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Mor E, Lonie S, Mitchell C, Henderson M, Webb A, Gyorki DE, Snow H. Pleomorphic dermal sarcoma of the scalp - A single-centre experience. Surg Oncol 2024; 52:102017. [PMID: 38091877 DOI: 10.1016/j.suronc.2023.102017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/12/2023] [Accepted: 11/28/2023] [Indexed: 02/19/2024]
Abstract
BACKGROUND Pleomorphic dermal sarcoma (PDS) of the scalp is a rare tumour which is usually slow growing, but occasionally displays rapid growth and has a low rate of local recurrence. Surgical resection is the mainstay of treatment, with or without radiotherapy. The aim of this study is to describe the surgical approach and the additional benefit of radiotherapy to the treatment of these patients. METHODS Retrospective, single-centre analysis of patients with PDS of the scalp that underwent surgical resection between 2007 and 2021 (n = 24). Treatment variables including depth of resection (superficial or deep to the galea aponeurotica) and adjuvant radiotherapy were investigated. RESULTS Twenty-four patients were included in this study. Median age was 80 (range, 52-95), with a median ASA score of 3 (2-3). Sixteen (66.6 %) patients underwent surgical resection including the galea, while the rest (n = 8) did not or was not known. Radiotherapy was given in 7 (29 %) patients in which only 3 (12.5 %) were in the galeal resection group. Reasons for radiotherapy administration were concomitant SCC found at the same area of resection and close margins. In a median follow-up of was 26.2 months (range, 13.6-102.5) there was only one recurrence event. CONCLUSIONS PDS of the scalp can be safely managed with a surgical resection if clear surgical margins are achieved without radiotherapy with good oncological outcomes.
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Affiliation(s)
- Eyal Mor
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
| | - Sarah Lonie
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Catherine Mitchell
- Department of Anatomical Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Henderson
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Angela Webb
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Hayden Snow
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Wang Z, Wu JH, Li CP, Lv A, Qiu H, Tian XY, Liu BN, Hao CY. Patients with first recurrent retroperitoneal sarcoma that can be macroscopically completely resected can achieve comparable outcomes with that of primary patients after en bloc resection of tumor and adjacent organs. Front Surg 2022; 9:956384. [PMID: 36157408 PMCID: PMC9489918 DOI: 10.3389/fsurg.2022.956384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022] Open
Abstract
The outcomes of patients with primary retroperitoneal sarcoma (RPS) are significantly superior to those with recurrence. En bloc resection of tumor and adjacent organs is recommended in primary RPS. However, whether en bloc resection of tumor and adjacent organs can benefit recurrent patients or some recurrent patients is unclear. We compared the outcomes of patients with primary RPS, first recurrence (RPS-Rec1), and ≥2 recurrences (≥RPS-Rec2) to evaluate the value and criteria for en bloc resection of tumor and adjacent organs in recurrent cases. We evaluated the safety of en bloc resection of tumor and adjacent organs by assessing operation time, blood loss volume, postoperative morbidities (POM), and efficacy by comparing local recurrence and peritoneal metastasis (LR-PM), distant metastasis, progression-free survival (PFS), and overall survival (OS). A total of 101, 47, and 30 patients with primary RPS, RPS-Rec1, and ≥RPS-Rec2 were included, respectively. Recurrent RPS invaded more adjacent organs and surrounding fat tissue than primary RPS. The operation time, amount of blood loss, incidence of grade III–V POM, LR-PM rate, PFS, and OS in the RPS-Rec1 group were similar to those of the primary group, both of which were significantly superior to those of the ≥RPS-Rec2 group. Macroscopically incomplete resection and high-grade RPS rather than first recurrence were independent risk factors for LR-PM, PFS, and OS. In conclusion, the safety and efficacy of en bloc resection of tumor and adjacent organs in RPS-Rec1 were comparable with those in primary RPS but significantly superior to those of ≥RPS-Rec2. For RPS-Rec1, comparable outcomes to patients with primary RPS can be achieved, particularly in those in whom a macroscopically complete resection is achieved.
