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Tattersall HL, Baia M, Messina V, Borghi A, Tirotta F, Almond M, Desai A, Ford SJ, Gronchi A. Overall survival in abdominal wall sarcoma treated with curative intent surgery: A retrospective study from two European referral centres. J Surg Oncol 2022; 126:365-371. [PMID: 35333402 DOI: 10.1002/jso.26867] [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: 11/22/2021] [Revised: 02/19/2022] [Accepted: 03/11/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Primary abdominal wall sarcomas are rare, heterogeneous tumours. The mainstay of management is surgery, although local recurrences (LR) and distant metastases (DM) are common. OBJECTIVES Overall survival (OS) and disease-free survival (DFS) were primary outcomes; factors associated with prognosis secondary outcomes. MATERIALS AND METHODS Patients undergoing surgery of primary abdominal wall sarcomas between April 2008 and May 2018 were identified at two referrals centres for sarcoma surgery. Patient demographics, tumour and treatment-related characteristics were recorded and analysed. RESULTS A cohort of 65 patients underwent surgical resection with a median follow-up of 56 months, 5-year OS and DFS were 69% and 71%, respectively. Eleven patients (16.9%) experienced a recurrence event: 6 LR (9.2%), 10 DM (15.4%) and 5 both (7.7%). At univariate analysis, size (p = 0.03), grade (p = 0.001) and depth (p = 0.04) were associated with OS while size (p = 0.02) was associated with DFS. No significant relationship with tumour depth, type of surgery, surgical margin status or neo-/adjuvant treatment was demonstrated. CONCLUSION Recurrence events are less common following treatment of abdominal wall sarcomas if compared to extremities STSs, but size (≥5 cm), high malignancy grade (FNCLCC 3) and depth are associated with worse OS.
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Affiliation(s)
- Hannah L Tattersall
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Marco Baia
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Valentina Messina
- Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori, Sarcoma Service, Milan, Italy
| | - Alessandra Borghi
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Fabio Tirotta
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Max Almond
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Anant Desai
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Samuel J Ford
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Alessandro Gronchi
- Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori, Sarcoma Service, Milan, Italy
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Whitham Z, Blackham A, Loven V. A Case of Primary Duodenal Liposarcoma. Case Rep Oncol 2020; 13:649-654. [PMID: 32774250 PMCID: PMC7383206 DOI: 10.1159/000507479] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 12/11/2022] Open
Abstract
Soft tissue sarcomas are common neoplasms accounting for 1% of all adult malignancies; however, soft tissue sarcomas infrequently arise from the abdominal viscera. Many case reports discuss gastric and esophageal neoplasms. In the group of gastrointestinal liposarcomas, primary duodenal liposarcomas are among the rarest, with only three previous cases reported in the literature. Herein, we discuss a case of primary duodenal liposarcoma. A 59-year-old woman presented with symptoms consistent with anemia raising suspicion for an upper gastrointestinal bleed. Upper endoscopy revealed an ulcerated mass in the first portion of the duodenum. The patient underwent a segmental duodenal resection and distal gastrectomy with Roux-en-Y reconstruction. A diagnosis of dedifferentiated liposarcoma was rendered on the resected specimen. At 16 months' follow-up, the patient remains without evidence of disease recurrence. We have presented a case of primary duodenal liposarcoma, which is among the rarest locations for gastrointestinal sarcomas with only three previous reports in the literature. Liposarcomas should be included in the differential for submucosal masses of the duodenum.
