz University Thoracic Center, Thoracic Surgery and Pulmonary Medicine, Mainz, Germany
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16
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Abstract
Repeat surgical resection (redo) for pulmonary metastases is a questionable, albeit intriguing topic. We performed an extensive review of the literature, to specifically analyze results of redo pulmonary metastasectomies. We reviewed a total of 3,523 papers. Among these, 2,019 were excluded for redundancy and 1,105 because they were not completely retrievable. Out of 399 eligible papers, 183 had missing information or missing abstract, while 96 lacked data on survival. A total of 120 papers dated from 1991 onwards were finally included. Data regarding mortality, major morbidity, prognostic factors and long-term survivals of the first redo pulmonary metastasectomies were retrieved and analyzed. Homogeneity of data was affected by the lack of guidelines for redo pulmonary metastasectomy and the risks of bias when comparing different studies has to be considered. According to the histology sub-types, redo metastasectomies papers were grouped as: colorectal (n=42), sarcomas (n=36), others (n=20) and all histologies (n=22); the total number of patients was 3,015. Data about chemotherapy were reported in half of the papers, whereas targeted or immunotherapy in 9. None of these associated therapies, except chemotherapy in two records, did significantly modify outcomes. Disease-free interval before the redo procedure was the prevailing prognostic factor and nearly all papers showed a significant correlation between patients’ comorbidities and prognosis. No perioperative mortality was reported, while perioperative major morbidity was overall quite low. Where available, overall survival after the first redo metastasectomy ranged from 10 to 72 months, with a 5-years survival of approximately 50%. The site of first recurrence after the redo procedure was mainly lung. Despite the data retrievable from literature are heterogeneous and confounding, we can state that redo lung metastasectomy is worthwhile when the lesions are resectable and the perioperative risk is low. At present, there are no “non-surgical” therapeutic options to replace redo pulmonary metastasectomies.
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Affiliation(s)
- Vincenzo Ambrogi
- Thoracic Surgery Unit, Tor Vergata University Polyclinic, Rome, Italy
| | | | - Riccardo Tajé
- Tor Vergata University School of Medicine, Rome, Italy
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17
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Ferrandina G, Aristei C, Biondetti PR, Cananzi FCM, Casali P, Ciccarone F, Colombo N, Comandone A, Corvo' R, De Iaco P, Dei Tos AP, Donato V, Fiore M, Franchi, Gadducci A, Gronchi A, Guerriero S, Infante A, Odicino F, Pirronti T, Quagliuolo V, Sanfilippo R, Testa AC, Zannoni GF, Scambia G, Lorusso D. Italian consensus conference on management of uterine sarcomas on behalf of S.I.G.O. (Societa' italiana di Ginecologia E Ostetricia). Eur J Cancer 2020; 139:149-168. [PMID: 32992154 DOI: 10.1016/j.ejca.2020.08.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/10/2020] [Accepted: 08/22/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Uterine sarcomas are very rare tumours with different histotypes, molecular features and clinical outcomes; therefore, it is difficult to carry out prospective clinical trials, and this often results in heterogeneous management of patients in the clinical practice. AIM We planned to set up an Italian consensus conference on these diseases in order to provide recommendations on treatments and quality of care in our country. RESULTS Early-stage uterine sarcomas are managed by hysterectomy + bilateral salpingo-oophorectomy according to menopausal status and histology; lymphadenectomy is not indicated in patients without bulky nodes, and morcellation must be avoided. The postoperative management is represented by observation, even though chemotherapy can be considered in some high-risk patients. In early-stage low-grade endometrial stromal sarcoma and adenosarcomas without sarcomatous overgrowth, hormonal adjuvant treatment can be offered based on hormone receptor expression. In selected cases, external beam radiotherapy ± brachytherapy can be considered to increase local control only. Patients with advanced disease involving the abdomen can be offered primary chemotherapy (or hormonal therapy in the case of low-grade endometrial stromal sarcoma and adenosarcoma without sarcomatous overgrowth), even if potentially resectable in the absence of residual disease in order to test the chemosensitivity (or hormonosensitivity); debulking surgery can be considered in patients with clinical and radiological response. Chemotherapy is based on anthracyclines ± ifosfamide or dacarbazine. Palliative radiotherapy can be offered for symptom control, and stereotactic radiotherapy can be used for up to five isolated metastatic lesions. CONCLUSIONS Treatment of uterine sarcoma should be centralised at referral centres and managed in a multidisciplinary setting.
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Affiliation(s)
- Gabriella Ferrandina
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology Unit, Roma, Italy; Universita' Cattolica Del Sacro Cuore, Roma, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Perugia General Hospital, Perugia, Italy
| | - Pietro Raimondo Biondetti
- Department of Radiology, Ca' Granda IRCSS Maggiore Policlinico Hospital Foundation Trust, Milan, Italy
| | | | - Paolo Casali
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Francesca Ciccarone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology Unit, Roma, Italy
| | - Nicoletta Colombo
- Gynecologic Cancer Program, University of Milan-Bicocca and European Institute of Oncology, IRCCS, Milan, Italy
| | - Alessandro Comandone
- Division of Medical Oncology, Humanitas Gradenigo Hospital, Turin, Italy; ASL Città di Torino, Turin, Italy
| | - Renzo Corvo'
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Health Science Department (DISSAL), University of Genoa, Genoa, Italy
| | - Pierandrea De Iaco
- Unit of Oncologic Gynecology, Department of Obstetrics and Gynecology, University of Bologna, Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Angelo Paolo Dei Tos
- Department of Pathology, Treviso General Hospital Treviso, Padova, Italy; University of Padua, Padova, Italy
| | - Vittorio Donato
- Radiation Oncology Division, Oncology and Specialty Medicine Department, San Camillo-Forlanini Hospital, Roma, Italy
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Franchi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Alessandro Gronchi
- Chair Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - Amato Infante
- UOC COVID-2, Department of Bioimaging and Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy
| | - Franco Odicino
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, Università degli Studi di Brescia, Italy
| | - Tommaso Pirronti
- UOC COVID-2, Department of Bioimaging and Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy; Catholic University of Sacred Hearth, Department of Radiology, Rome, Italy
| | - Vittorio Quagliuolo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberta Sanfilippo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antonia Carla Testa
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology Unit, Roma, Italy; Universita' Cattolica Del Sacro Cuore, Roma, Italy
| | - Gian Franco Zannoni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Woman, Child and Public Health Sciences, Gynecopathology and Breast Pathology Unit, Rome, Italy; Pathological Anatomy Institute, Catholic University of Sacred Hearth, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology Unit, Roma, Italy; Universita' Cattolica Del Sacro Cuore, Roma, Italy.
