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Arthur A, Orton MR, Emsley R, Vit S, Kelly-Morland C, Strauss D, Lunn J, Doran S, Lmalem H, Nzokirantevye A, Litiere S, Bonvalot S, Haas R, Gronchi A, Van Gestel D, Ducassou A, Raut CP, Meeus P, Spalek M, Hatton M, Le Pechoux C, Thway K, Fisher C, Jones R, Huang PH, Messiou C. A CT-based radiomics classification model for the prediction of histological type and tumour grade in retroperitoneal sarcoma (RADSARC-R): a retrospective multicohort analysis. Lancet Oncol 2023; 24:1277-1286. [PMID: 37922931 PMCID: PMC10618402 DOI: 10.1016/s1470-2045(23)00462-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Retroperitoneal sarcomas are tumours with a poor prognosis. Upfront characterisation of the tumour is difficult, and under-grading is common. Radiomics has the potential to non-invasively characterise the so-called radiological phenotype of tumours. We aimed to develop and independently validate a CT-based radiomics classification model for the prediction of histological type and grade in retroperitoneal leiomyosarcoma and liposarcoma. METHODS A retrospective discovery cohort was collated at our centre (Royal Marsden Hospital, London, UK) and an independent validation cohort comprising patients recruited in the phase 3 STRASS study of neoadjuvant radiotherapy in retroperitoneal sarcoma. Patients aged older than 18 years with confirmed primary leiomyosarcoma or liposarcoma proceeding to surgical resection with available contrast-enhanced CT scans were included. Using the discovery dataset, a CT-based radiomics workflow was developed, including manual delineation, sub-segmentation, feature extraction, and predictive model building. Separate probabilistic classifiers for the prediction of histological type and low versus intermediate or high grade tumour types were built and tested. Independent validation was then performed. The primary objective of the study was to develop radiomic classification models for the prediction of retroperitoneal leiomyosarcoma and liposarcoma type and histological grade. FINDINGS 170 patients recruited between Oct 30, 2016, and Dec 23, 2020, were eligible in the discovery cohort and 89 patients recruited between Jan 18, 2012, and April 10, 2017, were eligible in the validation cohort. In the discovery cohort, the median age was 63 years (range 27-89), with 83 (49%) female and 87 (51%) male patients. In the validation cohort, median age was 59 years (range 33-77), with 46 (52%) female and 43 (48%) male patients. The highest performing model for the prediction of histological type had an area under the receiver operator curve (AUROC) of 0·928 on validation, based on a feature set of radiomics and approximate radiomic volume fraction. The highest performing model for the prediction of histological grade had an AUROC of 0·882 on validation, based on a radiomics feature set. INTERPRETATION Our validated radiomics model can predict the histological type and grade of retroperitoneal sarcomas with excellent performance. This could have important implications for improving diagnosis and risk stratification in retroperitoneal sarcomas. FUNDING Wellcome Trust, European Organisation for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group, the National Institutes for Health, and the National Institute for Health and Care Research Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research.
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Affiliation(s)
| | | | | | - Sharon Vit
- The Institute of Cancer Research, London, UK
| | | | - Dirk Strauss
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Jason Lunn
- The Institute of Cancer Research, London, UK
| | - Simon Doran
- The Institute of Cancer Research, London, UK
| | - Hafida Lmalem
- The European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Axelle Nzokirantevye
- The European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Saskia Litiere
- The European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | | | - Rick Haas
- The Netherlands Cancer Institute (Antoni Van Leeuwenhoekziekenhuis), Amsterdam, Netherlands
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dirk Van Gestel
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne Ducassou
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Institut Claudius Regaud, Toulouse, France; Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Chandrajit P Raut
- Brigham and Women's Hospital, Boston, MA, USA; Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Mateusz Spalek
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Matthew Hatton
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Khin Thway
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - Cyril Fisher
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Robin Jones
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Christina Messiou
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
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2
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Tortorello GN, Li EH, Sharon CE, Ma KL, Maki RG, Miura JT, Fraker DL, DeMatteo RP, Karakousis GC. Neoadjuvant Chemotherapy in Retroperitoneal Sarcoma: A National Cohort Study. Ann Surg Oncol 2023; 30:6886-6893. [PMID: 37488394 DOI: 10.1245/s10434-023-13933-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Management of retroperitoneal sarcoma (RPS) remains controversial, with the mainstay of treatment being surgery. While neoadjuvant radiation demonstrated no improvement in recurrence-free survival in a prospective randomized trial (STRASS), the role of neoadjuvant chemotherapy (NCT) remains unknown and is the subject of ongoing study (STRASS2). METHODS Patients who underwent surgical resection of high-grade RP leiomyosarcoma (LMS) or dedifferentiated liposarcoma (DDLS) were identified from the National Cancer Database (2006-2019). Predictors of NCT were analyzed using univariate and multivariate logistic regression analyses. Differences in 5-year survival were examined using the Kaplan-Meier (KM) method and by Cox proportional hazard modeling. RESULTS A total of 2656 patients met inclusion criteria. Fifty-seven percent of patients had DDLS and 43.5% had LMS. Six percent of patients underwent NCT. Patients who received NCT were younger (median age 60 vs 64 years, p < 0.001) and more likely to have LMS (OR 1.4, p = 0.04). In comparing NCT with no-NCT patients, there was no difference in 5-year overall survival (OS) on KM analysis (57.3% vs 52.8%, p = 0.38), nor was any difference seen after propensity matching (54.9% vs 49.1%, p = 0.48, N = 144 per group). When stratified by histology, there was no difference in OS based on receipt of NCT (LMS: 59.8% for NCT group, 56.6% for no-NCT, p = 0.34; DDLS: 54.2% for NCT group, 50.1% for no-NCT, p = 0.99). CONCLUSION In patients undergoing surgical resection of RP LMS or DDLS, NCT does not appear to confer an OS advantage. Prospective randomized data from STRASS2 will confirm or refute these retrospective data.
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Affiliation(s)
- Gabriella N Tortorello
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Eric H Li
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Cimarron E Sharon
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin L Ma
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert G Maki
- Division of Hematology and Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - John T Miura
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas L Fraker
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ronald P DeMatteo
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Giorgos C Karakousis
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Liveringhouse CL, Palm RF, Bryant JM, Yang GQ, Mills MN, Figura ND, Ahmed KA, Mullinax J, Gonzalez R, Johnstone PA, Naghavi AO. Neoadjuvant Simultaneous Integrated Boost Radiation Therapy Improves Clinical Outcomes for Retroperitoneal Sarcoma. Int J Radiat Oncol Biol Phys 2023; 117:123-138. [PMID: 36935026 DOI: 10.1016/j.ijrobp.2023.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE Neoadjuvant radiation therapy (RT) with standard techniques (ST) offers a modest benefit in retroperitoneal sarcoma (RPS). As the high-risk region (HRR) at risk for a positive surgical margin and recurrence is posterior and away from radiosensitive organs at risk, using a simultaneous integrated boost (SIB) allows targeted dose escalation to the HRR while sparing these organs. We hypothesized that neoadjuvant SIB RT can improve disease control compared with ST, without increasing toxicity. METHODS AND MATERIALS We retrospectively identified patients with resectable nonmetastatic RPS from 2000 to 2021 who received neoadjuvant RT of 180 to 200 cGy/fraction to standard volumes. SIB patients received 205 to 230 cGy/fraction to the appropriate HRR. Clinical endpoints included abdominopelvic control (APC), recurrence-free survival (RFS), overall survival (OS), and acute toxicity. RESULTS With a median follow-up of 57 months (95% confidence interval [CI], 50-64), there were 103 patients with RPS who received either ST (n = 69) or SIB (n = 34) RT. Median standard volume dose was 5000 cGy (ST) and 4500 cGy (SIB), with a median HRR SIB dose of 5750 cGy. Liposarcomas (79% vs 53%; P = .004) and cT4 tumors (59% vs 19%; P < .001) were more common in the SIB cohort, without a significant difference in the rate of resection (82% vs 81%; P = .88) or R1 margin (53.5% vs 50%; P = .36); there were no R2 resections. SIB was associated with a significant improvement in 5-year APC (96% vs 70%; P = .046) and RFS (60.2% vs 36.3%; P = .036), with a nonsignificant OS difference (90.1% vs 67.5%; P = .164). On multivariable analysis, SIB remained a predictor for APC (hazard ratio, 0.07; 95% CI, 0.01-0.74; P = .027) and RFS (hazard ratio, 0.036; 95% CI, 0.13-0.98; P = .045). SIB showed no significant detriment in toxicity, albeit with a lower rate of overall grade 3 acute toxicity (3% vs 22%; P = .023) compared with ST. CONCLUSIONS In RPS, dose escalation with neoadjuvant SIB RT may be independently associated with improved APC and RFS, without a detriment in toxicity, compared with ST. With the addition of standard RT having only a modest benefit compared with surgery alone, our study suggests that future prospective studies evaluating for the benefit of SIB RT should be considered.
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Affiliation(s)
- Casey L Liveringhouse
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Russell F Palm
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - John M Bryant
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - George Q Yang
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Matthew N Mills
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Nicholas D Figura
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - John Mullinax
- Sarcoma Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Ricardo Gonzalez
- Sarcoma Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Peter A Johnstone
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Arash O Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
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Siew CCH, Cardona K, van Houdt WJ. Management of recurrent retroperitoneal sarcomas. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1115-1124. [PMID: 35810040 DOI: 10.1016/j.ejso.2022.06.008] [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: 12/08/2021] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 10/18/2022]
Abstract
Recurrent retroperitoneal sarcomas are rare, with patterns of recurrence determined by the histologic subtype. A range of patient characteristics and treatment profiles combined with a myriad of presentations and clinical courses of recurrences make this diverse entity challenging to manage. Although surgical resection improves survival in select patients, the oncological outcomes are inferior to that of primary retroperitoneal sarcomas. Management options for unresectable disease include local ablative therapy, radiation and systemic therapy, with palliative surgery indicated occasionally. Attempts at disease control must be balanced with potential morbidity and impact on the patient's quality of life. This review aims to offer insights into the current understanding of recurrent retroperitoneal sarcomas and provide some guidance on management.