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Surgical Principles of Primary Retroperitoneal Sarcoma in the Era of Personalized Treatment: A Review of the Frontline Extended Surgery. Cancers (Basel) 2022; 14:cancers14174091. [PMID: 36077627 PMCID: PMC9454716 DOI: 10.3390/cancers14174091] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Surgery is the only curative treatment for localized disease in retroperitoneal sarcoma (RPS). Frontline extended surgery, or compartmental surgery, is a recent surgical strategy consisting of resecting the tumor together with adjacent organs, with the aim of minimizing marginality. This review provides a practical step by step description of this standardized procedure, tailored to histologic behavior, tumor localization, and patient condition. Abstract Surgery is the key treatment in retroperitoneal sarcoma (RPS), as completeness of resection is the most important prognostic factor related to treatment. Compartmental surgery/frontline extended approach is based on soft-tissue sarcoma surgical principles, and involves resecting adjacent viscera to achieve a wide negative margin. This extended approach is associated with improved local control and survival. This surgery must be tailored to tumor histology, tumor localization, and patient performance status. We herein present a review of compartmental surgery principles, covering the oncological and technical basis, and describing the tailored approach to each tumor subtype and localization in the retroperitoneum.
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Siew CCH, Apte SS, Baia M, Gyorki DE, Ford S, van Houdt WJ. Retroperitoneal and Mesenteric Liposarcomas. Surg Oncol Clin N Am 2022; 31:399-417. [PMID: 35715141 DOI: 10.1016/j.soc.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Retroperitoneal liposarcomas are a rare entity and are comprised mostly of the well-differentiated and dedifferentiated subtypes. Eight-year survival ranges from 30% to 80% depending on histologic subtype and grade. Surgery is the cornerstone of treatment and compartment resection is the current standard. Mesenteric liposarcomas are extremely rare and comprise more high-grade lesions, with poorer prognosis of 50% 5-year overall survival. They are managed with a similar aggressive surgical approach. This review presents the current management of retroperitoneal and mesenteric liposarcomas.
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Affiliation(s)
- Caroline C H Siew
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam 1066 CX, the Netherlands; Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433 Singapore
| | - Sameer S Apte
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000 Australia
| | - Marco Baia
- The Sarcoma Unit, Queen Elizabeth Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, UK
| | - David E Gyorki
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000 Australia
| | - Samuel Ford
- The Sarcoma Unit, Queen Elizabeth Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, UK
| | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam 1066 CX, the Netherlands.
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5
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Tranberg A, Nielsen MK, Sørensen FB, Thygesen K, Verwaal VJ, Sørensen MM, Christensen HK, Funder JA. Intraabdominal and retroperitoneal soft-tissue sarcomas – Surgical treatment and outcomes. Surg Oncol 2022; 42:101781. [DOI: 10.1016/j.suronc.2022.101781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/01/2022] [Accepted: 05/07/2022] [Indexed: 11/15/2022]
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6
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Swallow CJ, Strauss DC, Bonvalot S, Rutkowski P, Desai A, Gladdy RA, Gonzalez R, Gyorki DE, Fairweather M, van Houdt WJ, Stoeckle E, Park JB, Albertsmeier M, Nessim C, Cardona K, Fiore M, Hayes A, Tzanis D, Skoczylas J, Ford SJ, Ng D, Mullinax JE, Snow H, Haas RL, Callegaro D, Smith MJ, Bouhadiba T, Stacchiotti S, Jones RL, DeLaney T, Roland CL, Raut CP, Gronchi A. Management of Primary Retroperitoneal Sarcoma (RPS) in the Adult: An Updated Consensus Approach from the Transatlantic Australasian RPS Working Group. Ann Surg Oncol 2021; 28:7873-7888. [PMID: 33852100 DOI: 10.1245/s10434-021-09654-z] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Retroperitoneal soft tissue sarcomas comprise a heterogeneous group of rare tumors of mesenchymal origin that include several well-defined histologic subtypes. In 2015, the Transatlantic Australasian RPS Working Group (TARPSWG) published consensus recommendations for the best management of primary retroperitoneal sarcoma (RPS). Since then, through international collaboration, new evidence and knowledge have been generated, creating the need for an updated consensus document. METHODS The primary aim of this study was to critically evaluate the current evidence and develop an up-to-date consensus document on the approach to these difficult tumors. The resulting document applies to primary RPS that is non-visceral in origin, with exclusion criteria as previously described. The relevant literature was evaluated and an international group of experts consulted to formulate consensus statements regarding the best management of primary RPS. A level of evidence and grade of recommendation were attributed to each new/updated recommendation. RESULTS Management of primary RPS was considered from diagnosis to follow-up. This rare and complex malignancy is best managed by an experienced multidisciplinary team in a specialized referral center. The best chance of cure is at the time of primary presentation, and an individualized management plan should be made based on the 29 consensus statements included in this article, which were agreed upon by all of the authors. Whenever possible, patients should be enrolled in prospective trials and studies. CONCLUSIONS Ongoing international collaboration is critical to expand upon current knowledge and further improve outcomes of patients with RPS. In addition, prospective data collection and participation in multi-institution trials are strongly encouraged.
