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Inoue Y, Umeda Y, Mitta S, Matsuno Y, Mori Y. Retroperitoneal Sarcoma Requiring Abdominal Aortic Replacement With Long-Term Survival: A Case Report. Cureus 2024; 16:e60198. [PMID: 38868254 PMCID: PMC11168244 DOI: 10.7759/cureus.60198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/14/2024] Open
Abstract
Retroperitoneal sarcoma (RPS) is a rare disease. RPS invading the abdominal aorta is exceedingly rare and has a poor prognosis. There have been scattered cases of RPS treated with combined abdominal aortic replacement. However, the average survival time for these cases was only 8 months, with a 2-year survival rate of 21%, indicating a poor prognosis. In this case study, a 44-year-old man presented to our hospital complaining of abdominal pain. Multiple imaging findings suggested a retroperitoneal mass that was diagnosed as a malignant tumor. The patient underwent tumor resection with abdominal aortic replacement due to an RPS tumor invading the abdominal aorta. The histopathological grade was determined to be grade 3, the most malignant grade tumor, according to the Fédération Nationale des Centres de Lutte Contre le Cancer grading system. Postoperative chemotherapy with doxorubicin and ifosfamide was administered for five cycles. The patient has been alive for over 8 years after the operation without any recurrence. This case presents a long-term survival of RPS requiring abdominal aortic replacement.
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Affiliation(s)
- Yuta Inoue
- Cardiovascular and Thoracic Surgery, Gifu Prefectural General Medical Center, Gifu, JPN
| | - Yukio Umeda
- Cardiovascular and Thoracic Surgery, Gifu Prefectural General Medical Center, Gifu, JPN
| | - Shohei Mitta
- Cardiovascular and Thoracic Surgery, Gifu Prefectural General Medical Center, Gifu, JPN
| | - Yukihiro Matsuno
- Cardiovascular and Thoracic Surgery, Gifu Prefectural General Medical Center, Gifu, JPN
| | - Yoshio Mori
- Cardiovascular and Thoracic Surgery, Gifu Prefectural General Medical Center, Gifu, JPN
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Montero A, Chen-Zhao X, Ciérvide R, Álvarez B, Prado A, López M, Sánchez E, Hernando O, de la Casa MA, García-Aranda M, Valero J, Alonso R, Fernández-Letón P, Rubio C. Moderate hypofractionated radiation therapy and pathologic response for soft tissue sarcomas (STS) of limbs and trunk: experience from a tertiary cancer center. Clin Transl Oncol 2024; 26:204-213. [PMID: 37277526 DOI: 10.1007/s12094-023-03237-y] [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: 04/04/2023] [Accepted: 05/28/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Preoperative radiation therapy following by limb-sparing or conservative surgery is a standard approach for limb and trunk STS. Data supporting hypofractionated radiotherapy schedules are scarce albeit biological sensitivity of STS to radiation would justify it. We sought to evaluate the impact of moderate hypofractionation on pathologic response and its influence on oncologic outcomes. MATERIAL AND METHODS From October 2018 to January 2023, 18 patients with limb or trunk STS underwent preoperative radiotherapy at a median dose of 52.5 Gy (range 49.5-60 Gy) in 15 fractions of 3.5 Gy (3.3-4 Gy) with or without neoadjuvant chemotherapy. A favorable pathologic response (fPR) was considered as ≥ 90% tumor necrosis on specimen examination. RESULTS All patients completed planned preoperative radiotherapy. Eleven patients (61.1%) achieved a fPR, and 7 patients (36.8%) a complete pathologic response with total disappearance of tumor cells. Nine patients (47%) developed grade 1-2 acute skin toxicity, and 7 patients (38.8%) had wound complications on follow-up. With a median follow-up of 14 months (range 1-40), no cases of local relapse were observed, and actuarial 3-year overall survival (OS) and distant metastases-free survival (DMFS) are 87% and 76.4%, respectively. In the univariate analysis, the presence of a favorable pathologic response (fPR) was associated with improved 3-year OS (100% vs. 56.03%, p = 0.058) and 3-year DMFS (86.91% vs. 31.46%, p = 0.002). Moreover, both complete or partial RECIST response and radiological stabilization of the tumor lesion showed a significant association with higher rates of 3-year distant metastasis-free survival (DMFS) (83% vs. 83% vs. 56%, p < 0.001) and 3-year overall survival (OS) (100% vs. 80% vs. 0, p = 0.002). CONCLUSIONS Preoperative moderate hypofractionated radiation treatment for STS is feasible and well tolerated and associates encouraging rates of pathologic response that could have a favorable impact on final outcomes.
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Affiliation(s)
- Angel Montero
- Department of Radiation Oncology, Centro Integral Oncológico Clara Campal (C.I.O.C.C.), HM Hospitales, Calle Oña 10, 28050, Madrid, Spain.
- Facultad de Ciencias de la Salud, Universidad Camilo José Cela, Madrid, Spain.
| | - Xin Chen-Zhao
- Department of Radiation Oncology, Centro Integral Oncológico Clara Campal (C.I.O.C.C.), HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - Raquel Ciérvide
- Department of Radiation Oncology, Centro Integral Oncológico Clara Campal (C.I.O.C.C.), HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - Beatriz Álvarez
- Department of Radiation Oncology, Centro Integral Oncológico Clara Campal (C.I.O.C.C.), HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - Alejandro Prado
- Department of Medical Physics, Centro Integral Oncológico Clara Campal (C.I.O.C.C.), HM Hospitales, Madrid, Spain
| | - Mercedes López
- Department of Radiation Oncology, Centro Integral Oncológico Clara Campal (C.I.O.C.C.), HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - Emilio Sánchez
- Department of Radiation Oncology, Centro Integral Oncológico Clara Campal (C.I.O.C.C.), HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - Ovidio Hernando
- Department of Radiation Oncology, Centro Integral Oncológico Clara Campal (C.I.O.C.C.), HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - Miguel Angel de la Casa
- Department of Medical Physics, Centro Integral Oncológico Clara Campal (C.I.O.C.C.), HM Hospitales, Madrid, Spain
| | - Mariola García-Aranda
- Department of Radiation Oncology, Centro Integral Oncológico Clara Campal (C.I.O.C.C.), HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - Jeannette Valero
- Department of Radiation Oncology, Centro Integral Oncológico Clara Campal (C.I.O.C.C.), HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - Rosa Alonso
- Department of Radiation Oncology, Centro Integral Oncológico Clara Campal (C.I.O.C.C.), HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
| | - Pedro Fernández-Letón
- Department of Medical Physics, Centro Integral Oncológico Clara Campal (C.I.O.C.C.), HM Hospitales, Madrid, Spain
| | - Carmen Rubio
- Department of Radiation Oncology, Centro Integral Oncológico Clara Campal (C.I.O.C.C.), HM Hospitales, Calle Oña 10, 28050, Madrid, Spain
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Acem I, van de Sande MAJ. Prediction tools for the personalized management of soft-tissue sarcomas of the extremity. Bone Joint J 2022; 104-B:1011-1016. [PMID: 36047022 PMCID: PMC9987162 DOI: 10.1302/0301-620x.104b9.bjj-2022-0647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Prediction tools are instruments which are commonly used to estimate the prognosis in oncology and facilitate clinical decision-making in a more personalized manner. Their popularity is shown by the increasing numbers of prediction tools, which have been described in the medical literature. Many of these tools have been shown to be useful in the field of soft-tissue sarcoma of the extremities (eSTS). In this annotation, we aim to provide an overview of the available prediction tools for eSTS, provide an approach for clinicians to evaluate the performance and usefulness of the available tools for their own patients, and discuss their possible applications in the management of patients with an eSTS.Cite this article: Bone Joint J 2022;104-B(9):1011-1016.