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Affiliation(s)
- Caroline C H Siew
- Division of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands; Department of General Surgery, Tan Tock Seng Hospital, Singapore, 11 Jalan Tan Tock Seng, 308433, Singapore.
| | - Kenneth Cardona
- Division of Surgical Oncology, Winship Cancer Institute of Emory University, 550 Peachtree Street, Medical Office Tower, Atlanta, GA, 30308, USA.
| | - Winan J van Houdt
- Division of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands. http://
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Jagosky MH, Anderson CJ, Symanowski JT, Steuerwald NM, Farhangfar CJ, Baldrige EA, Benbow JH, Livingston MB, Patt JC, Ahrens WA, Kneisl JS, Kim ES. Genomic alterations and clinical outcomes in patients with dedifferentiated liposarcoma. Cancer Med 2022; 12:7029-7038. [PMID: 36464833 PMCID: PMC10067084 DOI: 10.1002/cam4.5502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/20/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Patients with unresectable dedifferentiated liposarcoma (DDLPS) have poor overall outcomes. Few genomic alterations have been identified with limited therapeutic options. EXPERIMENTAL DESIGN Patients treated at Levine Cancer Institute with DDLPS were identified. Next generation sequencing (NGS), immunohistochemistry (IHC), and fluorescence in situ hybridization (FISH) testing were performed on tumor tissue collected at diagnosis or recurrence/progression. Confirmation of genomic alterations was performed by orthologous methods and correlated with clinical outcomes. Univariate Cox regression was used to identify genomic alterations associated with clinical outcomes. RESULTS Thirty-eight DDLPS patients with adequate tissue for genomic profiling and clinical data were identified. Patient characteristics included: median age at diagnosis (66 years), race (84.2% Caucasian), and median follow-up time for the entire cohort was 12.1 years with a range from approximately 3.5 months to 14.1 years. Genes involved in cell cycle regulation, including MDM2 (74%) CDK4 (65%), and CDKN2A (23%), were amplified along with WNT/Notch pathway markers: HMGA2, LGR5, MCL1, and CALR (19%-29%). While common gene mutations were identified, PDE4DIP and FOXO3 were also mutated in 47% and 34% of patients, respectively, neither of which have been previously reported. FOXO3 was associated with improved overall survival (OS) (HR 0.37; p = 0.043) along with MAML2 (HR 0.30; p = 0.040). Mutations that portended worse prognosis included RECQL4 (disease-specific survival HR 4.67; p = 0.007), MN1 (OS HR = 3.38; p = 0.013), NOTCH1 (OS HR 2.28, p = 0.086), and CNTRL (OS HR 2.42; p = 0.090). CONCLUSIONS This is one of the largest retrospective reports analyzing genomic aberrations in relation to clinical outcomes for patients with DDLPS. Our results suggest therapies targeting abnormalities should be explored and confirmation of prognostic markers is needed. Dedifferentiated liposarcoma is one of the most common subtypes of soft tissue sarcoma yet little is known of its molecular aberrations and possible impact on outcomes. The work presented here is an evaluation of genetic abnormalities among a population of patients with dedifferentiated liposarcoma and how they corresponded with survival and risk of metastases. There were notable gene mutations and amplifications commonly found, some of which had interesting prognostic implications.
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Affiliation(s)
- Megan H. Jagosky
- Department of Solid Tumor Oncology, Levine Cancer Institute, Carolinas Medical Center, Atrium Health Charlotte North Carolina USA
| | - Colin J. Anderson
- Department of Orthopedic Oncology, Musculoskeletal Institute, Atrium Health Charlotte North Carolina USA
| | - James T. Symanowski
- Department of Biostatistics, Levine Cancer Institute, Carolinas Medical Center Atrium Health Charlotte North Carolina USA
| | - Nury M. Steuerwald
- The Molecular Biology and Genomics Laboratory, Levine Cancer Institute, Carolinas Medical Center, Atrium Health Charlotte North Carolina USA
| | - Carol J. Farhangfar
- LCI Translational Research, Levine Cancer Institute, Carolinas Medical Center, Atrium Health Charlotte North Carolina USA
| | - Emily A. Baldrige
- LCI Research Support, Clinical Trials Office, Levine Cancer Institute, Carolinas Medical Center, Atrium Health Charlotte North Carolina USA
| | | | - Michael B. Livingston
- Department of Solid Tumor Oncology, Levine Cancer Institute, Carolinas Medical Center, Atrium Health Charlotte North Carolina USA
| | - Joshua C. Patt
- Department of Orthopedic Oncology, Musculoskeletal Institute, Atrium Health Charlotte North Carolina USA
| | - Will A. Ahrens
- Department of Pathology Levine Cancer Institute, Carolinas Medical Center, Atrium Health Charlotte North Carolina USA
| | - Jeffrey S. Kneisl
- Department of Orthopedic Oncology, Musculoskeletal Institute, Atrium Health Charlotte North Carolina USA
| | - Edward S. Kim
- City of Hope Comprehensive Cancer Center Duarte California USA
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Delisle M, Gyorki D, Bonvalot S, Nessim C. Landmark Series: A Review of Landmark Studies in the Treatment of Primary Localized Retroperitoneal Sarcoma. Ann Surg Oncol 2022; 29:7297-7311. [DOI: 10.1245/s10434-022-12517-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022]
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7
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Siew CCH, Apte SS, Baia M, Gyorki DE, Ford S, van Houdt WJ. Retroperitoneal and Mesenteric Liposarcomas. Surg Oncol Clin N Am 2022; 31:399-417. [PMID: 35715141 DOI: 10.1016/j.soc.2022.03.005] [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: 10/18/2022]
Abstract
Retroperitoneal liposarcomas are a rare entity and are comprised mostly of the well-differentiated and dedifferentiated subtypes. Eight-year survival ranges from 30% to 80% depending on histologic subtype and grade. Surgery is the cornerstone of treatment and compartment resection is the current standard. Mesenteric liposarcomas are extremely rare and comprise more high-grade lesions, with poorer prognosis of 50% 5-year overall survival. They are managed with a similar aggressive surgical approach. This review presents the current management of retroperitoneal and mesenteric liposarcomas.
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Affiliation(s)
- Caroline C H Siew
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam 1066 CX, the Netherlands; Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433 Singapore
| | - Sameer S Apte
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000 Australia
| | - Marco Baia
- The Sarcoma Unit, Queen Elizabeth Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, UK
| | - David E Gyorki
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000 Australia
| | - Samuel Ford
- The Sarcoma Unit, Queen Elizabeth Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, UK
| | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam 1066 CX, the Netherlands.
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Aeschbacher P, Kollár A, Candinas D, Beldi G, Lachenmayer A. The Role of Surgical Expertise and Surgical Access in Retroperitoneal Sarcoma Resection – A Retrospective Study. Front Surg 2022; 9:883210. [PMID: 35647004 PMCID: PMC9133808 DOI: 10.3389/fsurg.2022.883210] [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: 02/24/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundRetroperitoneal sarcoma (RPS) is a rare disease often requiring multi-visceral and wide margin resections for which a resection in a sarcoma center is advised. Midline incision seems to be the access of choice. However, up to now there is no evidence for the best surgical access. This study aimed to analyze the oncological outcome according to the surgical expertise and also the incision used for the resection.MethodsAll patients treated for RPS between 2007 and 2018 at the Department of Visceral Surgery and Medicine of the University Hospital Bern and receiving a RPS resection in curative intent were included. Patient- and treatment specific factors as well as local recurrence-free, disease-free and overall survival were analyzed in correlation to the hospital type where the resection occurred.ResultsThirty-five patients were treated for RPS at our center. The majority received their primary RPS resection at a sarcoma center (SC = 23) the rest of the resection were performed in a non-sarcoma center (non-SC = 12). Median tumor size was 24 cm. Resections were performed via a midline laparotomy (ML = 31) or flank incision (FI = 4). All patients with a primary FI (n = 4) were operated in a non-SC (p = 0.003). No patient operated at a non-SC received a multivisceral resection (p = 0.004). Incomplete resection (R2) was observed more often when resection was done in a non-SC (p = 0.013). Resection at a non-SC was significantly associated with worse recurrence-free survival and disease-free survival after R0/1 resection (2 vs 17 months; Log Rank p-value = 0.02 respectively 2 vs 15 months; Log Rank p-value < 0.001).ConclusionsResection at a non-SC is associated with more incomplete resection and worse outcome in RPS surgery. Inadequate access, such as FI, may prevent complete resection and multivisceral resection if indicated and demonstrates the importance of surgical expertise in the outcome of RPS resection.
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Affiliation(s)
- P. Aeschbacher
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A. Kollár
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D. Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - G. Beldi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A. Lachenmayer
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Correspondence: A. Lachenmayer
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Zhuang A, Lu W, Fang Y, Ma L, Xu J, Wang J, Tong H, Zhang Y. Prognostic Factors and Nomogram Construction for First Local Recurrent Retroperitoneal Sarcoma Following Surgical Resection: A Single Asian Cohort of 169 Cases. Front Oncol 2022; 12:856754. [PMID: 35480122 PMCID: PMC9035871 DOI: 10.3389/fonc.2022.856754] [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: 01/17/2022] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to explore the prognostic factors for first local recurrent retroperitoneal soft tissue sarcoma (FLR-RPS) and construct predictive nomograms in the Asian population. Methods In a single Asian sarcoma center, data of patients with FLR-RPS were retrospectively analyzed from January 2011 to September 2020. We developed and internally validated prognostic factors determined by the Cox regression model, as well as nomograms for predicting recurrence-free survival (RFS) and overall survival (OS). The concordance index and calibration curve were used to determine the nomogram’s discriminative and predictive ability. Results With 169 patients, the median follow-up duration was 48 months and the 5-year OS rate was 60.9% (95% confidence interval (CI), 51.9%–69.9%). OS was correlated with chemotherapy at the time of initial surgery and tumor grading. The 5-year cumulative local recurrence rate and distant metastasis rate were 75.9% (95% CI, 67.5%–84.3%) and 10.1% (95% CI, 4.2%–16.0%), respectively, and the length of the disease-free interval following the primary operation was associated with disease recurrence. The 6-year OS and cumulative recurrence rate after surgery in our cohort were comparable with those in the TARPSWG cohort, but the proportion of local recurrence was higher (80.4% vs. 59.0%), and distant metastasis was less common (10.1% vs. 14.6%). In this study, two nomogram prediction models were established, which could predict the 1-, 2-, and 5-year OS and RFS, and the concordance indices were 0.74 and 0.70, respectively. The calibration plots were excellent. Conclusions For the FLR-RPS patients, some can still achieve an ideal prognosis. The treatment of FLR-RPS in Asian populations can be aided by the predictive model established in this study.
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Affiliation(s)
- Aobo Zhuang
- Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Weiqi Lu
- Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuan Fang
- Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Lijie Ma
- Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jing Xu
- Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiongyuan Wang
- Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hanxing Tong
- Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Yong Zhang, ; Hanxing Tong,
| | - Yong Zhang
- Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Yong Zhang, ; Hanxing Tong,
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10
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Bredbeck BC, Delaney LD, Kathawate VG, Harter CA, Wilkowski J, Chugh R, Cuneo KC, Dossett LA, Sabel MS, Angeles CV. Factors associated with disease-free and abdominal recurrence-free survival in abdominopelvic and retroperitoneal sarcomas. J Surg Oncol 2022; 125:1292-1300. [PMID: 35239187 PMCID: PMC9313796 DOI: 10.1002/jso.26828] [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: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 11/07/2022]
Abstract
Background and Objectives Retroperitoneal and abdominopelvic sarcomas are rare heterogeneous malignancies. The only therapy proven to improve disease‐free survival (DFS) is R0/R1 surgical resection. We sought to analyze whether additional factors such as radiation and systemic therapy were associated with DFS and abdominal recurrence‐free survival (RFS). Methods Retrospective review of adults (≥18) with resectable abdominopelvic and retroperitoneal sarcomas who underwent intent‐to‐cure surgery at a high‐volume tertiary referral center between 1998 and 2015. The main outcome measures were DFS and abdominal RFS. Results Overall, 159 patients met the criteria for inclusion. Median follow‐up was 4.8 years (range 0.1–18.9 years). The most common histology was liposarcoma (49%). Systemic therapy was administered to 48% of patients and was not associated with improved outcomes. The neoadjuvant radiotherapy group (11%) had improved adjusted DFS (5.46 years, 95% CI [3.68, 7.24] vs. 3.1 years, 95% CI [2.48, 3.73]) and abdominal RFS (6.14 years, 95% CI [4.38, 7.89] vs. 3.22 years, 95% CI [2.61, 3.84]). The adjuvant radiotherapy group (19%) had no improvement. Conclusions In a cohort of patients undergoing resection for retroperitoneal or abdominopelvic sarcoma, neoadjuvant radiation improved DFS and abdominal RFS. A follow‐up of over three years was needed to appreciate a difference in outcomes.
