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Llacer-Moscardo C, Moureau-Zabotto L, Ollivier L, Helfré S, Ducassou A, Bonvalot S, Sunyach MP, Sargos P, Gillon P, Firmin N, Le Péchoux C, Thariat J. Management of oligometastatic/metastatic sarcomas and place of local treatments with focus on modern radiotherapy approaches. Cancer Radiother 2024; 28:93-102. [PMID: 38212215 DOI: 10.1016/j.canrad.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/09/2023] [Accepted: 06/29/2023] [Indexed: 01/13/2024]
Abstract
Soft tissue sarcomas are a rare and heterogeneous disease. For localized disease, treatment is based on surgery and radiotherapy with or without chemotherapy depending on risk factors. Upfront metastases are present in 7 to 20% of cases, and are localized to the lungs in most of cases. Disseminated disease is generally considered incurable but in selected cases, aggressive local treatment of metastases allowed long survival. Treatment of primary tumour is often debated. Our purpose is to evaluate the literature concerning the role of radiotherapy in the management of primary metastatic soft tissue sarcomas.
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Affiliation(s)
- C Llacer-Moscardo
- Radiation oncology department, institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France.
| | - L Moureau-Zabotto
- Department of radiotherapy, centre de radiothérapie du Pays d'Aix, avenue Henri-Pontier, 13100 Aix-en-Provence, France
| | - L Ollivier
- Department of radiotherapy, institut de cancérologie de l'Ouest (ICO), centre René-Gauducheau, Saint-Herblain, France
| | - S Helfré
- Department of radiotherapy, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - A Ducassou
- Department of radiotherapy, IUCT Oncopole, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France
| | - S Bonvalot
- Department of oncological surgery, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - M-P Sunyach
- Department of radiotherapy, centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - P Sargos
- Department of radiotherapy, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux, France
| | - P Gillon
- Department of radiotherapy, institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux, France
| | - N Firmin
- Radiation oncology department, institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France
| | - C Le Péchoux
- Department of radiotherapy, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - J Thariat
- Department of radiotherapy, centre François-Baclesse, 12, rue Jean-Baptiste-Colbert, 14000 Caen, France
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2
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Lebow ES, Lobaugh SM, Zhang Z, Dickson MA, Rosenbaum E, D'Angelo SP, Nacev BA, Shepherd AF, Shaverdian N, Wolden S, Wu AJ, Gelblum DY, Simone CB, Gomez DR, Alektiar K, Tap WD, Rimner A. Stereotactic body radiation therapy for sarcoma pulmonary metastases. Radiother Oncol 2023; 187:109824. [PMID: 37532104 PMCID: PMC11225867 DOI: 10.1016/j.radonc.2023.109824] [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: 04/06/2023] [Revised: 06/20/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND/PURPOSE Stereotactic body radiation therapy (SBRT) is standard for patients with inoperable early-stage NSCLC. We hypothesized that SBRT for sarcoma pulmonary metastases would achieve high rates of local control with acceptable toxicity and that patients with oligometastatic disease may achieve prolonged survival following SBRT. MATERIALS/METHODS This retrospective review included consecutive patients at our institution treated with SBRT for sarcoma pulmonary metastases. Cumulative incidence of local failure (LF) was estimated using a competing risks framework. RESULTS We identified 66 patients treated to 95 pulmonary metastases with SBRT. The median follow-up from the time of SBRT was 36 months (95% CI 34 - 53 months). The cumulative incidence of LF at 12 and 24 months was 3.1% (95% CI 0.9 - 10.6%) and 7.4% (95% CI 4.0% - 13.9%), respectively. The 12- and 24-month overall survival was 74% (95% CI 64 - 86%) and 49% (38 - 63%), respectively. Oligometastatic disease, intrathoracic only disease, and performance status were associated with improved survival on univariable analysis. Three patients had grade 2 pneumonitis, and one patient had grade 2 esophagitis. No patients had ≥ grade 3+ toxicities. CONCLUSION To the best of our knowledge, this is the largest series of patients treated with SBRT for pulmonary sarcoma metastases. We observed that SBRT offers an effective alternative to surgical resection with excellent local control and low proportions of toxicity.
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Affiliation(s)
- Emily S Lebow
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Stephanie M Lobaugh
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States.
| | - Zhigang Zhang
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Mark A Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Evan Rosenbaum
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Sandra P D'Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Benjamin A Nacev
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Annemarie F Shepherd
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Narek Shaverdian
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Suzanne Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Abraham J Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Daphna Y Gelblum
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Charles B Simone
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Kaled Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - William D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States.
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3
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Gerstberger S, Jiang Q, Ganesh K. Metastasis. Cell 2023; 186:1564-1579. [PMID: 37059065 PMCID: PMC10511214 DOI: 10.1016/j.cell.2023.03.003] [Citation(s) in RCA: 177] [Impact Index Per Article: 177.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/16/2023] [Accepted: 03/02/2023] [Indexed: 04/16/2023]
Abstract
Most cancer-associated deaths occur due to metastasis, yet our understanding of metastasis as an evolving, heterogeneous, systemic disease and of how to effectively treat it is still emerging. Metastasis requires the acquisition of a succession of traits to disseminate, variably enter and exit dormancy, and colonize distant organs. The success of these events is driven by clonal selection, the potential of metastatic cells to dynamically transition into distinct states, and their ability to co-opt the immune environment. Here, we review the main principles of metastasis and highlight emerging opportunities to develop more effective therapies for metastatic cancer.
