1
|
Chmiel P, Krotewicz M, Szumera-Ciećkiewicz A, Bartnik E, Czarnecka AM, Rutkowski P. Review on Lymph Node Metastases, Sentinel Lymph Node Biopsy, and Lymphadenectomy in Sarcoma. Curr Oncol 2024; 31:307-323. [PMID: 38248105 PMCID: PMC10814427 DOI: 10.3390/curroncol31010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/17/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Soft tissue sarcomas (STS) originating from connective tissue rarely affect the lymph nodes. However, involvement of lymph nodes in STS is an important aspect of prognosis and treatment. Currently, there is no consensus on the diagnosis and management of lymph node metastases in STS. The key risk factor for nodal involvement is the histological subtype of sarcoma. Radiological and pathological evaluation seems to be the most effective method of assessing lymph nodes in these neoplasms. Thus, sentinel lymph node biopsy (SLNB), which has been shown to be valuable in the management of melanoma or breast cancer, may also be a beneficial diagnostic option in some high-risk STS subtypes. This review summarizes data on the risk factors and clinical characteristics of lymph node involvement in STS. Possible management and therapeutic options are also discussed.
Collapse
Affiliation(s)
- Paulina Chmiel
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.C.); (M.K.); (P.R.)
| | - Maria Krotewicz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.C.); (M.K.); (P.R.)
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology, Maria Sklodowska Curie National Research Institute of Oncology, 02-781 Warsaw, Poland;
| | - Ewa Bartnik
- Institute of Genetics and Biotechnology, Faculty of Biology, University of Warsaw, 02-106 Warsaw, Poland;
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Anna M. Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.C.); (M.K.); (P.R.)
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.C.); (M.K.); (P.R.)
| |
Collapse
|
2
|
Fujiwara T, Evans S, Stevenson J, Tsuda Y, Gregory J, Grimer R, Abudu A. Impact of the national sarcoma guidelines on the prevalence and outcome of inadvertent excisions of soft tissue sarcomas: An observational study from a UK tertiary referral centre. Eur J Surg Oncol 2021; 48:533-540. [PMID: 34838395 DOI: 10.1016/j.ejso.2021.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/29/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES This study aims to investigate the impact of the national guideline on the prevalence and outcome in patients with soft-tissue sarcoma (STS) who had undergone inadvertent excisions. METHODS A total of 2336 patients were referred to a tertiary sarcoma centre from six regions (North East, North West, East Midlands, West Midlands, Wales, and South West) in the United Kingdom with a diagnosis of STS between 1996 and 2016, of whom 561 patients (24.0%) had undergone inadvertent excisions. Patients were categorised into two groups of 10-year periods pre and post the National Institute for Health and Clinical Excellence (NICE) guideline implementation in 2006. RESULTS The proportion of inadvertent excisions decreased after the NICE guideline implementation: 27.2% (pre-NICE) versus 19.8% (post-NICE) (p = 0.001). A substantial regional variation (17.4%-34.5%) in the proportion of inadvertent excisions in the pre-NICE era was reduced in the post-NICE era (14.3%-22.4%). The 5-year disease-specific survival was 77.7% (pre-NICE) versus 75.6% (post-NICE) (p = 0.961) and there was a trend toward lower incidence of local recurrence in the post-NICE era; 13.5% (pre-NICE) versus 10.5% (post-NICE) (p = 0.522). Multivariate analyses revealed that residual tumours in re-resection specimens were independently associated with an increased risk of disease-specific mortality (HR, 3.35; p < 0.001) and local recurrence (HR, 1.99; p = 0.017), which was significantly reduced after the NICE guideline implementation (53.2% versus 42.0%; p = 0.022). CONCLUSIONS The NICE guideline implementation reduced the proportion of patients with STS who had undergone inadvertent excisions and residual tumour in re-resection specimens, indicating an improved pre-referral management of STSs.
Collapse
Affiliation(s)
- Tomohiro Fujiwara
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK; Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Scott Evans
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan Stevenson
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Yusuke Tsuda
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan Gregory
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Robert Grimer
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Adesegun Abudu
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
3
|
The effect of preoperative radiotherapy on surgical resectability, tumor volume and the necrosis rate of soft tissue sarcomas: A retrospective single-center analysis. Surg Oncol 2021; 39:101668. [PMID: 34653769 DOI: 10.1016/j.suronc.2021.101668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/09/2021] [Accepted: 10/03/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The mainstay of soft tissue sarcoma treatment is limb preserving resection, often combined with radiotherapy, preferably preoperative radiotherapy. The goal of this study is to retrospectively assess the effect of preoperative (neoadjuvant) radiotherapy on the minimal distance to critical neurovascular structures, on tumor volume and the necrosis rate. MATERIAL AND METHODS The data of fifty-one patients treated for a localized soft tissue sarcoma (STS) of the extremity or the trunk were retrospectively reviewed. All patients were analyzed with MR imaging before and after preoperative radiotherapy to determine the impact of radiotherapy on the precise planning and execution of the surgical excision of the tumor. The volume of the tumor as well as the distance to anatomically relevant structures were measured on MRI. Tumor type, characteristics and necrosis rate were obtained from the pathology report. RESULTS At latest follow-up (median 51 months (range 6-113)) 32/51 (63%) patients were alive. The minimal distance between the myxoid liposarcomas (n = 12) and the vessels was significantly increased by preoperative radiotherapy from 1.09 mm [0-21.1] to 5.23 mm [0-32.70] (P = 0.045). High-grade tumors showed a significant increase in tumor volume after irradiation (p = 0.03) and a significantly greater necrosis rate than low-grade tumors (p < 0.001). CONCLUSION Preoperative radiotherapy significantly increases the minimal distance from myxoid liposarcomas to the vessel. In the subgroup of STS that demonstratea volume reduction the distance to nerves and vessels increases, but with the low number of cases, this increase is not statistically significant. The effect of preoperative radiotherapy on the tumor volume varies greatly, whereas the subtype of myxoid liposarcoma shows a significant volume reduction in all cases.
Collapse
|
4
|
Fujiwara T, Evans S, Stevenson J, Tsuda Y, Gregory J, Grimer RJ, Abudu S. Regional variation in the survival of patients with a soft-tissue sarcoma of the extremity and trunk wall under a centralized care system : what has been the impact of national policies in the UK? Bone Joint J 2021; 103-B:1541-1549. [PMID: 34465152 DOI: 10.1302/0301-620x.103b9.bjj-2020-2554.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS While a centralized system for the care of patients with a sarcoma has been advocated for decades, regional variations in survival remain unclear. The aim of this study was to investigate regional variations in survival and the impact of national policies in patients with a soft-tissue sarcoma (STS) in the UK. METHODS The study included 1,775 patients with a STS who were referred to a tertiary sarcoma centre. The geographical variations in survival were evaluated according to the periods before and after the issue of guidance by the National Institute for Health and Care Excellence (NICE) in 2006 and the relevant evolution of regional management. RESULTS There had been a significant difference in survival between patients referred from the North East, North West, East Midlands, West Midlands, South West, and Wales in the pre-NICE era (five-year disease-specific survival (DSS); South West, 74% vs North East, 47% (p = 0.045) or West Midlands, 54% (p = 0.049)), which was most evident for patients with a high-grade STS. However, this variation disappeared in the post-NICE era, in which the overall DSS for high-grade STS improved from 47% to 68% at five years (p < 0.001). Variation in the size of the tumour closely correlated with the variation in DSS, and the overall size of the tumour and incidence of metastasis at the time of diagnosis also decreased after the national policies were issued. CONCLUSION The survival of patients with a STS improved and regional variation corrected after the introduction of national policies, as a result of a decreasing size of tumour and incidence of metastasis at the time of diagnosis, particularly in patients with a high-grade STS. This highlights the positive impact of national guidelines on regional variation in the presentation, management, and outcome in patients with a STS. Cite this article: Bone Joint J 2021;103-B(9):1541-1549.
Collapse
Affiliation(s)
- Tomohiro Fujiwara
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.,Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Birmingham, UK
| | - Scott Evans
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Yusuke Tsuda
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan Gregory
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Robert J Grimer
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Seggy Abudu
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
5
|
Patterns of Perioperative Treatment and Survival of Localized, Resected, Intermediate- or High-Grade Soft Tissue Sarcoma: A 2000-2017 Netherlands Cancer Registry Database Analysis. Sarcoma 2021; 2021:9976122. [PMID: 34335076 PMCID: PMC8324372 DOI: 10.1155/2021/9976122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/18/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Standard therapy for localized soft tissue sarcoma (STS) is wide, limb-sparing resection. For intermediate- or high-grade tumors, (neo)adjuvant therapies are frequently added to the treatment plan. In this study, data from a Dutch nationwide database are used to (1) assess whether perioperative management of STS follows ESMO guidelines, (2) characterize prognostic factors for overall survival (OS), and (3) assess the association between perioperative treatment and survival. Methods All intermediate- or high-grade, localized STS cases, who have undergone surgery and diagnosed between 2000 and 2017, were identified in the Netherlands Cancer Registry (NCR) database. Variables with demographic, treatment, and survival data were obtained. Survival curves were estimated by Kaplan–Meier's method, and the effect of prognostic factors on OS was assessed in a multivariable Cox regression analysis. Results A total of 4957 patients were identified. There were slightly more males (54.7%). Median age at diagnosis was 64 years, and 53.6% of the tumors were located in the extremities. Radiotherapy (RT) was administered to 2481 (50.1%) patients, and 252 (5.1%) patients were treated with perioperative systemic chemotherapy. The total use of perioperative RT did not significantly change in the last 20 years, but the timing followed clinical guidelines: preoperative RT increased significantly (2000–2008: 3.7%, 2009–2017: 22.3%; p < 0.001), whereas the use of postoperative RT diminished (2000–2008: 45.9%, 2009–2017: 26.1%; p < 0.001). The use of perioperative chemotherapy slightly decreased (2000–2008: 5.9%, 2009–2017: 4.4%; p = 0.015). 5-year OS was 59.6% (95% CI: 58.2–61.0). Sex, age, year of diagnosis, tumor location, tumor size, histological grade, depth, histological subtype, surgical margins, and the use of perioperative RT were identified as independent predictors for OS. Conclusion Preoperative RT is gradually replacing postoperative RT for localized STS in the Netherlands. The use of perioperative chemotherapy is rare and has slightly decreased in recent years. Identified baseline characteristics and treatment factors predicting OS may aid in future treatment decisions.