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Affiliation(s)
- Brooke C Bredbeck
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Lia D Delaney
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | | | - Jodi Wilkowski
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Rashmi Chugh
- Department of Medicine, University of Michigan , Ann Arbor, Michigan, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Kyle C Cuneo
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA.,Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lesly A Dossett
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael S Sabel
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Christina V Angeles
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
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11
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Hasegawa S, Nomura Y, Okada T, Toyama H, Fukumoto T, Okada K. Complete resection and arterial reconstruction for primary sarcoma arising from superior mesenteric artery. J Vasc Surg Cases Innov Tech 2022; 8:70-74. [PMID: 35112036 PMCID: PMC8790618 DOI: 10.1016/j.jvscit.2021.11.008] [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: 09/21/2021] [Accepted: 11/23/2021] [Indexed: 11/19/2022] Open
Abstract
In the treatment of retroperitoneal sarcoma involving major vessels, complete resection with vascular reconstruction is challenging. We describe the case of a 72-year-old man who presented with 8 months of abdominal pain. Diagnostic workup revealed occlusion of the celiac trunk and the origin of the superior mesenteric artery due to a soft tissue sarcoma. Radical resection of the tumor and vessels was performed. Guided by intraoperative angiography, arterial reconstruction was performed without mesenteric ischemia. All arterial margins were negative. At the 6-year follow-up, the patient was alive with no evidence of recurrence.
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Affiliation(s)
- Shota Hasegawa
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yoshikatsu Nomura
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
- Correspondence: Yoshikatsu Nomura, MD, PhD, Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuou-ku, Kobe, Hyogo 650-0017, Japan
| | - Takuya Okada
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hirochika Toyama
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takumi Fukumoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kenji Okada
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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12
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Abstract
➤ Soft-tissue sarcomas (STS) in adults comprise a heterogeneous group of tumors of mesenchymal origin that share similar biological patterns of local tumor growth and metastatic dissemination. ➤ The judicious use of imaging studies, biopsy techniques, and pathological evaluations is essential for accurate diagnosis and for planning treatment strategy. ➤ Wide local resection and radiation therapy form the cornerstone of management of high-grade STS. The role of adjuvant radiation therapy is questionable in the management of small (≤5 cm) superficial lesions that can be resected with negative margins. Chemotherapy given to patients who have nonmetastatic, high-grade STS results in varying benefit in terms of local tumor control and overall survival. ➤ Coordinated care by a multidisciplinary team of trained surgeons, medical oncologists, radiologists, radiation oncologists, and pathologists has been documented to improve local tumor control and the overall survival of patients with STS. ➤ Although considerable progress in tumor diagnostics and targeted therapies has been made over the past 2 decades, recommendations and controversies relating to tumor imaging and margins of resection have not changed.
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Affiliation(s)
- Jacob Bickels
- Unit of Orthopedic Oncology, Orthopedic Division, Hillel-Yaffe Medical Center, Hadera, Israel, affiliated with the Rappaport Faculty of Medicine, The Technion, Haifa, Israel
| | - Martin M Malawer
- Department of Orthopedic Surgery, Georgetown University School of Medicine, Washington, DC
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13
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Kim KD, Lee KW, Lee JE, Hwang JA, Jo SJ, Kim J, Lim SH, Park JB. Postoperative Outcomes of Distal Pancreatectomy for Retroperitoneal Sarcoma Abutting the Pancreas in the Left Upper Quadrant. Front Oncol 2021; 11:792943. [PMID: 34988024 PMCID: PMC8721218 DOI: 10.3389/fonc.2021.792943] [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: 10/11/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background En bloc resection of the tumor with adjacent organs is recommended for localized retroperitoneal sarcoma (RPS). However, resection of the pancreas is controversial because it may cause serious complications, such as pancreatic fistula or bleeding. Thus, we evaluated the outcomes of distal pancreatectomy (DP) in pancreas-abutting RPS of the left upper quadrant (LUQ). Methods We retrospectively reviewed all consecutive patients who underwent surgery for RPS between September 2001 and April 2020. We selected 150 patients with all or part of their tumor located in the LUQ on preoperative computed tomography. Eighty-six patients who had tumors abutting the pancreas were finally enrolled in our study. Results Fifty-three patients (53/86; 61.6%) were included in the non-DP group, and 33 patients (33/86; 38.4%) were included in the DP group. Total postoperative complications and complication rates for those Clavien–Dindo grade 3 or higher were similar between the non-DP group and DP group (p = 0.290 and p = 0.550). In the DP group, grade B pancreatic fistulae occurred in 18.2% (6/33) of patients, but grade C pancreatic fistulae were absent, and microscopic pancreatic invasion was noted in 42.4% (14/33) of patients. During multivariate analysis, microscopic pancreatic invasion was deemed a risk factor for local recurrence (p = 0.029). However, there were no significant differences on preoperative computed tomography findings between the pancreatic invasion and non-invasion groups. Conclusion DP is a reasonable procedure for pancreas-abutting RPS located at the LUQ when both complications and complete resection are considered.
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Affiliation(s)
- Kyeong Deok Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyo Won Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- *Correspondence: Kyo Won Lee,
| | - Ji Eun Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, South Korea
| | - Jeong Ah Hwang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung Jun Jo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jinseob Kim
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul, South Korea
| | - So Hee Lim
- Transplantation Research Center, Samsung Medical Center, Seoul, South Korea
| | - Jae Berm Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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14
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Comparison of preoperative chemoradiation with radiation or chemotherapy alone in patients with non-metastatic, resectable retroperitoneal sarcoma. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396921000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Aim:
Optimal preoperative therapy regimen in the treatment of resectable retroperitoneal sarcoma (RPS) remains unclear. This study compares the impact of preoperative radiation, chemoradiation and chemotherapy on overall survival (OS) in RPS patients.
Materials and Methods:
The National Cancer Database (NCDB) was queried for patients with non-metastatic, resectable RPS (2006–15). The primary endpoint was OS, evaluated by Kaplan–Meier method, log-rank test, Cox multivariable analysis and propensity score matching.
Results:
A total of 1,253 patients met the inclusion criteria, with 210 patients (17%) receiving chemoradiation, 850 patients (68%) receiving radiation and 193 patients (15%) receiving chemotherapy. On Cox multivariable analysis, when compared to preoperative chemoradiation, preoperative radiation was not associated with improved OS (hazards ratio [HR] 0·98, 95% CI 0·76–1·25, p = 0·84), while preoperative chemotherapy was associated with worse OS (HR 1·64, 95% CI 1·24–2·18, p < 0·001). Similar findings were observed in 199 and 128 matched pairs for preoperative radiation and chemotherapy, respectively, when compared to preoperative chemoradiation.
Findings:
Our study suggested an OS benefit in using preoperative chemoradiation compared to chemotherapy alone, but OS outcomes were comparable between preoperative chemoradiation and radiation alone.
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15
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Brasoveanu V, Barbu I, Balescu I, Bacalbasa N, Cordos I. Infra-hepatic caval resection en bloc with right nephrectomy followed by caval reconstruction for locally advanced caval leiomyosarcoma: A case report and literature review. Exp Ther Med 2021; 22:1377. [PMID: 34650625 DOI: 10.3892/etm.2021.10812] [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: 07/16/2021] [Accepted: 08/16/2021] [Indexed: 11/06/2022] Open
Abstract
Retroperitoneal sarcomas often require complex surgical procedures in order to achieve complete resection; in such cases both vascular and visceral resections are needed. When it comes to the need for vascular reconstruction, the type of graft as well as the type of reconstructive process are chosen according to the length and location of the resected segment. Meanwhile, depending on the location of the resected segment, other vascular reconstructions may be needed such as the reimplantation of the renal veins. However, in certain cases, this reimplantation is not mandatory, an adequate renal outflow being reported through the collateral network at this level. We present the case of a 43-year-old patient diagnosed with a large retroperitoneal sarcoma originating from the cava vein invading the right kidney. Resection of the tumor was performed en bloc with caval resection and right nephrectomy, without reimplantation of the left renal vein at the level of the graft. Extended visceral and vascular resections might be needed in order to achieve complete resection of inferior cava vein sarcomas; re-implantation of the left renal vein being not mandatory if rich collateral circulation is present.
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Affiliation(s)
- Vladislav Brasoveanu
- Department of Visceral Surgery, 'Dan Setlacec' Center of Gastrointestinal Diseases and Liver Transplantation, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania.,Department of Surgery, 'Titu Maiorescu' University of Medicine and Pharmacy, 040051 Bucharest, Romania
| | - Ion Barbu
- Department of Visceral Surgery, 'Dan Setlacec' Center of Gastrointestinal Diseases and Liver Transplantation, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, 'Ponderas' Academic Hospital, 021188 Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Ioan Cordos
- Department of Thoracic Surgery, 'Marius Nasta' National Institute of Pneumology, 050159 Bucharest, Romania.,Department of Thoracic Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
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16
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Ishii K, Yokoyama Y, Nishida Y, Koike H, Yamada S, Kodera Y, Sassa N, Gotoh M, Nagino M. Characteristics of primary and repeated recurrent retroperitoneal liposarcoma: outcomes after aggressive surgeries at a single institution. Jpn J Clin Oncol 2021; 50:1412-1418. [PMID: 32699905 DOI: 10.1093/jjco/hyaa126] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/25/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study sought to investigate the characteristics of primary and repeated recurrent retroperitoneal liposarcoma. METHODS Patients treated with primary or recurrent retroperitoneal liposarcoma between 2005 and 2018 were retrospectively reviewed. Survival time analysis of recurrence-free survival and overall survival was conducted using Kaplan-Meier analysis and log-rank test. RESULTS Fifty-two patients with primary retroperitoneal liposarcoma were analysed. Amongst them, 46 patients (88%) had undergone surgery. Histologic grades included well-differentiated (n = 21), dedifferentiated (n = 21), myxoid (n = 3) and pleomorphic (n = 1) subtypes. The patients undergoing R0 resection in the first surgery had significantly higher recurrence-free survival rates compared with the patients undergoing non-R0 resection (3-year recurrence-free survival: 80 versus 38%; 5-year recurrence-free survival: 49 versus 29%, P = 0.033). Although overall survival rates tended to be higher in the patients undergoing R0 resection compared with the non-R0 resection, it did not reach to a statistical significant difference (5-year overall survival: 93 versus 75%; 10-year overall survival: 93 versus 59%, P = 0.124). The recurrence rates were 65, 67, 73 and 100%, and the median recurrence-free survival times were 46, 20, 9 and 3 months after the first, second, third and fourth surgeries, respectively. The 5-year overall survival rates were 82, 69, 40 and 0% after the first, second, third and fourth surgeries, respectively. CONCLUSIONS With repeated recurrence and surgeries, the time to recurrence decreased and the recurrence rate increased. R0 resection in the first surgery was considered the most important for longer recurrence-free survival and radical cure.