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Affiliation(s)
- Carol J Swallow
- Department of Surgical Oncology, Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto, ON, Canada. .,Department of Surgery, University of Toronto, Toronto, ON, Canada.
| | - Dirk C Strauss
- Sarcoma Unit, Department of Academic Surgery, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, London, UK.
| | - Sylvie Bonvalot
- Department of Surgical Oncology, Institut Curie, PSL University, Paris, France
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anant Desai
- Department of Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Rebecca A Gladdy
- Department of Surgical Oncology, Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Ricardo Gonzalez
- Sarcoma Department, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - David E Gyorki
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Mark Fairweather
- Department of Surgery, Brigham and Women's Hospital, Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Jae Berm Park
- Department of Surgery, Samsung Medical Center, Seoul, South Korea
| | - Markus Albertsmeier
- Department of General, Visceral and Transplantation Surgery, Ludwig-Maximilians-Universität, University Hospital, Munich, Germany
| | - Carolyn Nessim
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Kenneth Cardona
- Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrew Hayes
- Sarcoma Unit, Department of Academic Surgery, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, London, UK
| | - Dimitri Tzanis
- Department of Surgical Oncology, Institut Curie, PSL University, Paris, France
| | - Jacek Skoczylas
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Samuel J Ford
- Department of Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Deanna Ng
- Department of Surgical Oncology, Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - John E Mullinax
- Sarcoma Department, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Hayden Snow
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Rick L Haas
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Myles J Smith
- Sarcoma Unit, Department of Academic Surgery, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, London, UK
| | - Toufik Bouhadiba
- Department of Surgical Oncology, Institut Curie, PSL University, Paris, France
| | - Silvia Stacchiotti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Robin L Jones
- Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - Thomas DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christina L Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Role of neoadjuvant Radio-Chemotherapy for retroperitoneal Liposarcoma in primary and secondary surgical intervention. Int Surg 2020. [DOI: 10.9738/intsurg-d-19-00011.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract Background: Approximately 30–40 % of all retroperitoneal soft tissue tumors are sarcomas with liposarcoma prevailing in approximately 50% of these cases. Retroperitoneal liposarcomas typically show a high rate of local recurrence and late distant metastases. The aim of our retrospective analysis was to investigate the efficacy of treatment in our patients with liposarcoma. Methods: Thirty-four consecutive patients underwent surgery in our clinic between October 2004 and November 2017. Liposarcomas arising from the mesenteric or abdominal adipose tissue or the pelvis were excluded. In 2011 we had introduced neo-adjuvant therapy according to IAWS-Guidelines in patients younger than seventy without severe comorbidities to pretreatement. Results: Out of 34 patients, 23 (67,6%) presented with primary and 11 (32,4%) with recurrent disease. In 8 of the 27 patients (30 %), a radical resection (R0) could be achieved, and in 17 patients (63%) resection was marginal (R1). Time to recurrence was not affected by neoadjuvant radiotherapy. Patients that underwent systemic chemotherapy followed by radiotherapy developed earlier recurrences (p = 0.016). Overall survival appeared to be better in the neoadjuvant group but was not significant (0.080) Conclusions: Combining surgical resection with neoadjuvant radiation treatment showed survival benefits in primary but not recurrent disease. Repeated surgery stays a valid approach in carefully selected patients but all patients should be referred to a center of expertise in multimodal treatment approaches for retroperitoneal liposarcomas.
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Asencio Pascual JM, Fernandez Hernandez JA, Blanco Fernandez G, Muñoz Casares C, Álvarez Álvarez R, Fox Anzorena B, Lozano Borbalas A, Rodriguez Blanco M, Cantin Blázquez S, Artigas Raventós V. Update in pelvic and retroperitoneal sarcoma management: The role of compartment surgery. Cir Esp 2019; 97:480-488. [PMID: 31521244 DOI: 10.1016/j.ciresp.2019.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/22/2019] [Accepted: 06/21/2019] [Indexed: 12/31/2022]
Abstract
Surgery for retroperitoneal sarcomas should be "en bloc" compartmental, which involves resection of unaffected organs. Its upfront use is key, providing a high percentage of resections with negative margins, resulting in a better local control and increased survival in many patients. Preservation of organs should be done in an individualized manner, especially in the pelvic location, and adapted to the histological aggressiveness of the tumor. Preoperative biopsy is able to establish the diagnosis of sarcoma subtype and consequently an adequate perioperative strategy. These patients should be managed by expert surgeons at referral centers with multidisciplinary units and oncology committees. The use of chemotherapy and radiotherapy is not yet well defined, so it is only recommended at referral centers with clinical trials. Currently, this is the only option to offer the best morbidity and mortality rates, as well as possible improvements in the survival of these patients.
