1
|
Elmorsi R, Camacho L, Krijgh DD, Tilney GS, Lyu H, Traweek RS, Witt RG, Roubaud MS, Roland CL, Mericli AF. Optimizing Morbidity in Unplanned Soft Tissue Sarcoma Excisions: Should We Skip the Reconstructive Ladder? Ann Plast Surg 2024:00000637-990000000-00482. [PMID: 38920187 DOI: 10.1097/sap.0000000000004013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
INTRODUCTION Soft tissue sarcomas (STSs) are rare and diverse primary malignant tumors that comprise approximately 1% of all malignancies. Misdiagnoses and unplanned excisions of STSs are common due to the tumor's rarity, leading to secondary tumor bed excisions (TBEs). Reconstructive outcomes for TBEs remain poorly understood, prompting this study to address the knowledge gap and inform preoperative discussions. METHODS This was a retrospective cohort study of patients who underwent STS excisions at a quaternary cancer center. Patients were categorized into mass excision (ME) and TBE groups. Reconstructive approaches were divided into simple (primary closure, complex repair, skin grafts, local flaps) and advanced (pedicled or free flaps). The groups were compared for postoperative outcomes, including complications, recurrence, and death. RESULTS When simple reconstructive techniques were used, TBEs exhibited higher rates of overall and major complications, whereas MEs had higher rates of overall and minor complications. Intergroup analysis revealed that with simple reconstruction, rates of overall and major complications were higher in TBEs than in MEs, and rates of minor complications were higher in MEs than in TBEs. Regression analyses revealed that simple reconstruction of TBEs had 90% and 180% higher odds of major complications and reoperation compared to simple reconstruction of MEs (P < 0.05). CONCLUSION TBEs, despite their smaller size, exhibited a heightened susceptibility to overall and major complications, challenging the notion that simpler techniques suffice in these cases. Our findings encourage the consideration of advanced reconstructive techniques for TBEs that may seem amenable to simple reconstructive techniques.
Collapse
Affiliation(s)
- Rami Elmorsi
- From the Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Luis Camacho
- From the Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David D Krijgh
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gordon S Tilney
- From the Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Heather Lyu
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Raymond S Traweek
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Russell G Witt
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Margaret S Roubaud
- From the Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christina L Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alexander F Mericli
- From the Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
2
|
Fromm J, Klein A, Mentrup F, Lindner LH, Nachbichler S, Holzapfel BM, Goller SS, Knösel T, Dürr HR. Unplanned Resections of Soft Tissue Sarcomas-Necessity of Re-Resection? Cancers (Basel) 2024; 16:1851. [PMID: 38791930 PMCID: PMC11120091 DOI: 10.3390/cancers16101851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND In soft tissue sarcomas, unplanned resections, or so-called Whoops procedures, do occur quite frequently, thus primarily owing to the abundant presence of benign lesions. Whether re-resection reduces local recurrence or improves overall survival remains a topic of ongoing debate. The principle objective of this study was to analyze the outcomes of patients with soft tissue sarcomas of the extremities or trunk wall after an incidental marginal resection by comparing re-resections to individuals who declined the procedure. METHODS A total of 185 patients who underwent unplanned resection were included. These patients were stratified into two groups: Group A (n = 156) underwent re-excision, while Group B (n = 29) was treated conservatively. Depending on the clinical scenario, radio- or chemotherapy was either administered in a neoadjuvant or an adjuvant setting. The presence of residual tumor and metastatic disease was documented. Clinical outcomes, specifically local recurrence (LR), local recurrence-free survival (LRFS) and overall survival (OS), were utilized for evaluation. RESULTS Group B exhibited significantly larger tumors (p < 0.0001) and a higher mean age than Group A. Among the patients in Group A, 11 (5.9%) had contaminated resection margins (R1), and residual disease (RD) was observed in 93 (59.6%) of the resected specimens. In group B, 10 patients received adjuvant radiotherapy alone, 5 received chemotherapy alone, and 13 underwent a combined approach consisting of both radio- and chemotherapy. In Group A, 8% (n = 12) of the patients developed local recurrence (LR) during the observation period. Conversely, in Group B, this amount was 14% (n = 4) (n.s.). Of the 12 LR in Group A, 10 were found in the subgroup with residual disease. Overall survival and local recurrence-free survival were not significantly different between the groups. A total of 15% (n = 24) of the patients in Group A developed metastatic disease, while 10% (n = 3) in Group B developed metastatic disease (n.s.). CONCLUSIONS Following the reresection of unplanned resected STS, there was no statistically significant difference observed in overall survival or LR compared to patients who did not undergo re-resection. However, within the subgroup of patients with residual disease in the re-resected specimen, the OS was compromised, and the LR rate was higher. Particularly for low-grade lesions, adopting a more conservative approach seems to be justified.
Collapse
Affiliation(s)
- Julian Fromm
- Department of Orthopaedics and Trauma Surgery, Orthopaedic Oncology, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, D-81377 Munich, Germany; (J.F.); (A.K.); (F.M.); (B.M.H.)
- SarKUM, Center of Bone and Soft Tissue Tumors, LMU University Hospital, LMU Munich, D-81377 Munich, Germany; (L.H.L.); (S.N.); (S.S.G.); (T.K.)
| | - Alexander Klein
- Department of Orthopaedics and Trauma Surgery, Orthopaedic Oncology, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, D-81377 Munich, Germany; (J.F.); (A.K.); (F.M.); (B.M.H.)
- SarKUM, Center of Bone and Soft Tissue Tumors, LMU University Hospital, LMU Munich, D-81377 Munich, Germany; (L.H.L.); (S.N.); (S.S.G.); (T.K.)
| | - Franziska Mentrup
- Department of Orthopaedics and Trauma Surgery, Orthopaedic Oncology, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, D-81377 Munich, Germany; (J.F.); (A.K.); (F.M.); (B.M.H.)
- SarKUM, Center of Bone and Soft Tissue Tumors, LMU University Hospital, LMU Munich, D-81377 Munich, Germany; (L.H.L.); (S.N.); (S.S.G.); (T.K.)
| | - Lars H. Lindner
- SarKUM, Center of Bone and Soft Tissue Tumors, LMU University Hospital, LMU Munich, D-81377 Munich, Germany; (L.H.L.); (S.N.); (S.S.G.); (T.K.)