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Affiliation(s)
- Stefanie Gerstberger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qingwen Jiang
- Molecular Pharmacology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karuna Ganesh
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Molecular Pharmacology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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4
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[Translated article] Oligometastases in oncological orthopaedic surgery. Our experience. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:T389-T396. [DOI: 10.1016/j.recot.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/17/2021] [Indexed: 11/21/2022] Open
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5
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Ortiz-Cruz EJ, García-Mauriño Peñín C, Moriel-Garceso DJ, Peleteiro Pensado M, Barrientos Ruiz I, Redondo Sánchez A, Pozo-Kreilinger JJ, Belinchón-Olmeda B, Tapia-Viñe M. Oligometástasis en la cirugía ortopédica oncológica. Nuestra experiencia. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:389-396. [DOI: 10.1016/j.recot.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022] Open
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Devaud N, Vornicova O, Abdul Razak AR, Khalili K, Demicco EG, Mitric C, Bernardini MQ, Gladdy RA. Leiomyosarcoma: Current Clinical Management and Future Horizons. Surg Oncol Clin N Am 2022; 31:527-546. [PMID: 35715148 DOI: 10.1016/j.soc.2022.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Leiomyosarcomas are soft tissue tumors that are derived from smooth muscle mainly in the pelvis and retroperitoneum. Percutaneous biopsy is paramount to confirm diagnosis. Imaging is necessary to complete clinical staging. Multimodal treatment should be directed by expert sarcoma multidisciplinary teams that see a critical volume of these rare tumors. Surgery is the mainstay of curative intent treatment; however due to its high metastatic progression, there may be a benefit for neoadjuvant systemic treatment. Adjuvant systemic treatment has no proven disease-free survival, and its main role is in the palliative setting to potentially prolong overall survival.
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Affiliation(s)
- Nicolas Devaud
- Instituto Oncologico Fundacion Arturo Lopez Perez (FALP), Santiago, Chile
| | - Olga Vornicova
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Korosh Khalili
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth G Demicco
- Department of Laboratory Medicine and Pathobiology, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Cristina Mitric
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Marcus Q Bernardini
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca A Gladdy
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Division of General Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada.
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7
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Musculoskeletal Metastasis From Soft-tissue Sarcomas: A Review of the Literature. J Am Acad Orthop Surg 2022; 30:493-503. [PMID: 35320120 DOI: 10.5435/jaaos-d-21-00944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/13/2022] [Indexed: 02/01/2023] Open
Abstract
Soft-tissue sarcomas are a rare and extremely heterogeneous group of cancers, representing <1% of all human malignancies. The lungs are the most common site of distant metastasis, followed by the bone, lymph nodes, liver, brain, and subcutaneous tissue. Clinical experience suggests that skeletal metastasis is part of the natural history affecting the prognosis and quality of life in these patients. Approximately 2.2% of patients have skeletal metastasis at diagnosis. However, up to 10% will develop skeletal metastasis after a mean interval of 21.3 months. Although systemic therapy with conventional chemotherapy remains the primary treatment modality for those with metastatic sarcoma, increased survival has been achieved in selected patients who receive multimodality therapy, including surgery, for their metastatic disease. The 5-year overall survival of patients with isolated bone metastases was 41.2% (26.9% to 54.9%), which decreased to 32.9% (21.2% to 45.1%) in the setting of combined bone and lung metastases. Moreover, the resection of the primary soft-tissue sarcoma is a predictor of survival, resulting in a 58% decrease in mortality after surgery (hazard ratio, 0.42, P = 0.013). Understanding the effect of these metastases on patient survival may influence imaging, surveillance, and treatment decisions.
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8
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Mansur A, Garg T, Shrigiriwar A, Etezadi V, Georgiades C, Habibollahi P, Huber TC, Camacho JC, Nour SG, Sag AA, Prologo JD, Nezami N. Image-Guided Percutaneous Ablation for Primary and Metastatic Tumors. Diagnostics (Basel) 2022; 12:diagnostics12061300. [PMID: 35741109 PMCID: PMC9221861 DOI: 10.3390/diagnostics12061300] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/20/2022] [Accepted: 05/22/2022] [Indexed: 02/06/2023] Open
Abstract
Image-guided percutaneous ablation methods have been further developed during the recent two decades and have transformed the minimally invasive and precision features of treatment options targeting primary and metastatic tumors. They work by percutaneously introducing applicators to precisely destroy a tumor and offer much lower risks than conventional methods. There are usually shorter recovery periods, less bleeding, and more preservation of organ parenchyma, expanding the treatment options of patients with cancer who may not be eligible for resection. Image-guided ablation techniques are currently utilized for the treatment of primary and metastatic tumors in various organs including the liver, pancreas, kidneys, thyroid and parathyroid, prostate, lung, bone, and soft tissue. This article provides a brief review of the various imaging modalities and available ablation techniques and discusses their applications and associated complications in various organs.
