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Farzaliyev F, Steinau HU, Ring A, Hamacher R, Thiel T, Lauer H, Podleska LE. Outcome of Surgery as Part of Palliative Care of Patients with Symptomatic Advanced or Metastatic Extra-Abdominal High-Grade Soft Tissue Sarcoma. Palliat Med Rep 2023; 3:64-70. [PMID: 36941924 PMCID: PMC10024585 DOI: 10.1089/pmr.2022.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 03/19/2023] Open
Abstract
Background The modern multimodal treatment of malignant tumors has increased disease-specific survival and decreased the burden of tumor-associated complications. The main focus of palliative surgery is not based primarily on quantitative success parameters of tumor response but is instead mainly on the question of quality of life. Aim The current study was conducted to analyze the clinical and oncological outcomes of palliative patients with soft tissue sarcoma. Design Of 309 patients with extra-abdominal high-grade soft tissue sarcoma treated between August 2012 and December 2014, our retrospective analysis revealed 33 palliative patients for this study. All patients were evaluated and managed by a multidisciplinary team with expertise and experience in sarcoma treatment. The survival analysis was made using the Kaplan-Meier method. Results The main sarcoma symptoms were pain (27.3%) and ulcerated tumors or shortly before ulceration (24.2%). Thirteen patients (39.4%) were operated on with negative margins, 15 (45.5%) with positive margins, 2 with tumor debulking (6.1%), and 3 patients (9.1%) were treated only with palliative hyperthermic isolated limb perfusion. Ten pedicle flaps were performed after sarcoma resection. The median operation time was 85 minutes (range, 37-216 minutes). The median hospitalization stay was 9.5 days (range, 3-27 days). No patients died during hospitalization. Twelve-month disease-free survival was 48.5% (95% confidence interval: 45.4-51.6). Conclusions Palliative surgery of metastatic or advanced soft tissue sarcoma can improve the wound care and quality of life. Closed noninfected wounds enable further treatment options, such as chemotherapy, immunotherapy, and radiotherapy. This surgery should be considered during the discussion on interdisciplinary tumor boards.
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Affiliation(s)
- Farhad Farzaliyev
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Klinik, Eberhard Karls University, Tuebingen, Germany
- Address correspondence to: Farhad Farzaliyev, MD, Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Klinik, Eberhard Karls University Tuebingen, Schnarrenbergstraße 95, Tübingen 72076, Germany, ,
| | - Hans-Ulrich Steinau
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, Essen, Germany
| | - Andrej Ring
- Department of Plastic and Reconstructive Surgery, St. Rochus Hospital, Castrop-Rauxel, Germany
| | - Rainer Hamacher
- Department of Medical Oncology, Sarcoma Center, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Tobias Thiel
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Klinik, Eberhard Karls University, Tuebingen, Germany
| | - Henrik Lauer
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Klinik, Eberhard Karls University, Tuebingen, Germany
| | - Lars Erik Podleska
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, Essen, Germany
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Sardi A, Sipok A, Baratti D, Deraco M, Sugarbaker P, Salti G, Yonemura Y, Sammartino P, Glehen O, Bakrin N, Díaz-Montes TP, Gushchin V. Multi-institutional study of peritoneal sarcomatosis from uterine sarcoma treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Eur J Surg Oncol 2017; 43:2170-2177. [PMID: 28967566 DOI: 10.1016/j.ejso.2017.