| | - Domenica Lorusso
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology Unit, Roma, Italy; Universita' Cattolica Del Sacro Cuore, Roma, Italy
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Murakawa T. Past, present, and future perspectives of pulmonary metastasectomy for patients with advanced colorectal cancer. Surg Today 2020; 51:204-211. [PMID: 32857252 DOI: 10.1007/s00595-020-02119-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/15/2020] [Indexed: 12/16/2022]
Abstract
Over a half-century has passed since Thomford et al. proposed the selection criteria for pulmonary metastasectomy, and several prognostic factors have been identified. Although screening modalities and operations have changed dramatically, the important concepts of the selection criteria remain unchanged. Recent improvements in the survival outcomes of colorectal cancer patients undergoing pulmonary metastasectomy may be the result of strict adherence to the selection criteria for oligometastatic lung tumors, which can mimic local disease. Pulmonary metastasectomy has become an important option for selected patients with oligometastasis, based mainly on a large amount of retrospective data, but its effect on survival remains unclear. Curable pulmonary metastasis might be regarded as a "semi-local disease" under the spontaneous control of an acquired alteration in host immune status. The current practice of pulmonary metastasectomy for colorectal cancer focuses on selecting the most appropriate operation for selected patients. However, in the rapidly evolving era of immunotherapy, treatment-naïve patients for whom surgery is not suitable might be pre-conditioned by immunotherapy so that they may be considered for salvage surgery.
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Affiliation(s)
- Tomohiro Murakawa
- Department of Thoracic Surgery, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1010, Japan.
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19
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Abstract
The lung is one of the most common sites of metastatic disease. Assessing patients for pulmonary metastasectomy includes ensuring they are suitable surgical candidates for single-lung ventilation and pulmonary resection. Complete resection of metastases and control of primary tumor and oligometastatic disease are key tenets for metastasectomy. Negative prognostic factors include short disease-free interval, presence of lymphadenopathy, and multiple lesions. Primary tumors are associated with excellent outcomes. With modern high-resolution scans, minimally invasive approaches to metastasectomy are preferred. Consideration of extended resections should take place in a multidisciplinary manner. Nonoperative options include stereotactic body radiation therapy, radiofrequency ablation, and microwave ablation.
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20
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Tetta C, Londero F, Micali LR, Parise G, Algargoush AT, Algargoosh M, Albisinni U, Maessen JG, Gelsomino S. Stereotactic Body Radiotherapy Versus Metastasectomy in Patients With Pulmonary Metastases From Soft Tissue Sarcoma. Clin Oncol (R Coll Radiol) 2020; 32:303-315. [PMID: 32024603 DOI: 10.1016/j.clon.2020.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/23/2019] [Accepted: 11/14/2020] [Indexed: 10/25/2022]
Abstract
The lung is the preferred site of metastasis from soft tissue sarcoma (STS). This systematic review aims to evaluate the outcomes of stereotactic body radiotherapy (SBRT) and metastasectomy (MTS) for the treatment of lung metastases from STS. A systematic review was carried out according to the PRISMA protocol. PubMed, Medline, EMBASE, Cochrane Library, Ovid and Web of Knowledge databases were searched for English-language articles to December 2018 using a predefined strategy. Retrieved studies were independently screened and rated for relevance. Data were extracted by two researchers. In total, there were 1306 patients with STS: 1104 underwent MTS and 202 had SBRT. The mean age ranged from 40 to 55.8 years in the MTS group and from 47.9 to 64 years in the SBRT group. The cumulative death rate was 72% (95% confidence interval 59-85%) in the MTS group and 56% (38-74%) in the SBRT group. The cumulative mean overall survival time was 46.7 months (36.4-57.0%) in the MTS group and 47.6 months (33.7-61.5%) in the SBRT group. The cumulative rate of patients alive with disease was 5% (2-9%) in the MTS group and 15% (6-36%) in the SBRT group. Finally, the cumulative rate of patients alive without disease in the two groups was 19% (9-29%) and 20% (10-50%), respectively. Our study showed that local treatment of pulmonary metastases from STS with SBRT, compared with surgery, was associated with a lower cumulative overall death rate and similar overall survival time and survival rates without disease. By contrast, SBRT was associated with a higher survival rate with disease than MTS. Large randomised trials are necessary to confirm these findings and to establish whether SBRT may be a reliable option for early stage disease.
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Affiliation(s)
- C Tetta
- Rizzoli Orthopedic Institute, Bologna, Italy.
| | - F Londero
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - L R Micali
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - G Parise
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A T Algargoush
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M Algargoosh
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - U Albisinni
- Rizzoli Orthopedic Institute, Bologna, Italy
| | - J G Maessen
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S Gelsomino
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
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Management of metastatic retroperitoneal sarcoma: a consensus approach from the Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG). Ann Oncol 2019; 29:857-871. [PMID: 29432564 DOI: 10.1093/annonc/mdy052] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction Retroperitoneal sarcoma (RPS) is a rare disease accounting for 0.1%-0.2% of all malignancies. Management of RPS is complex and requires multidisciplinary, tailored treatment strategies at all stages, but especially in the context of metastatic or multifocal recurrent disease. Due to the rarity and heterogeneity of this family of diseases, the literature to guide management is limited. Methods The Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG) is an international collaboration of sarcoma experts from all disciplines convened in an effort to overcome these limitations. The TARPSWG has compiled the available evidence surrounding metastatic and multifocally recurrent RPS along with expert opinion in an iterative process to generate a consensus document regarding the complex management of this disease. The objective of this document is to guide sarcoma specialists from all disciplines in the diagnosis and treatment of multifocal recurrent or metastatic RPS. Results All aspects of patient assessment, diagnostic processes, local and systemic treatments, and palliation are reviewed in this document, and consensus recommendations provided accordingly. Recommendations were guided by available evidence, in conjunction with expert opinion where evidence was lacking. Conclusions This consensus document combines the available literature regarding the management of multifocally recurrent or metastastic RPS with the practical expertise of high-volume sarcoma centers from multiple countries. It is designed as a tool for decision making in the complex multidisciplinary management of this condition and is expected to standardize management across centers, thereby ensuring that patients receive the highest quality care.