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Affiliation(s)
- Ibtissam Acem
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.,Department of Orthopaedic Oncology, Leiden University Medical Centre, Leiden, the Netherlands
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Zhang L, Lin W, Zhou Y, Shao F, Gao Y, He J. A Complement-Related Gene Signature for Predicting Overall Survival and Immunotherapy Efficacy in Sarcoma Patients. Front Cell Dev Biol 2022; 10:765062. [PMID: 35493104 PMCID: PMC9046668 DOI: 10.3389/fcell.2022.765062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 03/07/2022] [Indexed: 12/24/2022] Open
Abstract
The prognoses of sarcomas are poor and the responses of them to systemic therapies are limited and controversial. Thus, there is an urgent need to stratify the risk factors and identify the patients who may benefit from systemic therapies. Here, we developed a reliable, complement-based gene signature to predict the prognosis of sarcoma patients. Survival-related complement genes were identified by univariate Cox analyses and were used to build a gene signature, which was further selected using the least absolute shrinkage and selection operator model, and determined using a stepwise Cox proportional hazards regression model. The whole sarcoma cohort of TCGA was randomly divided into a training set and a test set. The signature was constructed using the training set and validated subsequently in the test set, the whole TCGA sarcoma cohort, and another two independent cohorts from the TARGET and GEO databases, respectively. Furthermore, the prognostic value of the signature was also validated in an independent cohort from our center. This model effectively predicted prognoses across the training set, different validation cohorts, and different clinical subgroups. Next, immune cell infiltration analysis, GO and KEGG analysis, and gene set enrichment analysis were performed to explore possible underlying mechanisms of this signature. Moreover, this signature may predict the response to immunotherapy. Collectively, the current complement-related gene signature can predict overall survival and possible immunotherapy response of sarcoma patients; it may serve as a powerful prognostic tool to further optimize clinical treatment and prognosis management for sarcoma patients.
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Affiliation(s)
- Lin Zhang
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, China
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weihao Lin
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Zhou
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Shao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Qingdao Cancer Institute, Cancer Institute of the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yibo Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Molecular Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Yibo Gao, ; Jie He,
| | - Jie He
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, China
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Molecular Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Yibo Gao, ; Jie He,
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Acem I, Schultze BT, Schoonbeek A, van Houdt WJ, van de Sande MA, Visser JJ, Grünhagen DJ, Verhoef C. The added value of chest imaging after neoadjuvant radiotherapy for soft tissue sarcoma of the extremities and trunk wall: A retrospective cohort study. Eur J Surg Oncol 2022; 48:1543-1549. [DOI: 10.1016/j.ejso.2022.03.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022] Open
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Rauch M, Agaimy A, Semrau S, Willner A, Ott O, Fietkau R, Hohenberger W, Croner RS, Grützmann R, Fechner K, Vassos N. Long-Term Follow-Up of Patients Receiving Neoadjuvant Treatment Modalties for Soft Tissue Sarcomas of the Extremities. Cancers (Basel) 2021; 13:cancers13205244. [PMID: 34680391 PMCID: PMC8534061 DOI: 10.3390/cancers13205244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/03/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Neoadjuvant treatment modalities in soft tissue sarcoma (STS) of the extremities have become more popular in recent years, but because of the rarity and heterogeneity of STS, there are yet few studies on the long-term impact of neoadjuvant treatment modalities, especially in terms of neoadjuvant radiochemotherapy. METHODS The study enrolled 136 patients with primary STS of the extremities who underwent surgery with curative intent or neoadjuvant therapy, followed by surgery in a 15-year period. Neoadjuvant treatment consisted of radiotherapy (RT) with 60 Gy and in most cases simultaneous chemotherapy (CTx) with ifosfamide (1.5 g/m2/d, d1-5, q28) and doxorubicine (50 mg/m2/d, d3, q28). We investigated the clinical, (post)-operative and histopathological data and the oncological follow-up as well. The median follow-up period was 82 months (range 6-202). RESULTS A total of 136 patients (M:F = 73:63) with a mean age of 62 years (range; 21-93) was observed. Seventy-four patients (54.4%) received neoadjuvant therapy (NT), 62 patients (45.6%) received primary surgery (PS). When receiving NT, patients with high-risk STS had a lower risk to develop distant metastasis (p = 0.025). Age, histological type, tumor size and surgical margins (R0 vs. R1) had no influence on any survival rates. There was an association between NT and the occurrence of postoperative complications (p = 0.001). The 5-year local recurrence free survival (LRFS), metastasis free survival (MFS), disease free survival (DFS) and overall survival (OS) rate of the whole cohort was 89.9%, 77.0%, 70.6% and 72.6%; whereas the 5-year LRFS, MFS, DFS and OS rate was 90.5%, 67.2%, 64.1% and 62.8% for the NT group and 89.5%, 88.3%. 78.4% and 83.8% for the PS group. CONCLUSIONS Multimodal treatment strategies in patients with STS of extremities lead to excellent oncological outcomes. Patients with high-risk STS had a significantly better MFS when receiving NT than patients with low-risk STS. NT was associated with a higher probability of postoperative but well-manageable complications.
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Affiliation(s)
- Miriam Rauch
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (M.R.); (W.H.); (R.G.); (K.F.)
- Faculty of Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Abbas Agaimy
- Department of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Sabine Semrau
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (A.W.); (O.O.); (R.F.)
| | - Alexander Willner
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (A.W.); (O.O.); (R.F.)
| | - Oliver Ott
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (A.W.); (O.O.); (R.F.)
| | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (A.W.); (O.O.); (R.F.)
| | - Werner Hohenberger
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (M.R.); (W.H.); (R.G.); (K.F.)
| | - Roland S. Croner
- Department of Surgery, University Hospital Magdeburg, 39106 Magdeburg, Germany;
| | - Robert Grützmann
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (M.R.); (W.H.); (R.G.); (K.F.)
| | - Katja Fechner
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (M.R.); (W.H.); (R.G.); (K.F.)
| | - Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (M.R.); (W.H.); (R.G.); (K.F.)