- Department of Medicine III, LMU University Hospital, LMU Munich, D-81377 Munich, Germany
| | - Silke Nachbichler
- SarKUM, Center of Bone and Soft Tissue Tumors, LMU University Hospital, LMU Munich, D-81377 Munich, Germany; (L.H.L.); (S.N.); (S.S.G.); (T.K.)
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, D-81377 Munich, Germany
| | - Boris Michael Holzapfel
- Department of Orthopaedics and Trauma Surgery, Orthopaedic Oncology, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, D-81377 Munich, Germany; (J.F.); (A.K.); (F.M.); (B.M.H.)
| | - Sophia Samira Goller
- SarKUM, Center of Bone and Soft Tissue Tumors, LMU University Hospital, LMU Munich, D-81377 Munich, Germany; (L.H.L.); (S.N.); (S.S.G.); (T.K.)
- Department of Radiology, LMU University Hospital, LMU Munich, D-81377 Munich, Germany
| | - Thomas Knösel
- SarKUM, Center of Bone and Soft Tissue Tumors, LMU University Hospital, LMU Munich, D-81377 Munich, Germany; (L.H.L.); (S.N.); (S.S.G.); (T.K.)
- Institute of Pathology, LMU Munich, D-81377 Munich, Germany
| | - Hans Roland Dürr
- Department of Orthopaedics and Trauma Surgery, Orthopaedic Oncology, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, D-81377 Munich, Germany; (J.F.); (A.K.); (F.M.); (B.M.H.)
- SarKUM, Center of Bone and Soft Tissue Tumors, LMU University Hospital, LMU Munich, D-81377 Munich, Germany; (L.H.L.); (S.N.); (S.S.G.); (T.K.)
| |
Collapse
|
3
|
Gouin F, Michot A, Jafari M, Honoré C, Mattei JC, Rochwerger A, Ropars M, Tzanis D, Anract P, Carrere S, Gangloff D, Ducoulombier A, Lebbe C, Guiramand J, Waast D, Marchal F, Sirveaux F, Causeret S, Gimbergues P, Fiorenza F, Paquette B, Soibinet P, Guilloit JM, Le Nail LR, Dujardin F, Brinkert D, Chemin-Airiau C, Morelle M, Meeus P, Karanian M, Le Loarer F, Vaz G, Blay JY. Improved Metastatic-Free Survival after Systematic Re-Excision Following Complete Macroscopic Unplanned Excision of Limb or Trunk Soft Tissue Sarcoma. Cancers (Basel) 2024; 16:1365. [PMID: 38611043 PMCID: PMC11010862 DOI: 10.3390/cancers16071365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Whether re-excision (RE) of a soft tissue sarcoma (STS) of limb or trunk should be systematized as adjuvant care and if it would improve metastatic free survival (MFS) are still debated. The impact of resection margins after unplanned macroscopically complete excision (UE) performed out of a NETSARC reference center or after second resection was further investigated. METHODS This large nationwide series used data from patients having experienced UE outside of a reference center from 2010 to 2019, collected in a French nationwide exhaustive prospective cohort NETSARC. Patient characteristics and survival distributions in patients reexcised (RE) or not (No-RE) are reported. Multivariate Cox proportional hazard model was conducted to adjust for classical prognosis factors. Subgroup analysis were performed to identify which patients may benefit from RE. RESULTS Out of 2371 patients with UE for STS performed outside NETSARC reference centers, 1692 patients were not reviewed by multidisciplinary board before treatment decision and had a second operation documented. Among them, 913 patients experienced re-excision, and 779 were not re-excised. Characteristics were significantly different regarding patient age, tumor site, size, depth, grade and histotype in patients re-excised (RE) or not (No-RE). In univariate analysis, final R0 margins are associated with a better MFS, patients with R1 margins documented at first surgery had a better MFS as compared to patients with first R0 resection. The study identified RE as an independent favorable factor for MFS (HR 0.7, 95% CI 0.53-0.93; p = 0.013). All subgroups except older patients (>70 years) and patients with large tumors (>10 cm) had superior MFS with RE. CONCLUSIONS RE might be considered in patients with STS of limb or trunk, with UE with macroscopic complete resection performed out of a reference center, and also in originally defined R0 margin resections, to improve LRFS and MFS. Systematic RE should not be advocated for patients older than 70 years, or with tumors greater than 10 cm.
Collapse
Affiliation(s)
- Francois Gouin
- Surgery Department, Centre Léon Bérard, 69008 Lyon, France (G.V.)
| | - Audrey Michot
- Surgery Department, Institut Bergonié, 33076 Bordeaux, France
| | - Mehrdad Jafari
- General and Digestive Oncologic Surgery, Centre Oscar Lambret, 59000 Lille, France
| | - Charles Honoré
- Surgery Department, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Jean Camille Mattei
- Orthopedic and Traumatologic Surgery Department, Hôpital Nord, Hopital de la Conception, APHM, 13005 Marseille, France
| | - Alexandre Rochwerger
- Orthopedic and Traumatologic Surgery Department, Hôpital Nord, Hopital de la Conception, APHM, 13005 Marseille, France
| | - Mickael Ropars
- Orthopedic Surgery Department, CHU de Rennes, 35033 Rennes, France;
| | - Dimitri Tzanis
- Surgery Department, Institut Curie, PSL University, 75248 Paris, France;
| | - Philippe Anract
- Orthopedic Surgery Department, Hôpital Cochin, AP-HP, Université de Paris, Faculté de Santé, Unités de Formation et de Recherche de Médecine, 75015 Paris, France
| | - Sébastien Carrere
- Surgery Department, Institut de Recherche en Cancérologie, 34298 Montpellier, France
| | | | - Agnès Ducoulombier
- Senology Surgery Department, Onco-Gynécologique et Reconstructrice, Centre Antoine Lacassagne, 06100 Nice, France
| | - Céleste Lebbe
- Reconstructive et Esthetic Plastic Surgery, Hôpital Saint Louis, 75010 Paris, France
| | - Jérôme Guiramand
- Surgery Department, Institut Paoli Calmette, 13009 Marseille, France
| | - Denis Waast
- Orthopedic and Traumatologic Surgery Clinic, CHU Nantes, 44093 Nantes, France
| | - Frédéric Marchal
- Surgery Department, Institut de Cancérologie de Lorraine, Université de Lorraine, CNRS, CRAN, UMR 7039, 54000 Nancy, France
| | | | - Sylvain Causeret
- Surgery Department, Centre George-François Leclerc, 21079 Dijon, France;
| | - Pierre Gimbergues
- Surgery Department, Centre Jean Perrin, 63011 Clermont Ferrand, France
| | - Fabrice Fiorenza
- Orthopedic and Traumatology Surgery Department, CHU Limoges, 87000 Limoges, France
| | - Brice Paquette
- Department of Digestive Surgery, Jean Minjoz University Hospital, 25000 Besançon, France;
| | - Pauline Soibinet
- Medical Oncology Department, Institut Godinot, 51100 Reims, France
| | - Jean-Marc Guilloit
- Visceral et Digestive Surgery Department, Centre François Baclesse, 14076 Caen, France
| | - Louis R. Le Nail
- Onco-Orthopedic Surgery Department, Hôpital Trousseau, CHRU de Tours, 37000 Tours, France
| | - Franck Dujardin
- Medical Oncology and Surgical Oncology Department, Centre Henri Becquerel, 76038 Rouen, France
| | - David Brinkert
- Orthopedic Surgery Department, CHU de Strasbourg, 67200 Strasbourg, France;
| | - Claire Chemin-Airiau
- Clinical Research and Innovation Department, Centre Léon Bérard, 69008 Lyon, France
| | - Magali Morelle
- Clinical Research and Innovation Department, Centre Léon Bérard, 69008 Lyon, France
| | - Pierre Meeus
- Surgery Department, Centre Léon Bérard, 69008 Lyon, France (G.V.)