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Affiliation(s)
| | | | | | | | | | | | - Alicia Lozano Borbalas
- Oncología Radioterápica, Institut Català d'Oncologia, Hospital Duran i Reynals, L'Hospitalet de Llobregat, Barcelona, España
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Ghadimi M, Bruns CJ. [Systematic surgery of retroperitoneal sarcomas : Imaging-guided planning of surgical strategy]. Chirurg 2019; 90:447-456. [PMID: 31001643 DOI: 10.1007/s00104-019-0952-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abdominal and retroperitoneal sarcomas (RPS) represent approximately 25-30% of all soft tissue sarcomas, if besides typical retroperitoneal tumors gastrointestinal stromal tumors (GIST) are also included. The surgical R0 en bloc resection with histopathologically free margins is basically the only potentially curative treatment procedure. When planning the surgical strategy, the histopathological subtype and tumor localization are pivotal. The extent of resection should be guided by the goal to reach an en bloc resection with histopathologically negative margins. Due to the frequently found vast dimensions of RPS and ultimately topographic proximity to vital structures at primary diagnosis, R0 resections are not always achievable. Despite the introduction of multimodal treatment regimens and the development of standardized extended surgical procedures, such as systematic retroperitoneal compartmental resection (SRCR), local recurrences remain the most common cause of tumor-associated death. Finally, the results of the transatlantic RPS working group (TARPSWG) could show that treatment of RPS in specialized high-volume centers contributes to better long-term survival. Particularly in Germany there is an urgent demand for centralization of sarcoma patient treatment.
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Affiliation(s)
- M Ghadimi
- Klinik für Allgemein‑, Viszeral- und Tumorchirurgie, Uniklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
| | - C J Bruns
- Klinik für Allgemein‑, Viszeral- und Tumorchirurgie, Uniklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland
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10
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Tseng WW, Seo HJ, Pollock RE, Gronchi A. Historical perspectives and future directions in the surgical management of retroperitoneal sarcoma. J Surg Oncol 2017; 117:7-11. [PMID: 29127700 DOI: 10.1002/jso.24888] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/06/2022]
Abstract
Retroperitoneal sarcomas (RPS) have fascinated and intrigued physicians both past and present. Operative mortality rates were historically very high and complete resection was not possible for the majority of patients until only the last 2 decades. More recently, changes to the surgical approach and clinical decision-making in RPS have improved patient outcomes. With select integration of nonsurgical therapies, continued RPS-specific research, and ongoing collaborative efforts among major referral centers, the future appears promising.
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Affiliation(s)
- William W Tseng
- Department of Surgery, Section of Surgical Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Hyun Jae Seo
- Department of Surgery, Section of Surgical Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Raphael E Pollock
- Department of Surgery, The James Comprehensive Cancer Center, Ohio State University, Columbus, Ohio
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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11
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Ford S, Almond L, Gronchi A. An Update on Non-extremity Soft Tissue Sarcomas. Clin Oncol (R Coll Radiol) 2017; 29:516-527. [DOI: 10.1016/j.clon.2017.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/08/2017] [Indexed: 12/18/2022]
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12
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Tseng WW, Pollock RE, Gronchi A. The Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG): “Red wine or white”? Ann Surg Oncol 2016; 23:4418-4420. [DOI: 10.1245/s10434-016-5538-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Indexed: 11/18/2022]
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13
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Crago AM, Dickson MA. Liposarcoma: Multimodality Management and Future Targeted Therapies. Surg Oncol Clin N Am 2016; 25:761-73. [PMID: 27591497 DOI: 10.1016/j.soc.2016.05.007] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There are 3 biologic groups of liposarcoma: well-differentiated and dedifferentiated liposarcoma, myxoid/round cell liposarcoma, and pleomorphic liposarcoma. In all 3 groups, complete surgical resection is central in treatment aimed at cure and is based on grade. Radiation can reduce risk of local recurrence in high-grade lesions or minimize surgical morbidity in the myxoid/round cell liposarcoma group. The groups differ in chemosensitivity, so adjuvant chemotherapy is selectively used in histologies with metastatic potential but not in the resistant subtype dedifferentiated liposarcoma. Improved understanding of the genetic aberrations that lead to liposarcoma initiation is allowing for the rapid development of targeted therapies for liposarcoma.