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Affiliation(s)
| | - Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.G.); (C.G.)
| | - Apurva Shrigiriwar
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, MD 21287, USA;
| | - Vahid Etezadi
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Christos Georgiades
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.G.); (C.G.)
| | - Peiman Habibollahi
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Timothy C. Huber
- Vascular and Interventional Radiology, Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR 97239, USA;
| | - Juan C. Camacho
- Department of Clinical Sciences, College of Medicine, Florida State University, Tallahassee, FL 32306, USA;
- Vascular and Interventional Radiology, Radiology Associates of Florida, Sarasota, FL 34239, USA
| | - Sherif G. Nour
- Department of Radiology and Medical Imaging, Florida State University College of Medicine, Gainesville, FL 32610, USA;
| | - Alan Alper Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA;
| | - John David Prologo
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD 21201, USA
- Correspondence: or
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9
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Chen L, Zhu GY, Jin ZC, Zhong BY, Wang Y, Lu J, Pan T, Teng GJ, Guo JH. Efficacy and Safety of Radioactive 125I Seed Implantation for Patients with Oligo-Recurrence Soft Tissue Sarcomas. Cardiovasc Intervent Radiol 2022; 45:808-813. [PMID: 35316381 DOI: 10.1007/s00270-022-03077-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/17/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of computed tomography-guided radioactive iodine-125 (125I) seed implantation for oligo-recurrence soft tissue sarcomas following surgical resection. MATERIALS AND METHODS Patients with oligo-recurrence soft tissue sarcomas after curative surgical resection between June 2013 and December 2020 were included. The primary outcome measure was objective response rate according to the Response Evaluation Criteria in Solid Tumors (RECIST 1.1). The secondary outcomes included progression-free survival, overall survival, and safety profiles. RESULTS Twenty-nine patients receiving computed tomography-guided 125I seed implantation were included in the study. The objective response rates at 2-, 6- and 12-month follow-up were 48.3%, 65.5% and 40.9%, respectively. The median progression-free survival was 11.3 months. The median overall survival was 25.1 months, with a 1- and 2-year overall survival rate of 81.5% and 50.0%, respectively. No severe treatment-related adverse effects occured. CONCLUSION 125I seed implantation has the potential to be an effective and safe treatment for oligo-recurrence soft tissue sarcomas after surgical resection.
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Affiliation(s)
- Li Chen
- Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Guang-Yu Zhu
- Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Zhi-Cheng Jin
- Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Bin-Yan Zhong
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Yong Wang
- Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Jian Lu
- Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Tao Pan
- Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Gao-Jun Teng
- Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China
| | - Jin-He Guo
- Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China.
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Wu J, Hu Y, Abdihamid O, Huang G, Xiao S, Li B. Crizotinib in Sarcomatous Malignancies Harboring ALK Fusion With a Definitive Partner(s): Response and Efficacy. Front Oncol 2021; 11:684865. [PMID: 34722239 PMCID: PMC8551604 DOI: 10.3389/fonc.2021.684865] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Sarcoma or sarcomatoid malignancies are a set of mesenchymal-origin malignancies with vast heterogeneity in clinical and molecular characteristics. Anaplastic lymphoma kinase (ALK) is a tyrosine kinase oncoprotein expressed by several tumors, including sarcomas. Crizotinib is an effective ALK inhibitor. In this review paper, we summarized findings from the literature regarding the use of crizotinib for the treatment of sarcoma and sarcomatoid malignancies harboring ALK fusions with definitive partners (with the given gene(s) name) from the years 2010 to 2021.One hundred and four articles were retrieved and after exclusion, 28 studies containing 33 patients were finally selected. All 33 patients were treated with crizotinib. Among the 33 cases, 19 were adult patients, 11 were pediatric patients, and 3 cases did not have data on age and/or gender. Most cases had a primary abdominal lesion (16/30), followed by thoracic (10/30), trunk (3/30), retroperitoneal (1/30), and one case of right medial thigh (case 7). Stage IV disease was reported in 76.7% (23/30) of patients. The objective response rate and disease control rate was 86.7% (26/30) and 96.7% (29/30), respectively, which were assessed on average of 8 weeks after crizotinib initiation. Rapid improvement of symptoms was observed within one to two weeks in some cases including patients with extensive diseases or poor performance. There was no difference in crizotinib response between pediatrics and adult cases. Crizotinib is effective; however, surgery remains the mainstay of therapy, with newer evidence showing concurrent crizotinib with surgery conferring long-term overall survival. However, we should still be cognizant of the heterogeneous landscape of crizotinib efficacy and its associated fatal adverse events.