- Mannheim University Medical Center, Division of Surgical Oncology, Department of Surgery, University of Heidelberg, 68167 Mannheim, Germany
- Correspondence: ; Tel.: +49-621-383-3921; Fax: +49-621-383-1479
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7
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Machado I, Cruz J, Righi A, Gambarotti M, Ferrari C, Ruengwanichayakun P, Giner F, Rausell N, Lavernia J, Sugita S, Najera L, Suarez L, Sanjuan X, García JAN, García Del Muro FJ, Gómez-Mateo MC, Valladares MM, Ramos-Oliver I, Romagosa C, Parafioriti A, Elisabetta A, di Bernardo A, Navarro S, Hasegawa T, Arana E, Llombart-Bosch A. Ki-67 immunoexpression and radiological assessment of necrosis improves accuracy of conventional and modified core biopsy systems in predicting the final grade assigned to adult-soft tissue sarcomas. An international collaborative study. Pathol Res Pract 2021; 225:153562. [PMID: 34329836 DOI: 10.1016/j.prp.2021.153562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
Based on the French Federation Nationale des Centers de Lutte Contre le Cancer (FNCLCC) grading system, this study assesses the accuracy of conventional and modified core biopsy (CB) systems in predicting the final grade (low vs high) assigned to the resected specimen. Substituting Ki-67 immunoexpression for mitotic count, and radiological for histological assessment of necrosis, we used two modified FNCLCC CB grading systems: (1) Ki-67 immunoexpression alone, and (2) Ki-67 plus radiological assessment of necrosis. We graded 199 soft tissue sarcomas (STS) from nine centers, and compared the results for the conventional (obtained from local histopathology reports) and modified CB systems with the final FNCLCC grading of the corresponding resected specimens. Due to insufficient sample quality or lack of available radiologic data, five cases were not evaluated for Ki67 or radiological assessment of necrosis. The conventional FNCLCC CB grading system accurately identified 109 of the 130 high-grade cases (83.8%). The CB grading matched the final FNCLCC grading (low vs high) in 175 (87.9%) of the 199 resected tumors; overestimating the final grade in three cases and underestimating in 21 cases. Modified system 1 (Ki-67) accurately identified 117 of the 130 high-grade cases (90.0%). The CB grading matched the final FNCLCC grading (low vs high) in 175 (89.7%) of the 195 evaluated cases; overestimating seven and underestimating 13 cases. Modified system 2 (Ki-67 plus radiological necrosis) accurately identified 120 of the 130 high-grade cases (92.3%). This last matched the final FNCLCC grading (low vs high) in 177 (91.2%) of the 194 evaluated cases; overestimating seven and underestimating 10 cases. Modified system 2 obtained highest area under ROC curves, although not statistically significant. Underestimated CB grades did not correlate with histological subtypes, although many of the discrepant cases were myxoid tumors (myxofibrosarcomas or myxoid liposarcomas), leiomyosarcomas or undifferentiated pleomorphic/spindle cell sarcomas. Using modified FNCLCC CB grading systems to replace conventional mitotic count and histologic assessment of necrosis may improve the distinction between low and high-grade STS on CB. Our study confirms that classifying grade 1 as low grade and grades 2 and 3 as high grade improves correlation between CB and final grade by up to 21%, irrespective of CB system used. A higher than expected Ki-67 score in a low-grade sarcoma diagnosed on CB should raise concern that a higher-grade component may not have been sampled. Furthermore, correlation of all clinicopathological and radiological findings at multidisciplinary meetings is essential to assess the histological grade on CB as accurately as possible.
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Affiliation(s)
- Isidro Machado
- Pathology Department, Instituto Valenciano de Oncología, Valencia, Spain; Pathology Department, Patologika, Hospital Quirón-Salud, Valencia, Spain.
| | - Julia Cruz
- Pathology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | - Alberto Righi
- Pathology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Gambarotti
- Pathology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cristina Ferrari
- Pathology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Francisco Giner
- Pathology Department, University Hospital La Fe, Valencia, Spain
| | - Nuria Rausell
- Pathology Department, University Hospital La Fe, Valencia, Spain
| | - Javier Lavernia
- Oncology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | - Shintaro Sugita
- Department of Surgical Pathology, Sapporo Medical University, School of Medicine. Japan
| | - Laura Najera
- Pathology Department, University Hospital Puerta de Hierro, Madrid, Spain
| | - Lola Suarez
- Pathology Department, University Hospital Puerta de Hierro, Madrid, Spain
| | - Xavier Sanjuan
- Pathology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | | | | | | | - Cleofe Romagosa
- Pathology Department, Hospital Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Research Institut (VHIR), Universitat Autónoma de Barcelona, Spain; Centro de Investigación Biomédica en RED (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonina Parafioriti
- Pathology Department, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Armiraglio Elisabetta
- Pathology Department, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Andrea di Bernardo
- Pathology Department, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Samuel Navarro
- Pathology Department, University of Valencia, Valencia, Spain
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University, School of Medicine. Japan
| | - Estanislao Arana
- Radiology Department, Instituto Valenciano de Oncología, Valencia, Spain
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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.
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Efficacy and Safety of Hypofractionated Preoperative Radiotherapy for Primary Locally Advanced Soft Tissue Sarcomas of Limbs or Trunk Wall. Cancers (Basel) 2021; 13:cancers13122981. [PMID: 34198676 PMCID: PMC8232096 DOI: 10.3390/cancers13122981] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The use of adjuvant radiotherapy (RT) shows a significantly decreased incidence of local recurrence (LR) in soft tissue sarcomas (STS). This study aimed to assess the treatment scheme's effect in patients with primary STS treated at one institution. METHODS In this phase 2 trial, 311 patients aged ≥18 years with primary, locally advanced STS of the extremity or trunk wall were assigned to multimodal therapy conducted at one institution. The preoperative RT scheme consisted of 5 Gy per fraction for a total dose of 25 Gy. Surgery was performed within 2-4 days from the last day of RT. The primary endpoint was LR-free survival (LRFS). Adverse events of the treatment were assessed. RESULTS We included 311 patients with primary locally advanced STS. The median tumor size was 11 cm. In total, 258 patients (83%) had high-grade tumors. In 260 patients (83.6%), clear surgical margins (R0) were obtained. Ninety-six patients (30.8%) had at least one type of treatment adverse event. LR was observed in 13.8% patients. The 5-year overall survival was 63%. CONCLUSION In this group, with a significant percentage of patients with extensive, high-grade STS, hypofractionated preoperative RT was associated with good local control and tolerance.
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10
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Cananzi FCM, Ruspi L, Fiore M, Sicoli F, Quagliuolo V, Gronchi A. Major vascular resection in retroperitoneal sarcoma surgery. Surgery 2021; 170:848-856. [PMID: 33812753 DOI: 10.1016/j.surg.2021.02.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/17/2022]
Abstract
Major blood vessels may be invaded either by primary sarcomas arising from the vessel wall or by secondary infiltration of a retroperitoneal sarcoma. The involvement of major blood vessels is not considered to be an absolute contraindication for surgical resection. The main issue when evaluating a possible major vascular resection is to balance the possible surgical morbidity with the expected survival benefit. This is strictly related to the tumor's biology and clinical behavior and to the patient's performance status and comorbidities. A multidisciplinary approach in a specialized center is mandatory when approaching a possible oncovascular resection for retroperitoneal sarcoma, given the rarity and the heterogeneity of these tumors.
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Affiliation(s)
- Ferdinando Carlo Maria Cananzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.
| | - Laura Ruspi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Marco Fiore
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federico Sicoli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Vittorio Quagliuolo
- Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Alessandro Gronchi
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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11
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Bolia IK, Savvidou OD, Kang HP, Chatzichristodoulou N, Megaloikonomos PD, Mitsiokapa E, Mavrogenis AF, Papagelopoulos PJ. Cross-cultural adaptation and validation of the Musculoskeletal Tumor Society (MSTS) scoring system and Toronto Extremity Salvage Score (TESS) for musculoskeletal sarcoma patients in Greece. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1631-1638. [PMID: 33721082 PMCID: PMC7957037 DOI: 10.1007/s00590-021-02921-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/22/2021] [Indexed: 11/24/2022]
Abstract
Purpose To perform translation, cross-cultural adaptation, and validation of the Toronto Extremity Salvage Score (TESS) and Musculoskeletal Tumor Society (MSTS) scoring system in Greek patients with lower extremity sarcoma. Methods The Greek version of the MSTS for the lower extremity and TESS questionnaires was developed using previously reported methods. Included were 100 patients with musculoskeletal sarcoma who underwent limb salvage surgery. The test–retest reliability [interclass correlation coefficient (ICC) between 2 different time points], internal consistency (Cronbach’s alpha), construct validity (Kaiser’s criteria, Eigenvalue > 1 rule), and external validity (Short form-36, Spearman’s Rho) were assessed. Results The test–retest reliability (ICC was 0.99 for MSTS-LE and 1 for TESS) and internal consistency were high (Cronbach’s alpha was 0.763 for MSTS-LE and 0.924 for TESS) for both questionnaires. Based on the Scree plot, the number of factors retained was 1 for MSTS-LE and 2 for TESS. The TESS showed a strong correlation with SF-36 (Spearman’s rho = 0.714, p < 0.001), but the correlation between MSTS for lower extremity and SF-36 was weak (Spearman’s Rho = 0.313, p = 0.002). Conclusions The Greek version of both the MSTS for lower extremity and TESS questionnaire showed sufficient reliability, internal consistency and good performance using the loading factor analysis when used postoperatively in Greek patients who underwent surgical resection of lower extremity sarcoma. However, only the TESS showed strong correlation with the SF-36, indicating that MSTS for lower extremity was not as powerful for the evaluation of the global health status of these patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00590-021-02921-5.