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Cybulska P, Sioulas V, Orfanelli T, Zivanovic O, Mueller JJ, Broach VA, Long Roche KC, Sonoda Y, Hensley ML, O'Cearbhaill RE, Chi DS, Alektiar KM, Abu-Rustum NR, Leitao MM. Secondary surgical resection for patients with recurrent uterine leiomyosarcoma. Gynecol Oncol 2019; 154:333-337. [PMID: 31200927 DOI: 10.1016/j.ygyno.2019.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/13/2019] [Accepted: 05/18/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To assess outcomes after secondary surgical resection in patients with recurrent uterine leiomyosarcoma (uLMS). METHODS We retrospectively identified all patients who had no evidence of disease after initial surgery for uLMS, who underwent surgery for a first recurrence at our institution between 1/1991 and 10/2013. We excluded patients who received any therapy for recurrence prior to secondary resection, and patients who underwent surgery soon after morcellation [of presumed benign fibroids] showed widespread disease. Overall survival (OS) was determined from time of first recurrence to death or last follow-up. RESULTS We identified 62 patients: 29 with abdominal/pelvic recurrence only, 30 with lung recurrence only, 3 with both. Median time to first recurrence was 18 months (95% CI: 13.3-23.3): 15.8 months (95% CI: 13.0-18.6) abdominal/pelvic recurrence; 24.1 months (95% CI: 14.5-33.7) lung-only recurrence (p = 0.03). Median OS was 37.7 months (95% CI: 25.9-49.6) abdominal/pelvic recurrence; 78.1 months (95% CI: 44.8-11.4) lung recurrence (p = 0.02). Complete gross resection (CGR) was achieved in 58 cases (93%), with gross residual ≤1 cm in 2 (3.5%) and >1 cm in 2 (3.5%). Median OS based on residual disease was 54.1 months (95% CI: 24.9-83.3), 38.7 months (95% CI: NE), 1.7 months (95% CI: NE), respectively (p < 0.001). In cases with CGR, neither adjuvant radiation (N = 9), chemotherapy (N = 8) nor hormonal therapy (N = 10) was associated with improved OS. CONCLUSIONS Secondary surgical resection of recurrent uLMS is reasonable in patients with a high probability of achieving CGR. Lung-only recurrences were associated with more favorable outcome. Following CGR, additional therapy may not offer benefit.
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Affiliation(s)
- Paulina Cybulska
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Vasileios Sioulas
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Theofano Orfanelli
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Oliver Zivanovic
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Jennifer J Mueller
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Vance A Broach
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Kara C Long Roche
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Yukio Sonoda
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Martee L Hensley
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Roisin E O'Cearbhaill
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Dennis S Chi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Kaled M Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Nadeem R Abu-Rustum
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA
| | - Mario M Leitao
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA.
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Gadducci A, Grosso F, Scambia G, Raspagliesi F, Colombo N, Grignani G, Casali P, Sanfilippo R, Buonadonna A, Santoro A, Bruzzone M, Artioli G, Lorusso D, Biagioli E, Fossati R, Galli F, Negri E, Rulli E, Torri V, D'Incalci M. A phase II randomised (calibrated design) study on the activity of the single-agent trabectedin in metastatic or locally relapsed uterine leiomyosarcoma. Br J Cancer 2018; 119:565-571. [PMID: 30057406 PMCID: PMC6162262 DOI: 10.1038/s41416-018-0190-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/05/2018] [Accepted: 06/27/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients with recurrent/metastatic uterine leiomyosarcoma (U-LMS) have a dismal prognosis. This phase II study aims to evaluate trabectedin efficacy and safety in advanced U-LMS. METHODS Eligible patients had received ≥ one line of chemotherapy. Gemcitabine ± docetaxel naive patients were randomised to Arm A: trabectedin 1.3 mg/m2 or calibration Arm B: gemcitabine 900 mg/m2 and docetaxel 75 mg/m2. Patients who had already received gemcitabine ± docetaxel directly entered Arm A. Primary end-point: 6-month progression-free rate (PFS-6). The null hypothesis that the true PFS-6 = 14% was tested against a one-sided alternative. This design yielded a 5% type I error rate and 90% power when the true PFS-6 is 25%. RESULTS Overall, 126 patients entered Arm A (45 from randomisation and 81 directly) and 42 Arm B. Arm A patients characteristics: median age = 57; ≥2 previous chemotherapy lines = 37.4%; metastatic disease = 93%. The study met the condition for trabectedin activity: PFS-6 = 35.2% (95% CI: 26.2-45). No difference in PFS by the number of previous chemotherapy lines emerged. Median OS = 20.6 months (IQR: 8-36.4). In Arm B, the PFS-6 = 51.5% (95% CI: 33.5-69.2). No toxic deaths occurred. In Arm A, only 4 patients interrupted treatment for toxicity. CONCLUSIONS Trabectedin is active and well tolerated, retaining similar efficacy across one to three previous lines of chemotherapy.