Collapse
|
6
|
Hildebrand KM, Singla AK, McNeil R, Marritt KL, Hildebrand KN, Zemp F, Rajwani J, Itani D, Bose P, Mahoney DJ, Jirik FR, Monument MJ. The KrasG12D;Trp53fl/fl murine model of undifferentiated pleomorphic sarcoma is macrophage dense, lymphocyte poor, and resistant to immune checkpoint blockade. PLoS One 2021; 16:e0253864. [PMID: 34242269 PMCID: PMC8270133 DOI: 10.1371/journal.pone.0253864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/15/2021] [Indexed: 11/19/2022] Open
Abstract
Sarcomas are rare, difficult to treat, mesenchymal lineage tumours that affect children and adults. Immunologically-based therapies have improved outcomes for numerous adult cancers, however, these therapeutic strategies have been minimally effective in sarcoma so far. Clinically relevant, immunologically-competent, and transplantable pre-clinical sarcoma models are essential to advance sarcoma immunology research. Herein we show that Cre-mediated activation of KrasG12D, and deletion of Trp53, in the hindlimb muscles of C57Bl/6 mice results in the highly penetrant, rapid onset undifferentiated pleomorphic sarcomas (UPS), one of the most common human sarcoma subtypes. Cell lines derived from spontaneous UPS tumours can be reproducibly transplanted into the hindlimbs or lungs of naïve, immune competent syngeneic mice. Immunological characterization of both spontaneous and transplanted UPS tumours demonstrates an immunologically-‘quiescent’ microenvironment, characterized by a paucity of lymphocytes, limited spontaneous adaptive immune pathways, and dense macrophage infiltrates. Macrophages are the dominant immune population in both spontaneous and transplanted UPS tumours, although compared to spontaneous tumours, transplanted tumours demonstrate increased spontaneous lymphocytic infiltrates. The growth of transplanted UPS tumours is unaffected by host lymphocyte deficiency, and despite strong expression of PD-1 on tumour infiltrating lymphocytes, tumours are resistant to immunological checkpoint blockade. This spontaneous and transplantable immune competent UPS model will be an important experimental tool in the pre-clinical development and evaluation of novel immunotherapeutic approaches for immunologically cold soft tissue sarcomas.
Collapse
Affiliation(s)
- Karys M. Hildebrand
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- McCaig Bone and Joint Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arnie Charbonneau Cancer Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Arvind K. Singla
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- McCaig Bone and Joint Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arnie Charbonneau Cancer Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Reid McNeil
- Arnie Charbonneau Cancer Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kayla L. Marritt
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- McCaig Bone and Joint Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arnie Charbonneau Cancer Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kurt N. Hildebrand
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- McCaig Bone and Joint Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arnie Charbonneau Cancer Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Franz Zemp
- Arnie Charbonneau Cancer Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jahanara Rajwani
- Arnie Charbonneau Cancer Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Doha Itani
- Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Pinaki Bose
- Arnie Charbonneau Cancer Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Douglas J. Mahoney
- Arnie Charbonneau Cancer Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Frank R. Jirik
- McCaig Bone and Joint Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael J. Monument
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- McCaig Bone and Joint Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arnie Charbonneau Cancer Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| |
Collapse
|
7
|
Sambri A, Caldari E, Fiore M, Zucchini R, Giannini C, Pirini MG, Spinnato P, Cappelli A, Donati DM, De Paolis M. Margin Assessment in Soft Tissue Sarcomas: Review of the Literature. Cancers (Basel) 2021; 13:cancers13071687. [PMID: 33918457 PMCID: PMC8038240 DOI: 10.3390/cancers13071687] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Many classifications to assess margins status for soft tissue sarcomas are reported in the literature. Most of the series are heterogeneous and variable in size, making it difficult to compare results from study to study. Thus, which is the best way to assess margins in order to predict the risk of local recurrence is still debated. The aim of this narrative review is to provide a comprehensive assessment of the literature on margins, and to highlight the need for a uniform description of the margin status for patients with soft tissue sarcomas (STS). Abstract Adequacy of margins must take into consideration both the resection margin width (quantity) and anatomic barrier (quality). There are several classification schemes for reporting surgical resection margin status for soft tissue sarcomas (STS). Most of the studies regarding treatment outcomes in STS included all histologic grades and histological subtypes, which include infiltrative and non-infiltrative subtypes and are very heterogeneous in terms of both histologic characteristics and treatment modalities (adjuvant treatments or not). This lack of consistency makes it difficult to compare results from study to study. Therefore, there is a great need for evidence-based standardization concerning the width of resection margins. The aim of this narrative review is to provide a comprehensive assessment of the literature on margins, and to highlight the need for a uniform description of the margin status for patients with STS. Patient cases should be discussed at multidisciplinary tumor boards and treatments should be individualized to clinical and demographic characteristics, which must include also a deep knowledge of specific histotypes behaviors, particularly infiltrative ones.
Collapse
Affiliation(s)
- Andrea Sambri
- Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy;
- IRCCS Policlinico di Sant’Orsola, 40138 Bologna, Italy; (E.C.); (M.G.P.); (A.C.); (M.D.P.)
- Correspondence:
| | - Emilia Caldari
- IRCCS Policlinico di Sant’Orsola, 40138 Bologna, Italy; (E.C.); (M.G.P.); (A.C.); (M.D.P.)
| | - Michele Fiore
- IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.F.); (R.Z.); (C.G.); (P.S.)
| | - Riccardo Zucchini
- IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.F.); (R.Z.); (C.G.); (P.S.)
| | - Claudio Giannini
- IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.F.); (R.Z.); (C.G.); (P.S.)
| | - Maria Giulia Pirini
- IRCCS Policlinico di Sant’Orsola, 40138 Bologna, Italy; (E.C.); (M.G.P.); (A.C.); (M.D.P.)
| | - Paolo Spinnato
- IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.F.); (R.Z.); (C.G.); (P.S.)
| | - Alberta Cappelli
- IRCCS Policlinico di Sant’Orsola, 40138 Bologna, Italy; (E.C.); (M.G.P.); (A.C.); (M.D.P.)
| | - Davide Maria Donati
- Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy;
- IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.F.); (R.Z.); (C.G.); (P.S.)
| | - Massimiliano De Paolis
- IRCCS Policlinico di Sant’Orsola, 40138 Bologna, Italy; (E.C.); (M.G.P.); (A.C.); (M.D.P.)
| |
Collapse
|
8
|
Fujiwara T, Grimer RJ, Evans S, Medellin Rincon MR, Tsuda Y, Le Nail LR, Abudu S. Impact of NICE guidelines on the survival of patients with soft-tissue sarcomas. Bone Joint J 2021; 103-B:569-577. [PMID: 33641420 DOI: 10.1302/0301-620x.103b3.bjj-2020-0743.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS Urgent referral to a specialist centre for patients with a soft-tissue sarcoma (STS) has been recommended by the National Institute for Health and Care Excellence (NICE) in the UK since 2006. However, the impact of this recommendation on the prognosis for these patients remains unclear. We aimed to determine the impact of the NICE guidelines on the disease-specific survival (DSS) of patients with an STS. METHODS A total of 2,427 patients with an STS referred to a supraregional centre in the ten-year periods before (n = 1,386) and after (n = 1,041) the issue of the NICE guidelines were evaluated. RESULTS The mean size of the tumour was significantly smaller at the time of diagnosis (10.3 cm (SD 6.5) vs 9.1 cm (SD 6.2); p < 0.001) and the number of patients who had undergone an inadvertent excision significantly decreased (28% (n = 389) vs 20% (n = 204); p < 0.001) following the introduction of the NICE guidelines. The five-year DSS was 63% in the pre-NICE and 71% in post-NICE groups (p < 0.001). The improved survival was more significant for those with a high-grade tumour (pre-NICE, 48%; post-NICE, 68%; p < 0.001). In those with a high-grade tumour, the mean size of the tumour (11.6 cm (SD 6.2) vs 9.6 cm (SD 5.8); p < 0.001) and the number of patients with metastasis at the time of diagnosis (15% (n = 124 vs 10% (n = 80); p = 0.007) significantly decreased in the post-NICE group. CONCLUSION An improvement in survival was seen after the introduction of the NICE guidelines, especially in patients with a high-grade STS. More patients were referred at an earlier stage, indicating a clearer pathway after the issue of national policy for the management of STSs in the UK. Cite this article: Bone Joint J 2021;103-B(3):569-577.
Collapse
Affiliation(s)
- Tomohiro Fujiwara
- Department of Oncology, The Royal Orthopaedic Hospital, Birmingham, UK.,Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Robert J Grimer
- Department of Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Scott Evans
- Department of Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
| | | | - Yusuke Tsuda
- Department of Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
| | | | - Seggy Abudu
- Department of Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
| |
Collapse
|
9
|
Wu M, Hu Y, Ren A, Peng X, Ma Q, Mao C, Hang J, Li A. Nomogram Based on Ultrasonography and Clinical Features for Predicting Malignancy in Soft Tissue Tumors. Cancer Manag Res 2021; 13:2143-2152. [PMID: 33688257 PMCID: PMC7936676 DOI: 10.2147/cmar.s296972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/09/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose The objective of this study was to establish a predictive nomogram based on ultrasound (US) and clinical features for patients with soft tissue tumors (STTs). Patients and Methods A total of 260 patients with STTs were enrolled in this retrospective study and were divided into a training cohort (n=200, including 110 malignant and 90 benign masses) and a validation cohort (n=60, including 30 malignant and 30 benign masses). Multivariate analysis was performed by binary logistic regression analysis to determine the significant factors predictive of malignancy. A simple nomogram was established based on these independent risk factors including US and clinical features. The predictive accuracy and discriminative ability of the nomogram were measured by the calibration curve and the concordance index (C-index). Results The nomogram, comprising US features (maximum diameter, margin and vascular density) and clinical features (sex, age, and duration of disease), showed a favorable performance for predicting malignancy, with a sensitivity of 88.2% and a specificity of 78.7%. The calibration curve for malignancy probability in the training cohort showed good agreement between the nomogram predictions and actual observations. The C-indexes of the training cohort and validation cohort for predicting malignancy were 0.89 (95% CI: 0.85–0.94) and 0.83 (95% CI: 0.73–0.94), respectively. Conclusion The nomogram based on US and clinical features could be a simple, intuitive and reliable tool to individually predict malignancy in patients with STTs.