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Affiliation(s)
- Zachary Whitham
- University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Aaron Blackham
- Department of Surgical Oncology, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Victoria Loven
- Department of Pathology, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
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Willis F, Schimmack S, Uhl M, Haefner MF, Mechtersheimer G, Hinz U, Schmidt T, Debus J, Fröhling S, Schneider M. Significance of intraoperative radiation therapy and high cumulative radiation doses in retroperitoneal soft tissue sarcoma. Eur J Surg Oncol 2019; 46:905-913. [PMID: 31892479 DOI: 10.1016/j.ejso.2019.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/24/2019] [Accepted: 12/16/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION In retroperitoneal soft tissue sarcoma (STS) local recurrence (LR) rates remain high despite more aggressive surgical approaches. Since wide resection margins cannot be achieved in all patients, application of intraoperative radiation therapy (IORT) has been frequently discussed. Still, the significance of IORT in multimodal treatment of retroperitoneal STS remains unclear. MATERIAL AND METHODS Patients undergoing resection of primary or recurrent retroperitoneal STS at the University of Heidelberg Department of General, Visceral and Transplantation Surgery were retrospectively analyzed. Univariate Kaplan-Meyer and multivariate Cox regression analyses were performed to identify predictors of LR-free survival and to investigate the impact of IORT and high cumulative radiation doses. Analyses with propensity-score matched subgroups for IORT and cumulative radiation dose were performed to control for selection bias. Subgroup analyses for patients with retroperitoneal liposarcoma were likewise performed. RESULTS 272 patients were identified. Recurrent tumors, histology of dedifferentiated liposarcoma or unclassified sarcoma and microscopically incomplete resection were associated with decreased LR-free survival. In liposarcoma, only recurrent and dedifferentiated tumors were confirmed as poor prognostic factors concerning LR. IORT and cumulative radiation doses exceeding 60 Gy did not influence LR rates (estimated 5-year LR-free survival: IORT: 39%, non-IORT: 46%; p = 0.79). CONCLUSION In this retrospective evaluation, additional application of IORT does not significantly influence oncological outcome in retroperitoneal soft tissue sarcoma. Randomized trials are needed to clarify the benefit of IORT.
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Affiliation(s)
- Franziska Willis
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Simon Schimmack
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Uhl
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - Matthias F Haefner
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | | | - Ulf Hinz
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Schmidt
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - Stefan Fröhling
- Departement of Translation Medical Oncology, National Center for Tumor Diseases Heidelberg and German Cancer Research Center, Heidelberg, Germany
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.
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Trama A, Badalamenti G, Baldi GG, Brunello A, Caira M, Drove N, Marrari A, Palmerini E, Vincenzi B, Dei Tos AP, Grignani G. Soft tissue sarcoma in Italy: From epidemiological data to clinical networking to improve patient care and outcomes. Cancer Epidemiol 2019; 59:258-264. [PMID: 30870746 DOI: 10.1016/j.canep.2019.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 02/07/2019] [Accepted: 02/10/2019] [Indexed: 12/19/2022]
Abstract
Sarcomas are rare malignant neoplasms that develop from mesenchymal cells and include a heterogeneous and large group of histological subtypes that may occur at any anatomical site. Soft tissue sarcomas (STS), the focus of this review, account for ≈70‒80% of sarcomas and represent <1% of all cancers. The heterogeneity of STS applies to both their topography and morphology, and 5-year survival can vary widely depending on disease stage and the complex interplay between anatomical site and histology for different STS subtypes. The rarity and heterogeneity of STS, together with other factors, such as the lack of clinical expertise often lead to difficulties and delays in making an accurate diagnosis and to the inappropriate management of each STS subtype. Therefore, this group of cancers requires special attention and approaches to diagnosis and treatment. Epidemiological data on STS are limited, and concerns have been raised regarding accurate registration of STS in cancer registries, including issues related to details of the histotypes. This review provides an overview of the epidemiology of STS in Italy, focusing on data from the Italian Association of Cancer Registries (AIRTUM), and compares findings with those from other European countries. Based on these data, and considering that STS is among the most common group of rare cancers, the relevance of multidisciplinary care for STS patients through reference centres, clinical networks and collaborative disease-specific groups is discussed.