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Affiliation(s)
- Jinchun Wu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Yongbin Hu
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Omar Abdihamid
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Gengwen Huang
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Sheng Xiao
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Bin Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
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11
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Comparison of Percutaneous Image-Guided Microwave and Cryoablation for Sarcoma Lung Metastases: 10-Year Experience. AJR Am J Roentgenol 2021; 218:494-504. [PMID: 34612679 DOI: 10.2214/ajr.21.26551] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Outcomes between percutaneous microwave (MWA) and cryoablation of sarcoma lung metastases have not been compared to our knowledge. Objective: To compare technical success, complications, local tumor control, and overall survival (OS) following MWA versus cryoablation of sarcoma lung metastases. Methods: This retrospective cohort study included 27 patients (16 women, 11 men; median age 64 years; Eastern Cooperative Oncology Group performance score 0-2) who underwent 39 percutaneous CT-guided ablation sessions (21 MWA, 18 cryoablation; 1-4 sessions per patient) to treat 65 sarcoma lung metastases (median 1 tumor per patient, range 1-12; median tumor diameter 11 mm, range 5-33 mm; 25% non-peripheral) from 2009 to 2021. We compared complications by ablation modality using generalized-estimating equations. We evaluated ablation modality, tumor size, and location (peripheral vs non-peripheral) in relation to local tumor progression using proportional Cox hazard models with death as competing risk. We estimated OS using the Kaplan-Meier method. Results: Primary technical success was 97% for both modalities. Median follow-up was 23 months (range: 1-102 months; interquartile range: 12, 44 months). A total of 7/61 (12%) tumors progressed. Estimated 1-year and 2-year local control rates were, for tumors >1 cm, 97% and 95% following MWA versus 99% and 98% following cryoablation, and for tumors ≤1 cm, 74% and 62% following MWA versus 86% and 79% following cryoablation. Tumor size ≤1 cm was associated with decreased cumulative incidence of local progression (p =.048); ablation modality and tumor location were not associated with progression (p =.86; p =.54). Complications (CTCAE grade ≤3) occurred in 17/39 sessions (44%), prompting chest tube placement in nine (23%). No complications with grade ≥4 occurred. OS at 1-, 2-, and 3-years was 100%, 89%, and 82%, respectively. Conclusion: High primary technical success, local control, and OS support MWA and cryoablation for treating sarcoma lung metastases. Ablation modality and tumor location did not affect local progression. Treatment failure was low, especially for small tumors. No life-threatening complications occurred. Clinical Impact: Percutaneous MWA and cryoablation are both suited for treatment of sarcoma lung metastases, especially for tumors ≤1 cm, whether peripheral or non-peripheral. Complications, if they occur, are not life-threatening.
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12
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Zane KE, Cloyd JM, Mumtaz KS, Wadhwa V, Makary MS. Metastatic disease to the liver: Locoregional therapy strategies and outcomes. World J Clin Oncol 2021; 12:725-745. [PMID: 34631439 PMCID: PMC8479345 DOI: 10.5306/wjco.v12.i9.725] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/14/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023] Open
Abstract
Secondary cancers of the liver are more than twenty times more common than primary tumors and are incurable in most cases. While surgical resection and systemic chemotherapy are often the first-line therapy for metastatic liver disease, a majority of patients present with bilobar disease not amenable to curative local resection. Furthermore, by the time metastasis to the liver has developed, many tumors demonstrate a degree of resistance to systemic chemotherapy. Fortunately, catheter-directed and percutaneous locoregional approaches have evolved as major treatment modalities for unresectable metastatic disease. These novel techniques can be used for diverse applications ranging from curative intent for small localized tumors, downstaging of large tumors for resection, or locoregional control and palliation of advanced disease. Their use has been associated with increased tumor response, increased disease-free and overall survival, and decreased morbidity and mortality in a broad range of metastatic disease. This review explores recent advances in liver-directed therapies for metastatic liver disease from primary colorectal, neuroendocrine, breast, and lung cancer, as well as uveal melanoma, cholangiocarcinoma, and sarcoma. Therapies discussed include bland transarterial embolization, chemoembolization, radioembolization, and ablative therapies, with a focus on current treatment approaches, outcomes of locoregional therapy, and future directions in each type of metastatic disease.
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Affiliation(s)
- Kylie E Zane
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Jordan M Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Khalid S Mumtaz
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Vibhor Wadhwa
- Department of Radiology, Weill Cornell Medical Center, New York City, NY 10065, United States
| | - Mina S Makary
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
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13
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Abstract
BACKGROUND Pathological fractures are not only incisive events for tumor patients often with the need of surgical treatment but also often represent a relevant challenge in the overall concept of oncological treatment. OBJECTIVE The aim of this article is to illustrate the necessity of a pre-interventional interdisciplinary consideration of disease-specific and patient-specific characteristics. MATERIAL AND METHODS A literature search and evaluation of existing guidelines were carried out including the keywords "bone metastases" and "pathological fractures" with respect to the oncological and radiotherapeutic treatment. RESULTS An essential classification of the surgical and other needs for treatment is carried out by the identification of the underlying disease and dissemination situation. For tumor-related pathological fractures a palliative treatment situation is present in most cases. Nevertheless, a possible oligometastasis and an increasing number of effective systemic treatment methods must be taken into consideration when planning the surgical treatment. In addition to the therapeutic emergency indications in spinal compression or symptomatic hypercalcemia, both additive radiotherapy and supplementary pharmaceutical osteoprotection have to be addressed in this context. Radiotherapy in particular represents an effective alternative option for symptom and tumor control. CONCLUSION The work-up of the multifaceted oncological treatment concept represents an interdisciplinary challenge, which ideally defines the further treatment procedure, including fracture treatment, in an interdisciplinary tumor board within an overall oncological concept.