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Affiliation(s)
| | - Federica Grosso
- Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica, Rome, Italy
| | | | - Nicoletta Colombo
- Istituto Europeo di Oncologia, Milan, Italy
- Università di Milano-Bicocca, Milan, Italy
| | | | - Paolo Casali
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Università degli Studi di Milano, Milan, Italy
| | | | | | | | | | | | | | - Elena Biagioli
- IRCCS - Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Roldano Fossati
- IRCCS - Mario Negri Institute for Pharmacological Research, Milan, Italy.
| | - Francesca Galli
- IRCCS - Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Emanuele Negri
- IRCCS - Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Eliana Rulli
- IRCCS - Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Valter Torri
- IRCCS - Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Maurizio D'Incalci
- IRCCS - Mario Negri Institute for Pharmacological Research, Milan, Italy
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Nakamura K, Kajiyama H, Utsumi F, Suzuki S, Niimi K, Sekiya R, Sakata J, Yamamoto E, Shibata K, Kikkawa F. Secondary cytoreductive surgery potentially improves the oncological outcomes of patients with recurrent uterine sarcomas. Mol Clin Oncol 2018; 8:499-503. [PMID: 29556383 DOI: 10.3892/mco.2018.1560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 10/26/2017] [Indexed: 11/05/2022] Open
Abstract
Uterine sarcomas are some of the most malignant and aggressive tumor types among the gynecologic malignancies, and they are associated with a high rate of recurrence and a poor prognosis. Due to their rarity and diversity, the optimal treatment for recurrent uterine sarcomas has not yet been elucidated. The aim of the present study was to investigate the potential of secondary cytoreductive surgery (SCS) for patients with recurrent uterine sarcomas. A total of 18 patients with recurrent uterine sarcomas were retrospectively identified at the Department of Obstetrics and Gynecology, Nagoya University (Nagoya, Japan) between January 2002 and December 2015. This included 8 patients with leiomyosarcoma, 6 with carcinosarcoma, 3 with endometrial stromal sarcoma and 1 with adenosarcoma. All patients underwent primary debulking surgery as the initial treatment. In summary, 9 patients were treated with SCS when they experienced their first recurrence, and the other 9 patients were treated with non-SCS methods, including chemotherapy or radiotherapy. In the SCS group, 5/9 patients had confined pelvic recurrences, 3 patients had extra-pelvic diseases, including pulmonary metastasis, and one patient had intra- and extra-pelvic recurrence. The 3-year overall survival (OS) rates were 77.8 and 11.1% in the SCS and non-SCS groups, respectively. The patients who underwent SCS experienced a significantly longer OS time compared with those in the non-SCS group (P=0.006). In addition, the disease-free survival after second-line therapy was significantly longer in the SCS group than in the non-SCS group (P=0.0496). These findings suggest that resection of recurrent uterine sarcomas may be beneficial for the improvement of patient survival. Prospective studies with sufficient statistical power are warranted for further evaluation of the effect of SCS.
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Affiliation(s)
- Kenichi Nakamura
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Fumi Utsumi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Shiro Suzuki
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Kaoru Niimi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Ryuichiro Sekiya
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Jun Sakata
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
| | - Kiyosumi Shibata
- Department of Obstetrics and Gynecology, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya 454-8509, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8550, Japan
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Risk Factors Including Age, Stage and Anatomic Location that Impact the Outcomes of Patients with Synovial Sarcoma. Med Sci (Basel) 2018; 6:medsci6010021. [PMID: 29509716 PMCID: PMC5872178 DOI: 10.3390/medsci6010021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/10/2018] [Accepted: 03/01/2018] [Indexed: 01/12/2023] Open
Abstract
Synovial sarcoma is a high-grade soft tissue sarcoma that inflicts mostly children and young adults with high mortality rate; however, the risk factors that impact the outcomes remain incompletely understood. We have identified the synovial sarcoma cases from the Kaiser Permanente Northern California cancer registry between 1981 and 2014. Kaplan–Meier plots were used to display disease-free survival (DFS) and overall survival (OS); log-rank tests and Cox proportional hazard models were used to determine the impact of clinical factors on DFS, OS, and disease-specific survival. Tumor size > 5.0 cm and age > 50 years were associated with higher risk of presenting with stage IV disease. Median OS for patients with stage IV was 1.3 years and 7.8 years for early-stage disease. For patients with early-stage disease, tumor size > 5.0 cm was significantly associated with worse DFS, sarcoma-specific morality, and OS. Compared to extremity primary, patients with head and neck and trunk primary had approximately three-fold higher sarcoma-specific mortality and lower OS. There was no significant difference in DFS or OS among three histologic subtypes. Pre-operative and/or post-operative chemotherapy was not associated with improvement in DFS or OS. Twenty-six patients relapsed with predominantly lung metastasis, thirteen of whom received metastatectomy with a median OS of 7.8 years, compared to 2.3 years for patients who did not receive metastatectomy. In conclusion, age older than 50 years and tumor size > 5.0 cm are risk factors for presenting with stage IV disease. For early-stage patients, trunk and head and neck primary as well as tumor size > 5.0 cm are risk factors for decreased OS.
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Is Repeat Pulmonary Metastasectomy Indicated for Soft Tissue Sarcoma? Ann Thorac Surg 2017; 104:1837-1845. [PMID: 29074153 DOI: 10.1016/j.athoracsur.2017.07.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 07/05/2017] [Accepted: 07/17/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Because recurrence is high after pulmonary metastasectomy (PM) for soft tissue sarcoma (STS), repeat PM is commonly performed. Our objective was to define the selection criteria for repeat PM among patients experiencing recurrence and to identify factors associated with survival. METHODS We reviewed a prospectively maintained database of 539 patients undergoing PM for STS. Characteristics of the primary tumor, metastatic disease, treatment, and recurrence were examined. Multivariable Cox models were constructed to identify factors associated with the likelihood of operative selection after recurrence. Overall survival between patients with or without repeat PM was estimated using the Kaplan-Meier method, with prognostic factors identified using Cox models. Both analyses incorporated propensity score-matching weights. Factors associated with survival after repeat PM were assessed with multivariable Cox models among patients who underwent repeat PM. RESULTS After initial PM, 63% of patients (n = 341) experienced pulmonary recurrence; 141 (41%) underwent repeat PM. Patients who were younger (p = 0.033) underwent minimally invasive resection at first PM (p = 0.041), had a longer disease-free interval after first PM (p = 0.009), were without extrapulmonary disease (p < 0.001), and had fewer nodules on recurrence (p < 0.001) were more likely to undergo repeat PM. Comparison between the repeat and non-repeat PM groups demonstrated an increased hazard of death among patients managed nonoperatively. Factors associated with an increased hazard of death after second PM included preoperative chemotherapy (p = 0.008) and R1/R2 metastasectomy (p < 0.001). CONCLUSIONS Although operative selection occurs, when prognostic factors are controlled for, repeat PM for STS remains independently associated with prolonged overall survival.