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Affiliation(s)
- Kenta Ishii
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya
| | | | - Hiroshi Koike
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya
| | - Suguru Yamada
- Division of Digestive surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya
| | - Yasuhiro Kodera
- Division of Digestive surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya
| | - Naoto Sassa
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya
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17
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Quildrian SD, Nardi WS, David M. Resection of retroperitoneal soft-tissue sarcoma involving the abdominal aorta. BMJ Case Rep 2020; 13:13/11/e237107. [PMID: 33257376 DOI: 10.1136/bcr-2020-237107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Complete surgical resection of soft-tissue sarcomas (STSs) frequently requires complex multivisceral resections, which is the most important factor related to overall survival and local recurrence. Major vascular involvement is not rare in patients with primary retroperitoneal STSs. We present a 54-year-old woman with a retroperitoneal STS encasing the infrarenal abdominal aorta. The patient underwent complete oncological resection with vascular reconstruction using a bi-iliac vascular graft. Major blood vessel involvement is not a contraindication for STS surgery with a curative intent.
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Affiliation(s)
- Sergio Damián Quildrian
- Sarcoma and Melanoma Unit-General Surgery Department, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Walter Sebastián Nardi
- Sarcoma and Melanoma Unit-General Surgery Department, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Michel David
- Vascular Surgery Department, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
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18
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Li CP, Wang Z, Liu BN, Lv A, Liu DN, Wu JH, Qiu H, Hao CY. Pancreaticoduodenectomy for Retroperitoneal Sarcomas: A Mono-Institutional Experience in China. Front Oncol 2020; 10:548789. [PMID: 33072576 PMCID: PMC7538706 DOI: 10.3389/fonc.2020.548789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/13/2020] [Indexed: 01/04/2023] Open
Abstract
Background En bloc resection of retroperitoneal sarcoma (RPS) with adjacent organs such as pancreatic head and duodenum is challenging for surgeons. This mono-institutional study aims to evaluate the feasibility, safety, and outcome of performing pancreaticoduodenectomy (PD) during RPS resection. Methods The clinical data of RPS patients who underwent PD at the Sarcoma Center of Peking University Cancer Hospital from January 2011 to December 2019 was collected and analyzed. Results Twenty-seven patients out of a total of 264 surgically treated RPS underwent PD. The main pathological subtype was liposarcoma. All patients received concomitant resection of a median of three additional organs (range: 1–5), including 11 patients (40.7%) who underwent inferior vena cava resection and one patient who underwent segmental superior mesenteric-portal vein resection. Microscopic tumor infiltration to the duodenum or pancreas was observed in 81.5% of patients. Major complications occurred in 40.7% of patients; the reoperation rate was 22.2%. One patient (3.7%) died from liver abscess postoperatively. During a median follow-up of 18.9 months, 15 patients (55.6%) developed locally recurrent disease; two patients (7.4%) also had pulmonary metastases additionally. Twelve patients (44.4%) died from local relapse eventually. Conclusion PD during RPS resection is feasible, and it may be necessary to achieve complete resection. However, considering the complexity and risk, it should be performed by an experienced surgical team. The long-term survival benefit of this procedure should be verified by further large-scale multi-institutional studies.
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Affiliation(s)
- Cheng-Peng Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Sarcoma Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhen Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Sarcoma Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Bo-Nan Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Sarcoma Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Ang Lv
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Sarcoma Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Dao-Ning Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Sarcoma Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jian-Hui Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Sarcoma Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Hui Qiu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Sarcoma Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Chun-Yi Hao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Sarcoma Center, Peking University Cancer Hospital and Institute, Beijing, China
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19
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Houdt WJ, Fiore M, Barretta F, Rutkowski P, Blay J, Lahat G, Strauss D, Gonzalez RJ, Ahuja N, Grignani G, Quagliuolo V, Stoeckle E, De Paoli A, Schrage Y, Cardona K, Pennacchioli E, Pillarisetty VG, Nessim C, Swallow CJ, Bagaria SP, Canter R, Mullen JT, Callegaro D, Fairweather M, Miceli R, Raut CP, Gronchi A, Gladdy RA. Patterns of recurrence and survival probability after second recurrence of retroperitoneal sarcoma: A study from TARPSWG. Cancer 2020; 126:4917-4925. [DOI: 10.1002/cncr.33139] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Winan J. Houdt
- Department of Surgical Oncology The Netherlands Cancer Institute Amsterdam The Netherlands
| | - Marco Fiore
- Department of Surgical Oncology Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Francesco Barretta
- Medical Statistics, Biometry and Bioinformatics Unit Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma Maria Sklodowska‐Curie Memorial Cancer Center Warsaw Poland
| | - Jean‐Yves Blay
- Department of Medical Oncology Leon Berard Center, Claude Bernard Lyon 1 University Lyon France
| | - Guy Lahat
- Department of General Surgery Tel Aviv Sourasky Medical Center Tel Aviv Israel
| | - Dirk Strauss
- Sarcoma Unit, Department of Surgery Royal Marsden Hospital London United Kingdom
| | | | - Nita Ahuja
- Department of Surgery Yale School of Medicine New Haven Connecticut
| | - Giovanni Grignani
- Sarcoma Unit, Division of Medical Oncology Candiolo Cancer InstituteFPO‐IRCCS Candiolo Italy
| | | | - Eberhard Stoeckle
- Department of Surgery Bergonie InstituteRegional Cancer Centre Bordeaux Cedex France
| | - Antonino De Paoli
- Department of Radiation Oncology Oncology Reference Center (CRO), CRO‐IRCCS Aviano Italy
| | - Yvonne Schrage
- Department of Surgery Leiden University Medical Center Leiden The Netherlands
| | - Kenneth Cardona
- Department of Surgery Winship Cancer InstituteEmory University Atlanta Georgia
| | | | - Venu G. Pillarisetty
- Department of Surgery Seattle Cancer Care AllianceUniversity of Washington School of Medicine Seattle Washington
| | - Carolyn Nessim
- Department of Surgery The Ottawa HospitalUniversity of Ottawa Ottawa Ontario Canada
| | - Carol J. Swallow
- Division of General Surgery Mount Sinai HospitalPrincess Margaret HospitalUniversity of Toronto Toronto Ontario Canada
| | - Sanjay P. Bagaria
- Section of Surgical Oncology Department of Surgery Mayo Clinic Jacksonville Jacksonville Florida
| | - Robert Canter
- Department of Surgery University of California at Davis School of Medicine Davis California
| | - John T. Mullen
- Department of Surgery Massachusetts General HospitalHarvard Medical School Boston Massachusetts
| | - Dario Callegaro
- Department of Surgical Oncology Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Mark Fairweather
- Division of Surgical Oncology Department of Surgery Brigham and Women's Hospital Dana‐Farber Cancer Institute Harvard Medical School Boston Massachusetts
| | - Rosalba Miceli
- Medical Statistics, Biometry and Bioinformatics Unit Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Chandrajit P. Raut
- Department of Surgery Massachusetts General HospitalHarvard Medical School Boston Massachusetts
| | - Alessandro Gronchi
- Department of Surgical Oncology Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Rebecca A. Gladdy
- Division of General Surgery Mount Sinai HospitalPrincess Margaret HospitalUniversity of Toronto Toronto Ontario Canada
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20
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Bae S, Karnon J, Crane G, Bessen T, Desai J, Crowe P, Neuhaus S. Cost-effectiveness analysis of imaging surveillance in stage II and III extremity soft tissue sarcoma: an Australian perspective. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:5. [PMID: 32042270 PMCID: PMC6998821 DOI: 10.1186/s12962-020-0202-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/23/2020] [Indexed: 12/30/2022] Open
Abstract
Background Surveillance imaging is used to detect local and/or distant recurrence following primary treatment of localised soft tissue sarcoma (STS), however evidence supporting optimal surveillance modality or frequency is lacking. We used prospectively collected sarcoma data to describe current surveillance imaging practice in patients with AJCC stage II and III extremity STS and evaluate its cost-effectiveness. Methods From three selected Australian sarcoma referral centres, we identified patients with stage II and III extremity STS treated between 2009 and 2013. Medical records were reviewed to ascertain surveillance imaging practices, including modality, frequency and patient outcomes. A discrete event simulation model was developed and calibrated using clinical data to estimate health service costs and quality adjusted life years (QALYs) associated with alternative surveillance strategies. Results Of 133 patients treated for stage II and III extremity STS, the majority were followed up with CT chest (86%), most commonly at 3-monthly intervals and 62% of patients had the primary site imaged with MRI at 6-monthly. There was limited use of chest-X-ray. A discrete event simulation model demonstrated that CT chest screening was the most cost effective surveillance strategy, gaining additional QALYs at a mean incremental cost of $30,743. MRI alone and PET-CT alone were not cost-effective, whilst a combined strategy of CT + MRI had an incremental cost per QALY gained of $96,556. Conclusions Wide variations were observed in surveillance imaging practices in this high-risk STS cohort. Modelling demonstrated the value of CT chest for distant recurrence surveillance over other forms of imaging in terms of cost and QALYs. Further work is required to evaluate cost-effectiveness in a prospective manner.
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Affiliation(s)
- Susie Bae
- 1Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia.,2Sir Peter MacCallum, Department of Oncology, The University of Melbourne, Parkville, VIC 3010 Australia
| | - Jonathan Karnon
- 3College of Medicine and Public Health, Flinders University, 1 Flinders Dr, Bedford Park, SA 5042 Australia
| | - Glenis Crane
- 4The University of Adelaide, Adelaide, SA 5005 Australia
| | - Taryn Bessen
- 5Department of Radiology, Royal Adelaide Hospital, Adelaide, SA 5000 Australia
| | - Jayesh Desai
- 1Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia.,2Sir Peter MacCallum, Department of Oncology, The University of Melbourne, Parkville, VIC 3010 Australia
| | - Phillip Crowe
- 6Prince of Wales Hospital, Sydney, 320-346 Barker St, Randwick, NSW 2031 Australia
| | - Susan Neuhaus
- 4The University of Adelaide, Adelaide, SA 5005 Australia
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21
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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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22
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De Angelis C, Vigna PD, Varano GM, Mauri G. Laser thermal ablation to treat a recurrent soft-tissue sarcoma of the leg: a case report. Ecancermedicalscience 2019; 13:908. [PMID: 31123491 PMCID: PMC6445535 DOI: 10.3332/ecancer.2019.908] [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: 06/30/2018] [Indexed: 12/03/2022] Open
Abstract
We present the case of a 52-year-old male patient with recurrence of a soft-tissue sarcoma of the left leg treated with percutaneous laser ablation. The patient received the diagnosis of sarcoma for the first time in 2011; further local recurrences and a pulmonary metastatic spread occurred during follow-up, so the patient has been treated several times with chemotherapy, limb-sparing surgery and radiotherapy. In September 2017, a new local recurrence of sarcoma occurred, for which limb amputation was proposed but refused by the patient. Laser ablation with ultrasound guidance was performed, with complete ablation at 6 months and limb salvage.