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/11/2017] [Accepted: 08/23/2017] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Uterine sarcoma (US) is a rare tumor representing 1% of female genital tract malignancies. Peritoneal sarcomatosis (PS) after US, diminishes median overall survival (OS) and progression-free survival (PFS) with cytoreductive surgery (CRS) alone, with or without systemic chemotherapy is <1 year and 6 months, respectively. A multi-institutional review of PS from US was conducted to evaluate CRS and hyperthermic intraperitoneal chemotherapy (HIPEC) and effects on survival outcomes. METHODS A retrospective review of 36 patients from 7 specialized international centers was performed. Selection criteria included PS of uterine origin with CRS/HIPEC treatment. Clinical data were analyzed. OS and PFS were estimated with Kaplan-Meier method. RESULTS Thirty-six patients underwent a total 38 HIPEC procedures performed from 2005 to 2014; 35 previous treatment and 1 primary treatment. Twenty-nine (81%) LMS patients, 3 (8%) endometrial stromal sarcoma (ESS), 3 (8%) adeneosarcoma (AS), and 1 (3%) categorized as other. Median PCI was 16 (range: 2-39), 10 patients had PCI ≥20. Thirty-four patients (94%) had complete cytoreduction (CC 0-1), 19 patients recurred. CRS/HIPEC OS at 1, 3, and 5-years was 75%, 53%, and 32% respectively, with median OS of 37 months (CI 95%: 20-54). PFS in 32 patients with CC at 1, 3, and 5-years was 67%, 32% and 32%, respectively with median PFS of 18.9 months (CI 95%: 6.7-31). CONCLUSIONS CRS/HIPEC is a promising treatment modality for patients with PS. Histological subtype may influence survival. A global prospective registry of patients to further assess the efficacy of CRS/HIPEC is needed.
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Affiliation(s)
- Armando Sardi
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, 227 St. Paul Place, Baltimore, MD, 21202, USA.
| | - Arkadii Sipok
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, 227 St. Paul Place, Baltimore, MD, 21202, USA.
| | - Dario Baratti
- Fondazione IRCCS Istituto Nazionale Dei Tumori di Milano, Department of Surgery, Peritoneal Surface Malignancies Program, Via Venezian, 1, Milano, MI Cap 20133, Italy.
| | - Marcello Deraco
- Fondazione IRCCS Istituto Nazionale Dei Tumori di Milano, Department of Surgery, Peritoneal Surface Malignancies Program, Via Venezian, 1, Milano, MI Cap 20133, Italy.
| | - Paul Sugarbaker
- Department of Surgery, MedStar Washington Hospital Center, 106 Irving St NW, Washington, DC 20010, USA.
| | - George Salti
- Division of Surgical Oncology, University of Illinois at Chicago Hospital and Health Sciences System, 1740 W Taylor St, Chicago, Illinois, 60612, USA.
| | - Yutaka Yonemura
- Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka, 596-8522, Japan.
| | - Paolo Sammartino
- Department of Surgery Pietro Valdoni, Sapienza University of Rome, 5 Piazzale Aldo Moro, Rome, 00185, Italy.
| | - Olivier Glehen
- Department of General and Oncologic Surgery, Centre Hospitalier Lyon Sud, 69495, Pierre Bénite, France.
| | - Naoual Bakrin
- Department of General and Oncologic Surgery, Centre Hospitalier Lyon Sud, 69495, Pierre Bénite, France.
| | - Teresa P Díaz-Montes
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, 227 St. Paul Place, Baltimore, MD, 21202, USA.
| | - Vadim Gushchin
- Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, 227 St. Paul Place, Baltimore, MD, 21202, USA.
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Chao AH, Mayerson JL, Chandawarkar R, Scharschmidt TJ. Surgical management of soft tissue sarcomas: extremity sarcomas. J Surg Oncol 2014; 111:540-5. [PMID: 25335973 DOI: 10.1002/jso.23810] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/08/2014] [Indexed: 11/06/2022]
Abstract
Wide surgical resection is the recommended treatment for extremity soft tissue sarcomas. Chemotherapy and/or radiotherapy may improve local control, but with marginal effect on overall survival. Advanced reconstructive techniques and multidisciplinary care, including plastic surgery, may allow a higher rate of limb salvage. This report focuses on surgical and reconstructive aspects in the multimodality care of extremity sarcomas.
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Affiliation(s)
- Albert H Chao
- Department of Plastic Surgery, The Ohio State University, Columbus, Ohio
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