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Marulli G, Mammana M, Comacchio G, Rea F. Survival and prognostic factors following pulmonary metastasectomy for sarcoma. J Thorac Dis 2017; 9:S1305-S1315. [PMID: 29119019 DOI: 10.21037/jtd.2017.03.177] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Sarcomas are a heterogeneous group of malignancies with a marked propensity to metastasize to the lungs. Chemotherapy offers only a limited benefit in metastatic disease, whereas lung metastasectomy, in selected cases, can lead to long-term survival. Other local ablative techniques and hybrid therapies have been proposed. A multidisciplinary setting is of paramount importance for choosing the most appropriate treatment for each case. There is no randomized controlled trial providing formal evidence of the effectiveness of lung metastasectomy. Main areas of controversy concern the selection of surgical candidates, the operative approach and the role of chemotherapy. Five-year survival rates range from 15% to 50.9%, as reported mainly in retrospective case-series in which several prognostic factors were identified. In this article, the authors review the surgical management of sarcoma metastases to the lung, with a particular focus on the outcomes and prognostic factors associated with long-term survival after resection. The role of chemotherapy and other adjunctive therapies is also discussed.
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Affiliation(s)
- Giuseppe Marulli
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Marco Mammana
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Giovanni Comacchio
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
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Cui RR, Wright JD, Hou JY. Uterine leiomyosarcoma: a review of recent advances in molecular biology, clinical management and outcome. BJOG 2017; 124:1028-1037. [PMID: 28128524 DOI: 10.1111/1471-0528.14579] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 12/22/2022]
Abstract
Uterine leiomyosarcoma (LMS) are rare but aggressive tumours with poor clinical outcomes regardless of stage. Most tumours are identified by histopathology at time of surgery, and pre-operative diagnosis remains a clinical challenge. Management of early-stage LMS relies on surgical resection. Cytotoxic chemotherapy remains the mainstay of therapy for advanced-stage, recurrent or metastatic LMS, and includes single or combination doxorubicin-, ifosfamide- or gemcitabine-based regimens. Recent interest in genetic biomarkers led to developments of targeted therapies for LMS, although more research is needed to understand the molecular complexities underlying LMS to guide the development of novel treatment strategies. TWEETABLE ABSTRACT The diagnosis and treatment of uterine LMS is challenging. Novel biomarkers offer hope for future therapies.
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Affiliation(s)
- R R Cui
- Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - J D Wright
- Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - J Y Hou
- Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Keung EZ, Fairweather M, Raut CP. Surgical Management of Metastatic Disease. Surg Clin North Am 2016; 96:1175-92. [DOI: 10.1016/j.suc.2016.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Gravel G, Yevich S, Tselikas L, Mir O, Teriitehau C, De Baère T, Deschamps F. Percutaneous thermal ablation: A new treatment line in the multidisciplinary management of metastatic leiomyosarcoma? Eur J Surg Oncol 2016; 43:181-187. [PMID: 27371999 DOI: 10.1016/j.ejso.2016.06.391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/30/2016] [Accepted: 06/08/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The role of percutaneous thermal ablation (PTA) in the multidisciplinary management of metastatic leiomyosarcoma (LMS) has not been thoroughly evaluated. MATERIALS AND METHODS Single institution retrospective review of all patients with LMS metastases treated with PTA from June 2004 to December 2014. Iterative PTAs were performed as a multifocal treatment for all recurrent or residual macroscopic metastases discovered on imaging after completion of systemic treatment, or alternatively as a targeted treatment of selective metastases found to be progressive on systemic treatment. The primary endpoint was the time to untreatable progression (TTUP), recorded as the time elapsed between the first PTA and the re-initiation of systemic chemotherapy to treat disease progression. Secondary endpoints were overall survival, the 1, 3 and 5-year survival rates, and local control rate. RESULTS A total of 93 LMS metastases (average diameter 18.2 mm, range 3-45 mm) were successfully treated in 30 patients over 50 treatment sessions with a median follow-up of 34.6 months. The median TTUP was 14.2 months (range 2.4-122.8). The median overall survival after PTA was 48.3 months and the 1, 3 and 5-year overall survival rates were 96.7% (95%CI 84.3-100.0%), 62.0% (95%CI 45.8-84.0%), and 28.3% (95%CI 13.5-59.1%) respectively. Local control rate at 1 year was 95.2% and at 3 years was 89.4%. CONCLUSION Iterative PTA is an effective treatment line option for appropriately selected patients with metastatic LMS that can delay re-initiation of systemic chemotherapy.
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Affiliation(s)
- G Gravel
- Interventional Radiology Department, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France.
| | - S Yevich
- Interventional Radiology Department, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - L Tselikas
- Interventional Radiology Department, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - O Mir
- Department of Cancer Medicine, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - C Teriitehau
- Interventional Radiology Department, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - T De Baère
- Interventional Radiology Department, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France; Université Paris-Sud XI, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - F Deschamps
- Interventional Radiology Department, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
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Surgical management of lung, liver and brain metastases from gynecological cancers: a literature review. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2016; 3:7. [PMID: 27330821 PMCID: PMC4912748 DOI: 10.1186/s40661-016-0028-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/03/2016] [Indexed: 12/28/2022]
Abstract
Background The management of patients with recurrent gynecological malignancy is complex, and often contentious. While historically, patients with metastases in the lungs, liver or brain have been treated with palliative intent, surgery is proving to have an increasing role in the management of such patients. Methods In this review article, the surgical management of lung, liver and brain metastases from gynecological cancers is examined. A search of the English language literature over the last 25 years was conducted using the Medline and PubMed databases. Results The results for management of metastases from the endometrium, ovary and cervix to the lung, brain and liver show that surprisingly good long-term survival results can be achieved for resection of metastases from all three organs. Patient selection is critical, and surgery is often used in conjunction with other treatment modalities. Conclusions From this review, it is apparent that surgery should play an increasing role in the management of patients with parenchymal metastases from gynecological cancers. The surgery should ideally be performed in high volume, tertiary centers where there is a committed multi-disciplinary team with the necessary infrastructure to achieve the best possible outcomes in terms of both survival and morbidity.