Collapse
Affiliation(s)
- Mengjie Wu
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Yu Hu
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Anjing Ren
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Xiaojing Peng
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Qian Ma
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Cuilian Mao
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Jing Hang
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Ao Li
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, People's Republic of China
| |
Collapse
|
10
|
The role of surgical margin quality in myxofibrosarcoma and undifferentiated pleomorphic sarcoma. Eur J Surg Oncol 2020; 47:1756-1762. [PMID: 33342698 DOI: 10.1016/j.ejso.2020.11.144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/22/2020] [Accepted: 11/26/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The effect of margin quality as a barrier against infiltration of soft-tissue sarcomas (STSs) has been unclear. We aimed to investigate the effect of margin quantity and quality on local control for myxofibrosarcoma (MFS) and undifferentiated pleomorphic sarcoma (UPS). METHODS 278 patients with a localised MFS and UPS were studied. Margin quality was categorized into five types; type 1, pseudocapsule/reactive zone; type 2, fat/fibrofatty tissue; type 3, muscle; type 4, fascia; type 5, periosteum. RESULTS The 5-year cumulative LR incidence was 22% and 13% in patients with positive and 0.1-9.9 mm margins, respectively, but decreased to 3% with ≥10.0 mm margins (p = 0.009); the cumulative LR incidence was significantly lower in patients with ≥10.0 mm margins than those with positive margins (p = 0.033) but was not significantly different in those with 0.1-9.9 mm margins (p = 0.183). In patients with 0.1-9.9 mm margins, the cumulative LR incidence was affected by margin quality; type 4 and 5 provided an LR risk less than 5% (p < 0.001), which was similar to those with margins ≥10.0 mm. Combining these two factors together, the LR risk in patients with positive or 0.1-9.9 mm margins without fascia/periosteum was approximately 11 × higher than patients with 0.1-9.9 mm margins with fascia/periosteum or margins ≥10.0 mm (p = 0.002). CONCLUSIONS A resection margin of 0.1-9.9 mm with fascia or periosteum provided a similar LR risk profile to ≥10 mm margins with any margin quality, which provided the lowest LR risk. The quality of fascial or periosteal tissue margins may be equivalent to a margin quantity of 10 mm as a barrier to LR.
Collapse
|
11
|
The influence of different patient positions on the preoperative 3D planning for surgical resection of soft tissue sarcoma in the lower limb-a cadaver pilot study. Surg Oncol 2020; 35:478-483. [PMID: 33120254 DOI: 10.1016/j.suronc.2020.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/02/2020] [Accepted: 10/19/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Complete surgical resection remains the mainstay of the treatment of soft tissue sarcomas. Intraoperative positioning of the patient is dictated by tumor location, whereas preoperative imaging is always performed in the supine position. The effect of changing the patient position on the exact location of the tumor with regard to neurovascular structures and bone is unknown. MATERIAL AND METHODS Two fresh frozen cadavers (pelvis and legs) were thawed and warmed. Three standardized tumor models were implanted in the thigh and calf. MR/CT images of the cadavers were obtained sequentially in four different patient positions. The minimal distance of each "tumor" to neurovascular structures was measured on axial MR images and the 3D shift of the center of the tumor to the bone was measured after segmentation of the CT images. RESULTS A significant difference of the minimal distance of the "tumor" to the femoral artery (P = 0.019/0.023) and a significantly greater number of deviations of more than 5mm/10 mm in the thigh between the supine position and the other positions compared to two supine positions (p = 0.027/0.028) were seen. The center of the "tumor" compared to the bone shifted significantly in the thigh (P < 0.001/0.002) but not the lower leg. CONCLUSION Obtaining images in the same patient position as the planned tumor resection may become particularly relevant if computer assisted surgery, which is based on preoperative imaging, is introduced into soft tissue sarcoma surgery as the patient position significantly influences the spatial position of the tumor.
Collapse
|
12
|
Gu HY, Lin LL, Zhang C, Yang M, Zhong HC, Wei RX. The Potential of Five Immune-Related Prognostic Genes to Predict Survival and Response to Immune Checkpoint Inhibitors for Soft Tissue Sarcomas Based on Multi-Omic Study. Front Oncol 2020; 10:1317. [PMID: 32850416 PMCID: PMC7396489 DOI: 10.3389/fonc.2020.01317] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/24/2020] [Indexed: 12/12/2022] Open
Abstract
Low response rates to immunotherapy have been reported in soft tissue sarcoma (STS). There are few predictive biomarkers of response, and the tumor immune microenvironment associated with progression and prognosis remains unclear in STS. Gene expression data from the Cancer Genome Atlas were used to identify the immune-related prognostic genes (IRPGs) and construct the immune gene-related prognostic model (IGRPM). The tumor immune microenvironment was characterized to reveal differences between patients with different prognoses. Furthermore, somatic mutation data and DNA methylation data were analyzed to understand the underlying mechanism leading to different prognoses. The IGRPM was constructed using five IRPGs (IFIH1, CTSG, STC2, SECTM1, and BIRC5). Two groups (high- and low-risk patients) were identified based on the risk score. Low-risk patients with higher overall survival time had higher immune scores, more immune cell infiltration (e.g., CD8 T cell and activated natural killer cells), higher expression of immune-stimulating molecules, higher stimulating cytokines and corresponding receptors, higher innate immunity molecules, and stronger antigen-presenting capacity. However, inhibition of immunity was observed in low-risk patients owing to the higher expression of immune checkpoint molecules and inhibiting cytokines. High-risk patients had high tumor mutation burden, which did not significantly influence survival. Gene set enrichment analysis further revealed that pathways of cell cycle and cancers were activated in high-risk patients. DNA methylation analysis indicated that relative high methylation was associated with better overall survival. Finally, the age, mitotic counts, and risk scores were independent prognostic factors for STS. Five IRPGs performed well in risk stratification of patients and are candidate biomarkers for predicting response to immunotherapy. Differences observed through the multi-omic study of patients with different prognoses may reveal the underlying mechanism of the development and progression of STS, and thereby improve treatment.
Collapse
Affiliation(s)
- Hui-Yun Gu
- Department of Spine and Orthopedic Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lu-Lu Lin
- Department of Pathology and Pathophysiology, School of Basic Medicine, Wuhan University, Wuhan, China
| | - Chao Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China.,Department of Oncology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Min Yang
- Department of Spine and Orthopedic Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hou-Cheng Zhong
- Department of Spine and Orthopedic Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ren-Xiong Wei
- Department of Spine and Orthopedic Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
13
|
Pannier D, Cordoba A, Ryckewaert T, Robin YM, Penel N. Hormonal therapies in uterine sarcomas, aggressive angiomyxoma, and desmoid-type fibromatosis. Crit Rev Oncol Hematol 2019; 143:62-66. [DOI: 10.1016/j.critrevonc.2019.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 10/26/2022] Open
|
14
|
Chen Y, Chen M, Lin H. Giant retroperitoneal lipoma presenting as abdominal protrusion: One case report and review of literature. ADVANCES IN DIGESTIVE MEDICINE 2019. [DOI: 10.1002/aid2.13126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Yung‐Hung Chen
- Division of Gastroenterology, Department of Internal MedicineMacKay Memorial Hospital Taipei Taiwan
| | - Ming‐Jen Chen
- Division of Gastroenterology, Department of Internal MedicineMacKay Memorial Hospital Taipei Taiwan
- MacKay Junior College of MedicineNursing and Management Taipei Taiwan
- Department of Medicine, Mackay Medical College New Taipei Taiwan
| | - Han‐Jung Lin
- Division of Gastroenterology, Department of Internal MedicineMacKay Memorial Hospital Taipei Taiwan
- Department of Medicine, Mackay Medical College New Taipei Taiwan
| |
Collapse
|
15
|
Braig D, Becherer C, Bickert C, Braig M, Claus R, Eisenhardt AE, Heinz J, Scholber J, Herget GW, Bronsert P, Fricke A, Follo M, Stark GB, Bannasch H, Eisenhardt SU. Genotyping of circulating cell-free DNA enables noninvasive tumor detection in myxoid liposarcomas. Int J Cancer 2019; 145:1148-1161. [PMID: 30779112 DOI: 10.1002/ijc.32216] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/19/2019] [Accepted: 02/06/2019] [Indexed: 12/16/2022]
Abstract
Soft tissue sarcomas (STS) are rare tumors of mesenchymal origin. About 50% of patients with STS experience relapse and more than 30% will die within 10 years after diagnosis. In this study we investigated circulating free DNA (cfDNA) and tumor-specific genetic alterations therein (circulating tumor DNA, ctDNA) as diagnostic biomarkers. Plasma concentrations and fragmentation of cfDNA was analyzed with quantitative PCR. Patients with STS (n = 64) had significantly higher plasma concentrations and increased fragmentation of cfDNA when compared to patients in complete remission (n = 19) and healthy controls (n = 41) (p < 0.01 and p < 0.001). Due to overlapping values between patients with STS and controls, the sensitivity and specificity of these assays is limited. Sensitive assays to detect genomic alterations in cfDNA of synovial sarcomas (t(X;18)), myxoid liposarcomas (t(12;16) and TERT C228T promoter mutation) and well-differentiated/de-differentiated liposarcomas (MDM2 amplifications) were established. ctDNA was quantified in nine liposarcoma patients during the course of their treatment. Levels of breakpoint t(12;16) and TERT C228T ctDNA correlated with the clinical course and tumor burden in patients with myxoid liposarcomas (n = 4). ctDNA could detect minimal residual disease and tumor recurrence. In contrast, detection of MDM2 amplifications was not sensitive enough to detect tumors in patients with well-differentiated/de-differentiated liposarcomas (n = 5). Genotyping of cfDNA for tumor specific genetic alterations is a feasible and promising approach for monitoring tumor activity in patients with myxoid liposarcomas. Detection of ctDNA during follow-up examinations despite negative standard imaging studies might warrant more sensitive imaging (e.g. PET-CT) or closer follow-up intervals to timely localize and treat recurrences.