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Affiliation(s)
- Chiara De Angelis
- Division of Radiology, IEO, European Institute of Oncology IRCCS, via Ripamonti 435, 20141 Milan, Italy
| | - Paolo Della Vigna
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, via Ripamonti 435, 20141 Milan, Italy
| | - Gianluca Maria Varano
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, via Ripamonti 435, 20141 Milan, Italy
| | - Giovanni Mauri
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, via Ripamonti 435, 20141 Milan, Italy
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23
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Villano AM, Zeymo A, McDermott J, Barrak D, Unger KR, Shara NM, Chan KS, Al-Refaie WB. Regionalization of Retroperitoneal Sarcoma Surgery to High-Volume Hospitals: Missed Opportunities for Outcome Improvement. J Oncol Pract 2019; 15:e247-e261. [DOI: 10.1200/jop.18.00349] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE: Surgery continues to be the dominant therapy for the management of retroperitoneal soft-tissue sarcoma (RPS). Many groups advocate performing these resections at high-volume hospitals (HVHs), given their complexity. We therefore sought to explore whether RPS surgery has indeed begun to regionalize to HVHs in the same manner as pancreatic cancer (PC) surgery during the last decade. METHODS: We identified 70,763 patients who underwent surgical resection for RPS or PC using the National Cancer Database (2004 to 2015). Patients were stratified by hospital surgical volume. We performed an adjusted time trend analysis to compare trends in performance of surgery at HVHs for RPS versus PC. Multivariable logistic analyses were then performed, controlling for covariables, to elucidate relationships between patient-, hospital-, and treatment-related variables that may contribute to these observed trends. RESULTS: Only 9.6% of patients underwent RPS surgery at HVHs. During this time period, the odds ratio of undergoing RPS compared with pancreatectomy at HVHs was 0.65 ( P < .05). Time trend analysis estimated that whereas both procedures are regionalizing, the rate of RPS regionalization grew at 30.5% of the rate of PC (1.017 v 1.056; P < .001) and remained consistent after using several hospital volume thresholds and hospital volume as a continuous variable. CONCLUSION: Results from this retrospective multi-institutional analysis uncovered a lag in the regionalization of surgery for RPS compared with PC surgery. These findings reinforce the call to regionalize surgery for RPS to HVHs in a manner that is similar to that of other procedures in complex cancer surgery.
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Affiliation(s)
- Anthony M. Villano
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC
- MedStar-Georgetown University Hospital, Washington, DC
| | - Alexander Zeymo
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC
- MedStar Health Research Institute, Hyattsville, MD
| | - James McDermott
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC
| | - Dany Barrak
- Medstar-Washington Hospital Center, Washington, DC
| | | | - Nawar M. Shara
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC
- MedStar Health Research Institute, Hyattsville, MD
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC
| | - Kitty S. Chan
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC
| | - Waddah B. Al-Refaie
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC
- MedStar-Georgetown University Hospital, Washington, DC
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24
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Radiation Therapy for Retroperitoneal Sarcomas: Influences of Histology, Grade, and Size. Sarcoma 2018; 2018:7972389. [PMID: 30631245 PMCID: PMC6304833 DOI: 10.1155/2018/7972389] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/26/2018] [Accepted: 11/14/2018] [Indexed: 01/30/2023] Open
Abstract
Perioperative radiation therapy (RT) has been associated with reduced local recurrence in patients with retroperitoneal sarcomas (RPS); however, selection criteria remain unclear. We hypothesized that perioperative RT would improve survival in patients with RPS and would be associated with pathological factors. The National Cancer Database (NCDB) from 2004 to 2012 was reviewed for patients with nonmetastatic RPS undergoing curative intent resection. Tumor size was dichotomized at 15 cm based on 8th edition American Joint Committee on Cancer (AJCC) staging. Patients with the highest comorbidity score were excluded. Unadjusted Kaplan–Meier and adjusted Cox proportional hazards modeling analyzed overall survival (OS). Multivariable logistic regression modeled margin positivity. A total of 2,264 patients were included; 727 patients (32.1%) had perioperative radiation in whom 203 (9.0%) had radiation preoperatively. Median (IQR) RPS size was 17.5 [11.0–27.0] cm. Histopathology was high grade in 1048 patients (43.7%). Multivariable analysis revealed that perioperative radiation was independently associated with decreased mortality (HR 0.72, 95% confidence intervals (CIs) 0.62–0.84, p < 0.001), and preoperative RT was associated with reduced margin positivity (HR 0.72, 95% CI 0.53–0.97, p=0.032). Stratified survival analysis showed that radiation was associated with prolonged median OS for RPS that were high-grade (64.3 vs. 43.6 months, p < 0.001), less than 15 cm (104.1 vs. 84.2 months, p=0.007), and leiomyosarcomatous (104.8 vs. 61.8 months, p < 0.001). Perioperative radiation is independently associated with decreased mortality in patients with high-grade, less than 15 cm, and leiomyosarcomatous tumors. Preoperative radiation is independently associated with margin-negative resection. These data support the selective use of perioperative radiation in the multidisciplinary management of RPS.
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25
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Nathenson MJ, Barysauskas CM, Nathenson RA, Regine WF, Hanna N, Sausville E. Surgical resection for recurrent retroperitoneal leiomyosarcoma and liposarcoma. World J Surg Oncol 2018; 16:203. [PMID: 30309356 PMCID: PMC6182828 DOI: 10.1186/s12957-018-1505-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 09/28/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Retroperitoneal soft tissue sarcomas (STS) include a number of histologies but are rare, with approximately 3000 cases in the USA per year. Retroperitoneal STS have a high incidence of local and distant recurrence. The purpose of this study was to review the University of Maryland Medical Center's (UMMC) treatment experience of retroperitoneal STS, where the patient population served represents a diverse socioeconomic and ethnic catchment. METHODS IRB approval was obtained. We constructed a de-identified database of patients diagnosed with retroperitoneal liposarcomas (LPS) or leiomyosarcomas (LMS) treated at UMMC between 2000 and 2013. A total of 49 patients (Pts) with retroperitoneal STS met our eligibility criteria. Kaplan-Meier plots were used to graphically portray progression-free survival (PFS) and overall survival (OS). The log-rank test was used to compare time-to-event distributions. RESULTS The median OS for all patients (Pts) was 6.3 years, and the 2-year OS rate was 81%. The median PFS for all Pts was 1.8 years, and the 2-year PFS rate was 45%. There was no difference in OS and PFS among LMS and LPS patients; the median OS for LMS was 3.8 years vs. LPS 6.4 years (p = 0.33), and the median PFS for LMS was 1.2 years vs. LPS 2.5 years (p = 0.28). There was a significant difference between histology and race (p = 0.001). LPS were primarily Caucasian 86% vs. 14% black, whereas LMS were primarily black 52% vs. 33% Caucasian. OS was influenced by functional status, gender, American Joint Committee on Cancer (AJCC) stage, grade, histology, tumor size, and extent of resection. PFS was influenced by AJCC stage, grade, and extent of resection. Neither adjuvant chemotherapy (1 Pt) nor neoadjuvant/adjuvant radiation therapy (18 Pts) influenced OS or PFS. There was a non-significant difference that Pts who could undergo resection of local recurrence had improved 2-year OS, with 100% LMS and LPS compared to 2-year OS of 71% (LMS) and 78% (LPS) not undergoing resection of local recurrence. CONCLUSIONS This study suggests a higher incidence of leiomyosarcoma in the African-American population. This study confirms the prognostic importance of grade, tumor size, AJCC stage, histology, and extent of resection in patient outcomes, at a large substantially diverse academic medical center. Future research into the biological features of liposarcoma and leiomyosarcoma Pts imparting these characteristics will be important to define.
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Affiliation(s)
- Michael J Nathenson
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215 USA
| | - Constance M Barysauskas
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215 USA
| | - Robert A Nathenson
- University of Pennsylvania, 3440 Market Street Philadelphia, Philadelphia, PA 19146 USA
| | - William F Regine
- University of Maryland, Greenebaum Cancer Center, South Greene Street Suite 9d10 Baltimore, Baltimore, MD 21201 USA
| | - Nader Hanna
- University of Maryland, Greenebaum Cancer Center, South Greene Street Suite 9d10 Baltimore, Baltimore, MD 21201 USA
| | - Edward Sausville
- University of Maryland, Greenebaum Cancer Center, South Greene Street Suite 9d10 Baltimore, Baltimore, MD 21201 USA
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26
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Crompton JG, Ogura K, Bernthal NM, Kawai A, Eilber FC. Local Control of Soft Tissue and Bone Sarcomas. J Clin Oncol 2018; 36:111-117. [DOI: 10.1200/jco.2017.75.2717] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Sarcomas of soft tissue and bone are mesenchymal malignancies that can arise in any anatomic location, most commonly the extremity, retroperitoneum, and trunk. Even for lower grade histologic subtypes, local recurrence can cause significant morbidity and even disease-related death. Although surgery remains the cornerstone of local control, perioperative radiation and systemic therapy are often important adjuvants. This review will summarize the current therapeutic approaches for local control of soft tissue and bone sarcomas.
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Affiliation(s)
- Joseph G. Crompton
- Joseph G. Crompton, Nicholas M. Bernthal, and Fritz C. Eilber, University of California Los Angeles, Los Angeles, CA; and Koichi Ogura and Akira Kawai, National Cancer Center Hospital, Tokyo, Japan
| | - Koichi Ogura
- Joseph G. Crompton, Nicholas M. Bernthal, and Fritz C. Eilber, University of California Los Angeles, Los Angeles, CA; and Koichi Ogura and Akira Kawai, National Cancer Center Hospital, Tokyo, Japan
| | - Nicholas M. Bernthal
- Joseph G. Crompton, Nicholas M. Bernthal, and Fritz C. Eilber, University of California Los Angeles, Los Angeles, CA; and Koichi Ogura and Akira Kawai, National Cancer Center Hospital, Tokyo, Japan
| | - Akira Kawai
- Joseph G. Crompton, Nicholas M. Bernthal, and Fritz C. Eilber, University of California Los Angeles, Los Angeles, CA; and Koichi Ogura and Akira Kawai, National Cancer Center Hospital, Tokyo, Japan
| | - Fritz C. Eilber
- Joseph G. Crompton, Nicholas M. Bernthal, and Fritz C. Eilber, University of California Los Angeles, Los Angeles, CA; and Koichi Ogura and Akira Kawai, National Cancer Center Hospital, Tokyo, Japan
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27
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Fairweather M, Gonzalez RJ, Strauss D, Raut CP. Current principles of surgery for retroperitoneal sarcomas. J Surg Oncol 2018; 117:33-41. [PMID: 29315649 DOI: 10.1002/jso.24919] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/21/2017] [Indexed: 12/17/2022]
Abstract
Surgery for primary retroperitoneal sarcomas (RPS) often requires a technically challenging, en bloc multivisceral resection to optimize outcomes. Surgery may also be appropriate for patients with localized recurrent RPS. Anatomic considerations and tumor biology driven by histologic subtype may guide the extent of resection in patients with RPS. This review provides an overview of the current surgical principles for primary and recurrent RPS.