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Blumenfeld P, Sen N, Abrams R, Wang D. Advances in Radiation Therapy for Primary and Metastatic Adult Soft Tissue Sarcomas. Curr Oncol Rep 2016; 18:36. [DOI: 10.1007/s11912-016-0523-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Uterine leiomyosarcoma (uLMS) is a rare mesenchymal tumor of the gynecologic tract. Although diagnosed in only 1-3% of patients with uterine cancer, uLMS accounts for the majority of uterine cancer-related deaths. The standard of care for patients with uLMS includes total hysterectomy and bilateral salpingo-oophorectomy (BSO). There are no standard recommendations regarding adjuvant or palliative therapy. Many cytotoxic and targeted agents have been studied in clinical trials in an effort to identify an effective therapy that may alter the natural history of this disease. Unfortunately, as of now, there are no adjuvant therapy regimens that improve overall survival in this patient population. There is, therefore, an unmet need to identify a novel therapy that will improve the survival of women diagnosed with this aggressive disease. Here we summarize the existing literature on adjuvant therapy in uLMS, specifically highlighting advances made in the last 5 years.
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Affiliation(s)
- Jennifer A Ducie
- a Gynecology Service, Department of Surgery , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Mario M Leitao
- a Gynecology Service, Department of Surgery , Memorial Sloan Kettering Cancer Center , New York , NY , USA
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Abstract
ObjectiveThe main purpose of this article is to explore the current practice for follow-up of gynecological cancer, pointing out the different procedures, to determine the most clinically and cost-effective surveillance strategies after the primary treatment.Materials and MethodsWe analyzed the follow up strategies for ovarian, endometrial, and cervical cancer. All of the topics discussed below arose from the “ESGO State of Art Conference—Follow-up in gynaecological malignancies” in Turin, (September 11–13, 2014;http://torino2014.esgo.org/).ResultsPhysical but these practices should be integrated with biomarkers or imaging strategies. Currently, most recommendations about follow-up are based on retrospective studies and expert opinion, and there is some disagreement on surveillance strategies due to lack of evidence-based knowledge.ConclusionsAll surveillance procedures should be evidence-based with a clearly defined purpose: there is a need for prospective studies to compare the effectiveness of different follow-up regimens measuring overall survival, detection of recurrence, quality of life (QoL), and costs as outcomes.
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Gynecologic Cancer InterGroup (GCIG) consensus review: uterine and ovarian leiomyosarcomas. Int J Gynecol Cancer 2015; 24:S61-6. [PMID: 25341583 DOI: 10.1097/igc.0000000000000261] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES The Gynecologic Cancer InterGroup aimed to provide an overview of uterine and ovarian leiomyosarcoma management. METHODS Published articles and author experience were used to draft management overview. The draft manuscript was circulated to international members of the Gynecologic Cancer InterGroup for review and comment, and appropriate revisions were made. RESULTS The approach to management of uterine and ovarian leiomyosarcoma management is reviewed. CONCLUSIONS Uterine and ovarian leiomyosarcomas are rare and aggressive cancers that require specialized expertise for optimal management.
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Treating metastatic sarcomas locally: A paradoxe, a rationale, an evidence? Crit Rev Oncol Hematol 2015; 95:62-77. [DOI: 10.1016/j.critrevonc.2015.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/28/2014] [Accepted: 01/06/2015] [Indexed: 01/04/2023] Open
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Clinical outcomes of women with recurrent or persistent uterine leiomyosarcoma. Int J Gynecol Cancer 2015; 24:1434-40. [PMID: 25248114 DOI: 10.1097/igc.0000000000000221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This study aimed to identify prognostic factors influencing the outcome of recurrent or persistent uterine leiomyosarcoma (ULMS). METHODS All patients with recurrent or persistent ULMS who underwent treatment at the participating institutions between January 2000 and December 2010 were identified from the tumor registry. The Kaplan-Meier method was used to generate overall survival data. Factors predictive of outcome were compared using the log-rank test and Cox proportional hazards model. RESULTS One hundred fifteen (68.8%) patients who had recurrent/persistent disease were identified, 40 (34.8%) had persistent disease, and 75 (65.2%) had a recurrence. Median follow-up time was 24.9 months. The 5-year postrelapse survival rate was 15% and was not significantly different between women with recurrent or persistent disease (16% vs 13%; P = 0.1). Variables identified affecting the 5-year postrelapse survival rate included low number of mitosis at the time of diagnosis (<25, 25% vs 5%; P = 0.002), time to relapse from original diagnosis (≤6 vs >6 months, 8% vs 22%; P = 0.003)), and surgical treatment (17% vs 12%; P = 0.01). Age, stage, chemotherapy at time of original diagnosis or at the time of relapse, site of recurrence, and single versus multiple sites of recurrence were not associated with survival. In a multivariate Cox regression model, only low number of mitosis (hazard ratio, 0.5; 95% confidence interval, 0.3-0.8, P = 0.02) was identified as a predictor of overall survival. CONCLUSIONS The prognosis of patients with recurrent/persistent ULMS is, in general, poor. Women who have low number of mitosis at the time of diagnosis seemed to have better postrelapse survival.
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Navarria P, Ascolese AM, Cozzi L, Tomatis S, D'Agostino GR, De Rose F, De Sanctis R, Marrari A, Santoro A, Fogliata A, Cariboni U, Alloisio M, Quagliuolo V, Scorsetti M. Stereotactic body radiation therapy for lung metastases from soft tissue sarcoma. Eur J Cancer 2015; 51:668-74. [PMID: 25686482 DOI: 10.1016/j.ejca.2015.01.061] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 01/17/2015] [Accepted: 01/22/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE To appraise the role of stereotactic body radiation therapy (SBRT) in patients with lung metastasis from primary soft tissue sarcoma. METHODS Twenty-eight patients (51 lesions) were analysed. All patients were in good performance status (1-2 eastern cooperative oncology group (ECOG)), unsuitable for surgical resection, with controlled primary tumour and the number of lung metastases was ⩽4. In a risk adaptive scheme, the dose prescription was: 30Gy/1fr, 60Gy/3fr, 60Gy/8fr and 48Gy/4fr. Treatments were performed with Volumetric Modulated Arc Therapy. Clinical outcome was evaluated by thoracic and abdominal computed tomography (CT) scan before SBRT and than every 3months. Toxicity was evaluated with Common Terminology Criteria for Adverse Events (CTCAE) scale version 4.0. RESULTS Leiomyosarcoma (36%) and synovial sarcoma (25%) were the most common histologies. Five patients (18%) initially presented with pulmonary metastasis, whereas 23 (82%) developed them at a median time of 51months (range 11-311months) from the initial diagnosis. The median follow-up time from initial diagnosis was 65months (5-139months) and from SBRT was 21months (2-80months). No severe toxicity (grades III-IV) was recorded and no patients required hospitalisation. The actuarial 5-years local control rate (from SBRT treatment) was 96%. Overall survival at 2 and 5years was 96.2% and 60.5%, respectively. At last follow-up 15 patients (54%) were alive. All other died because of distant progression. CONCLUSIONS SBRT provides excellent local control of pulmonary metastasis from soft tissue sarcoma (STS) and may improve survival in selected patients. SBRT should be considered for all patients with pulmonary metastasis (PM) and evaluated in a multidisciplinary team.