Collapse
Affiliation(s)
- David Braig
- Department of Plastic and Hand Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Plastic and Reconstructive Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Caroline Becherer
- Department of Plastic and Hand Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christiane Bickert
- Department of Plastic and Hand Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Moritz Braig
- Department of Radiology, Medical Physics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rainer Claus
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Internal Medicine, Augsburg Hospital, Medical Faculty of the University of Augsburg, Augsburg, Germany
| | - Anja E Eisenhardt
- Department of Plastic and Hand Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Juergen Heinz
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jutta Scholber
- Department of Radiation Oncology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Georg W Herget
- Department of Orthopaedics and Traumatology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Bronsert
- Institute for Surgical Pathology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Tumorbank Comprehensive Cancer Center Freiburg, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alba Fricke
- Department of Plastic and Hand Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Plastic Aesthetic and Hand Surgery, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Marie Follo
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - G Bjoern Stark
- Department of Plastic and Hand Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Holger Bannasch
- Department of Plastic and Hand Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Steffen U Eisenhardt
- Department of Plastic and Hand Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
16
|
Limb-Salvage Surgery of Soft Tissue Sarcoma with Sciatic Nerve Involvement. Sarcoma 2018; 2018:6483579. [PMID: 29692655 PMCID: PMC5859890 DOI: 10.1155/2018/6483579] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 02/08/2018] [Indexed: 12/20/2022] Open
Abstract
Background The surgical resection of soft tissue sarcomas (STS) with sciatic nerve involvement presents a significant surgical and oncological challenge. Current treatment strategies pursue a multimodal approach with the aim of limb preservation. We aim to evaluate the outcomes of limb-sparing surgery of STS in a patient cohort and to propose a classification for STS with sciatic nerve involvement. Methods Patients receiving limb-preserving resections for STS with sciatic nerve involvement between 01/2010 and 01/2017 were included. Clinical and oncological data were prospectively collected in a computerized database and retrospectively analyzed. Sciatic nerve involvement in STS was classified preoperatively as follows: type A for nerve encasement; type B for nerve contact; and type C for no nerve involvement. Results A total of 364 patients with STS were treated, of which 27 patients had STS with sciatic nerve involvement. Eight patients with type A tumors (29.6%) underwent sciatic nerve resection, and 19 patients with type B tumors (70.4%) received epineural dissections. Disease progression was observed in 8 patients (29.6%) with a local recurrence of 11.1% and distant metastasis in 29.6%. The type of nerve resection significantly influenced leg function but had no impact on disease recurrence or overall survival. Conclusion In a cohort of carefully selected patients with STS and sciatic nerve involvement, the extent of sciatic nerve resection had no significant impact on disease recurrence or survival. Precise classification of neural involvement may therefore be useful in selecting the appropriate degree of nerve resection, without compromising oncological outcome or unnecessarily sacrificing leg function.
Collapse
|
17
|
Yuan Z, Xu L, Zhao Z, Xu S, Zhang X, Liu T, Zhang S, Yu S. Clinicopathological features and prognosis of malignant peripheral nerve sheath tumor: a retrospective study of 159 cases from 1999 to 2016. Oncotarget 2017; 8:104785-104795. [PMID: 29285213 PMCID: PMC5739600 DOI: 10.18632/oncotarget.18975] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/18/2017] [Indexed: 01/30/2023] Open
Abstract
Objective To investigate the clinicopathological features and prognosis of malignant peripheral nerve sheath tumors (MPNST). Results A total of 159 patients with MPNST were enrolled in the study. The ratio of male to female was 1.04 to 1. The median age was 40 (range: 5–76) years at the time of diagnosis. The 3- and 5-year overall survival rates were 50.0% and 43.0%, respectively. The median follow-up period was 31.0 (range: 2.0–199.0) months. Multivariate analysis showed that AJCC stage and S-100 were independent factors affecting overall survival (p < 0.05 for both). 3- and 5-year tumor-free survival rates for 140 completely resected patients were 40.0% and 34.0%, respectively. Multivariate analysis showed that AJCC stage, S-100 and Ki67 staining were independent factors of tumor-free survival (p < 0.05 for all). Materials and Methods The clinical data of MPNST patients who were treated at Cancer Institute and Hospital, Chinese Academy of Medical Science from January 1999 to January 2016 was retrospectively reviewed. Conclusions MPSNT is a highly aggressive tumor with poor prognosis and this study may be useful for prognostic assessment and management decisions. This had been largest documented retrospective study of MPSNT among Chinese populations. Some characteristics were different from those of foreign populations which may suggest the specificity of Chinese patients.
Collapse
Affiliation(s)
- Zhennan Yuan
- Department of Orthopaedics, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Libin Xu
- Department of Orthopaedics, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zhenguo Zhao
- Department of Orthopaedics, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Songfeng Xu
- Department of Orthopaedics, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xinxin Zhang
- Department of Orthopaedics, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ting Liu
- Department of Orthopaedics, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shuguang Zhang
- Department of Orthopaedics, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shengji Yu
- Department of Orthopaedics, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| |
Collapse
|
18
|
Trovik C, Bauer HCF, Styring E, Sundby Hall K, Vult Von Steyern F, Eriksson S, Johansson I, Sampo M, Laitinen M, Kalén A, Jónsson H, Jebsen N, Eriksson M, Tukiainen E, Wall N, Zaikova O, Sigurðsson H, Lehtinen T, Bjerkehagen B, Skorpil M, Egil Eide G, Johansson E, Alvegard TA. The Scandinavian Sarcoma Group Central Register: 6,000 patients after 25 years of monitoring of referral and treatment of extremity and trunk wall soft-tissue sarcoma. Acta Orthop 2017; 88:341-347. [PMID: 28266233 PMCID: PMC5434606 DOI: 10.1080/17453674.2017.1293441] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Purpose - We wanted to examine the potential of the Scandinavian Sarcoma Group (SSG) Central Register, and evaluate referral and treatment practice for soft-tissue sarcomas in the extremities and trunk wall (STS) in the Nordic countries. Background - Based on incidence rates from the literature, 8,150 (7,000-9,300) cases of STS of the extremity and trunk wall should have been diagnosed in Norway, Finland, Iceland, and Sweden from 1987 through 2011. The SSG Register has 6,027 cases registered from this period, with 5,837 having complete registration of key variables. 10 centers have been reporting to the Register. The 5 centers that consistently report treat approximately 90% of the cases in their respective regions. The remaining centers have reported all the patients who were treated during certain time periods, but not for the entire 25-year period. Results - 59% of patients were referred to a sarcoma center untouched, i.e. before any attempt at open biopsy. There was an improvement from 52% during the first 5 years to 70% during the last 5 years. 50% had wide or better margins at surgery. Wide margins are now achieved less often than 20 years ago, in parallel with an increase in the use of radiotherapy. For the centers that consistently report, 97% of surviving patients are followed for more than 4 years. Metastasis-free survival (MFS) increased from 67% to 73% during the 25-year period. Interpretation - The Register is considered to be representative of extremity and trunk wall sarcoma disease in the population of Scandinavia, treated at the reporting centers. There were no clinically significant differences in treatment results at these centers.
Collapse
Affiliation(s)
- Clement Trovik
- Department Musculo-Skeletal Tumor Service/Oncology, Haukeland University Hospital, Bergen, Norway;,Correspondence:
| | - Henrik C F Bauer
- Department Orthopedics/Oncology Service, Karolinska Hospital, Stockholm, Sweden
| | - Emelie Styring
- Department Orthopedics, Lund University, Skåne University Hospital, Lund, Sweden
| | - Kirsten Sundby Hall
- Department Oncology, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
| | | | - Sigvard Eriksson
- Department Orthopedics, Sahlgrenska Hospital, Gothenburg, Sweden
| | - Ingela Johansson
- Department Orthopedics, Norrland University Hospital, Umeå, Sweden
| | - Mika Sampo
- Department Oncology, Helsinki University Hospital, Helsinki, Finland
| | - Minna Laitinen
- Department Orthopedics, Tampere University Hospital, Tammerfors, Finland
| | - Anders Kalén
- Department Orthopedics, Linköping University Hospital, Linköping, Sweden
| | | | - Nina Jebsen
- Department Musculo-Skeletal Tumor Service/Oncology, Haukeland University Hospital, Bergen, Norway
| | | | - Erkki Tukiainen
- Department Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Najme Wall
- Department Oncology, Linköping University Hospital, Linköping, Sweden
| | - Olga Zaikova
- Department Orthopedics, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
| | | | - Tuula Lehtinen
- Department Oncology, Tampere University Hospital, Tammerfors, Finland
| | - Bodil Bjerkehagen
- Department Pathology, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
| | - Mikael Skorpil
- Department Radiology, Akademiska Sjukhuset, Uppsala, and Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Geir Egil Eide
- Department Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway;,Department Department of Global Public Health and Primary Care, University of Bergen, Norway
| | | | - Thor A Alvegard
- Department Cancer Epidemiology, Lund University Hospital, Lund, Sweden
| |
Collapse
|
19
|
Derbel O, Heudel PE, Cropet C, Meeus P, Vaz G, Biron P, Cassier P, Decouvelaere AV, Ranchere-Vince D, Collard O, De Laroche E, Thiesse P, Farsi F, Cellier D, Gilly FN, Blay JY, Ray-Coquard I. Survival impact of centralization and clinical guidelines for soft tissue sarcoma (A prospective and exhaustive population-based cohort). PLoS One 2017; 12:e0158406. [PMID: 28158190 PMCID: PMC5291382 DOI: 10.1371/journal.pone.0158406] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 06/15/2016] [Indexed: 12/15/2022] Open
Abstract
Purpose The outcome of sarcoma has been suggested in retrospective and non-exhaustive studies to be better through management by a multidisciplinary team of experts and adherence to clinical practice guidelines (CPGs). The aim of this prospective and exhaustive population based study was to confirm the impact of adherence to CPGs on survival in patients with localized sarcoma. Experimental design Between 2005 and 2007, all evaluable adult patients with a newly diagnosis of localized sarcoma located in Rhone Alpes region (n = 634), including 472 cases of soft-tissue sarcoma (STS), were enrolled. The prognostic impact of adherence to CPGs on progression-free survival (PFS) and overall survival (OS) was assessed by multivariate Cox model in this cohort. Results The median age was 61 years (range 16–92). The most common subtypes were liposarcoma (n = 133, 28%), unclassified sarcoma (n = 98, 20.7%) and leiomyosarcoma (n = 69, 14.6%). In the initial management phase, from diagnosis to adjuvant treatment, the adherence to CPGs for patients with localized STS was 36% overall, corresponding to 56%, 85%, 96% and 84% for initial surgery, radiation therapy, chemotherapy and follow-up, respectively. Adherence to CPGs for surgery was the strongest independent prognostic factor of PFS, along with age, gender, grade, and tumor size. For OS, multivariate analysis adherence to CPGs for surgery was a strong independent prognostic factor, with an important interaction with a management in the regional expert centers. Conclusions This study demonstrates impact of CPGs and treatment within an expert center on survival for STS patients in a whole population-based cohort.