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Affiliation(s)
- Ioanna K Bolia
- Department of Orthopaedic Surgery, USC Epstein Family Center for Sports Medicine At Keck Medicine of USC, University of Southern California, 1520 San Pablo st # 2000, Los Angeles, CA, USA.
| | - Olga D Savvidou
- First Department of Orthopaedic Surgery, Athens University Medical School, Athens, Greece
| | - Hyunwoo P Kang
- Department of Orthopaedic Surgery, USC Epstein Family Center for Sports Medicine At Keck Medicine of USC, University of Southern California, 1520 San Pablo st # 2000, Los Angeles, CA, USA
| | | | | | - Evanthia Mitsiokapa
- First Department of Orthopaedic Surgery, Athens University Medical School, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedic Surgery, Athens University Medical School, Athens, Greece
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12
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Rashid T, Noyd DH, Iranzad N, Davis JT, Deel MD. Advances in the Diagnosis and Management of Neonatal Sarcomas. Clin Perinatol 2021; 48:117-145. [PMID: 33583500 DOI: 10.1016/j.clp.2020.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neonatal sarcomas comprise a heterogeneous group of rare soft tissue neoplasms that present unique diagnostic and therapeutic challenges. Recent advances in molecular profiling have improved diagnostic capabilities and reveal novel therapeutic targets. Clinical trials demonstrate differences in behavior between sarcoma subtypes that allow for better clinical management. Surgical resection has been replaced with a multimodal approach that includes chemotherapy and radiotherapy. Despite these advances, neonates with sarcoma continue to fare worse than histologically similar sarcomas in older children, likely reflecting differences in tumor biology and the complexities of neonatal medicine. This review focuses on recent advances in managing neonatal sarcomas.
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Affiliation(s)
- Tooba Rashid
- Pediatric Hematology/Oncology, Duke University School of Medicine, DUMC, Box 102382, Durham, NC 27710, USA
| | - David H Noyd
- Pediatric Hematology/Oncology, Duke University School of Medicine, DUMC, Box 102382, Durham, NC 27710, USA
| | - Natasha Iranzad
- Pediatric Hematology/Oncology, Duke University School of Medicine, DUMC, Box 3712, Durham, NC 27710, USA
| | - Joseph T Davis
- Pediatric Hematology/Oncology, Duke University School of Medicine, DUMC, Box 3808, Durham, NC 27710, USA
| | - Michael D Deel
- Pediatric Hematology/Oncology, Duke University School of Medicine, DUMC, Box 102382, Durham, NC 27710, USA.
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13
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Parikh RP, Sacks JM. Lower Extremity Reconstruction After Soft Tissue Sarcoma Resection. Clin Plast Surg 2021; 48:307-319. [PMID: 33674052 DOI: 10.1016/j.cps.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Surgical resection with wide margins and perioperative radiation therapy is the standard treatment of extremity soft tissue sarcomas. This combination often results in complex wounds and functional compromise. Reconstructive surgery is integral to limb salvage after sarcoma resection. Advances in adjuvant therapy and reconstructive surgical techniques have made functional limb salvage, instead of amputation, possible for most patients. This article reviews key concepts in the multidisciplinary care of patients with extremity soft tissue sarcomas and details reconstructive surgical techniques, including locoregional and free tissue transfer, free functional muscle transfer, and vascularized bone transfer, to optimize functional limb restoration after sarcoma resection.
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Affiliation(s)
- Rajiv P Parikh
- Plastic and Reconstructive Surgical Service, Center for Advanced Reconstruction, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Justin M Sacks
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, Suite 1150 NWT, St Louis, MO 63110, USA.
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14
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Rytlewski JD, Scalora N, Garcia K, Tanas M, Toor F, Miller B, Allen B, Milhem M, Monga V. Photodynamic Therapy Using Hippo Pathway Inhibitor Verteporfin: A Potential Dual Mechanistic Approach in Treatment of Soft Tissue Sarcomas. Cancers (Basel) 2021; 13:cancers13040675. [PMID: 33567506 PMCID: PMC7915813 DOI: 10.3390/cancers13040675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 12/30/2022] Open
Abstract
Simple Summary Advanced sarcomas have yet to undergo improved outcomes seen in other cancer subtypes. Verteporfin has the potential to show landmark change in sarcoma due to its anti-proliferative properties: inhibition of the Hippo pathway and as photodynamic therapy. The effect of verteporfin on the Hippo pathway is reviewed specifically in the setting of sarcoma due to increased activation of this pathway in multiple subtypes. Role and efficacy of photodynamic therapy in other malignancies is also reviewed, with additional discussion of preclinical studies demonstrating synergistic effects of photodynamic therapy within current sarcoma standard of care treatment. Future investigations of the feasibility of incorporating verteporfin into sarcoma treatment are discussed. Abstract Sarcoma is a widely varied and devastating oncological subtype, with overall five-year survival of 65% that drops to 16% with the presence of metastatic disease at diagnosis. Standard of care for localized sarcomas is predicated on local control with wide-local resection and radiation therapy, or, less commonly, chemotherapy, depending on tumor subtype. Verteporfin has the potential to be incorporated into this standard of care due to its unique molecular properties: inhibition of the upregulated Hippo pathway that frequently drives soft tissue sarcoma and photodynamic therapy-mediated necrosis due to oxidative damage. The initial anti-proliferative effect of verteporfin is mediated via binding and dissociation of YAP/TEAD proteins from the nucleus, ultimately leading to decreased cell proliferation as demonstrated in multiple in vitro studies. This effect has the potential to be compounded with use of photodynamic therapy to directly induce cellular necrosis with use of a clinical laser. Photodynamic therapy has been incorporated into multiple malignancies and has the potential to be incorporated into sarcoma treatment.
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Affiliation(s)
| | - Nicholas Scalora
- Department of Pathology, University of Iowa, Iowa City, IA 52242, USA; (N.S.); (K.G.); (M.T.)
| | - Keith Garcia
- Department of Pathology, University of Iowa, Iowa City, IA 52242, USA; (N.S.); (K.G.); (M.T.)
| | - Munir Tanas
- Department of Pathology, University of Iowa, Iowa City, IA 52242, USA; (N.S.); (K.G.); (M.T.)