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Affiliation(s)
- Aimee M Crago
- Sarcoma Disease Management Team, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, H1220, New York, NY 10065, USA; Department of Surgery, Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA.
| | - Mark A Dickson
- Sarcoma Disease Management Team, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Sarcoma Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA; Department of Medicine, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
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14
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Histology-based Classification Predicts Pattern of Recurrence and Improves Risk Stratification in Primary Retroperitoneal Sarcoma. Ann Surg 2016; 263:593-600. [PMID: 25915910 DOI: 10.1097/sla.0000000000001149] [Citation(s) in RCA: 212] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the prognostic significance of histologic type/subtype in a large series of patients with primary resected retroperitoneal sarcoma. BACKGROUND The histologic diversity and rarity of retroperitoneal sarcoma has hampered the ability to predict patient outcome. METHODS From a single-institution, prospective database, 675 patients treated surgically for primary, nonmetastatic retroperitoneal sarcoma during 1982 to 2010 were identified and histologic type/subtype was reviewed. Clinicopathologic variables were analyzed for association with disease-specific death (DSD), local recurrence (LR), and distant recurrence (DR). RESULTS Median follow-up for survivors was 7.5 years. The predominant histologies were well-differentiated liposarcoma, dedifferentiated liposarcoma, and leiomyosarcoma. Five-year cumulative incidence of DSD was 31%, and factors independently associated with DSD were R2 resection, resection of 3 or more contiguous organs, and histologic type. Five-year cumulative incidence for LR was 39% and for DR was 24%. R1 resection, age, tumor size, and histologic type were independently associated with LR; size, resection of 3 or more organs, and histologic type were independently associated with DR. Liposarcoma and leiomyosarcoma were associated with late recurrence and DSD (as long as 15 years from diagnosis). For solitary fibrous tumor, LR was uncommon (<10%), but early distant recurrence was common (36% at 5 years). Nomograms were developed to predict DSD, LR, and DR. CONCLUSIONS Histologic type/subtype is the most important independent predictor of DSD, LR, and DR in primary retroperitoneal sarcoma. Histology predicts the pattern and incidence of LR and DR and will aid in more accurate patient counseling and selection of patients for adjuvant therapy trials.
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15
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Leiomyosarcoma of the Inferior Vena Cava: A Case Series and Review of the Literature. Ann Vasc Surg 2016; 33:245-51. [DOI: 10.1016/j.avsg.2015.10.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/04/2015] [Accepted: 10/15/2015] [Indexed: 12/20/2022]
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16
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Raut CP, Miceli R, Strauss DC, Swallow CJ, Hohenberger P, van Coevorden F, Rutkowski P, Fiore M, Callegaro D, Casali PG, Haas RL, Hayes AJ, Honore C, Cannell AJ, Jakob J, Szacht M, Fairweather M, Pollock RE, Bonvalot S, Gronchi A. External validation of a multi-institutional retroperitoneal sarcoma nomogram. Cancer 2016; 122:1417-24. [DOI: 10.1002/cncr.29931] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/07/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Chandrajit P. Raut
- Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute; Harvard Medical School; Boston Massachusetts
| | - Rosalba Miceli
- Department of Medical Statistics, Biometry and Bioinformatics; IRCCS Foundation National Cancer Institute; Milan Italy
| | - Dirk C. Strauss
- Department of Surgery; Royal Marsden Hospital NHS Foundation Trust; London United Kingdom
| | - Carol J. Swallow
- Department of Surgical Oncology; Mount Sinai Hospital and Princess Margaret Cancer Centre; Toronto Ontario Canada
- Department of Surgery; University of Toronto; Toronto Ontario Canada
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery; Mannheim University Hospital; Mannheim Germany
| | - Frits van Coevorden
- Department of Surgical Oncology; Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology; Warsaw Poland
| | - Marco Fiore
- Department of Surgery; IRCCS Foundation National Cancer Institute; Milan Italy
| | - Dario Callegaro
- Department of Surgery; IRCCS Foundation National Cancer Institute; Milan Italy
| | - Paolo G. Casali
- Department of Cancer Medicine; IRCCS Foundation National Cancer Institute; Milan Italy
| | - Rick L. Haas
- Department of Radiation Oncology; Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Andrew J. Hayes