| | - Marie Karanian
- Department of Biopathology, Centre Léon Bérard, 69008 Lyon, France
| | - François Le Loarer
- Anatomo-Pathology Surgery Department, Institut Bergonié, 33076 Bordeaux, France
| | - Gualter Vaz
- Surgery Department, Centre Léon Bérard, 69008 Lyon, France (G.V.)
| | - Jean-Yves Blay
- Department of Medical Oncology, University Claude Bernard Lyon I, 69008 Lyon, France
- Department of Medicine, Léon Bérard Center, Unicancer, 69008 Lyon, France
| |
Collapse
|
4
|
Larios F, Gonzalez MR, Ruiz-Arellanos K, Aquilino E Silva G, Pretell-Mazzini J. Is Unplanned Excision of Soft Tissue Sarcomas Associated with Worse Oncological Outcomes?-A Systematic Review and Meta-Analysis. Cancers (Basel) 2024; 16:443. [PMID: 38275885 PMCID: PMC10814439 DOI: 10.3390/cancers16020443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/28/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Soft tissue sarcomas are a group of rare neoplasms which can be mistaken for benign masses and be excised in a non-oncologic fashion (unplanned excision). Whether unplanned excision (UE) is associated with worse outcomes is highly debated due to conflicting evidence. METHODS We performed a systematic review and meta-analysis following PRISMA guidelines. Main outcomes analyzed were five-year overall survival (OS), five-year local recurrence-free survival (LRFS), amputation rate and plastic reconstruction surgery rate. Risk ratios were used to compare outcomes between patients treated with planned and unplanned excision. RESULTS We included 16,946 patients with STS, 6017 (35.5%) with UE. UE was associated with worse five-year LRFS (RR 1.35, p = 0.019). Residual tumor on the tumor bed was associated with lower five-year LRFS (RR = 2.59, p < 0.001). Local recurrence was associated with worse five-year OS (RR = 1.82, p < 0.001). UE was not associated with a worse five-year OS (RR = 0.90, p = 0.16), higher amputation rate (RR = 0.77, p = 0.134), or a worse plastic reconstruction surgery rate (RR = 1.25, p = 0.244). CONCLUSIONS Unplanned excision of Soft Tissue Sarcomas and the presence of disease in tumor bed after one were associated with worse five-year LRFS. Tumor bed excision should remain the standard approach, with special consideration to the presence of residual disease.
Collapse
Affiliation(s)
- Felipe Larios
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima 15102, Peru; (F.L.); (K.R.-A.)
| | - Marcos R. Gonzalez
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Kim Ruiz-Arellanos
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima 15102, Peru; (F.L.); (K.R.-A.)
| | | | - Juan Pretell-Mazzini
- Miami Cancer Institute, Division of Orthopedic Oncology, Baptist Health System South Florida, Plantation, FL 33324, USA
| |
Collapse
|
5
|
Belzarena AC, Binitie O, Letson GD, Joyce DM. Unplanned Sarcoma Excisions: Understanding How They Happen. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202401000-00008. [PMID: 38252542 PMCID: PMC10805420 DOI: 10.5435/jaaosglobal-d-23-00176] [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: 08/30/2023] [Revised: 12/03/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Soft-tissue sarcomas present as a mass with nonspecific symptoms, and unplanned excisions commonly occur. The purpose of this study was to analyze the incidence of unplanned excisions performed by orthopaedic surgeons and to conduct a root cause analysis (RCA) of the steps that led to unplanned excisions in all the cases. METHODS A retrospective case-control study was conducted. Two cohorts were identified, one including patients who underwent an unplanned excision of a soft-tissue sarcoma (n = 107) and a second cohort with patients whose entire care was performed at our sarcoma center (n = 102). A RCA was conducted with the whole sample to identify the preventable causes that led to sarcoma unplanned excisions. RESULTS Orthopedic surgeons were the second group of physicians to perform the most unplanned excisions, only behind general surgeons. Inadequate imaging was encountered in 76.6% of the patients (n = 82, 95% confidence interval, 67.8 to 83.6). Forty-five patients (42.1%) had no imaging studies before the unplanned procedure. In the RCA, the most notable obstacles found were (1) incorrect assumption of a benign diagnosis, (2) failure to obtain the appropriate imaging study, (3) incorrectly reported imaging studies, (4) failure to order a biopsy, and (5) incorrect reporting of the biopsy. CONCLUSIONS Despite educational efforts, unplanned excisions and the devastating consequences that sometimes follow continue to occur. Orthopaedic surgeons persist in playing a role in the unplanned procedure burden.