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GEIS-SEHOP clinical practice guidelines for the treatment of rhabdomyosarcoma. Clin Transl Oncol 2021; 23:2460-2473. [PMID: 34212338 DOI: 10.1007/s12094-021-02654-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
Rhabdomyosarcoma (RMS) is the most frequent soft tissue sarcoma (STS) in children and adolescents. In Spain the annual incidence is 4.4 cases per million children < 14 years. It is an uncommon neoplasm in adults, but 40% of RMS are diagnosed in patients over 20 years of age, representing 1% of all STS in this age group. RMS can appear anywhere in the body, with some sites more frequently affected including head and neck, genitourinary system and limbs. Assessment of a patient with suspicion of RMS includes imaging studies (MRI, CT, PET-CT) and biopsy. All patients with RMS should receive chemotherapy, either at diagnosis in advanced or metastatic stages, or after initial resection in early local stages. Local control includes surgery and/or radiotherapy depending on site, stage, histology and response to chemotherapy. This guide provides recommendations for diagnosis, staging and treatment of this neoplasm.
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Facchini G, Ceccarelli L, Tomà P, Bartoloni A. Recent Imaging Advancements for Lung Metastases in Children with Sarcoma. Curr Med Imaging 2021; 17:236-243. [PMID: 33371858 DOI: 10.2174/1573405616666201228125657] [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: 05/11/2020] [Revised: 11/19/2020] [Accepted: 12/07/2020] [Indexed: 11/22/2022]
Abstract
In children and adolescents affected by musculoskeletal sarcomas (both soft tissue and bone sarcomas), the presence of lung metastases is a frequent complication, that should be known since the patient's prognosis, as management, and treatment depend on it. During the staging phase, the detection of lung metastases should be sensitive and specific, and it should be carried out by minimizing the radiation exposure. To deal with this problem, imaging has reached important goals in recent years, thanks to the development of cone-beam CT or low-dose computed tomography, with some new iterative reconstruction methods, such as Veo and ASIR. Imaging is also fundamental for the possibility to perform lung biopsies under CT guidance, with less morbidity, less time-consumption, and shorter recovery time, compared to surgical biopsies.Moreover, important results have also been demonstrated in the treatment of lung metastases, due to the improvement of new mini-invasive image-guided percutaneous thermal ablation procedures, which proved to be safe and effective also in young patients.
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Affiliation(s)
- Giancarlo Facchini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Ceccarelli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Tomà
- Department of Imaging, IRCCS Ospedale Pediatrico Bambino Gesu, Rome, Italy
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Benkhaled S, Mané M, Jungels C, Shumelinsky F, Aubain NDS, Van Gestel D. Successful treatment of synchronous chemoresistant pulmonary metastasis from pleomorphic rhabdomyosarcoma with stereotaxic body radiation therapy: A case report and a review of the literature. Cancer Treat Res Commun 2020; 26:100282. [PMID: 33360328 DOI: 10.1016/j.ctarc.2020.100282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Rhabdomyosarcoma (RMS) is a highly malignant soft tissue sarcoma (STS), usually of adults, displaying skeletal muscle differentiation. STS principally metastasize to the lungs with more than 50% of metastatic patients presenting with isolated pulmonary metastasis. Paradoxically, the majority of drugs prescribed to treat RMS are associated with multidrug resistance. CASE REPORT We report the case of a 53 year-old patient who developed three synchronous chemoresistant lung metastasis from pleomorphic RMS. Considering the poor prognosis, the patient's preference and the chemoresistance of her lung metastasis, we decided to perform two consecutive stereotactic body radiotherapy (SBRT) on two of these three lesions. DISCUSSION Initially, the patient was referred to our institute with a painful mass in the anterior part of the left thigh increasing in volume for 3 months. Biopsy revealed a high-grade pleomorphic RMS. The cancer being staged IB, she had neoadjuvant radiotherapy. After complete surgical excision, pathology examination revealed a 6 cm Grade II pleomorphic RMS, with clear margins. Six months later, she developed three synchronous lung metastases. She got 4 courses of doxorubicin-ifosfamide which were poorly supported. After two courses, a heterogeneous (morphological and metabolic) response was observed, hence SBRT was delivered with a Biologically Equivalent Dose (α/β10)> 100 Gray on the two more chemoresistant lesions. This SBRT was very well tolerated, no side effects were reported. The patient remained alive and achieved a complete response of these three metastases, which sustains after more than 3 years. CONCLUSION Early recognition and proper management of these oligometastatic patients may lead to motivating results in a poor prognosis disease.
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Affiliation(s)
- Sofian Benkhaled
- Institut Jules Bordet-Université Libre de Bruxelles, Department of Radiation-Oncology, Brussels, Belgium.