- Department of Surgery; Royal Marsden Hospital NHS Foundation Trust; London United Kingdom
| | - Charles Honore
- Department of Surgery; Gustave Roussy Institute; Villejuif France
| | - Amanda J. Cannell
- Department of Surgical Oncology; Mount Sinai Hospital and Princess Margaret Cancer Centre; Toronto Ontario Canada
- Department of Surgery; University of Toronto; Toronto Ontario Canada
| | - Jens Jakob
- Division of Surgical Oncology and Thoracic Surgery; Mannheim University Hospital; Mannheim Germany
| | - Milena Szacht
- Department of Soft Tissue/Bone Sarcoma and Melanoma; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology; Warsaw Poland
| | - Mark Fairweather
- Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute; Harvard Medical School; Boston Massachusetts
| | - Raphael E. Pollock
- Division of Surgical Oncology, Department of Surgery; Ohio State University Medical Center; Columbus Ohio
| | | | - Alessandro Gronchi
- Department of Surgery; IRCCS Foundation National Cancer Institute; Milan Italy
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17
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Kirane A, Crago AM. The importance of surgical margins in retroperitoneal sarcoma. J Surg Oncol 2015; 113:270-6. [PMID: 26707028 DOI: 10.1002/jso.24135] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 11/07/2022]
Abstract
Surgery is the "gold-standard" treatment for retroperitoneal sarcomas, but local recurrence is common, and can cause disease-related death. Complete gross resection is associated with improved survival, but debate exists as to whether resection of adjacent organs to improve margins or prescription of neoadjuvant radiation leads to better outcomes. This review summarizes data addressing prognostic value of margin, extent of surgery necessary to optimize treatment of retroperitoneal sarcomas, and role of histology in optimizing therapy.
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Affiliation(s)
- Amanda Kirane
- Department of Surgery, Memorial Sloan Kettering Cancer Center, Gastric and Mixed Tumor Service, New York, New York.,Department of Surgery, Weill Cornell Medical School, New York, New York
| | - Aimee M Crago
- Department of Surgery, Memorial Sloan Kettering Cancer Center, Gastric and Mixed Tumor Service, New York, New York.,Department of Surgery, Weill Cornell Medical School, New York, New York
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18
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Hull MA, Niemierko A, Haynes AB, Jacobson A, Chen YL, DeLaney TF, Mullen JT. Post-operative renal function following nephrectomy as part of en bloc resection of retroperitoneal sarcoma (RPS). J Surg Oncol 2015; 112:98-102. [DOI: 10.1002/jso.23949] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 06/01/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Melissa A. Hull
- Department of Surgery; Massachusetts General Hospital; Boston Massachusetts
| | - Andrzej Niemierko
- Department of and Radiation Oncology; Massachusetts General Hospital; Boston Massachusetts
| | - Alex B. Haynes
- Department of Surgery; Massachusetts General Hospital; Boston Massachusetts
| | - Alex Jacobson
- Department of and Radiation Oncology; Massachusetts General Hospital; Boston Massachusetts
| | - Yen-Lin Chen
- Department of and Radiation Oncology; Massachusetts General Hospital; Boston Massachusetts
| | - Thomas F. DeLaney
- Department of and Radiation Oncology; Massachusetts General Hospital; Boston Massachusetts
| | - John T. Mullen
- Department of Surgery; Massachusetts General Hospital; Boston Massachusetts
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19
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Olimpiadi Y, Song S, Hu JS, Matcuk GR, Chopra S, Eisenberg BL, Sener SF, Tseng WW. Contemporary Management of Retroperitoneal Soft Tissue Sarcomas. Curr Oncol Rep 2015; 17:39. [DOI: 10.1007/s11912-015-0462-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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20
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Callegaro D, Miceli R, Brunelli C, Colombo C, Sanfilippo R, Radaelli S, Casali PG, Caraceni A, Gronchi A, Fiore M. Long-term morbidity after multivisceral resection for retroperitoneal sarcoma. Br J Surg 2015; 102:1079-87. [DOI: 10.1002/bjs.9829] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/17/2015] [Accepted: 03/12/2015] [Indexed: 11/06/2022]
Abstract
Abstract
Background
More than 60 per cent of patients treated surgically for primary retroperitoneal sarcoma survive for at least 5 years. Extended surgical resection has been proposed for primary disease, but long-term morbidity data are lacking. A cross-sectional study was conducted to assess the long-term morbidity of patients undergoing surgery for retroperitoneal sarcoma.