Collapse
Affiliation(s)
- Olfa Derbel
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
- * E-mail:
| | | | - Claire Cropet
- Department of Biostatistics, Centre Léon Bérard, Lyon, France
| | - Pierre Meeus
- Department of Surgery, Centre Léon Bérard, Lyon, France
- Groupe Sarcome Français, Groupe d’Etude des Tumeurs Osseuses (GSF-GETO), Lyon France
| | - Gualter Vaz
- Department of Surgery, Centre Léon Bérard, Lyon, France
- Groupe Sarcome Français, Groupe d’Etude des Tumeurs Osseuses (GSF-GETO), Lyon France
- Department of Orthopedic Surgery, Clinique des IRIS, Lyon, France
| | - Pierre Biron
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Philippe Cassier
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Dominique Ranchere-Vince
- Groupe Sarcome Français, Groupe d’Etude des Tumeurs Osseuses (GSF-GETO), Lyon France
- Department of Pathology, Centre Léon Bérard, Lyon, France
| | - Olivier Collard
- Groupe Sarcome Français, Groupe d’Etude des Tumeurs Osseuses (GSF-GETO), Lyon France
- Institut de Cancérologie Lucien Neuwirth, Saint-Priest en Jarez, France
| | - Eric De Laroche
- Institut de Cancérologie Lucien Neuwirth, Saint-Priest en Jarez, France
| | | | | | - Dominic Cellier
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
- Groupe Sarcome Français, Groupe d’Etude des Tumeurs Osseuses (GSF-GETO), Lyon France
- Réseau Espace Santé Cancer, Rhône-Alpes, France
- Claude Bernard University, Lyon, France
- Laboratoire HESPER EA 7425, Lyon 1 University, Lyon, France
| | - Isabelle Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
- Groupe Sarcome Français, Groupe d’Etude des Tumeurs Osseuses (GSF-GETO), Lyon France
- Réseau Espace Santé Cancer, Rhône-Alpes, France
- Claude Bernard University, Lyon, France
- Laboratoire HESPER EA 7425, Lyon 1 University, Lyon, France
| |
Collapse
|
20
|
Spitzer AB, Maheshwari AV. Follow-Up/Late Effects Clinics. Sarcoma 2017. [DOI: 10.1007/978-3-319-43121-5_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
21
|
Stoeckle E, Michot A, Henriques B, Sargos P, Honoré C, Ferron G, Meeus P, Babre F, Bonvalot S. [Surgery for soft-tissue sarcomas of the limbs and trunk wall]. Cancer Radiother 2016; 20:657-65. [PMID: 27599681 DOI: 10.1016/j.canrad.2016.07.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 07/08/2016] [Accepted: 07/11/2016] [Indexed: 11/16/2022]
Abstract
Soft-tissue sarcoma of the limbs or the trunk wall determine a heterogeneous group of tumours that tends to receive a more individualized approach. The surgeon in charge with soft-tissue sarcoma has to be familiar with these tumours in order to deliver an adequate treatment. Most important is the initial diagnostic procedure, comprising imaging with MRI, a core needle biopsy, and in France, referral to a centre of expertise within the clinical network NETSARC. Prior to surgery, a multidisciplinary conference determines its moment and the extent of surgical resection within the frame of a multidisciplinary approach, and also plans reconstructive surgery, when needed. A standardized operative report summarizes items necessary to describe the resection quality (i.e. tumour seen, tumour infiltrated?). In multidisciplinary staff meetings, they are compared to margins measured by the pathologist on the operative specimen. Hence, resection quality is determined collegially and defined by resection type R (R0, R1, R2) as a qualitative result. The quality of resection directly determines the 5-year risk of local recurrence, estimated between 10 and 20% in specialized centres, with the objective to attain 10%. Early rehabilitation favours better functional outcome. The surgeon's experience with soft-tissue sarcoma, as part of a multidisciplinary treatment, is key in achieving the best adequacy between oncological resection and favourable functional outcome. In France, a specific university course for soft-tissue sarcoma will be set-up.
Collapse
Affiliation(s)
- E Stoeckle
- Service de chirurgie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France.
| | - A Michot
- Service de chirurgie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - B Henriques
- Service de radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - P Sargos
- Service de radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - C Honoré
- Service de chirurgie, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - G Ferron
- Service de chirurgie, institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - P Meeus
- Service de chirurgie, centre Léon-Bérard, 28, rue Laënnec, 69373 Lyon cedex, France
| | - F Babre
- Service d'anesthésie-réanimation, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - S Bonvalot
- Service de chirurgie, institut Curie, 26, rue d'Ulm, 75248 Paris, France
| |
Collapse
|
22
|
Zielichowska A, Daczewska M, Saczko J, Michel O, Kulbacka J. Applications of calcium electroporation to effective apoptosis induction in fibrosarcoma cells and stimulation of normal muscle cells. Bioelectrochemistry 2016; 109:70-8. [DOI: 10.1016/j.bioelechem.2016.01.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/16/2016] [Accepted: 01/26/2016] [Indexed: 02/06/2023]
|
23
|
Müller DA, Beltrami G, Scoccianti G, Frenos F, Capanna R. Combining limb-sparing surgery with radiation therapy in high-grade soft tissue sarcoma of extremities - Is it effective? Eur J Surg Oncol 2016; 42:1057-63. [PMID: 26924784 DOI: 10.1016/j.ejso.2016.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 01/17/2016] [Accepted: 02/02/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Limb-sparing surgery in combination with radiation therapy is a well-established treatment for high-grade soft tissue sarcomas of the extremities. But selection of cases and optimal sequence of irradiation and surgery still remain controversial. METHODS 769 patients with a high-grade soft tissue sarcoma of the extremities, who underwent a limb-sparing surgery, were retrospectively reviewed. Group 1 (N = 89) was treated with neo-adjuvant radiation therapy, group 2 (N = 315) with adjuvant irradiation and group 3 (N = 365) with surgery alone. RESULTS After a mean follow up of 45 months 95 local recurrences occurred resulting in a local recurrence-free survival of 83.2% after 5 years and 75.9% after 10 years. Contaminated surgical margins (Odds ratio: 2.42) and previous inadequate surgeries (Odds ratio: 1.89) were identified as risk factors for failed local control. Neo-adjuvant radiation therapy provides the best local recurrence-free rate for 5 years (90.0%), whereas after 10 years (78.3%) adjuvant irradiation showed better local control. The metastatic-free rate was independent from achieved surgical margins (p = 0.179). Group 1 showed the highest rate of revision surgery (9.0%), followed by group 3 (5.5%) and group 2 (4.4%) (p = 0.085). However, the rate of irradiation-correlated side effects was higher in group 2 (15.2%) than in group 1 (11.2%) (p = 0.221). CONCLUSION Surgery has to be effective for successful local control and remains the mainstay of the treatment in combination with neo-adjuvant as well as adjuvant irradiation. In really wide or even radical resections the benefit of radiation therapy can be discussed as the irradiation induced side effects are not negligible.
Collapse
Affiliation(s)
- D A Müller
- Department of Orthopedic Surgery, University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland.
| | - G Beltrami
- Department of Orthopedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Firenze, Italy.
| | - G Scoccianti
- Department of Orthopedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Firenze, Italy.
| | - F Frenos
- Department of Orthopedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Firenze, Italy.
| | - R Capanna
- Department of Orthopedic Oncology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Firenze, Italy.
| |
Collapse
|
24
|
Honoré C, Méeus P, Stoeckle E, Bonvalot S. Le sarcome des tissus mous en France en 2015 : épidémiologie, classification et structuration de la prise en charge. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jchirv.2015.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
25
|
Abstract
PET imaging has been evaluated in five areas of sarcoma diagnosis and treatment: biopsy guidance, therapeutic monitoring, tumor detection and grading, tumor staging, and prognostication. Current evidence does not include any cost-benefit analysis showing a decreased number of invasive procedures from false-positive results. There is overlap from more conventional imaging and PET imaging without obvious added benefit from information gained from PET/computed tomography scanning. Use as a routine test in patients with sarcoma cannot be recommended. Use in specific histologic subtypes with differing patterns of metastasis or in monitoring those cases undergoing neoadjuvant chemotherapy needs further study before PET/computed tomography becomes standard of care for patients with sarcoma.
Collapse
Affiliation(s)
- Stephen Becher
- Department of Orthopedic Surgery, Emory University, 57 Executive Park South, 160-3, Atlanta, GA 30329, USA.
| | - Shervin Oskouei
- Department of Orthopedic Surgery, Emory University, 57 Executive Park South, 160-3, Atlanta, GA 30329, USA
| |
Collapse
|
26
|
Honoré C, Méeus P, Stoeckle E, Bonvalot S. Soft tissue sarcoma in France in 2015: Epidemiology, classification and organization of clinical care. J Visc Surg 2015; 152:223-30. [PMID: 26088366 DOI: 10.1016/j.jviscsurg.2015.05.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Four thousand new cases of soft tissue sarcomas are diagnosed each year in France, 23% of which are localized in the abdomen and pelvis; the treatment of non-metastatic tumor is based on wide surgical resection, the quality of which determines the long-term outcome. To ensure appropriate care, the European Society of Medical Oncology (ESMO) recommends that any patient with an unexplained soft tissue mass (of any size for deep lesions or of>5cm for superficial lesions) be referred to a specialized center with capacities for multidisciplinary team decision; appropriate imaging should be performed prior to treatment and a percutaneous image-guided needle biopsy should be routinely performed. In France, clinical and pathology networks (NetSarc and RRePS) currently offer patients a structured means to make a systematic diagnosis of soft tissue sarcoma and help to provide access to appropriate treatment in a specialized center.
Collapse
Affiliation(s)
- C Honoré
- Département de chirurgie générale, Gustave Roussy Cancer Center, 114, rue Édouard-Vaillant, 94805 Villejuif, France.
| | - P Méeus
- Département de chirurgie, centre Léon-Bérard, 69008 Lyon, France
| | - E Stoeckle
- Institut Bergonié, département de chirurgie, 33076 Bordeaux, France
| | - S Bonvalot
- Institut Curie, Service de chirurgie, 26, rue d'Ulm, 75005 Paris, France
| |
Collapse
|
27
|
Schmitz K, Koeppen H, Binot E, Fassunke J, Künstlinger H, Ihle MA, Heydt C, Wardelmann E, Büttner R, Merkelbach-Bruse S, Rüschoff J, Schildhaus HU. MET gene copy number alterations and expression of MET and hepatocyte growth factor are potential biomarkers in angiosarcomas and undifferentiated pleomorphic sarcomas. PLoS One 2015; 10:e0120079. [PMID: 25844809 PMCID: PMC4386816 DOI: 10.1371/journal.pone.0120079] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 01/19/2015] [Indexed: 11/19/2022] Open
Abstract
Soft tissue sarcomas are a heterogeneous group of tumors with many different subtypes. In 2014 an estimated 12,020 newly diagnosed cases and 4,740 soft tissue sarcoma related deaths can be expected in the United States. Many soft tissue sarcomas are associated with poor prognosis and therapeutic options are often limited. The evolution of precision medicine has not yet fully reached the clinical treatment of sarcomas since therapeutically tractable genetic changes have not been comprehensively studied so far. We analyzed a total of 484 adult-type malignant mesenchymal tumors by MET fluorescence in situ hybridization and MET and hepatocyte growth factor immunohistochemistry. Eleven different entities were included, among them the most common and clinically relevant subtypes and tumors with specific translocations or complex genetic changes. MET protein expression was observed in 2.6% of the cases, all of which were either undifferentiated pleomorphic sarcomas or angiosarcomas, showing positivity rates of 14% and 17%, respectively. 6% of the tumors showed hepatocyte growth factor overexpression, mainly seen in undifferentiated pleomorphic sarcomas and angiosarcomas, but also in clear cell sarcomas, malignant peripheral nerve sheath tumors, leiomyosarcomas and gastrointestinal stromal tumors. MET and hepatocyte growth factor overexpression were significantly correlated and may suggest an autocrine activation in these tumors. MET FISH amplification and copy number gain were present in 4% of the tumors (15/413). Two samples, both undifferentiated pleomorphic sarcomas, fulfilled the criteria for high level amplification of MET, one undifferentiated pleomorphic sarcoma reached an intermediate level copy number gain, and 12 samples of different subtypes were categorized as low level copy number gains for MET. Our findings indicate that angiosarcomas and undifferentiated pleomorphic sarcomas rather than other frequent adult-type sarcomas should be enrolled in screening programs for clinical trials with MET inhibitors. The screening methods should include both in situ hybridization and immunohistochemistry.