| | - Fatima Toor
- Department of Electrical and Computer Engineering, University of Iowa Technology Institute, University of Iowa, Iowa City, IA 52242, USA;
| | - Benjamin Miller
- Department of Orthopedic Surgery, University of Iowa, Iowa City, IA 52242, USA;
| | - Bryan Allen
- Department of Radiation Oncology, University of Iowa, Iowa City, IA 52242, USA;
| | - Mohammed Milhem
- Division of Hematology, Oncology, and Blood & Marrow Transplant, Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA;
| | - Varun Monga
- Division of Hematology, Oncology, and Blood & Marrow Transplant, Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA;
- Correspondence: ; Tel.: +1-3-193-849-497
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15
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Llacer-Moscardo C, Terlizzi M, Bonvalot S, Le Loarer F, Carrère S, Tetrau R, D'ascoli A, Lerouge D, Le Péchoux C, Thariat J. Pre- or postoperative radiotherapy for soft tissue sarcomas. Cancer Radiother 2020; 24:501-512. [PMID: 32807685 DOI: 10.1016/j.canrad.2020.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 11/17/2022]
Abstract
Sarcomas are rare tumours arising from mesenchymal tissue. A multimodal management in an expert centre combining surgery and radiotherapy is the current standard of care for localized soft-tissue sarcomas of the extremities, to enable limb-sparing strategies. The delivery of pre- radiotherapy or postoperative radiotherapy offers similar local control and survival rates but the toxicity profile is quite different: preoperative radiotherapy increases the risk of wound complications and postoperative radiotherapy affects long-term functional outcomes. While postoperative radiotherapy has long been the rule, especially in Europe, technical improvements with image-guided- and intensity-modulated radiotherapy associated with a better management of postoperative wounds has tended to change practices with more frequent preoperative radiotherapy. More recently the possibilities of a hypofractionated regimen or potentiation by nanoparticles to increase the therapeutic index plead in favour of a preoperative delivery of radiotherapy. The aim of this paper is to report pros and cons of pre- and post-operative radiotherapy for 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.
| | - M Terlizzi
- Radiation Oncology Department, hôpital Haut-Lévêque, CHU de Bordeaux, 1, avenue Magellan, 33600 Pessac, France
| | - S Bonvalot
- Department of Surgical Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - F Le Loarer
- Department of Pathology, institut Bergonié, 229, cours de l'Argonne, CS 61283, 33076 Bordeaux cedex, France
| | - S Carrère
- Department of Surgical Oncology, institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France
| | - R Tetrau
- Radiology Department, institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France
| | - A D'ascoli
- Department of Orthopaedics and Sports Surgery, hôpital Pasteur 2, Institut universitaire locomoteur et sports (IULS), 30, voie Romaine, 06000 Nice, France
| | - D Lerouge
- Radiation Oncology Department, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France; Association Advance Resource Centre for Hadrontherapy in Europe (Archade), 3, avenue General-Harris, 14000 Caen, France
| | - C Le Péchoux
- Radiation Oncology Department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - J Thariat
- Radiation Oncology Department, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France; Association Advance Resource Centre for Hadrontherapy in Europe (Archade), 3, avenue General-Harris, 14000 Caen, France
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16
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Koseła-Paterczyk H, Spałek M, Borkowska A, Teterycz P, Wągrodzki M, Szumera-Ciećkiewicz A, Morysiński T, Castaneda-Wysocka P, Cieszanowski A, Zdzienicki M, Goryń T, Rutkowski P. Hypofractionated Radiotherapy in Locally Advanced Myxoid Liposarcomas of Extremities or Trunk Wall: Results of a Single-Arm Prospective Clinical Trial. J Clin Med 2020; 9:jcm9082471. [PMID: 32752185 PMCID: PMC7464815 DOI: 10.3390/jcm9082471] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: Myxoid liposarcoma (MLPS) has been reported to be more radiosensitive compared with other soft tissue sarcomas. The main objective of the study was to assess the efficacy of hypofractionated radiotherapy (RT) in the preoperative setting in patients with locally advanced primary MLPS. Methods: Single-arm prospective exploratory clinical trial enrolled MLPS patients for preoperative 5 × 5 Gy RT with delayed surgery. The endpoints of the study were the rate of early wound healing complications and 5-year local control rate. Results: 29 patients (pts) were included, all had tumors located on the lower limb. The median maximum size of the tumor was 13 cm (IQR 10–15 cm). Early RT tolerance was good. Postoperative wound complications occurred in 11 pts (37.9%), late complications concerned 13.8% of patients. A total of 27 patients were included for the efficacy analyses. The pathological features of response to RT were detected in all analyzed surgical specimens. In 25 patients R0 margins were achieved, two patients had an R1 resection. None of the patients had local recurrence. Conclusion: Preoperative hypofractionated RT with a prolonged gap between RT and surgery is a feasible method of the management of MLPS, providing a good local control and low rates of treatment toxicity.
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Affiliation(s)
- Hanna Koseła-Paterczyk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.S.); (A.B.); (P.T.); (T.M.); (M.Z.); (T.G.); (P.R.)
- Correspondence:
| | - Mateusz Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.S.); (A.B.); (P.T.); (T.M.); (M.Z.); (T.G.); (P.R.)
| | - Aneta Borkowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.S.); (A.B.); (P.T.); (T.M.); (M.Z.); (T.G.); (P.R.)
| | - Paweł Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.S.); (A.B.); (P.T.); (T.M.); (M.Z.); (T.G.); (P.R.)
| | - Michał Wągrodzki
- Department of Pathology and Laboratory Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.W.); (A.S.-C.)
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology and Laboratory Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.W.); (A.S.-C.)
- Diagnostic Hematology Department, Institute of Hematology and Transfusion Medicine, 02-781 Warsaw, Poland
| | - Tadeusz Morysiński
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.S.); (A.B.); (P.T.); (T.M.); (M.Z.); (T.G.); (P.R.)
| | - Patrycja Castaneda-Wysocka
- Department of Radiology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.C.-W.); (A.C.)
| | - Andrzej Cieszanowski
- Department of Radiology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.C.-W.); (A.C.)
| | - Marcin Zdzienicki
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.S.); (A.B.); (P.T.); (T.M.); (M.Z.); (T.G.); (P.R.)
| | - Tomasz Goryń
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.S.); (A.B.); (P.T.); (T.M.); (M.Z.); (T.G.); (P.R.)
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.S.); (A.B.); (P.T.); (T.M.); (M.Z.); (T.G.); (P.R.)
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17
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Mandair GS, Oest ME, Mann KA, Morris MD, Damron TA, Kohn DH. Radiation-induced changes to bone composition extend beyond periosteal bone. Bone Rep 2020; 12:100262. [PMID: 32258252 PMCID: PMC7125315 DOI: 10.1016/j.bonr.2020.100262] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cancer patients receiving radiotherapy for soft tissue sarcomas are often at risk of post-irradiation (post-RTx) bone fragility fractures, but our understanding of factors controlling radiation-induced bone injury is limited. Previous studies have evaluated post-RTx changes to cortical bone composition in the periosteum of irradiated tibiae, but have not evaluated effects of irradiation in deeper tissues, such as endosteal or mid-cortical bone, and whether there are differential spatial effects of irradiation. In this study, we hypothesize that post-RTx changes to cortical bone composition are greater in endosteal compared to mid-cortical or periosteal bone. METHODS A pre-clinical mouse model of limited field hindlimb irradiation was used to evaluate spatial and temporal post-RTx changes to the metaphyseal cortex of irradiated tibiae. Irradiation was delivered unilaterally to the hindlimbs of 12-wk old female BALB/cJ mice as 4 consecutive daily doses of 5 Gy each. RTx and non-RTx tibiae were obtained at 0, 2, 4, 8, and 12 wks post-RTx (n = 9 mice/group/time). Raman spectroscopy was used to evaluate spatial and temporal post-RTx changes to cortical bone composition in age-matched RTx and non-RTx groups. RESULTS Significant early spatial differences in mineral/matrix and collagen crosslink ratios were found between endosteal and periosteal or mid-cortical bone at 2-wks post-RTx. Although spatial differences were transient, mineral/matrix ratios significantly decreased and collagen crosslink ratios significantly increased with post-RTx time throughout the entire tibial metaphyseal cortex. CONCLUSIONS Irradiation negatively impacts the composition of cortical bone in a spatially-dependent manner starting as early as 2-wks post-RTx. Long-term progressive post-RTx changes across all cortical bone sites may eventually contribute to the increased risk of post-RTx bone fragility fractures.