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Affiliation(s)
- Annalisa Trama
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Giuseppe Badalamenti
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giacomo Giulio Baldi
- 'Sandro Pitigliani' Department of Medical Oncology, Hospital of Prato, Prato, Italy
| | - Antonella Brunello
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | | | | | - Andrea Marrari
- Department of Medical Oncology and Hematology, Humanitas Cancer Center and Research Hospital, IRCCS, Rozzano, Milan, Italy
| | | | - Bruno Vincenzi
- University Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy.
| | | | - Giovanni Grignani
- Division of Medical Oncology Candiolo Cancer Institute - FPO, IRCCS, Strada Provinciale 142, 10060 Candiolo, Torino, Italy
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Lee EM, Kim DH, Kim DY, Seol YM, Choi YJ, Kim H. Efficacy of adjuvant radiotherapy in non-extremity soft tissue sarcoma with moderate chemosensitivity. Radiat Oncol J 2019; 36:325-331. [PMID: 30630271 PMCID: PMC6361253 DOI: 10.3857/roj.2018.00262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/24/2018] [Indexed: 11/21/2022] Open
Abstract
Purpose Soft tissue sarcoma (STS) is a rare and heterogeneous cancer with over 50 known subtypes. It is difficult to understand the role of adjuvant treatment in STS. We aimed to determine the benefits of adjuvant treatment for a rare STS subset: non-extremity STS with moderate chemosensitivity. Materials and Methods We reviewed medical records from Pusan National University Hospital and Kosin University Gospel Hospital, which had detailed pathological reports on patients diagnosed between 2006 and 2016. The most important inclusion criterion was resection with curative intent. We grouped STS by chemosensitivity based on reported data and analyzed non-extremity STS with moderate chemosensitivity. Results We investigated 142 patients with 20 pathological subtypes of STS. Eighty-six patients had extremity STS and 56 had non-extremity STS. Thirty-eight of 56 patients were categorized as having moderate chemosensitivity. Seventeen of 38 patients (44.7%) received adjuvant radiotherapy and 14 (36.8%) received adjuvant chemotherapy. A log-rank test showed longer disease-free survival (DFS) in the adjuvant radiotherapy group than in the group treated without adjuvant radiotherapy (not reached vs. 1.468 years, p = 0.037). Multivariate Cox proportional hazard analysis, with covariates including age, stage, resection margin, adjuvant chemotherapy, and adjuvant radiotherapy, revealed that adjuvant radiotherapy was associated with longer DFS (odds ratio = 0.369, p = 0.045). Overall survival was not correlated with adjuvant radiotherapy. Conclusion Adjuvant radiotherapy may be associated with longer DFS in patients with non-extremity STS with moderate chemosensitivity.
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Affiliation(s)
- Eun Mi Lee
- Division of Hemato-oncology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Dong Hyun Kim
- Department of Radiation Oncology, Pusan National University School of Medicine, Busan, Korea
| | - Do Young Kim
- Division of Hemato-oncology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Young Mi Seol
- Division of Hemato-oncology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Young Jin Choi
- Division of Hemato-oncology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hyojeong Kim
- Division of Hemato-oncology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
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Abstract
PURPOSE OF REVIEW Retroperitoneal sarcomas are rare tumors and with complex treatment. In this manuscript we give an overview of current standards in treatment of this disease and discuss new developments. RECENT FINDINGS Surgery with complete resection of the primary tumor is still the only curative modality. The role of preoperative radiotherapy is not clear and is currently being investigated in a clinical trial. Neo-adjuvant chemotherapy is not the standard of care but can be considered occasionally when complete resection is uncertain. Local and distant recurrent disease carries a dismal prognosis, although long-term survival can be achieved. Liposarcomas tend to recur locally, whereas distant recurrences are more often seen in leiomyosarcoma and other subtypes. Outcome improves when patients are treated in high volume sarcoma centers. In the metastatic setting, newer systemic agents have recently been approved. SUMMARY Treatment of retroperitoneal sarcomas is complex and all patients should be treated in multidisciplinary sarcoma centers. Increasing international collaboration of expert centers in sharing expertise and performing clinical trials might lead to better treatment and improved survival.
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Ajithkumar TV, Hatcher H. Multidisciplinary Management of Sarcomas - Where Are We Now? Clin Oncol (R Coll Radiol) 2017; 29:467-470. [PMID: 28583345 DOI: 10.1016/j.clon.2017.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 05/11/2017] [Accepted: 05/11/2017] [Indexed: 02/07/2023]
Affiliation(s)
- T V Ajithkumar
- Cambridge University Hospitals NHS Trust, Cambridge, UK.
| | - H Hatcher
- Cambridge University Hospitals NHS Trust, Cambridge, UK
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