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Rodrigues C, Peretz Soroka H, Pierro A, Baertschiger RM, Cypel M, Donahoe L, Tsang DS, Cho J, De Perrot M, Waddell TK, Gupta AA. Extra-Pleural Pneumonectomy (EPP) in Children and Adults with Locally Advanced Sarcoma: A CanSaRCC Study. Curr Oncol 2022; 29:4260-4266. [PMID: 35735449 PMCID: PMC9221731 DOI: 10.3390/curroncol29060340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Extra-pleural pneumonectomy (EPP) involves the removal of the parietal and visceral pleura, ipsilateral lungs, pericardium, and hemi diaphragm. In patients with advanced sarcoma in the pleura, EPP is often the only option for local control. The aim of our study was to review our institutional experience with EPP. Of ten patients in our study, five were alive without disease at last follow-up after multi-modality therapy including EPP. Two patients had local recurrence and died of progressive disease. One patient died of brain metastasis, one patient died of radiation induced sarcoma, and one patient died of surgical complications. Our results suggest that EPP is a feasible option for patients when used in combination with chemotherapy and radiation. Moreover, high-volume cancer centers should discuss the use of EPP during tumor board discussion. Abstract Sarcoma can present as locally advanced disease involving pleura for which extra-pleural pneumonectomy (EPP) may be the only surgical option to ensure adequate local control. Data were collected on patients who underwent EPP between January 2009 and August 2021 at Princess Margret Hospital and SickKids (Toronto) using the CanSaRCC (Canadian Sarcoma Research and Clinical Collaboration). Ten patients with locally advanced sarcoma involving the pleura, aged 4 to 59 years (median 19.5 years) underwent EPP. Nine (90%) received pre-operative chemotherapy and eight (80%) achieved an R0 resection. Hemithoracic radiation was administered preoperatively (n = 6, 60%) or postoperatively (n = 4, 40%). Five (50%) patients were alive without disease at last follow-up (median 34.2 months) and time from EPP to last FU was median 29.2 months (range 2.2–87.5). Two patients (20%) had local recurrence, 4.3 and 5.8 months from EPP, and both died from progressive disease, 13.1 and 8.2 months from EPP, respectively. One patient died from brain metastasis (17 months), one died from radiation associated osteosarcoma (66 months), and one died from surgical complications (heart failure from constrictive pericarditis). EPP offers a feasible and life-prolonging surgical consideration for patients with locally advanced sarcoma involving the pleura in combination with chemotherapy and radiation. Consequently, EPP should be considered during multi-disciplinary tumor board discussions at high-volume centers.
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Affiliation(s)
- Caroline Rodrigues
- Division of Medical Oncology, Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC), Princess Margaret Cancer Centre—University Health Network, Toronto, ON M5G 2C1, Canada; (C.R.); (H.P.S.)
| | - Hagit Peretz Soroka
- Division of Medical Oncology, Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC), Princess Margaret Cancer Centre—University Health Network, Toronto, ON M5G 2C1, Canada; (C.R.); (H.P.S.)
| | - Agostino Pierro
- Division of General Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada; (A.P.); (R.M.B.)
| | - Reto M. Baertschiger
- Division of General Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada; (A.P.); (R.M.B.)
| | - Marcelo Cypel
- Division of Thoracic Surgery, Toronto General Hospital—University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (M.C.); (L.D.); (M.D.P.); (T.K.W.)
| | - Laura Donahoe
- Division of Thoracic Surgery, Toronto General Hospital—University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (M.C.); (L.D.); (M.D.P.); (T.K.W.)
| | - Derek S. Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C1, Canada; (D.S.T.); (J.C.)
| | - John Cho
- Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2C1, Canada; (D.S.T.); (J.C.)
| | - Marc De Perrot
- Division of Thoracic Surgery, Toronto General Hospital—University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (M.C.); (L.D.); (M.D.P.); (T.K.W.)
| | - Thomas K. Waddell
- Division of Thoracic Surgery, Toronto General Hospital—University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada; (M.C.); (L.D.); (M.D.P.); (T.K.W.)
| | - Abha A. Gupta
- Division of Medical Oncology, Canadian Sarcoma Research and Clinical Collaboration (CanSaRCC), Princess Margaret Cancer Centre—University Health Network, Toronto, ON M5G 2C1, Canada; (C.R.); (H.P.S.)
- Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
- Correspondence: ; Tel.: +1-416-946-2252; Fax: +1-416-946-6546
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Patel PB, Sankrith M, Cedeno-Rodriguez A. Pediatric pleuropulmonary synovial sarcoma: A case report in a recurrent spontaneous pneumothorax. Respir Med Case Rep 2022; 36:101622. [PMID: 35256996 PMCID: PMC8897704 DOI: 10.1016/j.rmcr.2022.101622] [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: 10/01/2021] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 11/08/2022] Open
Abstract
Pleuropulmonary Synovial Sarcoma is a rare lung cancer with a prevalence of <1% among all lung cancers. Little is known about the clinical presentation, disease process, and appropriate treatment. Here we present a 9-year-old male who was taken to the operating room for pleurodesis and blebectomy due to a recurrent spontaneous pneumothorax. Final pathology showed a bleb with an associated mass positive for Pleuropulmonary synovial sarcoma.
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Sabath B, Muhammad HA, Balagani A, Ost DE, Vakil E, Ahmed T, Vial MR, Grosu HB. Secondary spontaneous pneumothorax in patients with sarcoma treated with Pazopanib, a case control study. BMC Cancer 2018; 18:937. [PMID: 30285733 PMCID: PMC6167904 DOI: 10.1186/s12885-018-4858-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/26/2018] [Indexed: 11/16/2022] Open
Abstract
Background The tyrosine kinase inhibitor pazopanib is used for treatment of sarcoma. Recent studies have suggested that the use of pazopanib may lead to the development of pneumothorax, an unexpected adverse effect in patients with sarcoma metastatic to the chest. Methods We conducted a retrospective case control study of patients with sarcoma with metastases to the chest with pneumothorax (cases) and without pneumothorax (controls). The control population was selected from tumor registry in a 1:4 (cases to controls) ratio. The primary outcome of interest was the association between pazopanib and pneumothorax risk in patients with sarcoma metastatic to the chest. Secondary objective was to evaluate risk factors for pneumothorax. Results We identified 41 cases and 164 controls. Using purposeful selection method the odds of developing pneumothorax while being on pazopanib was not significant in univariate (p = .06) and multivariable analysis (p = .342). On univariate analysis risk factors of pneumothorax in patients with sarcoma were age, male sex, African American race, the presence of cavitary lung nodules/masses, and the presence of pleural-based nodules/masses. On multivariate analysis, only the presence of cavitary lung nodules/masses (P < .001) and the presence of pleural-based nodules/masses (P < .001) remained as risk factors for developing pneumothorax. Conclusion Pazopanib does not increase the risk of pneumothorax in patients with sarcoma and evidence of metastatic disease to the chest. Presence of cavitary lung nodules/masses and the presence of pleural-based nodules/masses were found to be risk factors for pneumothorax.
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Affiliation(s)
- Bruce Sabath
- Department of Pulmonary Medicine, Unit 1462, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Hasan A Muhammad
- Department of Pulmonary Medicine, Unit 1462, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Amulya Balagani
- Department of Pulmonary Medicine, Unit 1462, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - David E Ost
- Department of Pulmonary Medicine, Unit 1462, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Erik Vakil
- Department of Pulmonary Medicine, Unit 1462, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Tahreem Ahmed
- Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Macarena R Vial
- Universidad del Desarrollo Clinica Alemana de Santiago, Santiago, Chile
| | - Horiana B Grosu
- Department of Pulmonary Medicine, Unit 1462, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
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An extremely rare lung tumor of a young adult: Primary synovial sarcoma. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:157-160. [PMID: 32082727 DOI: 10.5606/tgkdc.dergisi.2018.13765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 03/10/2017] [Indexed: 11/21/2022]
Abstract
Primary lung sarcoma is an extremely rare tumor accounting for less than 0.5% of all malignant lung tumors. Diagnosis is mostly established postoperatively. In this article, we present a 29-yearold male patient with a lobulated and well-marginated mass in the lower lobe of the right lung. A diagnosis of monophasic fibrous synovial sarcoma of the lung was established after right lower lobectomy. Resection margins were tumor-free. Postoperative positron-emission tomography/computed tomography did not show any other primary or metastatic focus. Despite the lack of a preoperative diagnosis, the advised treatment in such tumors is complete resection ensuring tumor-free surgical margins.
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