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Affiliation(s)
- Mark Fairweather
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute; Harvard Medical School, Boston, Massachusetts
| | | | - Dirk Strauss
- Department of Surgery, Royal Marsden Hospital, NHS Foundation Trust, London, UK
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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28
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Fairweather M, Wang J, Jo VY, Baldini EH, Bertagnolli MM, Raut CP. Surgical Management of Primary Retroperitoneal Sarcomas: Rationale for Selective Organ Resection. Ann Surg Oncol 2017; 25:98-106. [DOI: 10.1245/s10434-017-6136-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Indexed: 12/26/2022]
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29
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Albertsmeier M, Rauch A, Roeder F, Hasenhütl S, Pratschke S, Kirschneck M, Gronchi A, Jebsen NL, Cassier PA, Sargos P, Belka C, Lindner LH, Werner J, Angele MK. External Beam Radiation Therapy for Resectable Soft Tissue Sarcoma: A Systematic Review and Meta-Analysis. Ann Surg Oncol 2017; 25:754-767. [PMID: 28895107 DOI: 10.1245/s10434-017-6081-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of this study was to evaluate the role of preoperative and postoperative external beam radiation therapy (EBRT) in the treatment of resectable soft tissue sarcomas (STSs) of different tumor locations. METHODS A systematic literature search was performed to identify studies investigating the effects of EBRT (versus no EBRT) on local recurrence (LR) and overall survival (OS) or comparing different EBRT sequences. Random effects meta-analyses were calculated and presented as cumulative odds ratios (ORs). RESULTS Sixteen studies (n = 3958 patients) comparing EBRT versus no EBRT, including one randomized controlled trial (RCT) in extremity sarcoma, were analyzed. EBRT appeared to reduce LR in both retroperitoneal tumors (OR 0.47, p < 0.0001) and other locations (OR 0.49, p = 0.001). OS was improved by EBRT in retroperitoneal STSs (OR 0.37, p < 0.0001) but not in other tumor locations. Eleven studies (n = 2140), including one RCT, compared preoperative and postoperative radiotherapy. LR was less frequent following preoperative EBRT in retroperitoneal STSs (OR 0.03, p = 0.02), as well as in other tumor locations (OR 0.67, p = 0.01), while wound complications in extremity sarcoma were more frequent following preoperative EBRT (OR 2.92, p < 0.0001). Several studies included in this meta-analysis bear a high risk of bias and no RCT has been published for retroperitoneal STS. CONCLUSIONS This meta-analysis supports the use of EBRT for local tumor control in patients with resectable STSs. Based on a small number of non-randomized studies, a positive effect on OS may exist in the subgroup of retroperitoneal STSs.
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Affiliation(s)
- Markus Albertsmeier
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilian University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Alexandra Rauch
- Department of Medical Informatics, Biometry and Epidemiology-IBE, Research Unit for Biopsychosocial Health, Chair for Public Health and Health Care Research, Ludwig Maximilian University, Munich, Germany.,Furtwangen University, Furtwangen, Germany
| | - Falk Roeder
- Department of Radiation Oncology, Ludwig Maximilian University Hospital, Ludwig-Maximilians-University, Munich, Germany.,Department of Molecular Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Sandro Hasenhütl
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilian University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Sebastian Pratschke
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilian University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Michaela Kirschneck
- Department of Medical Informatics, Biometry and Epidemiology-IBE, Research Unit for Biopsychosocial Health, Chair for Public Health and Health Care Research, Ludwig Maximilian University, Munich, Germany
| | - Alessandro Gronchi
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nina L Jebsen
- Department of Oncology, Musculo-Skeletal Tumour Service, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - Claus Belka
- Department of Radiation Oncology, Ludwig Maximilian University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Lars H Lindner
- Department of Medical Oncology, Ludwig Maximilian University Hospital, Munich, Germany
| | - Jens Werner
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilian University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Martin K Angele
- Department of General, Visceral and Transplantation Surgery, Ludwig Maximilian University Hospital, Marchioninistr. 15, 81377, Munich, Germany.
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30
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MacNeill AJ, Miceli R, Strauss DC, Bonvalot S, Hohenberger P, Van Coevorden F, Rutkowski P, Callegaro D, Hayes AJ, Honoré C, Fairweather M, Cannell A, Jakob J, Haas RL, Szacht M, Fiore M, Casali PG, Pollock RE, Raut CP, Gronchi A, Swallow CJ. Post-relapse outcomes after primary extended resection of retroperitoneal sarcoma: A report from the Trans-Atlantic RPS Working Group. Cancer 2017; 123:1971-1978. [PMID: 28152173 DOI: 10.1002/cncr.30572] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/16/2016] [Accepted: 12/28/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Despite a radical surgical approach to primary retroperitoneal sarcoma (RPS), many patients experience locoregional and/or distant recurrence. The objective of this study was to analyze post-relapse outcomes for patients with RPS who had initially undergone surgical resection of their primary tumor at a specialist center. METHODS All consecutive patients who underwent macroscopically complete resection for primary RPS at 8 high volume centers from January 2002 to December 2011 were identified, and those who developed local recurrence (LR) only, distant metastasis (DM) only, or synchronous local recurrence and distant metastasis (LR+DM) during the follow-up period were included. Overall survival (OS) was calculated for all groups, as was the crude cumulative incidence of a second recurrence after the first LR. Multivariate analyses for OS were performed. RESULTS In an initial series of 1007 patients with primary RPS, 408 patients developed recurrent disease during the follow-up period. The median follow-up from the time of recurrence was 41 months. The median OS was 33 months after LR (n = 219), 25 months after DM (n = 146), and 12 months after LR+DM (n = 43), and the 5-year OS rates were 29%, 20%, and 14%, respectively. Predictors of OS after LR were the time interval to LR and resection of LR, while histologic grade approached significance. For DM, significant predictors of OS were the time interval to DM and histologic subtype. The subgroup of patients who underwent resection of recurrent disease had a longer median OS than patients who did not undergo resection. CONCLUSIONS Relapse of RPS portends high disease-specific mortality. Patients with locally recurrent or metastatic disease should be considered for resection. Cancer 2017;123:1971-1978. © 2017 American Cancer Society.
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Affiliation(s)
- Andrea J MacNeill
- Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - Rosalba Miceli
- Department of Biostatistics, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - Dirk C Strauss
- Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Peter Hohenberger
- University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frits Van Coevorden
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Dario Callegaro
- Department of Surgery, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - Andrew J Hayes
- Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Charles Honoré
- Department of Surgery, Gustave Roussy Institute, Villejuif, France
| | - Mark Fairweather
- Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital and Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Amanda Cannell
- Ontario Institute for Cancer Research, MaRS Centre, Toronto, Ontario, Canada
| | - Jens Jakob
- University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Rick L Haas
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Milena Szacht
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Marco Fiore
- Department of Surgery, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - Paolo G Casali
- Department of Cancer Medicine, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - Raphael E Pollock
- Division of Surgical Oncology, Department of Surgery, Ohio State University Medical Center, Columbus, Ohio
| | - Chandrajit P Raut
- Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital and Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Alessandro Gronchi
- Department of Surgery, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - Carol J Swallow
- Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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31
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Hull MA, Molina G, Niemierko A, Haynes AB, Jacobson A, Bernstein KDA, Chen Y, DeLaney TF, Mullen JT. Improved local control with an aggressive strategy of preoperative (with or without intraoperative) radiation therapy combined with radical surgical resection for retroperitoneal sarcoma. J Surg Oncol 2017; 115:746-751. [DOI: 10.1002/jso.24557] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 12/26/2016] [Accepted: 12/29/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Melissa A. Hull
- Department of SurgeryMassachusetts General HospitalBostonMassachusetts
| | - George Molina
- Department of SurgeryMassachusetts General HospitalBostonMassachusetts
| | - Andrzej Niemierko
- Department of Radiation OncologyMassachusetts General HospitalBostonMassachusetts
| | - Alex B. Haynes
- Department of SurgeryMassachusetts General HospitalBostonMassachusetts
| | - Alex Jacobson
- Department of Radiation OncologyMassachusetts General HospitalBostonMassachusetts
| | | | - Yen‐Lin Chen
- Department of Radiation OncologyMassachusetts General HospitalBostonMassachusetts
| | - Thomas F. DeLaney
- Department of Radiation OncologyMassachusetts General HospitalBostonMassachusetts
| | - John T. Mullen
- Department of SurgeryMassachusetts General HospitalBostonMassachusetts
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Clarke MJ, Price DL, Cloft HJ, Segura LG, Hill CA, Browning MB, Brandt JM, Lew SM, Foy AB. En bloc resection of a C-1 lateral mass osteosarcoma: technical note. J Neurosurg Pediatr 2016; 18:46-52. [PMID: 26966885 DOI: 10.3171/2015.12.peds15496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Osteosarcoma is an aggressive primary bone tumor. It is currently treated with multimodality therapy including en bloc resection, which has been demonstrated to confer a survival benefit over intralesional resection. The authors present the case of an 8-year-old girl with a C-1 lateral mass osteosarcoma, which was treated with a 4-stage en bloc resection and spinal reconstruction. While technically complex, the feasibility of en bloc resection for spinal osteosarcoma should be explored in the pediatric population.
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Affiliation(s)
| | | | | | | | | | - Meghen B Browning
- Department of Pediatric Oncology, Medical College of Wisconsin, Milwaukee
| | - Jon M Brandt
- Department of Pediatric Oncology, St. Vincent Hospital, Green Bay; and
| | - Sean M Lew
- Department of Pediatric Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrew B Foy
- Department of Pediatric Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Impact of chemotherapy in uterine sarcoma (UtS): review of 13 clinical trials from the EORTC Soft Tissue and Bone Sarcoma Group (STBSG) involving advanced/metastatic UtS compared to other soft tissue sarcoma (STS) patients treated with first line chemotherapy. Gynecol Oncol 2016; 142:95-101. [DOI: 10.1016/j.ygyno.2016.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/10/2016] [Accepted: 05/15/2016] [Indexed: 01/12/2023]
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Pham V, Henderson-Jackson E, Doepker MP, Caracciolo JT, Gonzalez RJ, Druta M, Ding Y, Bui MM. Practical Issues for Retroperitoneal Sarcoma. Cancer Control 2016; 23:249-64. [DOI: 10.1177/107327481602300308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Retroperitoneal sarcoma is rare. Using initial specimens on biopsy, a definitive diagnosis of histological subtypes is ideal but not always achievable. Methods A retrospective institutional review was performed for all cases of adult retroperitoneal sarcoma from 1996 to 2015. A review of the literature was also performed related to the distribution of retroperitoneal sarcoma subtypes. A meta-analysis was performed. Results Liposarcoma is the most common subtype (45%), followed by leiomyosarcoma (21%), not otherwise specified (8%), and undifferentiated pleomorphic sarcoma (6%) by literature review. Data from Moffitt Cancer Center demonstrate the same general distribution for subtypes of retroperitoneal sarcoma. A pathology-based algorithm for the diagnosis of retroperitoneal sarcoma is illustrated, and common pitfalls in the pathology of retroperitoneal sarcoma are discussed. Conclusions An informative diagnosis of retroperitoneal sarcoma via specimens on biopsy is achievable and meaningful to guide effective therapy. A practical and multidisciplinary algorithm focused on the histopathology is helpful for the management of retroperitoneal sarcoma.
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Affiliation(s)
- Vicky Pham
- University of South Florida Morsani College of Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Evita Henderson-Jackson
- Departments of Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Sarcoma, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Matthew P. Doepker
- Sarcoma, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Surgical Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Jamie T. Caracciolo
- Sarcoma, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Diagnostic Imaging, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Ricardo J. Gonzalez
- University of South Florida Morsani College of Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Mihaela Druta
- Sarcoma, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Yi Ding
- Department of Pathology, JiShuiTan Hospital, Beijing, China
| | - Marilyn M. Bui
- Departments of Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Sarcoma, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Dekutoski MB, Clarke MJ, Rose P, Luzzati A, Rhines LD, Varga PP, Fisher CG, Chou D, Fehlings MG, Reynolds JJ, Williams R, Quraishi NA, Germscheid NM, Sciubba DM, Gokaslan ZL, Boriani S, _ _. Osteosarcoma of the spine: prognostic variables for local recurrence and overall survival, a multicenter ambispective study. J Neurosurg Spine 2016; 25:59-68. [DOI: 10.3171/2015.11.spine15870] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Primary spinal osteosarcomas are rare and aggressive neoplasms. Poor outcomes can occur, as obtaining marginal margins is technically demanding; further Enneking-appropriate en bloc resection can have significant morbidity. The goal of this study is to identify prognostic variables for local recurrence and mortality in surgically treated patients diagnosed with a primary osteosarcoma of the spine.