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Affiliation(s)
- Pierina Navarria
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - Anna Maria Ascolese
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - Luca Cozzi
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy.
| | - Stefano Tomatis
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - Giuseppe Roberto D'Agostino
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - Fiorenza De Rose
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - Rita De Sanctis
- Oncology and Haematology Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - Andrea Marrari
- Oncology and Haematology Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - Armando Santoro
- Oncology and Haematology Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - Antonella Fogliata
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - Umberto Cariboni
- Thoracic Surgery Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - Marco Alloisio
- Thoracic Surgery Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - Vittorio Quagliuolo
- General Surgery Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - Marta Scorsetti
- Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
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Treasure T, Mineo T, Ambrogi V, Fiorentino F. Survival is higher after repeat lung metastasectomy than after a first metastasectomy: Too good to be true? J Thorac Cardiovasc Surg 2015; 149:1249-52. [PMID: 25802136 DOI: 10.1016/j.jtcvs.2015.01.067] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/17/2015] [Accepted: 01/29/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, United Kingdom.
| | - Tommaso Mineo
- Thoracic Surgery, Policlinic Tor Vergata University, Rome, Italy
| | - Vincenzo Ambrogi
- Thoracic Surgery, Policlinic Tor Vergata University, Rome, Italy
| | - Francesca Fiorentino
- Francesca Fiorentino Cardiothoracic Surgery, National Heart and Lung Institute Imperial College London, London, United Kingdom
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Abstract
PURPOSE OF REVIEW The purpose of this article is to review current evidence-based management strategies for patients with recurrent and metastatic uterine leiomyosarcoma (LMS). We will focus on treatment of advanced multifocal disease as well as new developments in targeted cancer therapies. RECENT FINDINGS The management of patients with advanced uterine LMS is divided between those with localized and those with disseminated disease. Selected patients with localized or single-organ oligometastatic disease may benefit from surgical resection. For patients with disseminated disease, fixed-dose-rate gemcitabine plus docetaxel is an appropriate first-line chemotherapy regimen. Other active cytotoxic agents include doxorubicin, ifosfamide, and dacarbazine. The role of trabectedin (approved by the European Medicine Agency to be marketed for advanced or metastatic soft tissue sarcoma) is being explored. Trials are also underway for targeted therapy in uterine LMS. Currently, the only approved targeted therapy for advanced soft tissue sarcoma is pazopanib. In patients with small volume and slowly progressive estrogen receptor/progesterone receptor-positive disease, antiestrogen therapy with an aromatase inhibitor is a reasonable alternative to observation alone. SUMMARY Despite recent advances, overall survival for advanced disease remains poor and identification of novel agents with activity in LMS is clearly needed.
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Fiorentino F, Treasure T. Pulmonary metastasectomy: a call for better data collection, presentation and analysis. Future Oncol 2015; 11:19-23. [PMID: 25662323 DOI: 10.2217/fon.14.263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A systematic review of the literature for outcomes in pulmonary metastasectomy has revealed the variability in reporting and the paucity of data that would allow a clear understanding of the effectiveness of this operation. The authors, a surgeon and a mathematician, start from the experience of assessing the evidence on which the practice of pulmonary metastasectomy is based and give some simple examples on a more adequate approach to the collection and analysis of surgical data and the importance of its correct interpretation. Retrospective data analysis is constrained by the availability of data. While this can give insight on certain aspects, it is important to discern what data are necessary to give a complete understanding of the effectiveness of a practice. Typically well designed prospective studies and randomised controlled trials with a pre-specified data collection plan give more complete, consistent and reliable data than follow-up or retrospective studies. Pulmonary metastasectomy lends itself well as an example of practice based on uncertain evidence and biased reporting. All the available published studies are follow-up studies, there is no randomised controlled trial, so no control data to estimate its treatment effect on patient's survival. The pool of colorectal or sarcoma patients from which patients are selected to have a pulmonary metastasectomy is never reported on, thus it is hard to estimate the degree of selection and the influence of the surgeon's decision.
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Abstract
INTRODUCTION Pharmacological treatment plays a major role in the management of advanced, persistent or recurrent uterine leiomyosarcoma (LMS), whereas its usefulness in the adjuvant setting is still debated. A thorough literature search was undertaken using the Pubmed databases. Systematic reviews and controlled trials on medical treatment of uterine LMS were collected and critically analyzed. Other study types were secondarily considered when pertinent. AREAS COVERED Doxorubicin (DOX), ifosfamide and dacarbazine have been long used in the treatment of this malignancy. Novel active agents are represented by gemcitabine, docetaxel, trabectedin, pazopanib and aromatase inhibitors, whereas the role of eribulin, bevacizumab, aflibercept and mammalian target of rapamycin inhibitors is still investigational. EXPERT OPINION DOX alone, gemcitabine alone, DOX + dacarbazine and gemcitabine + docetaxel may be treatment options for first-line and second-line therapies. However, the clinical benefit of the combination chemotherapy versus single-agent chemotherapy is still debated. Trabectedin is a promising agent for recurrent uterine LMS, able to obtain a prolonged disease control, with 3-month and 6-month progression-free survival rates exceeding 50 and 30%, respectively, and with sometimes unexpectedly durable responses. Pazopanib is the only approved targeted therapy. Hormone therapy with aromatase inhibitors may be a therapeutic option in heavily treated patients with slowly progressive, steroid receptor-positive tumors. Whenever possible, women with recurrent uterine LMS should be encouraged to enter well-designed clinical trials aimed to detect novel active agents.