| | - Maïmouna Mané
- Cancer Institute of Dakar Department of Radiation-Oncology, Dakar, Senegal
| | - Christiane Jungels
- Institut Jules Bordet-Université Libre de Bruxelles, Department of Medical Oncology, Brussels, Belgium
| | - Felix Shumelinsky
- Institut Jules Bordet-Université Libre de Bruxelles, Department of Surgery, Brussels, Belgium
| | - Nicolas De Saint Aubain
- Institut Jules Bordet-Université Libre de Bruxelles, Department of Pathology, Brussels, Belgium
| | - Dirk Van Gestel
- Institut Jules Bordet-Université Libre de Bruxelles, Department of Radiation-Oncology, Brussels, Belgium
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Silencing KIF18B enhances radiosensitivity: identification of a promising therapeutic target in sarcoma. EBioMedicine 2020; 61:103056. [PMID: 33038765 PMCID: PMC7648128 DOI: 10.1016/j.ebiom.2020.103056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 12/20/2022] Open
Abstract
Background Sarcomas are rare heterogeneous tumours, derived from primitive mesenchymal stem cells, with more than 100 distinct subtypes. Radioresistance remains a major clinical challenge for sarcomas, demanding urgent for effective biomarkers of radiosensitivity. Methods The radiosensitive gene Kinesin family member 18B (KIF18B) was mined through bioinformatics with integrating of 15 Gene Expression Omnibus (GEO) datasets and The Cancer Genome Atlas (TCGA) database. We used radiotherapy-sh-KIF18B combination to observe the anti-tumour effect in sarcoma cells and subcutaneous or orthotopic xenograft models. The KIF18B-sensitive drug T0901317 (T09) was further mined to act as radiosensitizer using the Genomics of Drug Sensitivity in Cancer (GDSC) database. Findings KIF18B mRNA was significantly up-regulated in most of the subtypes of bone and soft tissue sarcoma. Multivariate Cox regression analysis showed that KIF18B high expression was an independent risk factor for prognosis in sarcoma patients with radiotherapy. Silencing KIF18B or using T09 significantly improved the radiosensitivity of sarcoma cells, delayed tumour growth in subcutaneous and orthotopic xenograft model, and elongated mice survival time. Furthermore, we predicted that T09 might bind to the structural region of KIF18B to exert radiosensitization. Interpretation These results indicated that sarcomas with low expression of KIF18B may benefit from radiotherapy. Moreover, the radiosensitivity of sarcomas with overexpressed KIF18B could be effectively improved by silencing KIF18B or using T09, which may provide promising strategies for radiotherapy treatment of sarcoma. Fundings A full list of funding can be found in the Funding Sources section.
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le Guevelou J, Debaigt C, Saada-Bouzid E, Viotti J, Khalladi N, Thibouw D, Penel N, Sunyach MP, Moureau-Zabotto L, Benchalal M, Veresezan O, Ducassou A, le Pechoux C, Jolnerovski M, Bazille C, Vaur D, Escande A, Serre R, Lovera C, Thariat J. Phase II study of concomitant radiotherapy with atezolizumab in oligometastatic soft tissue sarcomas: STEREOSARC trial protocol. BMJ Open 2020; 10:e038391. [PMID: 32967883 PMCID: PMC7513631 DOI: 10.1136/bmjopen-2020-038391] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Up to 50% of soft tissue sarcoma (STS) patients develop metastases in the course of their disease. Cytotoxic therapy is a standard treatment in this setting but yields average tumour response rates of 25% at first line and ≤10% at later lines. In oligometastatic stage, stereotactic body radiation therapy (SBRT) allows reaching high control rates at treated sites (≥80%) and is potentially equally effective to surgery in term of overall survival. In order to shift the balance towards antitumour immunity by multisite irradiation, radiation could be combined with inhibitors of the immunosuppressive pathways. METHODS AND ANALYSIS STEREOSARC is a prospective, multicentric, randomised phase II, designed to evaluate the efficacy of SBRT associated with immunotherapy versus SBRT only. Randomisation is performed with a 2:1 ratio within two arms. The primary objective is to evaluate the efficacy, in term of progression-free survival (PFS) rate at 6 months, of immunomodulated stereotactic multisite irradiation in oligometastatic sarcoma patients. The secondary objectives include PFS by immune response criteria, overall survival, quality-of-life evaluation and developing mathematical models of tumour growth and dissemination predictive of oligometastatic versus polymetastatic evolution. Patients will be randomised in two groups: SBRT with atezolizumab and SBRT alone. The total number of included patients should be 103. TRIAL REGISTRATION The trial is registered on ClinicalTrials.gov (ID: NCT03548428). ETHICS AND DISSEMINATION This study has been approved by Comité de Protection des Personnes du sud-ouest et outre-mer 4 on 18 October 2019 (Reference CPP2019-09-076-PP) and from National Agency for Medical and Health products Safety (Reference: MEDAECNAT-2019-08-00004_2017-004239-35) on 18 September 2019.The results will be disseminated to patients upon individual request or through media release from scientific meetings. The results will be communicated through scientific meetings and publications.