Collapse
Affiliation(s)
- Ana Cecilia Belzarena
- From the Department of Orthopedic Surgery, University of Missouri, Columbia, MO (Dr. Belzarena), and the Sarcoma Department, Moffitt Cancer Center, Tampa, FL (Dr. Binitie, Dr. Letson, and Dr. Joyce)
| | - Odion Binitie
- From the Department of Orthopedic Surgery, University of Missouri, Columbia, MO (Dr. Belzarena), and the Sarcoma Department, Moffitt Cancer Center, Tampa, FL (Dr. Binitie, Dr. Letson, and Dr. Joyce)
| | - George Douglas Letson
- From the Department of Orthopedic Surgery, University of Missouri, Columbia, MO (Dr. Belzarena), and the Sarcoma Department, Moffitt Cancer Center, Tampa, FL (Dr. Binitie, Dr. Letson, and Dr. Joyce)
| | - David Michael Joyce
- From the Department of Orthopedic Surgery, University of Missouri, Columbia, MO (Dr. Belzarena), and the Sarcoma Department, Moffitt Cancer Center, Tampa, FL (Dr. Binitie, Dr. Letson, and Dr. Joyce)
| |
Collapse
|
6
|
Novillo-Casal D, Mandía-Mancebo FJ, Jorge-Mora AA, González-García J, de Castro-Carrasco A. Unplanned excision of soft tissue sarcomas of the musculoskeletal system. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:18-25. [PMID: 36841328 DOI: 10.1016/j.recot.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/12/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023] Open
Abstract
INTRODUCTION The diagnosis process of soft tissue sarcomas of the musculoskeletal system (SPBAL) continues to be complex, with cases of unplanned excisions ("whoops" surgeries). This study evaluates the frequency of these type of procedures, trying to indentify patient characteristics, tumors, surgical treatment and final results. MATERIAL AND METHODS 131 patients treated surgically between October 2018 and December 2021 of a SPBAL were retrospectively reviewed. Patients with SPBAL located in the viscera, mediastinum, heart, retroperitoneum, peritoneum and genital tract were excluded. Differences between patients with planned and unplanned excisions were assessed with chi2 tests and a Cox multivariate regression model. RESULTS Unplanned excisions of SPBAL have taken place in 18% of the patients in our área, mainly in tumors of less than 5 cm and located superficial to the fascia. 29,2% of these patients did not have a previous imaging test. It has not been shown that a "whoops" surgery can lead to a decrease in survival or a higher rate of recurrences. CONCLUSIONS We recommend carrying out an imaging test always prior to the removal of any type of soft tissue tumor, as well as adherence to the referral guidelines to reference centers.
Collapse
Affiliation(s)
- D Novillo-Casal
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España.
| | - F J Mandía-Mancebo
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - A A Jorge-Mora
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - J González-García
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - A de Castro-Carrasco
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| |
Collapse
|
7
|
Novillo-Casal D, Mandía-Mancebo FJ, Jorge-Mora AA, González-García J, De Castro-Carrasco A. [Translated article] Unplanned excision of soft tissue sarcomas of the musculoskeletal system. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T18-T25. [PMID: 37981200 DOI: 10.1016/j.recot.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/20/2023] [Indexed: 11/21/2023] Open
Abstract
INTRODUCTION The diagnosis process of soft tissue sarcomas of the musculoskeletal system (SPBAL) continues to be complex, with cases of unplanned excisions ("whoops" surgeries). This study evaluates the frequency of these type of procedures, trying to identify patient characteristics, tumours, surgical treatment and final results. MATERIAL AND METHODS 131 patients treated surgically between October 2018 and December 2021 of a SPBAL were retrospectively reviewed. Patients with SPBAL located in the viscera, mediastinum, heart, retroperitoneum, peritoneum and genital tract were excluded. Differences between patients with planned and unplanned excisions were assessed with Chi2 tests and a Cox multivariate regression model. RESULTS Unplanned excisions of SPBAL have taken place in 18% of the patients in our area, mainly in tumours of less than 5cm and located superficial to the fascia. 29.2% of these patients did not have a previous imaging test. It has not been shown that a "whoops" surgery can lead to a decrease in survival or a higher rate of recurrences. CONCLUSIONS We recommend carrying out an imaging test always prior to the removal of any type of soft tissue tumour, as well as adherence to the referral guidelines to reference centres.
Collapse
Affiliation(s)
- D Novillo-Casal
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Santiago de Compostela, Spain.
| | - F J Mandía-Mancebo
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Santiago de Compostela, Spain
| | - A A Jorge-Mora
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Santiago de Compostela, Spain
| | - J González-García
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Santiago de Compostela, Spain
| | - A De Castro-Carrasco
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Santiago de Compostela, Spain
| |
Collapse
|
8
|
Stauss R, Aigner A, Richter A, Suero E, Altemeier A, Savov P, Ettinger M, Omar M. The prognostic significance of surgical resection margins for local recurrence, distant metastasis, and overall survival in sarcoma. J Surg Oncol 2023; 128:1160-1170. [PMID: 37530536 DOI: 10.1002/jso.27411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/16/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Surgical resection with microscopically negative margins constitutes one of the key elements of a curative therapeutic approach for localized sarcomas. However, the prognostic value of quantitative margin width remains controversial. We sought to determine the prognostic significance of margin status and margin width for local recurrence (LR), distant recurrence (DR), and overall survival. METHODS Retrospective analysis of 210 patients undergoing resection of localized sarcoma between 1997 and 2018 at a national sarcoma reference center. RESULTS Logistic regression did not reveal an effect of metric margin width as a prognostic factor for LR (odds ratio [OR] = 0.98, p = 0.574), DR (OR = 1, p = 0.908), or overall survival (hazard ratio = 0.98, 95% confidence interval = 0.73-1.20, p = 0.609). Subgroup analysis revealed no differences between complete first resections (R0) and re-resections (re-R0) following unplanned R1-resections for LR (p = 0.727) and overall survival (p = 0.125), but a significantly higher DR-rate in re-R0 cases (p = 0.022). CONCLUSIONS Achieving a negative margin is essential in sarcoma surgery, however, metric margin width was not associated with disease-specific outcomes. Re-resection of unplanned R1-resections should be performed to control for LR and overall survival rates. As re-R0 cases were at significantly higher risk of DR, these patients should be followed up closely in standardized surveillance protocols.