METHODS
A multicenter ambispective database of surgically treated patients with primary spine osteosarcomas was developed by AOSpine Knowledge Forum Tumor. Patient demographic, diagnosis, treatment, perioperative morbidity, local recurrence, and cross-sectional survival data were collected. Tumors were classified in 2 cohorts: Enneking appropriate (EA) and Enneking inappropriate (EI), as defined by pathology margin matching Enneking-recommended surgical margins. Prognostic variables were analyzed in reference to local recurrence and survival.
RESULTS
Between 1987 and 2012, 58 patients (32 female patients) underwent surgical treatment for primary spinal osteosarcoma. Patients were followed for a mean period of 3.5 ± 3.5 years (range 0.5 days to 14.3 years). The median survival for the entire cohort was 6.7 years postoperative. Twenty-four (41%) patients died, and 17 (30%) patients suffered a local recurrence, 10 (59%) of whom died. Twenty-nine (53%) patients underwent EA resection while 26 (47%) patients underwent EI resection with a postoperative median survival of 6.8 and 3.7 years, respectively (p = 0.048). EI patients had a higher rate of local recurrence than EA patients (p = 0.001). Patient age, previous surgery, biopsy type, tumor size, spine level, and chemotherapy timing did not significantly influence recurrence and survival.
CONCLUSIONS
Osteosarcoma of the spine presents a significant challenge, and most patients die in spite of aggressive surgery. There is a significant decrease in recurrence and an increase in survival with en bloc resection (EA) when compared with intralesional resection (EI). The effect of adjuvant and neoadjuvant chemotherapeutics, as well as method of biopsy, requires further exploration.
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Affiliation(s)
| | | | - Peter Rose
- 3Orthopedics, Mayo Clinic, Rochester, Minnesota
| | - Alessandro Luzzati
- 4Oncologia Ortopedica e Ricostruttiva del Rachide, Istituto Ortopedico Galeazzi, Milan, Italy
| | - Laurence D. Rhines
- 5Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peter P. Varga
- 6National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary
| | - Charles G. Fisher
- 7Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Dean Chou
- 8Department of Neurological Surgery, University of California, San Francisco, California
| | - Michael G. Fehlings
- 9Division of Neurosurgery, Department of Surgery, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada
| | - Jeremy J. Reynolds
- 10Spinal Division, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Richard Williams
- 11Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nasir A. Quraishi
- 12Center for Spine Studies and Surgery, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | | | - Daniel M. Sciubba
- 14Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ziya L. Gokaslan
- 15Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Stefano Boriani
- 16Unit of Oncologic and Degenerative Spine Surgery, Rizzoli Institute, Bologna, Italy
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Garcia-Ortega DY, Villa-Zepeda O, Martinez-Said H, Cuellar-Hübbe M, Luna-Ortiz K. Oncology outcomes in Retroperitoneal sarcomas: Prognostic factors in a Retrospective Cohort study. Int J Surg 2016; 32:45-9. [PMID: 27268726 DOI: 10.1016/j.ijsu.2016.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/29/2016] [Accepted: 06/02/2016] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Retroperitoneal sarcomas are a rare group of malignant soft tissue tumors with a generally poor prognosis. The aim of the study was to define the demographic characteristics and prognostic factors for patients with retroperitoneal sarcomas (RPS) in a Tertiary Referral Center at Mexico. METHODS A retrospective study of patients with RPS treated from January 2005 to December 2012 at the National Cancer Institute at Mexico. Patient, tumor and treatment variables were analyzed including use of adjuvant therapy and survival status. Survival and local recurrence curves were estimated using the Kaplan-Meier method. RESULTS Ninety-five patients with a mean age of 47 years with retroperitoneal sarcoma were included. Median follow-up was 25 months (range 1-108 months). The average tumor size was 23.7 cm. Histology, 58 (61.1%) were liposarcoma, 14 (14.7%), leiomyosarcomas and 23 (24.2%) were from other histologies. In 64 (67.4%) patients were high-grade malignancies. The median survival was 51 months for patients with complete resection, 25.1 months for those with incomplete resection, and 4.4 months for those with unresectable tumors. Complete resection (p = 0.0001), and liposarcoma (p = 0.03) were prognostic factors for overall survival. CONCLUSION In this study of patients with retroperitoneal, complete resection and liposarcoma histology are prognostic factors related to the disease-free and overall survival. Patients approached with curative intent should undergo aggressive attempts at complete surgical resection.
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Affiliation(s)
- Dorian Yarih Garcia-Ortega
- Department of Skin and Soft Tissue Tumors, Instituto Nacional de Cancerologia (México), Av. San Fernando #22, Col. Sección XVI, Tlalpan, Mexico D.F., 14080, Mexico
| | - Oscar Villa-Zepeda
- Department of Skin and Soft Tissue Tumors, Instituto Nacional de Cancerologia (México), Av. San Fernando #22, Col. Sección XVI, Tlalpan, Mexico D.F., 14080, Mexico
| | - Héctor Martinez-Said
- Department of Skin and Soft Tissue Tumors, Instituto Nacional de Cancerologia (México), Av. San Fernando #22, Col. Sección XVI, Tlalpan, Mexico D.F., 14080, Mexico
| | - Mario Cuellar-Hübbe
- Department of Skin and Soft Tissue Tumors, Instituto Nacional de Cancerologia (México), Av. San Fernando #22, Col. Sección XVI, Tlalpan, Mexico D.F., 14080, Mexico
| | - Kuauhyama Luna-Ortiz
- Department of Head and Neck Surgery, Instituto Nacional de Cancerologia (México), Av. San Fernando #22, Col. Sección XVI, Tlalpan, Mexico D.F., 14080, Mexico.
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[Retroperitoneal tumors]. Urologe A 2016; 55:748-55. [PMID: 27220892 DOI: 10.1007/s00120-016-0117-2] [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: 10/21/2022]
Abstract
BACKGROUND Retroperitoneal tumors are rare malignancies. The retroperitoneum can host a wide spectrum of pathologies including primary or metastatic lesions. OBJECTIVE Treatment of retroperitoneal tumors is often associated with several challenges because of their relative late presentation and anatomic location. MATERIALS AND METHODS Because of various pathologies, a detailed case history, laboratory investigation and ultrasound should be performed. Radiologic examinations remain a major component in the diagnosis. In addition to computed tomography, magnetic resonance imaging and positron emission tomography are used. Although radiologic findings are often unspecific, there are often typical findings such as dissemination, margins, vascularization and tumor texture which contribute to the differential diagnosis even before making a definitive diagnosis. Due to the complexity of primary retroperitoneal tumors, which require different treatments depending on the final diagnosis, the treatment approach should be determined in a multidisciplinary tumor conference prior to histological confirmation and initiation of treatment. CONCLUSION To ensure the best potential curative treatment modality for retroperitoneal tumors, treatment is best performed in high-volume centers by a multidisciplinary team.
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Abstract
Sarcomas are a heterogeneous group of rare tumors that originate from mesenchymal tissue. Radical R0 resection is the only curative option, which is especially challenging in retroperitoneal or intra-abdominal sarcomas. This article describes the current data on optimal interdisciplinary and primarily surgical therapy of visceral sarcomas. Surgical resection of retroperitoneal sarcomas must be performed according to the principle of radical compartmental resection, i.e. with complete excision of the mass along with en bloc visceral resection of adjacent organs and tissues covering the tumor, which also contains any not obviously infiltrated neighboring organs. The main objective is R0 resection without opening the tumor capsule in the primary operation because the best long-term results can be achieved with this approach.
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Affiliation(s)
- J Kirchberg
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - J Weitz
- Klinik und Poliklinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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Belfiore MP, Ronza FM, Della Volpe T, Pascale M, Belfiore G. Long-term local disease control in a recurrent soft-tissue sarcoma of the thigh treated by radiofrequency ablation. J Surg Oncol 2015; 111:708-10. [PMID: 25864731 DOI: 10.1002/jso.23877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 11/26/2014] [Accepted: 12/01/2014] [Indexed: 11/06/2022]
Abstract
In 2008, we performed radiofrequency ablation (RFA) in an elderly patient with a large recurrent soft-tissue sarcoma of the thigh, previously treated with surgery and radiotherapy. After ablation, a marked shrinkage of tumor was obtained. Further local recurrences occurred during follow-up, all safely treated by RFA, with local control of the disease maintained until 6-year follow-up. RFA was safe, effective, and repeatable for soft-tissue sarcoma recurrences, and allowed long-term local control of the disease.
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Affiliation(s)
- Maria P Belfiore
- Department of Clinical and Experimental Medicine, "F. Magrassi - A. Lanzara" Second University of Naples, Naples, Italy
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Effectiveness of regional hyperthermia with chemotherapy for high-risk retroperitoneal and abdominal soft-tissue sarcoma after complete surgical resection: a subgroup analysis of a randomized phase-III multicenter study. Ann Surg 2015; 260:749-54; discussion 754-6. [PMID: 25379845 DOI: 10.1097/sla.0000000000000978] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether regional hyperthermia (RHT) in addition to chemotherapy improves local tumor control after macroscopically complete resection of abdominal or retroperitoneal high-risk sarcomas. BACKGROUND Within the prospectively randomized EORTC 62961 phase-III trial, RHT and systemic chemotherapy significantly improved local progression-free survival (LPFS) and disease-free survival (DFS) in patients with abdominal and extremity sarcomas. That trial included macroscopically complete and R2 resections. METHODS A subgroup analysis of the EORTC trial was performed and long-term survival determined. From 341 patients, 149 (median age 52 years, 18-69) were identified with macroscopic complete resection (R0, R1) of abdominal and retroperitoneal soft-tissue sarcomas (median diameter 10 cm, G2 48.3%, G3 51.7%). Seventy-six patients were treated with EIA (etoposide, ifosfamide, doxorubicin)+RHT (≥5 cycles: 69.7%) versus 73 patients receiving EIA alone (≥5 cycles: 52.1%, P=0.027). LPFS and DFS as well as overall survival were determined. RESULTS RHT and systemic chemotherapy significantly improved LPFS (56% vs 45% after 5 years, P=0.044) and DFS (34% vs 27% after 5 years, P=0.040). Overall survival was not significantly improved in the RHT group (57% vs 55% after 5 years, P=0.82). Perioperative morbidity and mortality were not significantly different between groups. CONCLUSIONS In patients with macroscopically complete tumor resection, RHT in addition to chemotherapy resulted in significantly improved local tumor control and DFS without increasing surgical complications. Within a multimodal therapeutic concept for abdominal and retroperitoneal high-risk sarcomas, RHT is a treatment option beside radical surgery and should be further evaluated in future trials.