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Affiliation(s)
- Jennifer le Guevelou
- Radiation oncology department, Centre de Lutte Contre le Cancer, Centre Francois Baclesse, Caen, France
| | - Colin Debaigt
- clinical research department, UNICANCER, Paris, Île-de-France, France
| | - Esma Saada-Bouzid
- Medical oncology department, Centre Antoine Lacassagne, Nice, Provence-Alpes-Côte d'Azur, France
| | - Julien Viotti
- Medical oncology department, Centre Antoine Lacassagne, Nice, Provence-Alpes-Côte d'Azur, France
| | - Nazim Khalladi
- Biomolecular pathology department, Centre de Lutte Contre le Cancer, Centre François Baclesse, Caen, France
| | - David Thibouw
- Medical oncology department, Georges-Francois Leclerc Centre, Dijon, Bourgogne-Franche-Comté, France
| | - Nicolas Penel
- Medical oncology department, Centre Oscar Lambret, lille, France
| | | | | | | | - Ovidiu Veresezan
- Radiation oncology department, CHU Rouen Biochimie Médicale, Rouen, Haute-Normandie, France
| | - Anne Ducassou
- Radiation oncology department, IUCT Oncopole, Toulouse, Languedoc-Roussillon-Midi, France
| | | | - Maria Jolnerovski
- clinical research department, UNICANCER, Paris, Île-de-France, France
| | - Celine Bazille
- Biomolecular pathology department, CHU Caen, Caen, Basse-Normandie, France
| | - Dominique Vaur
- Biomolecular pathology department, Centre de Lutte Contre le Cancer, Centre François Baclesse, Caen, France
| | - Alexandre Escande
- Radiation oncology department, Oscar Lambret Cancer Centre, Lille, Hauts-de-France, France
| | - Raphael Serre
- Radiation oncology department, CHU Limoges, Limoges, France
| | - Christine Lovera
- clinical research department, UNICANCER, Paris, Île-de-France, France
| | - Juliette Thariat
- Radiation oncology department, Centre de Lutte Contre le Cancer, Centre Francois Baclesse, Caen, France
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Tagliaferri L, Vavassori A, Lancellotta V, Sanctis VD, Vidali C, Casà C, Aristei C, Genovesi D, Jereczek-Fossa BA, Morganti AG, Kovács G, Guinot JL, Rembielak A, Greto D, Gambacorta MA, Valentini V, Donato V, Corvò R, Magrini SM, Livi L. INTERACTS (INTErventional Radiotherapy ACtive Teaching School) consensus conference on sarcoma interventional radiotherapy (brachytherapy) endorsed by AIRO (Italian Association of Radiotherapy and Clinical Oncology). J Contemp Brachytherapy 2020; 12:397-404. [PMID: 33293980 PMCID: PMC7690224 DOI: 10.5114/jcb.2020.98120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To report the results of INTERACTS (INTErventional Radiotherapy ACtive Teaching School) consensus conference on sarcoma interventional radiotherapy (brachytherapy). MATERIAL AND METHODS An international board of multidisciplinary experts was invited to a consensus conference on the state-of-the-art of sarcoma interventional oncology during the 9th Rome INTER-MEETING (INTERventional Radiotherapy Multidisciplinary Meeting), proposing 3 statements for each one speech. At the end of each lecture, the entire group of experts was invited to vote with an electronic device. The preliminary results were presented and discussed at the end of the meeting, during a dedicated session. After the meeting, a survey was distributed within the consensus conference board to share and definitively vote the statements. RESULTS All the invited authors of the consensus conference board completed the final survey. All the 38 statements received more than 70% of agreement, 31 statements (82%) obtained an agreement of level higher or equal to 90%, 6 statements (15.8%) received an agreement level between 80% and 90%, and 1 statement (2.6%) had less than 80% of agreement. CONCLUSIONS The consensus conference demonstrated that interventional radiotherapy must be considered by a multidisciplinary management of patients affected by sarcoma.
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Affiliation(s)
- Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,
| | - Andrea Vavassori
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy,
| | - Valentina Lancellotta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,
- Address for correspondence: Valentina Lancellotta, MD, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy, e-mail:
| | - Vitaliana De Sanctis
- Department of Radiation Oncology, Faculty of Medicina e Psicologia, Sant’Andrea Hospital, University of Rome “La Sapienza”, Rome, Italy,
| | - Cristiana Vidali
- Former Deputy Chair of Interventional Radiotherapy AIRO working Group – IntraOperative RadioTherapy, Trieste, Italy,
| | | | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgery and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy,
| | - Domenico Genovesi
- Department of Radiation Oncology, Santissima Annunziata Hospital, Gabriele D’Annunzio University of Chieti-Pescara, Chieti, Italy,
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy,
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy,
| | - Alessio Giuseppe Morganti
- Department of Experimental, Diagnostic and Specialty Medicine – DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy,
| | | | - Jose Luis Guinot
- Foundation Instituto Valenciano de Oncologia (I.V.O.), Valencia, Spain,
| | - Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester and Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom,
| | - Daniela Greto
- Radiotherapy Department, University of Florence, Florence, Italy,
| | - Maria Antonietta Gambacorta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,
- Università Cattolica del Sacro Cuore, Rome, Italy,
| | - Vincenzo Valentini
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,
- Università Cattolica del Sacro Cuore, Rome, Italy,
| | - Vittorio Donato
- Radiation Oncology Department, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy,
| | - Renzo Corvò
- Radiation Oncology, IRCCS Ospedale Policlinico San Martino and Department of Health Science, University of Genoa, Italy,
| | - Stefano Maria Magrini