Collapse
Affiliation(s)
- Katja Schmitz
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
- Institute of Pathology, University Hospital Göttingen, Göttingen, Germany
| | - Hartmut Koeppen
- Genentech Inc., South San Francisco, California, United States of America
| | - Elke Binot
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Jana Fassunke
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Helen Künstlinger
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Michaela A. Ihle
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Carina Heydt
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Eva Wardelmann
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
- Gerhard Domagk Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Reinhard Büttner
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | | | | | - Hans-Ulrich Schildhaus
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
- Institute of Pathology, University Hospital Göttingen, Göttingen, Germany
- * E-mail:
| |
Collapse
|
28
|
Delea TE, Amdahl J, Nakhaipour HR, Manson SC, Wang A, Fedor N, Chit A. Cost-effectiveness of pazopanib in advanced soft-tissue sarcoma in Canada. ACTA ACUST UNITED AC 2014; 21:e748-59. [PMID: 25489263 DOI: 10.3747/co.21.1899] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In the phase iii palette trial of pazopanib compared with placebo in patients with advanced or metastatic soft-tissue sarcoma (sts) who had received prior chemotherapy, pazopanib treatment was associated with improved progression-free survival (pfs). We used an economic model and data from palette and other sources to evaluate the cost-effectiveness of pazopanib in patients with advanced sts who had already received chemotherapy. METHODS We developed a multistate model to estimate expected pfs, overall survival (os), lifetime sts treatment costs, and quality-adjusted life-years (qalys) for patients receiving pazopanib or placebo as second-line therapy for advanced sts. Cost-effectiveness was calculated alternatively from the health care system and societal perspectives for the province of Quebec. Estimated pfs, os, incidence of adverse events, and utilities values for pazopanib and placebo were derived from the palette trial. Costs were obtained from published sources. RESULTS Compared with placebo, pazopanib is estimated to increase qalys by 0.128. The incremental cost of pazopanib compared with placebo is CA$20,840 from the health care system perspective and CA$15,821 from the societal perspective. The cost per qaly gained with pazopanib in that comparison is CA$163,336 from the health care system perspective and CA$124,001 from the societal perspective. CONCLUSIONS Compared with placebo, pazopanib might be cost-effective from the Canadian health care system and societal perspectives depending on the threshold value used by reimbursement authorities to assess novel cancer therapies. Given the unmet need for effective treatments for advanced sts, pazopanib might nevertheless be an appropriate alternative to currently used treatments.
Collapse
Affiliation(s)
- T E Delea
- Policy Analysis Inc. ( pai ), Brookline, MA, U.S.A
| | - J Amdahl
- Policy Analysis Inc. ( pai ), Brookline, MA, U.S.A
| | - H R Nakhaipour
- Health Outcomes-Oncology, Medical Division, GlaxoSmithKline, Mississauga, ON
| | - S C Manson
- Global Health Outcomes-Oncology, GlaxoSmith-Kline, Stockley Park, Uxbridge, Middlesex, U.K
| | - A Wang
- Policy Analysis Inc. ( pai ), Brookline, MA, U.S.A
| | - N Fedor
- Policy Analysis Inc. ( pai ), Brookline, MA, U.S.A
| | - A Chit
- Health Outcomes-Oncology, Medical Division, GlaxoSmithKline, Mississauga, ON. ; University of Toronto, Toronto, ON
| |
Collapse
|
29
|
Amdahl J, Manson SC, Isbell R, Chit A, Diaz J, Lewis L, Delea TE. Cost-effectiveness of pazopanib in advanced soft tissue sarcoma in the United kingdom. Sarcoma 2014; 2014:481071. [PMID: 25024640 PMCID: PMC4082932 DOI: 10.1155/2014/481071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/03/2014] [Indexed: 01/01/2023] Open
Abstract
In the phase III PALETTE trial, pazopanib improved progression-free survival (PFS) compared with placebo in patients with advanced/metastatic soft tissue sarcomas (mSTS) who had received prior chemotherapy. We used a multistate model to estimate expected PFS, overall survival (OS), lifetime STS treatment costs, and quality-adjusted life-years (QALYs) for patients receiving pazopanib, placebo, trabectedin, ifosfamide, or gemcitabine plus docetaxel as second-line mSTS therapies. The cost-effectiveness of pazopanib was expressed as the incremental costs per QALY gained. Estimates of PFS/OS, adverse events, and utilities for pazopanib and placebo were from the PALETTE trial. Estimates of relative effectiveness of the other comparators were from an unadjusted indirect comparison versus pazopanib. Costs were from published sources. Pazopanib is estimated to increase QALYs by 0.128 and costs by £7,976 versus placebo; cost per QALY gained with pazopanib versus placebo is estimated to be £62,000. Compared with the other chemotherapies, pazopanib provides similar QALYs at a lower cost. Pazopanib may not be cost-effective versus placebo but may be cost-effective versus the most commonly used active treatments, although this conclusion is uncertain. Given the unmet need for effective treatments for mSTS, pazopanib may be an appropriate alternative to some currently used medications in the United Kingdom.
Collapse
Affiliation(s)
- Jordan Amdahl
- Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA 02445, USA
| | | | - Robert Isbell
- GlaxoSmithKline, Stockley Park West, Uxbridge, Middlesex UB11 1BT, UK
| | - Ayman Chit
- GlaxoSmithKline, 7333 Mississauga Road, Mississauga, ON, Canada L5N 6L4
- University of Toronto, 144 College Street, Toronto, ON, Canada M5S 3M2
| | - Jose Diaz
- GlaxoSmithKline, Stockley Park West, Uxbridge, Middlesex UB11 1BT, UK
| | - Lily Lewis
- York Health Economics Consortium, Level 2, Market Square, University of York, Heslington, York YO10 5NH, UK
| | - Thomas E. Delea
- Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA 02445, USA
| |
Collapse
|
30
|
Challoumas D, Dimitrakakis G. eComment. Soft-tissue sarcomas in a 'nutshell'. Interact Cardiovasc Thorac Surg 2013; 17:987. [PMID: 24243947 DOI: 10.1093/icvts/ivt446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
31
|
Zehou O, Fabre E, Zelek L, Sbidian E, Ortonne N, Banu E, Wolkenstein P, Valeyrie-Allanore L. Chemotherapy for the treatment of malignant peripheral nerve sheath tumors in neurofibromatosis 1: a 10-year institutional review. Orphanet J Rare Dis 2013; 8:127. [PMID: 23972085 PMCID: PMC3766199 DOI: 10.1186/1750-1172-8-127] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 08/04/2013] [Indexed: 01/23/2023] Open
Abstract
Background Neurofibromatosis 1 (NF1) is the most common autosomal dominant disorder, with an incidence of 1 in 2,500-3,300 live births. NF1 is associated with significant morbidity and mortality because of complications, especially malignant peripheral nerve sheath tumors (MPNSTs), which mainly develop during adulthood. We evaluated our experience with management of NF1 with MPNSTs by standard chemotherapy with anthracycline and/or ifosfamide in terms of time to treatment failure and overall survival. Methods We performed a retrospective review of consecutive patients with NF1 and a diagnosis of MPNSTs between 1993 and 2003 in our referral center for NF1. Prognostic factors were evaluated by univariate analysis. Results We evaluated data for 21 patients with grade 1 (n=1), grade 2 (n=8) and grade 3 (n=12) MPNST; 16 presented localized disease and underwent surgery: margins for 6 were tumor-free (including 3 patients with amputation), 2 showed microscopic residual disease and 8 showed macroscopic residual disease. All patients received chemotherapy and 9 radiotherapy. Median time to treatment failure and overall survival were 7.8 and 17 months, respectively. Two patients were still alive at 138 and 167 months. We found no significant relationship between type of chemotherapy and time to treatment failure or overall survival. Conclusions MPNSTs are highly aggressive in NF1. Conventional chemotherapy does not seem to reduce mortality, and its role must be questioned. Recent advances in the molecular biology of MPNSTs may provide new prognostic factors and targeted therapies.
Collapse
Affiliation(s)
- Ouidad Zehou
- Department of Dermatology, Referral center for Neurofibromatosis, Henri Mondor Hospital, UPEC, Créteil, France.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Soyfer V, Corn BW, Kollender Y, Issakov J, Dadia S, Flusser G, Bickels J, Meller I, Merimsky O. Hypofractionated adjuvant radiation therapy of soft-tissue sarcoma achieves excellent results in elderly patients. Br J Radiol 2013; 86:20130258. [PMID: 23709514 DOI: 10.1259/bjr.20130258] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Adjuvant radiation therapy (RT) is an essential part of combined limb-sparing treatment of soft-tissue sarcoma (STS). Elderly or medically unfit patients often have difficulty in completing 6-7 weeks of standard fractionated daily treatment. Our aim was to evaluate the efficacy of a hypofractionated adjuvant approach with RT for STS in elderly and debilitated patients. METHODS 21 elderly patients were treated with a short course of adjuvant RT (39-48 Gy, 3 Gy per fraction) for STS. The medical records of the patients were retrospectively reviewed for local or distant recurrence and side effects of RT. RESULTS At a mean 26 months of follow-up, three local recurrences (14%) were detected. Eight patients (38%) had lung metastases during the observed period. Three of them died from metastatic disease. The hypofractionated radiation was well tolerated with minimum long-term side effects. CONCLUSION Hypofractionated adjuvant radiation appears to be an effective treatment in terms of local control in elderly and debilitated patients. ADVANCES IN KNOWLEDGE The results of this study might provide an alternative to commonly used standard fractionation of radiotherapy in sarcoma patients.