Methods
Patients operated on between January 2002 and December 2011 were eligible for the study. Long-term morbidity was evaluated based on a semistructured clinical interview. Lower limb function was assessed by means of the Lower Extremity Functional Scale (LEFS), a self-report questionnaire with a total score ranging from 0 (low functioning) to 80 (high functioning). Pain was investigated by means of the Brief Pain Inventory – Short Form, with pain intensity scores reported on a scale from 0 (no pain) to 10 (worst pain).
Results
Some 243 patients underwent surgery, and 101 of 160 patients who were alive at the time of the investigation responded to the study invitation letter. Finally, 95 patients were enrolled in the study. Sensory impairment of the limbs was reported in 72 patients (76 per cent). The median LEFS score was 60 (i.q.r. 43–73). Mean scores for the pain intensity items varied from 1·23 to 2·68. In multivariable analysis, there was no difference in median levels of creatinine at survey between patients who did or did not undergo nephrectomy (difference between median values 13 (95 per cent c.i. −4 to 30) µmol/l; P = 0·170).
Conclusion
Severe chronic pain and lower limb motor impairment after multivisceral resection for retroperitoneal sarcomas are rare. Long-term renal function is not significantly impaired when nephrectomy is performed.
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Affiliation(s)
- D Callegaro
- Department of Surgery, Pain Therapy and Rehabilitation Unit, Milan, Italy
| | - R Miceli
- Department of Biostatistics, Pain Therapy and Rehabilitation Unit, Milan, Italy
| | - C Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Milan, Italy
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - C Colombo
- Department of Surgery, Pain Therapy and Rehabilitation Unit, Milan, Italy
| | - R Sanfilippo
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - S Radaelli
- Department of Surgery, Pain Therapy and Rehabilitation Unit, Milan, Italy
| | - P G Casali
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Caraceni
- Palliative Care, Pain Therapy and Rehabilitation Unit, Milan, Italy
| | - A Gronchi
- Department of Surgery, Pain Therapy and Rehabilitation Unit, Milan, Italy
| | - M Fiore
- Department of Surgery, Pain Therapy and Rehabilitation Unit, Milan, Italy
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21
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Pasquali S, Vohra R, Tsimopoulou I, Vijayan D, Gourevitch D, Desai A. Outcomes Following Extended Surgery for Retroperitoneal Sarcomas: Results From a UK Referral Centre. Ann Surg Oncol 2015; 22:3550-6. [DOI: 10.1245/s10434-015-4380-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Indexed: 11/18/2022]
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22
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Crago AM. Extended surgical resection and histology in retroperitoneal sarcoma. Ann Surg Oncol 2014; 22:1401-3. [PMID: 25316490 DOI: 10.1245/s10434-014-4135-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Aimee M Crago
- Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA,
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23
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Management of Primary Retroperitoneal Sarcoma (RPS) in the Adult: A Consensus Approach From the Trans-Atlantic RPS Working Group. Ann Surg Oncol 2014; 22:256-63. [DOI: 10.1245/s10434-014-3965-2] [Citation(s) in RCA: 205] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Indexed: 12/28/2022]
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24
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Gronchi A, Miceli R, Allard MA, Callegaro D, Le Péchoux C, Fiore M, Honoré C, Sanfilippo R, Coppola S, Stacchiotti S, Terrier P, Casali PG, Le Cesne A, Mariani L, Colombo C, Bonvalot S. Personalizing the Approach to Retroperitoneal Soft Tissue Sarcoma: Histology-specific Patterns of Failure and Postrelapse Outcome after Primary Extended Resection. Ann Surg Oncol 2014; 22:1447-54. [DOI: 10.1245/s10434-014-4130-7] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Indexed: 12/19/2022]
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25
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Tseng WW, Madewell JE, Wei W, Somaiah N, Lazar AJ, Ghadimi MP, Hoffman A, Pisters PWT, Lev DC, Pollock RE. Locoregional disease patterns in well-differentiated and dedifferentiated retroperitoneal liposarcoma: implications for the extent of resection? Ann Surg Oncol 2014; 21:2136-43. [PMID: 24705628 DOI: 10.1245/s10434-014-3643-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND Well-differentiated (WD)/dedifferentiated (DD) liposarcoma is the most common soft tissue sarcoma of the retroperitoneum. The frequency of distant metastasis is low and the major burden of disease is locoregional. We sought to define the patterns of locoregional disease to help guide surgical decision making. METHODS Data were collected from 247 patients with de novo or recurrent tumors treated at our institution from 1993 to early 2012. The number