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Affiliation(s)
- Angiolo Gadducci
- University of Pisa, Division of Gynecology and Obstetrics, Department of Experimental and Clinical Medicine , Via Roma 56, Pisa, 56127 , Italy +39 50 992609 ; +39 50 992354 ;
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Reza J, Sammann A, Jin C, Horvai A, Hudnall M, Jablons DM, Jahan T, Kornak J, Mann MJ. Aggressive and minimally invasive surgery for pulmonary metastasis of sarcoma. J Thorac Cardiovasc Surg 2014; 147:1193-200; discussion 1200-1. [DOI: 10.1016/j.jtcvs.2013.12.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 08/06/2013] [Accepted: 12/09/2013] [Indexed: 10/25/2022]
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Treasure T, Milošević M, Fiorentino F, Macbeth F. Pulmonary metastasectomy: what is the practice and where is the evidence for effectiveness? Thorax 2014; 69:946-9. [PMID: 24415715 PMCID: PMC4174129 DOI: 10.1136/thoraxjnl-2013-204528] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pulmonary metastasectomy is a commonly performed operation and is tending to increase as part of a concept of personalised treatment for advanced cancer. There have been no randomised trials; belief in effectiveness of metastasectomy is based on registry data and surgical follow-up studies. These retrospective series are comprised predominately of solitary or few metastases with primary resection to metastasectomy intervals longer than 2-3 years. Five-year survival rates of 30-50% are recorded, but as case selection is based on favourable prognostic features, an apparent association between metastasectomy and survival cannot be interpreted as causation. Cancers for which lung metastasectomy is used are considered in four pathological groups. In non-seminomatous germ cell tumour, for which chemotherapy is highly effective, excision of residual pulmonary disease guides future treatment and in particular allows an informed decisions as to further chemotherapy. Sarcoma metastasises predominately to lung and pulmonary metastasectomy for both bone and soft tissues sarcoma is routinely considered as a treatment option but without randomised data. The commonest circumstance for lung and liver metastasectomy is colorectal cancer. Repeated resections and ablations are commonplace but without evidence of effectiveness for either. For melanoma, results are particularly poor, but lung metastases are resected when no other treatment options are available. In this review, the available evidence is considered and the conclusion reached is that in the absence of randomised trials there is uncertainty about effectiveness. A randomised controlled trial, Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC), is in progress and randomised trials in sarcoma seem warranted.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | - Mišel Milošević
- Clinic for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Francesca Fiorentino
- Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College London, London, UK
| | - Fergus Macbeth
- Wales Cancer Trials Unit, Cardiff University, Cardiff, UK
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Ripley RT, Downey RJ. Pulmonary metastasectomy. J Surg Oncol 2013; 109:42-6. [PMID: 24301202 DOI: 10.1002/jso.23450] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 09/10/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Robert T Ripley
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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Treasure T, Milošević M, Migliore M, Lees B. Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC International). COLORECTAL CANCER 2013. [DOI: 10.2217/crc.13.61] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
SUMMARY Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) is a randomized controlled trial. Patients with resected colorectal cancer found to have one or more pulmonary metastases are randomized to have a metastasectomy or not. Both arms include active monitoring. Patients considered possible candidates for pulmonary metastasectomy are asked to first give consent to be assessed according to protocol after which a decision to have or not have metastasectomy may be made. If there is uncertainty, patients are invited to consent to randomization, including minimization for known prognostic factors: the number of metastases, the interval since primary resection, carcinoembryonic antigen levels and the TNM stage of the primary cancer. The primary outcomes are survival and quality of life. The trial is open in England, and in Serbia and Italy as PulMiCC International.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | - Mišel Milošević
- Clinic for Thoracic Surgery, Institute for Pulmonary Diseases of Vojvodina, University of Novi Sad, Serbia
| | - Marcello Migliore
- Department of Thoracic Surgery, Policlinico Hospital Catania, University of Catania, Catania, Italy
| | - Belinda Lees
- Clinical Trials & Evaluation Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
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Treasure T, Møller H, Fiorentino F, Utley M. Forty years on: pulmonary metastasectomy for sarcoma. Eur J Cardiothorac Surg 2013; 43:799-800. [PMID: 23509342 DOI: 10.1093/ejcts/ezs448] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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50
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Clinical indications and results after chest wall resection for recurrent mesothelioma. J Thorac Cardiovasc Surg 2013; 146:1373-9; discussion 1379-80. [PMID: 24113019 DOI: 10.1016/j.jtcvs.2013.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 05/24/2013] [Accepted: 07/03/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The ipsilateral hemithorax is the most common site of recurrence after surgical resection for malignant pleural mesothelioma. Salvage treatment has generally been ineffective. We reviewed the outcomes after resection of isolated ipsilateral chest recurrence after cytoreductive surgery in patients with malignant pleural mesothelioma. METHODS Patients with malignant pleural mesothelioma who underwent initial surgical resection at our institution from 1988 to 2011 and were subsequently treated for localized recurrence with an additional chest resection were identified and their data retrospectively reviewed. RESULTS A total of 1142 patients underwent either extrapleural pneumonectomy (n = 794) or pleurectomy/decortication (n = 348). Of the patients who returned for follow-up, 47 (4.1%) had chest wall recurrence amenable to resection. The location of recurrence was predominantly incisional (49%) and/or costophrenic (38%). The median time to recurrence after either extrapleural pneumonectomy or pleurectomy/decortication was 16.1 months (range, 2.7-58.2). No 30-day mortality was found for chest wall resection, and the median length of stay in the hospital was 3 days (range, 0-12). The median overall survival duration after chest wall resection correlated positively with the time to recurrence (epithelial: median, 8.9, 17.2, and 35.8 months for a time to recurrence of <12, 12 to <24, and ≥24 months, respectively; biphasic: median, 2.7 and 15.9 months for a time to recurrence of <10 and ≥10 months, respectively). CONCLUSIONS Chest wall resection is a safe and effective therapeutic option in the management of localized chest wall recurrence of malignant pleural mesothelioma. The time to recurrence appears to be predictive of the expected survival benefit in both epithelial and biphasic malignant pleural mesothelioma.
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