- Radiation Oncology Department, Ospedali Civili Hospital and Brescia University, Brescia, Italy
| | - Lorenzo Livi
- Radiotherapy Department, University of Florence, Florence, Italy,
| | - Consensus Conference Board
- Consensus Conference Board: Rosa Autorino (radiation oncologist, Rome), Carmelo Caldarella (nuclear medicine physician, Rome), Annamaria Cerrotta (radiation oncologist, Milan), Antonino De Paoli (radiation oncologist, Aviano), Vitaliana De Sanctis (radiation oncologist, Rome), Nicola Dinapoli (radiation oncologist, Rome), Vittorio Donato (radiation oncologist, Rome), Martina Ferioli (radiation oncologist, Bologna), Vincenzo Fusco (radiation oncologist, Rionero in Vulture), Maria Antonietta Gambacorta (radiation oncologist, Rome), Domenico Genovesi (radiation oncologist, Chieti), Daniela Greto (radiation oncologist, Florence), Jose Luis Guinot (radiation oncologist, València), Roberto Iezzi (interventional radiologist, Rome), Barbara Alicja Jereczek-Fossa (radiation oncologist, Milan), György Kovács (radiation oncologist, Rome and Lübeck), Valentina Lancellotta (radiation oncologist, Rome), Antonio Leone (radiologist, Rome), Giulio Maccauro (orthopedic surgeon, Rome), Stefano Maria Magrini (radiation oncologist, Brescia), Alessio Giuseppe Morganti (radiation oncologist, Bologna), Michela Quirino (medical oncologist, Rome), Agata Rembielak (clinical and radiation oncologist, Manchester), Umberto Ricardi (radiation oncologist, Turin), Vittoria Rufini (nuclear medicine physician, Rome), Giuseppe Sanguineti (radiation oncologist, Rome), Luca Tagliaferri (radiation oncologist, Rome), Andrea Vavassori (radiation oncologist, Milan), Cristiana Vidali (radiation oncologist, Trieste)
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Analysis of the Chemotherapy-Free Interval following Image-Guided Ablation in Sarcoma Patients. Sarcoma 2020; 2020:3852420. [PMID: 32148436 PMCID: PMC7044489 DOI: 10.1155/2020/3852420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/08/2020] [Indexed: 02/07/2023] Open
Abstract
One way to enhance quality of life for patients with metastatic sarcoma is to maximize time off chemotherapy—a chemotherapy-free interval. While image-guided ablation of sarcoma metastases may reduce the need for chemotherapy, it remains unknown how long ablation could extend the chemotherapy-free interval. The purpose of our study was to determine the chemotherapy-free interval in comparison to overall survival and progression-free survival in sarcoma patients who undergo ablation procedures. An IRB-approved, single institution, HIPAA compliant database was queried for sarcoma patients who underwent image-guided ablation procedures between 2007 and 2018. Patient demographics, histologic subtype, and other clinical characteristics were recorded. Kaplan-Meier analysis was performed to compute median overall survival, median progression-free survival (local and distant), and the median chemotherapy-free interval (systemic and cytotoxic) after ablation. Univariate and multivariate analyses were performed using the log-rank test and Cox proportional-hazards model, respectively. A total of 100 sarcoma patients were included in the analysis. The most common histologic subtype was leiomyosarcoma (38%). Median overall survival after ablation of sarcoma metastases was 52.4 months (95% CI: 46.9–64.0 months). The median systemic chemotherapy-free interval following ablation of sarcoma metastases was 14.7 months (95% CI: 8.6–34.3 months). The median cytotoxic chemotherapy-free interval following ablation of sarcoma metastases was 81.3 months (95% CI: 34.3-median not reached). In conclusion, ablation of sarcoma metastases can provide an extended systemic chemotherapy-free interval of greater than 1 year. Ablation of sarcoma metastases may improve patient quality of life by extending the chemotherapy-free interval.
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Ablation of soft tissue tumours by long needle variable electrode-geometry electrochemotherapy: final report from a single-arm, single-centre phase-2 study. Sci Rep 2020; 10:2291. [PMID: 32042142 PMCID: PMC7010705 DOI: 10.1038/s41598-020-59230-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/24/2020] [Indexed: 02/07/2023] Open
Abstract
Standard electrochemotherapy (ECT) is effective in many tumour types but is confined to the treatment of small superficial lesions. Variable electrode-geometry ECT (VEG-ECT) may overcome these limitations by using long freely-placeable electrodes. Patients with bulky or deep-seated soft-tissue malignancies not amenable to resection participated in a single-arm phase-2 study (ISRCTN.11667954) and received a single course of VEG-ECT with intravenous bleomycin (15,000 IU/m2) and concomitant electric pulses applied through an adjustable electrode array. The primary outcome was radiologic complete response rate (CRR) per RECIST; secondary endpoints included feasibility, metabolic response, toxicity (CTCAE), local progression-free survival (LPFS) and patient perception (EQ-5D). During 2009–2014, we enrolled 30 patients with trunk/limb sarcomas, melanoma, Merkel-cell carcinoma, and colorectal/lung cancer. Median tumour size was 4.7 cm. Electrode probes were placed under US/TC guidance (28 and 2 patients, respectively). Median procedure duration was 80 minutes. Tumour coverage rate was 97% (29 of 30 patients). Perioperative side-effects were negligible; one patient experienced grade-3 ulceration and infection. One-month 18F-FDG-SUV decreased by 86%; CRR was 63% (95% CI 44–79%). Local control was durable in 24 of 30 patients (two-year LPFS, 62%). Patients reported an improvement in “usual activities”, “anxiety/depression”, and “overall health” scores. VEG-ECT demonstrated encouraging antitumour activity in soft-tissue malignancies; a single course of treatment produced high and durable responses, with low complications.
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