Collapse
Affiliation(s)
- Ricarda Stauss
- Hannover Medical School, Department of Trauma Surgery, Hannover, Germany
- University of Oldenburg, Department of Orthopaedic and Trauma Surgery, Pius Hospital, Oldenburg, Germany
| | - Alexander Aigner
- Hannover Medical School, Department of Trauma Surgery, Hannover, Germany
| | - Alena Richter
- Hannover Medical School, Department of Orthopaedic Surgery, Hannover, Germany
| | - Eduardo Suero
- Ludwig-Maximilians-University, Department of General Trauma and Reconstructive Surgery, Munich, Germany
| | - Anna Altemeier
- University of Oldenburg, Department of Orthopaedic and Trauma Surgery, Pius Hospital, Oldenburg, Germany
| | - Peter Savov
- University of Oldenburg, Department of Orthopaedic and Trauma Surgery, Pius Hospital, Oldenburg, Germany
| | - Max Ettinger
- University of Oldenburg, Department of Orthopaedic and Trauma Surgery, Pius Hospital, Oldenburg, Germany
| | - Mohamed Omar
- Hannover Medical School, Department of Trauma Surgery, Hannover, Germany
| |
Collapse
|
9
|
Chung YL, Huang TT, Chen CF. Differential impacts of initial treatment status on long-term survival in patients with sarcomas treated in a referral center according to histologic type and anatomic site. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106927. [PMID: 37149404 DOI: 10.1016/j.ejso.2023.05.002] [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: 01/30/2023] [Revised: 04/07/2023] [Accepted: 05/02/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE The aim of this work was to estimate the magnitude of the differential impacts of initial treatment status relative to the impact of classic clinicopathologic factors on the long-term overall survival (OS) of sarcoma patients in a referral cancer center. METHODS From the institutional database, we identified 2185 patients who presented to the institutional multidisciplinary team (MDT) prior to (N = 717, 32.8%) or after (N = 1468, 67.2%) initial treatment, with a first diagnosis of sarcoma from January 1999 to December 2018. Descriptive, univariate and multivariate analyses were applied to identify the factors related to OS. By performing propensity score matching of each completely MDT-treated patient to a referral patient with similar characteristics, the differential impacts of the identified risk and prognostic factors on OS in the 2 groups were estimated by the Kaplan‒Meier survival curves, log-rank test and Cox proportional hazard regression; the results were compared using calibrated nomograph models and forest plots. RESULTS Adjusted for the clinicopathologic factors of patient age, sex, primary site, tumor grade, tumor size, resection margin and histology, hazard ratio-based modeling analysis indicated that the initial treatment status was an independent but intermediate prognostic factor associated with long-term OS. The major impacts of the initial and comprehensive MDT-based management on significant improvement of the 20-year OS of sarcomas were reflected in the subgroup of patients with stromal, undifferentiated pleomorphic, fibromatous, fibroepithelial, or synovial neoplasms and tumors in the breast, gastrointestinal tract, or soft tissues of limb and trunk. CONCLUSIONS This retrospective study supports early referral of patients with soft tissue masses of unknown identity to a specialized MDT before biopsy and initial resection to reduce the risk of death but highlights an unmet need for a greater understanding of some of the most difficult sarcoma subtypes and subsites and their management.
Collapse
Affiliation(s)
- Yih-Lin Chung
- Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
| | - Tzu-Ting Huang
- Departments of Research, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Cheng-Feng Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| |
Collapse
|
10
|
Acem I, van Praag VM, Mostert CQ, van der Wal RJ, Neijenhuis RM, Verhoef C, Grünhagen DJ, van de Sande MA. Noninvasive detection of soft tissue sarcoma using volatile organic compounds in exhaled breath: a pilot study. Future Oncol 2023; 19:697-704. [PMID: 37129048 DOI: 10.2217/fon-2022-1122] [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] [Indexed: 05/03/2023] Open
Abstract
Aim: The aim of this pilot study was to assess whether an electronic nose can detect patients with soft tissue sarcoma (STS) based on volatile organic compound profiles in exhaled breath. Patients & methods: In this cross-sectional pilot study, patients with primary STS and healthy controls, matched on sex and age, were included for breath analysis. Machine learning techniques were used to develop the best-fitting model. Results: Fifty-nine breath samples were collected (29 STS and 30 control) from March 2018 to March 2022. The final model yielded a c-statistic of 0.85 with a sensitivity of 83% and specificity of 60%. Conclusion: This study suggests that exhaled volatile organic compound analysis could serve as a noninvasive diagnostic biomarker for the detection of STS with a good performance.
Collapse
Affiliation(s)
- Ibtissam Acem
- Department of Surgical Oncology & Gastrointestinal Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, Rotterdam, 3015, GD, The Netherlands
- Department of Orthopedic Oncology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333, ZA, The Netherlands
| | - Veroniek M van Praag
- Department of Orthopedic Oncology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333, ZA, The Netherlands
| | - Cassidy Qb Mostert
- Department of Orthopedic Oncology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333, ZA, The Netherlands
| | - Robert Jp van der Wal
- Department of Orthopedic Oncology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333, ZA, The Netherlands
| | - Ralph Ml Neijenhuis
- Department of Orthopedic Oncology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333, ZA, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology & Gastrointestinal Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, Rotterdam, 3015, GD, The Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology & Gastrointestinal Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, Rotterdam, 3015, GD, The Netherlands
| | - Michiel Aj van de Sande
- Department of Orthopedic Oncology, Leiden University Medical Centre, Albinusdreef 2, Leiden, 2333, ZA, The Netherlands
| |
Collapse
|
11
|
Wang EHM, Araneta KTS, Gaston CLL, Rubio DAT, de Dios AMV, Cañal JPA, Goleta-Dy AN, Alcasabas APA, Odoño EG, Atun JML, Fernando GY, Dimayuga CCD, Quintos AJD. Unplanned Excision of Soft Tissue Sarcomas of the Extremities in a Low-to-Middle-Income Country. Ann Surg Oncol 2023; 30:3681-3689. [PMID: 36800129 PMCID: PMC9936942 DOI: 10.1245/s10434-023-13188-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/14/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Outcomes of unplanned excisions of extremity soft tissue sarcomas (STSE) range from poor to even superior compared with planned excisions in developed countries. However, little is known regarding outcomes in low-to-middle-income countries. This study aimed to determine whether definitively treated STSE patients with a previous unplanned excision have poorer oncologic outcomes compared with those with planned excisions. PATIENTS AND METHODS Using the database of a single sarcoma practice, we reviewed 148 patients with STSE managed with definitive surgery-78 with previous unplanned excisions (UE) and 70 with planned excisions (PE). RESULTS Median follow-up was 4.4 years. UE patients had more surgeries overall and plastic reconstructions (P < 0.001). On multivariate analysis, overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were not worse among UE patients compared with PE patients. Negative predictors for LRFS were high tumor grade (P = 0.031) and an R1 surgical margin (P < 0.001). High grade (P <0.001), local recurrence (P = 0.001), and planned excisions (P = 0.009) predicted poorer DMFS, while age over 65 years (P = 0.011) and distant metastasis predicted poorer OS (P < 0.001). CONCLUSIONS We recommend systematic re-excision for patients with unplanned excisions. Our study shows that STSE patients with UE, when subjected to re-excision with appropriate surgical margins, can achieve oncologic results similar to those for PE patients. However, there is an associated increased number of surgeries and plastic reconstruction for UE patients. This underscores the need, especially in a resource-limited setting, for education and collaborative policies to raise awareness about STSE among patients and physicians.