and location of tumors at both initial presentation and subsequent locoregional recurrence were determined by combined analysis of operative dictations and radiologic imaging. RESULTS Thirty-four percent of patients had multifocal locoregional disease (two or more tumors) at initial presentation to our institution, including 9 % who had tumors at synchronous remote retroperitoneal sites. The impact of multifocal disease on overall survival was dependent on histologic subtype (WD vs. DD) and disease presentation (de novo vs. recurrence) at the time of resection. Among patients with initial unifocal disease, 57 % progressed to multifocal locoregional disease with subsequent recurrence, including 11 % with new tumors outside of the original resection field. No clinicopathologic or treatment-related variable, including the type or extent of resection, was predictive of either multifocal or 'outside field' progression. CONCLUSIONS Multifocal disease is common in patients with WD/DD retroperitoneal liposarcoma, and tumors can also develop at remote, locoregional sites. Surgical resection remains the primary method of locoregional control in this disease; however, the aggressiveness of resection should be individualized, with consideration of both tumor and patient-related factors.
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Affiliation(s)
- William W Tseng
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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26
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Combined management of retroperitoneal sarcoma with dose intensification radiotherapy and resection: Long-term results of a prospective trial. Radiother Oncol 2014; 110:165-71. [DOI: 10.1016/j.radonc.2013.10.041] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 10/29/2013] [Accepted: 10/31/2013] [Indexed: 11/21/2022]
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27
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Gyorki DE, Brennan MF. Management of recurrent retroperitoneal sarcoma. J Surg Oncol 2013; 109:53-9. [PMID: 24155163 DOI: 10.1002/jso.23463] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 09/10/2013] [Indexed: 01/01/2023]
Abstract
Approximately 15% of soft tissue sarcomas are retroperitoneal. The occult location and anatomic complexity results in local recurrences in the majority of patients. Predictors of recurrence include histological subtype, completeness of resection, and the hospital case volume. The most significant predictor of outcome following local recurrence is the resectability of the recurrent disease. An understanding of the implication of tumor biology on outcomes is essential in determining optimal management for patients with recurrent retroperitoneal sarcoma.
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Affiliation(s)
- David E Gyorki
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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28
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Bonvalot S, Raut CP, Pollock RE, Rutkowski P, Strauss DC, Hayes AJ, Van Coevorden F, Fiore M, Stoeckle E, Hohenberger P, Gronchi A. Technical Considerations in Surgery for Retroperitoneal Sarcomas: Position Paper from E-Surge, a Master Class in Sarcoma Surgery, and EORTC–STBSG. Ann Surg Oncol 2012; 19:2981-91. [DOI: 10.1245/s10434-012-2342-2] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Indexed: 12/26/2022]
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29
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Tsuyoshi H, Yoshida Y, Kurokawa T, Kotsuji F. Diagnosis and management of leiomyosarcoma arising from ovarian vein: case report and literature review. J Obstet Gynaecol Res 2012; 38:466-70. [PMID: 22229846 DOI: 10.1111/j.1447-0756.2011.01725.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Primary leiomyosarcomas arising from the ovarian vein are extremely rare and are associated with high morbidity. A 49-year-old nulliparous woman presented with a left lower abdominal mass. Although extremely rare, the radiological appearance is able to preoperatively identify malignant retroperitoneal masses, such as leiomyosarcomas originating from the ovarian vein; thus, the patient underwent a simple total excision of the mass-adjacent organs, as well as complete resection of the uterus, bilateral adnexae and the left ovarian vein. Adjuvant postoperative combination chemotherapy with gemcitabine and docetaxel was administered. At 22 months, she had no recurrence or metastasis. Delayed diagnosis and high metastatic potentiality are associated with the high morbidity of vascular leiomyosarcomas. The preoperative radiological appearance is useful for early diagnosis, and radical treatment with adjuvant chemotherapy consisting of gemcitabine and docetaxel may improve the poor prognosis of patients with leiomyosarcoma arising from the ovarian vein.
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Affiliation(s)
- Hideaki Tsuyoshi
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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