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Yang JY, Kong SH, Ahn HS, Lee HJ, Jeong SY, Ha J, Yang HK, Park KJ, Lee KU, Choe KJ. Prognostic factors for reoperation of recurrent retroperitoneal sarcoma: The role of clinicopathological factors other than histologic grade. J Surg Oncol 2014; 111:165-72. [DOI: 10.1002/jso.23783] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 08/09/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Jun-Young Yang
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Seong-Ho Kong
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Hye Seong Ahn
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Hyuk-Joon Lee
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Korea
| | - Seung-Yong Jeong
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Jongwon Ha
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Han-Kwang Yang
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
- Cancer Research Institute; Seoul National University College of Medicine; Seoul Korea
| | - Kyu Joo Park
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Kuhn Uk Lee
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Kuk Jin Choe
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
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Wong P, Dickie C, Lee D, Chung P, O’Sullivan B, Letourneau D, Xu W, Swallow C, Gladdy R, Catton C. Spatial and volumetric changes of retroperitoneal sarcomas during pre-operative radiotherapy. Radiother Oncol 2014; 112:308-13. [DOI: 10.1016/j.radonc.2014.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 07/08/2014] [Accepted: 08/02/2014] [Indexed: 10/24/2022]
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Abstract
Retroperitoneal soft tissue sarcomas are characterized by a high rate of local recurrence. Complete tumor resection is the only potentially curative therapeutic option. The concept of a systematic compartmental resection is to remove the tumor en bloc with a margin of uninvolved tissue and organs. This is frequently only achieved by multivisceral resection which often includes kidney, colon, pancreas and parts of the diaphragm or the psoas muscle. The adoption of such a policy of multivisceral organ resection improves the proportion of curative resections and, ultimately, results in lower local recurrence rates. The present article comprehensively describes the operative procedures, perioperative treatment and the oncological results of surgery for retroperitoneal sarcomas. The role of surgery in oncological treatment plans and the importance of specialized centres are outlined in detail.
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TERT promoter hotspot mutations are recurrent in myxoid liposarcomas but rare in other soft tissue sarcoma entities. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2014; 33:33. [PMID: 24726063 PMCID: PMC4022359 DOI: 10.1186/1756-9966-33-33] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 04/08/2014] [Indexed: 01/21/2023]
Abstract
Background Recently, recurrent point mutations in the telomerase reverse transcriptase (TERT) promoter region have been found in many human cancers, leading to a new transcription factor binding site, increased induction of TERT and subsequently to telomere maintenance. We determined the prevalence of TERT promoter mutations in soft tissue sarcomas of 341 patients comprising 16 entities and in 16 sarcoma cell lines covering 7 different soft tissue sarcoma types. Methods The sarcoma tissue samples were collected from the archives of the Institute of Pathology, University of Heidelberg and were composed of 39 myxoid liposarcomas (MLS), 61 dedifferentiated liposarcomas, 15 pleomorphic liposarcomas, 27 leiomyosarcomas, 25 synovial sarcomas (SS), 35 malignant peripheral nerve sheath tumors (MPNST), 40 undifferentiated pleomorphic sarcomas, 17 myxofibrosarcomas, 9 low grade fibromyxoid sarcomas, 10 cases of dermatofibrosarcoma protuberans, 31 solitary fibrous tumors (SFT), 8 extraskeletal myxoid chondrosarcomas, 9 angiosarcomas, 6 alveolar soft part sarcomas, 5 clear cell sarcomas and 4 epithelioid sarcomas. Sarcoma cell lines were obtained from the raising laboratories. A 193 bp fragment of the TERT promoter region covering the hot-spot mutations C228T and C250T was amplified, and direct sequencing of the PCR products was performed. Results TERT promoter mutations were detected in 36/341 sarcomas. They were highly recurrent in MLS (29/39; 74%) and were in the present MLS series not associated with the phenotype (myxoid vs. round cell variant), tumor grade, tumor site and patients’ median age or gender. In the remaining cases, TERT promoter mutations were found only in 7/302 sarcoma samples and confined to SFTs (4/31; 13%), MPNSTs (2/35; 6%), and SSs (1/25; 4%). Within the collection of sarcoma cell lines examined, TERT promoter mutations were detected in two MLS and in one of three MPNST cell lines. Conclusions TERT promoter mutations are frequent in MLSs including their round cell variants, representing the most prevalent mutation identified in this sarcoma entity to date, and in a minor fraction of SFTs, MPNSTs and SSs. The majority of sarcomas are devoid of TERT promoter hotspot mutations. These data suggest that telomere maintenance through increased expression of telomerase plays an important role in the pathogenesis especially of MLS.
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Toulmonde M, Bonvalot S, Méeus P, Stoeckle E, Riou O, Isambert N, Bompas E, Jafari M, Delcambre-Lair C, Saada E, Le Cesne A, Le Péchoux C, Blay JY, Piperno-Neumann S, Chevreau C, Bay JO, Brouste V, Terrier P, Ranchère-Vince D, Neuville A, Italiano A. Retroperitoneal sarcomas: patterns of care at diagnosis, prognostic factors and focus on main histological subtypes: a multicenter analysis of the French Sarcoma Group. Ann Oncol 2014; 25:735-742. [PMID: 24567518 PMCID: PMC4433510 DOI: 10.1093/annonc/mdt577] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 12/04/2013] [Accepted: 12/05/2013] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Retroperitoneal sarcomas (RPS) are heterogeneous. No previous study has investigated the impact of specialized surgery, evaluated locoregional relapse (LRR), abdominal sarcomatosis and distant metastatic relapse as separate events, or considered histological subtypes separately. This study addresses these specific points in a homogeneous cohort of patients with completely resected primary RPS. PATIENTS AND METHODS We conducted a retrospective analysis of adult patients diagnosed with a RPS between 1 January 1988 and 31 December 2008 and eventually referred to one of 12 centers of the French Sarcoma Group. All cases were centrally reviewed by an expert pathologist. RESULTS Five hundred eighty-six patients were included. Median follow-up was 6.5 years [95% confidence interval (CI) 5.9-7.1]. Five hundred thirty-seven patients had localized disease and 389 patients (76%) had macroscopically complete resection of the tumor. In this latter group, the 5-year LRR-free survival rate was 46% [41-52] and the 5-year overall survival (OS) rate was 66% [61-71]. In multivariate analysis, gender, adjacent organ involvement, specialization of the surgeon, piecemeal resection and perioperative radiotherapy were independently associated with LRR. Specialization of the surgeon and piecemeal resection were independently associated with abdominal sarcomatosis whereas histology and adjacent organ involvement were independently associated with distant metastasis. Age, gender, grade, adjacent organ involvement and piecemeal resection were significantly associated with OS. Prognostic factors for LRR and OS were analyzed in well-differentiated and dedifferentiated liposarcomas and leiomyosarcomas. Grade 3 was an independent prognostic factor for OS of dedifferentiated liposarcomas. CONCLUSION This study underlines the crucial role of pretherapeutic assessment and meticulous histological examination of RPS as well as the need to consider histological subtypes separately. Surgery in a specialized center and avoidance of piecemeal resection stand out as the two most important prognostic factors for RPS and highlight the importance of treating these patients in specialized centers.
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Affiliation(s)
- M Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux.
| | - S Bonvalot
- Department of Surgical Oncology, Institut Gustave Roussy, Villejuif
| | - P Méeus
- Department of Surgical Oncology, Centre Léon Bérard, Lyon
| | - E Stoeckle
- Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - O Riou
- Department of Radiation Oncology, Institut Régional du Cancer Montpellier, Montpellier
| | - N Isambert
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon
| | - E Bompas
- Department of Medical Oncology, Centre René Gauducheau, Nantes
| | - M Jafari
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | | | - E Saada
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice
| | | | - C Le Péchoux
- Radiation Oncology, Institut Gustave Roussy, Villejuif
| | - J Y Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon
| | | | - C Chevreau
- Department of Medical Oncology, Centre Claudius Regaud, Toulouse
| | - J O Bay
- Department of Medical Oncology, Centre Jean Perrin, Clermont-Ferrand
| | - V Brouste
- Department of Clinical and Epidemiological Research, Institut Bergonié, Bordeaux
| | - P Terrier
- Department of Pathology, Institut Gustave Roussy, Villejuif
| | | | - A Neuville
- Department of Pathology, Institut Bergonié, Bordeaux, France
| | - A Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux
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Bray J, Polton G. Neoadjuvant and adjuvant chemotherapy combined with anatomical resection of feline injection-site sarcoma: results in 21 cats. Vet Comp Oncol 2014; 14:147-60. [DOI: 10.1111/vco.12083] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 12/02/2013] [Accepted: 12/10/2013] [Indexed: 12/22/2022]
Affiliation(s)
- J. Bray
- Veterinary Teaching Hospital; Massey University; Palmerston North New Zealand
| | - G. Polton
- North Downs Specialist Referrals; Bletchingley UK
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Choong PFM, Rüdiger HA. Prognostic factors in soft-tissue sarcomas: what have we learnt? Expert Rev Anticancer Ther 2014; 8:139-46. [DOI: 10.1586/14737140.8.2.139] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Combined management of retroperitoneal sarcoma with dose intensification radiotherapy and resection: Long-term results of a prospective trial. Radiother Oncol 2014; 110:165-71. [DOI: 10.1016/j.radonc.2013.10.041] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 10/29/2013] [Accepted: 10/31/2013] [Indexed: 11/21/2022]
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Gyorki DE, Brennan MF. Management of recurrent retroperitoneal sarcoma. J Surg Oncol 2013; 109:53-9. [PMID: 24155163 DOI: 10.1002/jso.23463] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 09/10/2013] [Indexed: 01/01/2023]
Abstract
Approximately 15% of soft tissue sarcomas are retroperitoneal. The occult location and anatomic complexity results in local recurrences in the majority of patients. Predictors of recurrence include histological subtype, completeness of resection, and the hospital case volume. The most significant predictor of outcome following local recurrence is the resectability of the recurrent disease. An understanding of the implication of tumor biology on outcomes is essential in determining optimal management for patients with recurrent retroperitoneal sarcoma.
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Affiliation(s)
- David E Gyorki
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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Shiraev T, Pasricha SS, Choong P, Schlicht S, van Rijswijk CSP, Dimmick S, Stuckey S, Anderson SE. Retroperitoneal sarcomas: A review of disease spectrum, radiological features, characterisation and management. J Med Imaging Radiat Oncol 2013; 57:687-700. [DOI: 10.1111/1754-9485.12123] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 09/02/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Timothy Shiraev
- School of Medicine; University of Notre Dame; Sydney New South Wales Australia
| | - Sundeep Singh Pasricha
- Southern Health; Department of Diagnostic Imaging; Monash Medical Centre; Melbourne Victoria Australia
| | - Peter Choong
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
- Department of Orthopaedics; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
- Bone and Soft Tissue Tumour Unit; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Stephen Schlicht
- Department of Medical Imaging; St. Vincent's Hospital Melbourne; Melbourne Victoria Australia
| | | | - Simon Dimmick
- School of Medicine; University of Notre Dame; Sydney New South Wales Australia
- Department of Radiology; Royal North Shore Hospital; Sydney New South Wales Australia
| | - Stephen Stuckey
- Southern Health; Department of Diagnostic Imaging; Monash Medical Centre; Melbourne Victoria Australia
- Southern Clinical School; Faculty of Medicine; Nursing and Health Sciences; Monash University; Melbourne Victoria Australia
| | - Suzanne E Anderson
- School of Medicine; University of Notre Dame; Sydney New South Wales Australia
- Southern Health; Department of Diagnostic Imaging; Monash Medical Centre; Melbourne Victoria Australia
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