Collapse
Affiliation(s)
- V Soyfer
- Department of Oncology, Tel Aviv Sourasky Medical Center, Ashdod, Israel
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Utility values for advanced soft tissue sarcoma health States from the general public in the United kingdom. Sarcoma 2013; 2013:863056. [PMID: 23576896 PMCID: PMC3613051 DOI: 10.1155/2013/863056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 01/17/2013] [Indexed: 11/17/2022] Open
Abstract
Soft tissue sarcomas are a rare type of cancer generally treated with palliative chemotherapy when in the advanced stage. There is a lack of published health utility data for locally advanced "inoperable"/metastatic disease (ASTS), essential for calculating the cost-effectiveness of current and future treatments. This study estimated time trade-off (TTO) and standard gamble (SG) preference values associated with four ASTS health states (progressive disease, stable disease, partial response, complete response) among members of the general public in the UK (n = 207). The four health states were associated with decreases in preference values from full health. Complete response was the most preferred health state (mean utility of 0.60 using TTO). The second most preferred health state was partial response followed by stable disease (mean utilities were 0.51 and 0.43, respectively, using TTO). The least preferred health state was progressive disease (mean utility of 0.30 using TTO). The utility value for each state was significantly different from one another (P < 0.001). This study demonstrated and quantified the impact that different treatment responses may have on the health-related quality of life of patients with ASTS.
Collapse
|
34
|
Surgical resection with adjuvant brachytherapy in soft tissue sarcoma of the extremity - a case report. J Contemp Brachytherapy 2013; 4:227-31. [PMID: 23378852 PMCID: PMC3561605 DOI: 10.5114/jcb.2012.32557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 12/12/2012] [Accepted: 12/14/2012] [Indexed: 11/29/2022] Open
Abstract
Purpose Surgery is the major therapeutic method in soft tissue sarcomas of the extremity (E-STS). Treatment of large high-grade tumours, which resection cannot be performed with a wide safe margin, should include complementary radiation and/or chemo-therapy. Hopefully, the use of adjuvant brachytherapy will improve the prognosis of E-STS. Case description After a long process of diagnosing a tumour in the medial compartment of the thigh, a 65-year-old woman with diagnosed synovial sarcoma underwent a surgery. Compartment resection was performed and the tumour was removed with a 10 mm safety margin of healthy tissue. Adjuvant brachytherapy was delivered with 192Ir (MicroSelectron, Nucletron Electa Group, Stockholm, Sweden®) with 10 Ci of nominal activity to a dose of 55 Gy in 16 days because of large tumour size (99 × 78 × 73 mm) and its proximity to the neurovascular bundle. No complications were reported. The patient was discharged from the hospital on the 28th day after the surgery. The wound healed without any complications and the outpatient follow-up is being continued. Discussion Adjuvant brachytherapy is rarely used after surgical treatment due to its limited accessibility in hospitals with surgical and orthopaedic departments. There are numerous publications proving positive influence of brachytherapy on local control and decreased number of recurrences. The recurrence-free survival time also increased significantly, however no direct impact on the number of distant metastases was found. Treatment is well tolerated and short. The complication rate varies between centres from 5 to 30%. The most common adverse effects include: peripheral neuropathy, skin necrosis and osteonecrosis of the long bones. Conclusions Treatment of large soft tissue sarcomas of the extremity (E-STS) should include combination of surgical intervention and external beam radiotherapy or brachytherapy. Adjuvant brachytherapy improves local control rate up to 78%, is well tolerated and rarely causes complications. We couldn't determine which type of adjuvant radiation therapy is more effective.
Collapse
|
35
|
el Sayadi H, Pissaloux D, Alberti L, Tabone-Eglinger S, Ranchere D, Decouvelaere AV, Tabone E, Ray-Coquard I, Caux C, Fayette J, Blay JY. Autocrine role for Gas6 with Tyro3 and Axl in leiomyosarcomas. Target Oncol 2013; 8:261-9. [PMID: 23354874 DOI: 10.1007/s11523-012-0249-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 12/20/2012] [Indexed: 12/11/2022]
Abstract
Leiomyosarcoma (LMS) represent 15 % of adult sarcomas. The aim of this work was to identify novel altered pathways in LMS, which may be of therapeutic value for patients. Thirteen fresh frozen samples of soft tissue and visceral LMS were analyzed and compared with normal smooth muscle uterine tissue (NSM) for phosphoproteomic profile. Four proteins were found differentially expressed including Tyro3. The functional role of Tyro3 and its ligand Gas6 was investigated in two LMS cell lines, SK-LMS-1 and CNIO-AA. Four proteins and phosphoproteins were differentially expressed in LMS samples vs NSM: A loss of FAK Y397 phosphorylation was observed in all LMSs, while Tyro3, MSH2 and PKC theta were consistently overexpressed. Gas6, the major ligand of Tyro3, was expressed in 8 of the 13 LMS samples, and Gas6 expression highly correlated to Akt Y473 phosphorylation and to a lesser extent to Erk1/2 phosphorylation. SK-LMS-1 and CNIO-AA LMS expressed Tyro3, Axl and Gas6 at high level in CNIO-AA while at low levels in SK-LMS-1. Exposure of both cell lines to foretinib, a tyrosine kinase inhibitor of Met, Axl and Tyro3, reduced cell viability and induced caspase 3/7 activation. Transfection of CNIO-AA with small interfering RNA directed against Tyro3 and Axl genes induced a reduction of the expression of the specific proteins and, when combined, significantly reduced CNIO-AA cell viability. Leiomyosarcomas overexpress Tyro3. Gas6, a ligand of Tyro3, exerts an autocrine activities though Tyro3 and Axl in a subgroup of LMS.
Collapse
Affiliation(s)
- Hiba el Sayadi
- Pole des Sciences Cliniques & Centre de Recherche en Cancerologie de Lyon, INSERM UMR5286 Equipe 11, Centre Léon Bérard, Lyon, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Matushansky I, Dela Cruz F, Insel BJ, Hershman DL, Neugut AI. Chemotherapy Use in Elderly Patients with Soft Tissue Sarcoma: A Population-based Study. Cancer Invest 2013; 31:83-91. [DOI: 10.3109/07357907.2012.756112] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
37
|
Liu SL, Chen G, Zhao YP, Wu WM, Zhang TP. Optimized dose of imatinib for treatment of gastrointestinal stromal tumors: a meta-analysis. J Dig Dis 2013; 14:16-21. [PMID: 23121684 DOI: 10.1111/1751-2980.12010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the efficacy and safety of standard-dose versus high-dose imatinib. METHODS After a systematic review of English language articles, five studies including 2008 patients were eligible for the meta-analysis. Data extracted from each study were synthesized into overall odds ratios (OR). RESULTS The overall OR for the high dose vs standard dose was 1.19 (95% CI 1.00-1.42) and the Z-score for the overall effect was 1.93 (P = 0.054), suggesting that high-dose imatinib added no survival benefits. The dose-related toxicity was also assessed in the same way. The rates of rash, hemorrhage, nausea, vomiting and taste disturbance increased as dose increased (P < 0.05), whereas the incidence of headache, abdominal pain, edema, fatigue, anemia, infection, muscle cramp and constipation was nearly identical and showed no significant difference. CONCLUSIONS Imatinib at a standard dose produces a similar effect to that at a high dose. The severity of the toxicity is associated with the dose of imatinib. However, larger and randomized studies are needed to draw definitive conclusions.
Collapse
Affiliation(s)
- Shang Long Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | | | | |
Collapse
|
38
|
Sarcoma of the Breast: Outcome and Reconstructive Options. Clin Breast Cancer 2012; 12:438-44. [DOI: 10.1016/j.clbc.2012.09.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 08/31/2012] [Accepted: 09/13/2012] [Indexed: 11/19/2022]
|
39
|
Bonvalot S, Desai A, Coppola S, Le Péchoux C, Terrier P, Dômont J, Le Cesne A. The treatment of desmoid tumors: a stepwise clinical approach. Ann Oncol 2012; 23 Suppl 10:x158-66. [DOI: 10.1093/annonc/mds298] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
40
|
Puri A, Gulia A. Multimodality management of extremity soft tissue sarcomas-an Indian perspective. Indian J Surg Oncol 2011; 2:291-7. [PMID: 23204784 PMCID: PMC3338133 DOI: 10.1007/s13193-012-0125-7] [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: 09/29/2011] [Accepted: 01/18/2012] [Indexed: 10/14/2022] Open
Abstract
Soft-tissue sarcomas are a rare and heterogeneous group of tumors. The last few decades have seen rapid strides in the management of these complex lesions. The presence of a soft-tissue sarcoma in the extremity is no longer an indication for amputation. Function preserving alternatives for local control in these lesions are the norm without compromising on overall disease survival. Good functional and oncological results can be achieved with a combination of excision of the tumor and where required, suitable adjuvant therapies. These lesions are best managed at specialty centres where the requisite multidisciplinary care can be offered to the patient to optimise results. This article outlines the current understanding and emphasises the multimodality management of these challenging tumors. We also present Indian data of the incidence and oncologic outcomes of these lesions and suggest a treatment algorithm.
Collapse
Affiliation(s)
- Ajay Puri
- Orthopaedic Oncologist, Tata Memorial Hospital, Room No: 26, E. Borges Road, Parel, Mumbai, 400 012 India
| | - Ashish Gulia
- Orthopaedic Oncologist, Tata Memorial Hospital, Room No: 26, E. Borges Road, Parel, Mumbai, 400 012 India
| |
Collapse
|
41
|
Abstract
Soft-tissue sarcomas are rare diseases with >50 subtypes. Surgery is the most important treatment in localized disease, sometimes combined with radiotherapy. Chemotherapy is used as palliation in advanced disease, sometimes also with a potential to decrease tumour size and eradicate micro-metastases, making meaningful surgery possible. The role of chemotherapy as adjuvant treatment in localized disease is not finally settled. Doxorubicin and ifosfamide are the two drugs with the best established response rates in soft-tissue sarcoma, and a combination of these drugs has been a 'gold standard' for several years. However, there is an emerging knowledge of the biology and sensitivity to treatment for different histological subtypes. New drugs such as gemcitabine, taxanes and trabectedin have been explored in several studies, showing promising results. Even if most studies have encompassed many different subtypes and were limited in size, knowledge related to specific treatment for different subtypes is emerging. Examples are trabectedin in lyposarcoma and leiomyosarcoma, and taxanes in angiosarcoma.