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Affiliation(s)
| | - Megan E. Oest
- Department of Orthopedic Surgery, Upstate Medical University, Syracuse, NY, USA
| | - Kenneth A. Mann
- Department of Orthopedic Surgery, Upstate Medical University, Syracuse, NY, USA
| | | | - Timothy A. Damron
- Department of Orthopedic Surgery, Upstate Medical University, Syracuse, NY, USA
| | - David H. Kohn
- School of Dentistry, University of Michigan, Ann Arbor, MI, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, USA
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18
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Martin E, Coert JH, Flucke UE, Slooff WBM, van de Sande MAJ, van Noesel MM, Grünhagen DJ, Wijnen MHWA, Verhoef C. Neurofibromatosis-associated malignant peripheral nerve sheath tumors in children have a worse prognosis: A nationwide cohort study. Pediatr Blood Cancer 2020; 67:e28138. [PMID: 31889416 DOI: 10.1002/pbc.28138] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/29/2019] [Accepted: 12/09/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Malignant peripheral nerve sheath tumors (MPNST) are rare and aggressive non-rhabdomyoblastic soft-tissue sarcomas (NRSTS) in children. This study set out to investigate clinical presentation, treatment modalities, and factors associated with survival in pediatric MPNST using Dutch nationwide databases. METHODS Data were obtained from the Netherlands Cancer Registry (NCR) and the Dutch Pathology Database (PALGA) from 1989 to 2017. All primary MPNSTs were collected. Demographic differences were analyzed between adult and pediatric (age ≤18 years) MPNST. In children, demographic and treatment differences between neurofibromatosis type 1 (NF1) and non-NF1 were analyzed. A Cox proportional hazard model was constructed for localized pediatric MPNSTs. RESULTS A total of 70/784 MPNST patients were children (37.1% NF1). Children did not present differently from adults. In NF1 children, tumor size was more commonly large (> 5 cm, 92.3% vs 59.1%). Localized disease was primarily resected in 90.6%, and radiotherapy was administered in 37.5%. Non-NF1 children tended to receive chemotherapy more commonly (39.5% vs 26.9%). Overall, estimated five-year survival rates of localized NF1-MPNST was 52.4% (SE: 10.1%) compared with 75.8% (SE: 7.1%) in non-NF1 patients. The multivariate model showed worse survival in NF1 patients (HR: 2.98; 95% CI, 1.17-7.60, P = 0.02) and increased survival in patients diagnosed after 2005 (HR: 0.20; 95% CI, 0.06-0.69, P = 0.01). No treatment factors were independently associated with survival. CONCLUSION Pediatric MPNSTs have presentations similar to adult MPNSTs. In children, NF1 patients present with larger tumors, but are treated similarly to non-NF1 MPNSTs. In localized pediatric MPNST, NF1 is associated with worse survival. Promisingly, survival has increased for pediatric MPNSTs after 2005.
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Affiliation(s)
- Enrico Martin
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Henk Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Uta E Flucke
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.,Diagnostic Laboratory and Pathology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Willem-Bart M Slooff
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel A J van de Sande
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Solid Tumors, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Max M van Noesel
- Department of Solid Tumors, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Marc H W A Wijnen
- Department of Solid Tumors, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
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19
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Krengli M, Cena T, Zilli T, Jereczek-Fossa BA, De Bari B, Villa Freixa S, Kaanders JH, Torrente S, Pasquier D, Sole CV, Lutsyk M, Dincbas FO, Habboush Y, Fariselli L, Dragan T, Baumert BG, Khanfir K, Ugurluer G, Thariat J. Radiotherapy in the treatment of extracranial hemangiopericytoma/solitary fibrous tumor: Study from the Rare Cancer Network. Radiother Oncol 2020; 144:114-120. [DOI: 10.1016/j.radonc.2019.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 01/06/2023]
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20
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Oncological Treatment Considerations Differ across Surgical Subspecialties Treating Malignant Peripheral Nerve Sheath Tumors: An International Survey. Sarcoma 2020; 2020:6406439. [PMID: 32189989 PMCID: PMC7064831 DOI: 10.1155/2020/6406439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/15/2020] [Accepted: 01/24/2020] [Indexed: 12/18/2022] Open
Abstract
Background Malignant peripheral nerve sheath tumors (MPNSTs) are rare and aggressive soft tissue sarcomas (STS) that, because of their origin, are operated by several surgical subspecialties. This may cause differences in oncologic treatment recommendations based on presentation. This study investigated these differences both within and between subspecialties. Methods A survey was distributed among several (inter)national surgical societies. Differences within and between subspecialties were analyzed by χ2-tests. Results In total, 30 surgical oncologists, 30 neurosurgeons, 85 plastic surgeons, and 29 “others” filled out the survey. Annual caseload, tumor sites operated, and fellowship training differed significantly between subspecialties. While most surgeons agreed upon preoperative use of MRI, the use of radiological staging and FDG-PET use differed between subspecialties. Surgical oncologists agreed upon core needle biopsies as an ideal type of biopsy while other subspecialties differed in opinion. On average, 53% of surgeons always consider preservation of function preoperatively, but 42% would never perform less extensive resections for function preservation. Respondents agreed that radiotherapy should be considered in tumor sizes >10 cm, microscopic, and macroscopic positive margins. A preferred sequence of radiotherapy administration differed between subspecialties. There was no consensus on indications and sequence of administration of chemotherapy in localized disease. Conclusion Surgical oncologists generally agree on preoperative diagnostics; other subspecialties do not. Considering the preservation of function differed among all subspecialties. Surgeons do agree on some indications for radiotherapy, yet the use of chemotherapy in localized MPNSTs lacks consensus. A preferred sequence of multimodal therapy differs between and within surgical subspecialties, but surgical oncologists prefer neoadjuvant radiotherapy.
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Surgical Resection Margin Classifications for High-grade Pleomorphic Soft Tissue Sarcomas of the Extremity or Trunk After Neoadjuvant Cytotoxic Therapy. Am J Surg Pathol 2020; 43:844-850. [PMID: 30932925 DOI: 10.1097/pas.0000000000001246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Soft tissue sarcomas of the extremities or trunk are often resected after treatment with neoadjuvant radiotherapy. Adequate surgical resection margins for sarcomas after neoadjuvant cytotoxic therapy are not well characterized. Minimum surgical resection margins required for local control of primary, high-grade, pleomorphic soft tissue sarcomas treated with neoadjuvant therapy was assessed by competing risk regression in a series of 166 cases. Optimal tumor clearance was determined to be ≥1 mm. Predictive accuracy of three commonly used resection margin classification schemes (American Joint Committee on Cancer, Musculoskeletal Tumor Society, and the margin distance method) were comparable. However, diagnostic performance of a binary system (positive vs. negative) was more specific than margin distance classification (positive or <1 vs. ≥1 mm from tumor), but less sensitive in predicting local recurrence. The American Joint Committee on Cancer R classification (R0 vs. R1/R2) seems to adequately stratify patients by risk for local recurrence after neoadjuvant therapy and subsequent surgical resection. Furthermore, close but negative resection margins (<1 mm from tumor) appear sufficient for local control of high-grade pleomorphic soft tissue sarcomas of the extremity or trunk in this clinical setting, with minimal reduction in the risk of local recurrence with increasing margin width or surgical clearance.