Collapse
Affiliation(s)
- Edward H. M. Wang
- Department of Orthopedics, Section of Tumor Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | | | - Czar Louie L. Gaston
- Department of Orthopedics, Section of Tumor Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Donnel Alexis T. Rubio
- Department of Orthopedics, Section of Tumor Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Ariel M. Vergel de Dios
- Department of Pathology, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Johanna Patricia A. Cañal
- Department of Radiology, Section of Radiation Oncology, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Amy N. Goleta-Dy
- Department of Pediatrics, Section of Hematologic Oncology, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Ana Patricia A. Alcasabas
- Department of Pediatrics, Section of Hematologic Oncology, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Eugene G. Odoño
- Department of Pathology, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Jenny Maureen L. Atun
- Department of Pathology, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Gracieux Y. Fernando
- Department of Internal Medicine, Section of Medical Oncology, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Cesar Cipriano D. Dimayuga
- Department of Orthopedics, Section of Tumor Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Albert Jerome D. Quintos
- Department of Orthopedics, Section of Tumor Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| |
Collapse
|
12
|
Traweek RS, Martin AN, Rajkot NF, Guadagnolo BA, Bishop AJ, Lazar AJ, Keung EZ, Torres KE, Hunt KK, Feig BW, Roland CL, Scally CP. Re-excision After Unplanned Excision of Soft Tissue Sarcoma is Associated with High Morbidity and Limited Pathologic Identification of Residual Disease. Ann Surg Oncol 2023; 30:480-489. [PMID: 36085392 DOI: 10.1245/s10434-022-12359-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/11/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with unplanned excision (UPE) of trunk and extremity soft tissue sarcoma (STS) present a significant management challenge for sarcoma specialists. Oncologic re-resection has been considered standard practice after UPE with positive or uncertain margins. A strategy of active surveillance or "watch and wait" has been suggested as a safe alternative to routine re-excision. In this context, the current study sought to evaluate short-term outcomes and morbidity after re-resection to better understand the risks and benefits of this treatment strategy. METHODS A retrospective, single-institution study reviewed patients undergoing oncologic re-resection after UPE of an STS during a 5-year period (2015-2020), excluding those with evidence of gross residual disease. Short-term clinical outcomes were evaluated together with final pathologic findings. RESULTS The review identified 67 patients undergoing re-resection after UPE of an STS. Of these 67 patients, 45 (67%) were treated with a combination of external beam radiation therapy (EBRT) and surgery. Plastic surgery was involved for reconstruction in 49 cases (73%). The rate of wound complications after re-resection was 45 % (n = 30), with 15 % (n = 10) of the patients experiencing a major wound complication. Radiation therapy and plastic surgery involvement were independently associated with wound complications. Notably, 45 patients (67%) had no evidence of residual disease in the re-resection specimen, whereas 13 patients (19 %) had microscopic disease, and 9 patients (13%) had indeterminate pathology. CONCLUSION Given the morbidity of re-resection and limited identification of residual disease, treatment plans and discussions with patients should outline the expected pathologic findings and morbidity of surgery.
Collapse
Affiliation(s)
- Raymond S Traweek
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Allison N Martin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nikita F Rajkot
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - B Ashleigh Guadagnolo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Andrew J Bishop
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexander J Lazar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Emily Z Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Keila E Torres
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kelly K Hunt
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Barry W Feig
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christina L Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christopher P Scally
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| |
Collapse
|
13
|
Gil LA, Asti L, Apfeld JC, Sebastião YV, Deans KJ, Minneci PC. Perioperative outcomes in minimally-invasive versus open surgery in infants undergoing repair of congenital anomalies. J Pediatr Surg 2022; 57:755-762. [PMID: 35985848 DOI: 10.1016/j.jpedsurg.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 07/22/2022] [Accepted: 08/03/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study compared perioperative outcomes among infants undergoing repair of congenital anomalies using minimally invasive (MIS) versus open surgical approaches. METHODS The ACS NSQIP Pediatric (2013-2018) was queried for patients undergoing repair of any of the following 9 congenital anomalies: congenital lung lesion (LL), mediastinal mass (MM), congenital malrotation (CM), anorectal malformation (ARM), Hirschsprung disease (HD), congenital diaphragmatic hernia (CDH), tracheoesophageal fistula (TEF), hepatobiliary anomalies (HB), and intestinal atresia (IA). Inverse probability of treatment weights (IPTW) derived from propensity scores were utilized to estimate risk-adjusted association between surgical approach and 30-day outcomes. RESULTS 12,871 patients undergoing congenital anomaly repair were included (10,343 open; 2528 MIS). After IPTW, MIS was associated with longer operative time (difference; 95% CI) (16 min; 9-23) and anesthesia time (13 min; 6-21), but less postoperative ventilation days (-1.0 days; -1.4- -0.6) and shorter postoperative length of stay (-1.4 days; -2.4- -0.3). MIS repairs had decreased risk of any surgical complication (risk difference: -6.6%; -9.2- -4.0), including hematologic complications (-7.3%; -8.9- -5.8). There was no significant difference in risk of complication when hematologic complications were excluded (RD -2.3% [-4.7%, 0.1%]). There were no significant differences in the risk of unplanned reoperation (0.4%; -1.5-2.2) or unplanned readmission (0.2%; -1.2-1.5). CONCLUSIONS MIS repair of congenital anomalies is associated with improved perioperative outcomes when compared to open. Additional studies are needed to compare long-term functional and disease-specific outcomes. MINI-ABSTRACT In this propensity-weighted multi-institutional analysis of nine congenital anomalies, minimally invasive surgical repair was associated with improved 30-day outcomes when compared to open surgical repair. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Lindsay A Gil
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA
| | - Lindsey Asti
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA
| | - Jordan C Apfeld
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA
| | - Yuri V Sebastião
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Division of Global Women's Health, School of Medicine, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Katherine J Deans
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA.