Collapse
Affiliation(s)
- M Eriksson
- Department of Oncology, Lund University and Skånes University Hospital, Lund, Sweden.
| |
Collapse
|
42
|
Aggerholm-Pedersen N, Rasmussen P, Dybdahl H, Rossen P, Nielsen OS, Safwat A. Serum Natrium Determines Outcome of Treatment of Advanced GIST with Imatinib: A Retrospective Study of 80 Patients from a Single Institution. ISRN ONCOLOGY 2011; 2011:523915. [PMID: 22091419 PMCID: PMC3196196 DOI: 10.5402/2011/523915] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 07/11/2011] [Indexed: 01/10/2023]
Abstract
Treatment with tyrosine kinase inhibitors (TKIs) has drastically improved overall survival (OS) of patients with advanced GIST. The aim of this study is to evaluate the results of treatment with different TKIs on advanced GIST and identify prognostic factors for OS. The medical records of all patients treated at the Department of Oncology, Aarhus University Hospital were retrospectively reviewed. Between 2001 and 2009, 80 patients with advanced GIST were treated with imatinib as first-line therapy. The median OS was 44 months (95% CI 31-56), and the 5-year OS was 40%. Since 2005, 32 patients were treated with sunitinib as 2nd-line therapy. The median time to progression was 9 months (95% CI: 3-13 months), and the 3-year OS was 30%. The data illustrate that data from large multicenter studies are reproducible in a single sarcoma centre. This retrospective study pointed to low serum sodium at the start of imatinib as a possible prognostic factor affecting OS.
Collapse
|
43
|
Abstract
The mainstay of treatment for adults with soft-tissue sarcomas is wide surgical excision. Half of all patients with adequate local control of high-grade sarcomas develop distant metastases and, despite additional treatment, ultimately die from their disease. This daunting reality has resulted in a three-decade research effort to assess the efficacy of adjuvant therapy for adult soft-tissue sarcomas. The multitude of histopathological subtypes, each with its own biology and clinical behavior, and the rarity of adult soft-tissue sarcomas as a whole greatly complicate such an assessment. This Perspectives article examines data that support or refute the use of adjuvant chemotherapy in the treatment of soft-tissue sarcomas.
Collapse
|
44
|
Toulmonde M, Bellera C, Mathoulin-Pelissier S, Debled M, Bui B, Italiano A. Quality of randomized controlled trials reporting in the treatment of sarcomas. J Clin Oncol 2011; 29:1204-9. [PMID: 21321290 DOI: 10.1200/jco.2010.30.9369] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Randomized controlled trials (RCTs) represent the best evidence in oncology practice. The aim of this study was to assess the reporting quality of sarcoma RCTs and to identify significant predictors of quality. PATIENTS AND METHODS Two investigators searched MEDLINE for pediatric and adult bone and soft tissue sarcoma RCTs published between January 1988 and December 2008. The quality of each report was assessed by using a 15-point overall reporting quality score based on 15 items from the revised Consolidated Standards of Reporting Trials (CONSORT) statement (overall quality score [OQS] range, 0 to 15 points). Concealment of allocation, appropriate blinding, and analysis according to intention-to-treat principle were assessed separately because of their crucial methodologic importance by using a 3-point key methodologic index score (MIS; range, 0 to 3). RESULTS We retrieved 72 relevant RCTs that included 16,029 patients. The median OQS was 9.5. Allocation concealment, blinding, and analysis by intent to treat were reported only in 21 (29%), nine (12.5%), and 23 (32%) of the 72 RCTs, respectively. The median MIS was 1 with a minimum of 0 and a maximum of 2. On multivariate analysis, publication after 1996 and high impact factor remained independent and significant predictors of improved OQS. The sole variable associated with improved MIS was the publication of chemotherapy-only trials. CONCLUSION Although the overall quality of sarcoma RCTs reporting has improved over time, reporting of key methodologic issues remains poor. This may lead to biased interpretation of sarcoma trial results.
Collapse
|
45
|
Mir O, Domont J, Cioffi A, Bonvalot S, Boulet B, Le Pechoux C, Terrier P, Spielmann M, Le Cesne A. Feasibility of metronomic oral cyclophosphamide plus prednisolone in elderly patients with inoperable or metastatic soft tissue sarcoma. Eur J Cancer 2011; 47:515-9. [PMID: 21251814 DOI: 10.1016/j.ejca.2010.11.025] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 11/22/2010] [Accepted: 11/26/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND The number of elderly people with soft tissue sarcoma (STS) is increasing. A sizeable population of elderly patients with STS is unfit for conventional doxorubicin- or ifosfamide-based chemotherapy. We assessed the feasibility of metronomic oral cyclophosphamide (CPM) in this population. PATIENTS AND METHODS Patients aged 65 years or older with unresectable STS received CPM 100mg twice daily plus prednisolone 20mg daily, the first week of a 2-week cycle in the outpatient setting. Main evaluation criterion was safety. Secondary evaluation criteria were objective response rate and progression-free survival. RESULTS Twenty-six patients (median age: 72, range 66-88) received a total of 330 cycles (median per patient: 10, range 2-41) as first (n=19) or second-line chemotherapy (n=7). The most frequent histological subtypes were poorly differentiated sarcoma (n=8), leiomyosarcoma and liposarcoma (n = 5 each) and angiosarcoma (n=3). Grade ≥3 lymphopenia was observed in 81% of pts but no opportunist infection occurred. Grade 3 anaemia and thrombocytopenia occurred in 2 pts (8%) each. No other grade 3-4 toxicity was seen. The response rate was 26.9% (95%CI: 9.9-44.0) and the disease control rate (responses and stable disease >12 weeks) was 69.2% (95%CI: 51.5-87.0). One complete (hepatic epithelioid haemangio-endothelioma) and 6 partial responses (including 5pts with radiation-induced sarcomas) were seen. Progression-free survival ranged from 0 to 20.6 months (median: 6.8 months) and was significantly longer in patients with radiation-induced sarcomas (median: 7.8 versus 5.2 months, p=0.02). CONCLUSION Metronomic CPM showed good safety results for this frail population, with promising activity in patients with radiation-induced sarcoma. Toxicity profile was favourable, allowing prolonged home staying and rare treatment discontinuations. A larger prospective study is warranted to confirm these encouraging results in elderly with STS.
Collapse
Affiliation(s)
- Olivier Mir
- Sarcoma Unit, Herault Ward, Department of Medicine, Institut Gustave Roussy, Université Paris 11, 39 Rue Camille Desmoulins, Villejuif, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
Soft-tissue sarcomas are a rare and heterogeneous group of tumors. The last few decades have seen rapid strides in surgery with function preserving alternatives for local control in these lesions becoming the norm without compromising on overall disease survival. Good functional and oncological results can be achieved with a combination of excision of the tumor, and where required, suitable adjuvant therapies. These lesions are best managed at specialty centres where the requisite multidisciplinary care can be offered to the patient to optimise results. This overview is intended as a review of current understanding and the multimodality management of these challenging tumors.
Collapse
Affiliation(s)
- Ajay Puri
- Department of Orthopaedic Oncology, Tata Memorial Hospital, Mumbai, India,Address for correspondence: Prof. Ajay Puri, Room No: 26, Tata Memorial Hospital, E. Borges Road, Parel, Mumbai-400 012, India. E-mail:
| | - Ashish Gulia
- Department of Orthopaedic Oncology, Tata Memorial Hospital, Mumbai, India
| |
Collapse
|
47
|
Brochard C, Michalak S, Aubé C, Singeorzan C, Fournier HD, Laccourreye L, Calès P, Boursier J. A not so solitary fibrous tumor of the liver. ACTA ACUST UNITED AC 2010; 34:716-20. [PMID: 20864281 DOI: 10.1016/j.gcb.2010.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 07/27/2010] [Accepted: 08/04/2010] [Indexed: 12/20/2022]
Abstract
Solitary fibrous tumor (SFT) is a rare neoplasm. Liver parenchyma is a rare location of SFT and, in this case, it usually follows a benign course. We report here the case of a 54-year-old man who presented a large SFT tumor of the right hepatic lobe. The tumor was surgically resected. Local recurrence occurred 6 years later as a 15 cm diameter liver tumor. Histological examination of the resected lesion showed features of an aggressive form of SFT. Two years later, the patient presented with complaints of neck pain and ensuing examinations revealed a tumor of the cranial base. A new surgical resection was performed and histological examination confirmed a metastasis of the SFT. Few weeks later, the patient presented an irreducible psoitis due to an iliac bone metastasis. He died within 1 month.
Collapse
Affiliation(s)
- C Brochard
- Service d'hepato-gastroentérologie, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 09, France
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Liu CY, Yen CC, Chen WM, Chen TH, Chen PCH, Wu HTH, Shiau CY, Wu YC, Liu CL, Tzeng CH. Soft tissue sarcoma of extremities: the prognostic significance of adequate surgical margins in primary operation and reoperation after recurrence. Ann Surg Oncol 2010; 17:2102-11. [PMID: 20217247 DOI: 10.1245/s10434-010-0997-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Adult soft tissue sarcomas (STS) of extremities are prone to recurrence despite apparently complete resection. This study aimed to explore the impact of clinicopathological factors on outcome and to define an "oncological safe margin" in these patients. METHODS A total of 181 patients with extremity STS were enrolled in a retrospective study. The prognostic influence of margin status and other clinicopathological characteristics on local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and disease-specific survival (DSS), were examined by univariate and multivariate analyses. The influence of surgical margins on postrecurrence survival (PRS) of patients undergoing reoperation for relapsed lesions during follow-up was analyzed by the Kaplan-Meier method. RESULTS Surgical margin width <10 mm and deep tumor depth at primary operation were consistently statistically significant independent adverse factors for LRFS, DMFS, and DSS. Patients with liposarcoma or low grade tumors had significantly higher chances of achieving adequate margins. Of 83 patients who experienced recurrence or metastasis, 53 (63.9%) received reoperation for their relapsed lesions. Patients who achieved microscopically negative margins (R0) at reoperation had significantly better PRS than those who did not (P < 0.007). Overall, patients with no recurrences had the best DSS, while relapsed patients receiving R0 reoperation had better DSS than those receiving either non-R0 reoperation or no reoperation at all. CONCLUSION Surgical margins prognostically influence survival in both patients undergoing primary surgery and those undergoing reoperation for relapse of extremity STS. In primary surgery, the chance of achieving adequate margin may reflect the underlying aggressiveness of tumors.
Collapse
Affiliation(s)
- Chun-Yu Liu
- Division of Hematology & Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | | | | | | | | | | | | |
Collapse
|