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Haeger A, Alexander S, Vullings M, Kaiser FM, Veelken C, Flucke U, Koehl GE, Hirschberg M, Flentje M, Hoffman RM, Geissler EK, Kissler S, Friedl P. Collective cancer invasion forms an integrin-dependent radioresistant niche. J Exp Med 2020; 217:e20181184. [PMID: 31658985 PMCID: PMC7037234 DOI: 10.1084/jem.20181184] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 06/25/2019] [Accepted: 09/03/2019] [Indexed: 12/12/2022] Open
Abstract
Cancer fatalities result from metastatic dissemination and therapy resistance, both processes that depend on signals from the tumor microenvironment. To identify how invasion and resistance programs cooperate, we used intravital microscopy of orthotopic sarcoma and melanoma xenografts. We demonstrate that these tumors invade collectively and that, specifically, cells within the invasion zone acquire increased resistance to radiotherapy, rapidly normalize DNA damage, and preferentially survive. Using a candidate-based approach to identify effectors of invasion-associated resistance, we targeted β1 and αVβ3/β5 integrins, essential extracellular matrix receptors in mesenchymal tumors, which mediate cancer progression and resistance. Combining radiotherapy with β1 or αV integrin monotargeting in invading tumors led to relapse and metastasis in 40-60% of the cohort, in line with recently failed clinical trials individually targeting integrins. However, when combined, anti-β1/αV integrin dual targeting achieved relapse-free radiosensitization and prevented metastatic escape. Collectively, invading cancer cells thus withstand radiotherapy and DNA damage by β1/αVβ3/β5 integrin cross-talk, but efficient radiosensitization can be achieved by multiple integrin targeting.
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Affiliation(s)
- Anna Haeger
- Department of Cell Biology, Radboudumc, Nijmegen, Netherlands
| | - Stephanie Alexander
- Department of Dermatology, Venerology, and Allergology, University of Würzburg, Germany
- Rudolf Virchow Center for Experimental Biomedicine, University of Würzburg, Germany
- Department of Genitourinary Oncology, MD Anderson Cancer Center, Houston, TX
| | - Manon Vullings
- Department of Cell Biology, Radboudumc, Nijmegen, Netherlands
| | - Fabian M.P. Kaiser
- Rudolf Virchow Center for Experimental Biomedicine, University of Würzburg, Germany
| | | | - Uta Flucke
- Department of Pathology, Radboudumc, Nijmegen, Netherlands
| | - Gudrun E. Koehl
- Department of Surgery, Section of Experimental Surgery, University Hospital Regensburg, University of Regensburg, Germany
| | - Markus Hirschberg
- Department of Dermatology, Venerology, and Allergology, University of Würzburg, Germany
- Rudolf Virchow Center for Experimental Biomedicine, University of Würzburg, Germany
| | - Michael Flentje
- Department of Radiation Oncology, University of Würzburg, Germany
| | - Robert M. Hoffman
- Department of Surgery, University of California San Diego, San Diego, CA
- AntiCancer, Inc., San Diego, CA
| | - Edward K. Geissler
- Department of Surgery, Section of Experimental Surgery, University Hospital Regensburg, University of Regensburg, Germany
| | - Stephan Kissler
- Rudolf Virchow Center for Experimental Biomedicine, University of Würzburg, Germany
| | - Peter Friedl
- Department of Cell Biology, Radboudumc, Nijmegen, Netherlands
- Department of Dermatology, Venerology, and Allergology, University of Würzburg, Germany
- Rudolf Virchow Center for Experimental Biomedicine, University of Würzburg, Germany
- Department of Genitourinary Oncology, MD Anderson Cancer Center, Houston, TX
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Martin E, Coert JH, Flucke UE, Slooff WBM, Ho VKY, van der Graaf WT, van Dalen T, van de Sande MAJ, van Houdt WJ, Grünhagen DJ, Verhoef C. A nationwide cohort study on treatment and survival in patients with malignant peripheral nerve sheath tumours. Eur J Cancer 2019; 124:77-87. [PMID: 31760312 DOI: 10.1016/j.ejca.2019.10.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/01/2019] [Accepted: 10/06/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Despite curative intents of treatment in localized malignant peripheral nerve sheath tumours (MPNSTs), prognosis remains poor. This study investigated survival and prognostic factors for overall survival in non-retroperitoneal and retroperitoneal MPNSTs in the Netherlands. METHODS Data were obtained from the Netherlands Cancer Registry and the Dutch Pathology Database. All primary MPNSTs were collected. Paediatric cases (age ≤18 years) and synchronous metastases were excluded from analyses. Separate Cox proportional hazard models were made for retroperitoneal and non-retroperitoneal MPNSTs. RESULTS A total of 629 localized adult MPNSTs (35 retroperitoneal cases, 5.5%) were included for analysis. In surgically resected patients (88.1%), radiotherapy and chemotherapy were administered in 44.2% and 6.7%, respectively. In retroperitoneal cases, significantly less radiotherapy and more chemotherapy were applied. In non-retroperitoneal MPNSTs, older age (60+), presence of NF1, size >5 cm, and deep-seated tumours were independently associated with worse survival. In retroperitoneal MPNSTs, male sex and age of 60+ years were independently associated with worse survival. Survival of R1 and that of R0 resections were similar for any location, whereas R2 resections were associated with worse outcomes. Radiotherapy and chemotherapy administrations were not associated with survival. CONCLUSION In localized MPNSTs, risk stratification for survival can be done using several patient- and tumour-specific characteristics. Resectability is the most important predictor for survival in MPNSTs. No difference is present between R1 and R0 resections in both retroperitoneal and non-retroperitoneal MPNSTs. The added value of radiotherapy and chemotherapy is unclear.
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Affiliation(s)
- Enrico Martin
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, the Netherlands.
| | - J Henk Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, the Netherlands
| | - Uta E Flucke
- Department of Pathology, University Medical Center Utrecht, the Netherlands; Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands; Diagnostic Laboratory and Pathology, Princess Máxima Center for pediatric oncology, Utrecht, the Netherlands
| | | | - Vincent K Y Ho
- Departments of Registry and Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - Winette T van der Graaf
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thijs van Dalen
- Department of Surgical Oncology, University Medical Center Utrecht, the Netherlands; Department of Surgical Oncology, Diakonessenhuis Utrecht, the Netherlands
| | - Michiel A J van de Sande
- Department of Orthopedic Surgery, Leiden University Medical Center, the Netherlands; Department of Solid Tumors, Princess Máxima Center for pediatric oncology, Utrecht, the Netherlands
| | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
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Resuscitating extremities after soft tissue sarcoma resections: Are functional reconstructions an overlooked option in limb salvage? A systematic review. Eur J Surg Oncol 2019; 45:1762-1769. [DOI: 10.1016/j.ejso.2019.05.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/07/2019] [Accepted: 05/20/2019] [Indexed: 12/27/2022] Open
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Nussbaum DP. Nanoparticle augmentation of radiotherapy in sarcoma. Lancet Oncol 2019; 20:1046-1048. [PMID: 31296492 DOI: 10.1016/s1470-2045(19)30392-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Daniel P Nussbaum
- Department of Surgery, Duke University Medical Center, Duke University, Durham, NC 27710, USA.