| |
Collapse
|
14
|
Sergeev AN, Maksimov DA, Morozov AM, Belyak MA, Penyaz' EV, Popova MO. Issues of diagnostic search of soft tissue sarcoma. BULLETIN OF THE MEDICAL INSTITUTE "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH) 2022. [DOI: 10.20340/vmi-rvz.2022.6.morph.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Relevance. Soft tissue sarcoma is a heterogeneous group of relatively rare types of tumors, which demonstrates a huge variety of anatomical localization and histopathological characteristics. The rarity of soft tissue sarcomas combined with a variety of subtypes, forms of growth, progression and frequency of relapses makes it difficult to study them, make a correct diagnosis and early referral of patients for specialized care.The purpose of study. To analyze the problem of differential diagnosis of malignant and benign soft tissue neoplasms.Materials and methods. In the course of the work, current literary sources of domestic and foreign authors on a given topic were analyzed.Results. Since it is absolutely impossible to determine the clinical features of the presented sarcoma, soft tissue tumors showing any of the following signs are considered malignant until the opposite is proven: increasing in size, >5 cm, deeply located and/or painful. The greater the number of these clinical signs present, the higher the risk that the soft tissue tumor will turn out to be malignant; at the same time, an increase in size is the best individual indicator. It is worth noting that the absence of concomitant constitutional symptoms, such as fever, chills, night sweats or unintentional weight loss, should not reduce the doctor's suspicion of malignancy.Conclusion. In order to avoid erroneous diagnoses, a standardized diagnostic approach should be followed, starting from the moment of collecting the patient's medical history, clinical examination and ending with the use of appropriate imaging methods and biopsy.
Collapse
|
15
|
Sergeev AN, Maksimov DA, Morozov AM, Belyak MA, Penyaz' EV, Popova MO. Issues of diagnostic search of soft tissue sarcoma. BULLETIN OF THE MEDICAL INSTITUTE "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH) 2022. [DOI: 10.20340/616-006.3.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Relevance. Soft tissue sarcoma is a heterogeneous group of relatively rare types of tumors, which demonstrates a huge variety of anatomical localization and histopathological characteristics. The rarity of soft tissue sarcomas combined with a variety of subtypes, forms of growth, progression and frequency of relapses makes it difficult to study them, make a correct diagnosis and early referral of patients for specialized care.The purpose of study. To analyze the problem of differential diagnosis of malignant and benign soft tissue neoplasms.Materials and methods. In the course of the work, current literary sources of domestic and foreign authors on a given topic were analyzed.Results. Since it is absolutely impossible to determine the clinical features of the presented sarcoma, soft tissue tumors showing any of the following signs are considered malignant until the opposite is proven: increasing in size, >5 cm, deeply located and/or painful. The greater the number of these clinical signs present, the higher the risk that the soft tissue tumor will turn out to be malignant; at the same time, an increase in size is the best individual indicator. It is worth noting that the absence of concomitant constitutional symptoms, such as fever, chills, night sweats or unintentional weight loss, should not reduce the doctor's suspicion of malignancy.Conclusion. In order to avoid erroneous diagnoses, a standardized diagnostic approach should be followed, starting from the moment of collecting the patient's medical history, clinical examination and ending with the use of appropriate imaging methods and biopsy.
Collapse
|
16
|
Thomas B, Bigdeli AK, Nolte S, Gazyakan E, Harhaus L, Bischel O, Lehner B, Egerer G, Mechtersheimer G, Hohenberger P, Horch RE, Andreou D, Schmitt J, Schuler MK, Eichler M, Kneser U. The Therapeutic Role of Plastic and Reconstructive Surgery in the Interdisciplinary Treatment of Soft-Tissue Sarcomas in Germany-Cross-Sectional Results of a Prospective Nationwide Observational Study (PROSa). Cancers (Basel) 2022; 14:cancers14174312. [PMID: 36077847 PMCID: PMC9454490 DOI: 10.3390/cancers14174312] [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: 08/08/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The mainstay of soft-tissue-sarcoma treatment remains ablative surgery with complete tumor resection. In this context, reconstructive plastic surgery has become an important aspect of multidisciplinary sarcoma therapy aiming at limb preservation as an alternative to amputations. In this present study, cross-sectional data collected prospectively at 39 study centers across Germany were analyzed, focusing on both the inhouse availability of plastic surgery and external accessibility to plastic surgery in 621 cases. In summary, unplanned and incomplete primary tumor resections carried out at centers with lower degrees of specialization were associated with a significantly increased need for subsequent flap-based defect coverage. In line with this, a readily available team of plastic surgeons was independently associated with successful defect reconstruction, which in turn was associated with significantly higher chances of limb preservation. We conclude that easily accessible plastic surgery and a high degree of expertise in the field of sarcoma treatment are indispensable for limb preservation following sarcoma resection. Plastic and reconstructive surgery therefore plays a vital role in achieving the best possible outcomes in the interdisciplinary treatment of soft-tissue sarcomas. Abstract Although the involvement of plastic surgery has been deemed important in the treatment of sarcoma patients to avoid oncological compromises and ameliorate patient outcomes, it is not ubiquitously available. The accessibility of defect reconstruction and its therapeutic impact on sarcoma care is the subject of this analysis. Cross-sectional data from 1309 sarcoma patients were collected electronically at 39 German study centers from 2017 to 2019. A total of 621 patients with surgical treatment for non-visceral soft-tissue sarcomas were included. The associated factors were analyzed exploratively using multifactorial logistic regression to identify independent predictors of successful defect reconstruction, as well Chi-squared and Cochran–Mantel–Haenszel tests to evaluate subgroups, including limb-salvage rates in extremity cases. A total of 76 patients received reconstructive surgery, including 52 local/pedicled versus 24 free flaps. Sarcomas with positive margins upon first resection (OR = 2.3, 95%CI = 1.2–4.4) that were excised at centers with lower degrees of specialization (OR = 2.2, 95%CI = 1.2–4.2) were independently associated with the need for post-oncological defect coverage. In this context, the inhouse availability of plastic surgery (OR = 3.0, 95%CI = 1.6–5.5) was the strongest independent predictor for successful flap-based reconstruction, which in turn was associated with significantly higher limb-salvage rates (OR = 1.4, 95%CI = 1.0–2.1) in cases of extremity sarcomas (n = 366, 59%). In conclusion, consistent referral to specialized interdisciplinary sarcoma centers significantly ameliorates patient outcomes by achieving higher rates of complete resections and offering unrestricted access to plastic surgery. The latter in particular proved indispensable for limb salvage through flap-based defect reconstruction after sarcoma resection. In fact, although there remains a scarcity of readily available reconstructive surgery services within the current sarcoma treatment system in Germany, plastic and reconstructive flap transfer was associated with significantly increased limb-salvage rates in our cohort.