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Abstract
PURPOSE OF REVIEW Nonrhabdomyosarcoma soft tissue sarcoma (NRSTS) is a rare subgroup of malignancy in childhood that is composed of a variety of soft tissue and bony tumors. Prognosis for resectable localized disease is usually good and improved with systemic treatment. However, survival from locally advanced and metastatic disease remains poor. There have been numerous preclinical and clinical studies to define histopathology, biology, and genetic alteration of sarcomas. The purpose of this review is to clarify the progress in the management of NRSTS. RECENT FINDINGS Genomic analysis, including the use of next-generation sequencing, has revealed fusion transcripts or specific genetic alterations which provide diagnostic biomarkers and potential targets for novel therapies. SUMMARY Most cases are sporadic, but some are associated with genetic predispositions. Most present as a painless mass and diagnosis is frequently delayed because of a low index of suspicion. There is a wide array of histopathological subtypes. Investigations usually involve core, incisional or excisional biopsy for tissue diagnosis, and cross-sectional and nuclear imaging for staging. Management of pediatric sarcoma is largely dependent on the patient's histopathological diagnosis, age, disease stage, and co-morbidities but usually involves a combination of systemic and local therapies. Preclinical studies and phase I/II trials of newer targeted therapies are ongoing.
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Callegaro D, Miceli R, Bonvalot S, Ferguson P, Strauss DC, Levy A, Griffin A, Hayes AJ, Stacchiotti S, Le Pèchoux C, Smith MJ, Fiore M, Dei Tos AP, Smith HG, Catton C, Casali PG, Wunder JS, Gronchi A. Impact of perioperative chemotherapy and radiotherapy in patients with primary extremity soft tissue sarcoma: retrospective analysis across major histological subtypes and major reference centres. Eur J Cancer 2018; 105:19-27. [DOI: 10.1016/j.ejca.2018.09.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/17/2018] [Accepted: 09/25/2018] [Indexed: 01/01/2023]
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Adjuvant chemotherapy and postoperative radiotherapy in high-risk soft tissue sarcoma patients defined by biological risk factors-A Scandinavian Sarcoma Group study (SSG XX). Eur J Cancer 2018; 99:78-85. [PMID: 29929092 DOI: 10.1016/j.ejca.2018.05.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/09/2018] [Accepted: 05/13/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE To investigate the outcome following adjuvant doxorubicin and ifosfamide in a prospective non-randomised study based on a soft tissue sarcoma (STS) patient subgroup defined by specific morphological characteristics previously shown to be at a high-risk of metastatic relapse. The expected 5-year cumulative incidence of metastases in patients with this risk profile has previously been reported to be about 50% without adjuvant chemotherapy. METHODS High-risk STS was defined as high-grade morphology (according to the Fédération Nationale des Centres de Lutte Contre le Cancer [FNCLCC] grade II-III) and either vascular invasion or at least two of the following criteria: tumour size ≥8.0 cm, infiltrative growth and necrosis. Six cycles of doxorubicin (60 mg/m2) and ifosfamide (6 g/m2) were given. Postoperative accelerated radiotherapy was applied and scheduled between cycles 3 and 4. RESULTS For the 150 eligible patients, median follow-up time for metastases-free survival was 3.9 years (range 0.2-8.7). Five-year metastases-free survival (MFS) was 70.4% (95% confidence interval [CI]: 63.1-78.4) with a local recurrence rate of 14.0% (95% CI: 7.8-20.2). For overall survival (OS), the median follow-up time was 4.4 years (range: 0.2-8.7). The five-year OS was 76.1% (95% CI: 68.8-84.2). Tumour size, deep location and reduced dose intensity (<80%) had a negative impact on survival. Toxicity was moderate with no treatment-related death. CONCLUSIONS A benefit of adjuvant chemotherapy, compared to similar historical control groups, was demonstrated in STS patients with defined poor prognostic factors. Vascular invasion, tumour size, growth pattern and necrosis may identify patients in need of adjuvant chemotherapy.
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Levy A, Bonvalot S, Callegaro D, Botticella A, Le Cesne A, Gronchi A, Le Péchoux C. Consistent Margin-Status Reporting in Soft Tissue Sarcoma Is Essential to Establish Risk-Adapted Strategies Integrating Biology and Histotype in Perioperative Treatments. J Clin Oncol 2018; 36:2357-2358. [PMID: 29878864 DOI: 10.1200/jco.2018.78.6657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Antonin Levy
- Antonin Levy, Gustave Roussy Cancer Campus; INSERM U1030, Molecular Radiotherapy, Villejuif, France; Sylvie Bonvalot, Institut Curie; PSL Research University, Paris, France; Dario Callegaro, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Angela Botticella, Axel Le Cesne, Gustave Roussy Cancer Campus Villejuif, France; Alessandro Gronchi, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; and Cécile Le Péchoux, Gustave Roussy Cancer Campus Villejuif, France
| | - Sylvie Bonvalot
- Antonin Levy, Gustave Roussy Cancer Campus; INSERM U1030, Molecular Radiotherapy, Villejuif, France; Sylvie Bonvalot, Institut Curie; PSL Research University, Paris, France; Dario Callegaro, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Angela Botticella, Axel Le Cesne, Gustave Roussy Cancer Campus Villejuif, France; Alessandro Gronchi, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; and Cécile Le Péchoux, Gustave Roussy Cancer Campus Villejuif, France
| | - Dario Callegaro
- Antonin Levy, Gustave Roussy Cancer Campus; INSERM U1030, Molecular Radiotherapy, Villejuif, France; Sylvie Bonvalot, Institut Curie; PSL Research University, Paris, France; Dario Callegaro, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Angela Botticella, Axel Le Cesne, Gustave Roussy Cancer Campus Villejuif, France; Alessandro Gronchi, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; and Cécile Le Péchoux, Gustave Roussy Cancer Campus Villejuif, France
| | - Angela Botticella
- Antonin Levy, Gustave Roussy Cancer Campus; INSERM U1030, Molecular Radiotherapy, Villejuif, France; Sylvie Bonvalot, Institut Curie; PSL Research University, Paris, France; Dario Callegaro, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Angela Botticella, Axel Le Cesne, Gustave Roussy Cancer Campus Villejuif, France; Alessandro Gronchi, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; and Cécile Le Péchoux, Gustave Roussy Cancer Campus Villejuif, France
| | - Axel Le Cesne
- Antonin Levy, Gustave Roussy Cancer Campus; INSERM U1030, Molecular Radiotherapy, Villejuif, France; Sylvie Bonvalot, Institut Curie; PSL Research University, Paris, France; Dario Callegaro, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Angela Botticella, Axel Le Cesne, Gustave Roussy Cancer Campus Villejuif, France; Alessandro Gronchi, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; and Cécile Le Péchoux, Gustave Roussy Cancer Campus Villejuif, France
| | - Alessandro Gronchi
- Antonin Levy, Gustave Roussy Cancer Campus; INSERM U1030, Molecular Radiotherapy, Villejuif, France; Sylvie Bonvalot, Institut Curie; PSL Research University, Paris, France; Dario Callegaro, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Angela Botticella, Axel Le Cesne, Gustave Roussy Cancer Campus Villejuif, France; Alessandro Gronchi, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; and Cécile Le Péchoux, Gustave Roussy Cancer Campus Villejuif, France
| | - Cécile Le Péchoux
- Antonin Levy, Gustave Roussy Cancer Campus; INSERM U1030, Molecular Radiotherapy, Villejuif, France; Sylvie Bonvalot, Institut Curie; PSL Research University, Paris, France; Dario Callegaro, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Angela Botticella, Axel Le Cesne, Gustave Roussy Cancer Campus Villejuif, France; Alessandro Gronchi, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; and Cécile Le Péchoux, Gustave Roussy Cancer Campus Villejuif, France
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Affiliation(s)
- Gary K Schwartz
- Gary K. Schwartz, Herbert Irving Comprehensive Cancer Center, New York; and Robert G. Maki, Northwell Health, Great Neck, NY
| | - Robert G Maki
- Gary K. Schwartz, Herbert Irving Comprehensive Cancer Center, New York; and Robert G. Maki, Northwell Health, Great Neck, NY
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