Collapse
Affiliation(s)
- Benjamin Thomas
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
- Correspondence: (B.T.); (U.K.); Tel.: +49-(621)-6810-2944 (B.T.); +49-(621)-6810-2328 (U.K.)
| | - Amir K. Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Steffen Nolte
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Armed Forces Hospital Ulm, 89081 Ulm, Germany
| | - Emre Gazyakan
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Leila Harhaus
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
| | - Oliver Bischel
- Department of Trauma and Orthopedics, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen, Germany
| | - Burkhard Lehner
- Department of Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Gerlinde Egerer
- Department of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | | | - Peter Hohenberger
- Division of Surgical Oncology, Department of Surgery, Mannheim University Medical Center, University of Heidelberg, 68167 Mannheim, Germany
| | - Raymund E. Horch
- Department of Plastic and Hand Surgery, Comprehensive Cancer Center, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Dimosthenis Andreou
- Department of General Orthopedics and Tumor Orthopedics, University Hospital Münster, 48149 Münster, Germany
- Department of Orthopedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Jochen Schmitt
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus, Technical University Dresden, 01307 Dresden, Germany
| | - Markus K. Schuler
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany
| | - Martin Eichler
- National Center for Tumor Diseases (NCT/UCC), 01307 Dresden, Germany
- Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany
- Correspondence: (B.T.); (U.K.); Tel.: +49-(621)-6810-2944 (B.T.); +49-(621)-6810-2328 (U.K.)
| |
Collapse
|
17
|
Kollender R, Merimsky O, Sternheim A, Gortzak Y, Dadia S, Doron A, Novikov I, Kollender Y, Soyfer V. Radiation Therapy Before the Repeat Wide Resection for Unplanned Surgery of Soft Tissue Sarcoma (“Oops” Operation) Results in Improved Disease-Free Survival. Adv Radiat Oncol 2022; 7:101007. [DOI: 10.1016/j.adro.2022.101007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/22/2022] [Indexed: 10/31/2022] Open
|
18
|
Takemori T, Kawamoto T, Hara H, Fukase N, Fujiwara S, Kitayama K, Yahiro S, Miyamoto T, Mifune Y, Hoshino Y, Kakutani K, Matsumoto T, Matsushita T, Niikura T, Kuroda R, Akisue T. Clinical Outcomes and Prognostic Factors in Soft Tissue Sarcoma Patients After Unplanned Excision. Cancer Manag Res 2022; 14:1815-1824. [PMID: 35642242 PMCID: PMC9148585 DOI: 10.2147/cmar.s364912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/09/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Soft tissue sarcomas (STSs) constitute a group of rare, heterogeneous tumors representing approximately 1% of all cancers. Owing to the rarity and pathological diversity of the disease, unplanned excision (UE) has often been performed for STS, resulting in an unfavorable prognosis. This study aimed to clarify clinical outcomes and prognostic factors in STS patients who underwent UE. Patients and Methods In a retrospective review of the medical records of patients with STS who underwent surgery at our institution between 1999 and 2015, patients were enrolled to either a UE group or a planned excision (PE) group. An analysis was then conducted to identify factors associated with prognosis after UE. Results Of 134 patients undergoing surgery for STS, 110 were enrolled to the PE group and 24 to the UE group. The median size of the primary tumor was significantly smaller, and more lesions were located in the superficial layer in the UE group than in the PE group. In addition, plastic reconstruction after additional radical resection was required significantly more often in the UE group than in the PE group. No significant difference in overall survival, local recurrence-free survival, or disease-free survival (DFS) between the UE and PE groups was observed; however, metastasis-free survival was significantly better in the UE group. In the UE group, poorer DFS was associated with older age (≥61 years) and a larger primary tumor (≥2.9 cm). Conclusion A prognosis similar to that in patients undergoing PE could be achieved by appropriate additional surgeries in patients initially undergoing UE. However, UE for STS should be avoided, especially in older patients and those with a larger primary tumor.
Collapse
Affiliation(s)
- Toshiyuki Takemori
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Teruya Kawamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Division of Orthopaedic Surgery, Kobe University Hospital International Clinical Cancer Research Center, Kobe, Japan
- Correspondence: Teruya Kawamoto, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan, Tel +81-783825985, Fax +81-783516944, Email
| | - Hitomi Hara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naomasa Fukase
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shuichi Fujiwara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumichi Kitayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shunsuke Yahiro
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomohiro Miyamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshihiro Akisue
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
| |
Collapse
|
19
|
Nakamura T, Kawai A, Sudo A. The incidence of unplanned excision in patients with soft tissue sarcoma: Reports from the Bone and Soft Tissue Tumor registry in Japan. J Orthop Sci 2022; 27:468-472. [PMID: 33558102 DOI: 10.1016/j.jos.2020.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Due to their rarity, soft tissue sarcomas (STS)s are often treated surgically as unplanned excisions (UE)s before referral to specialists. The Bone and Soft Tissue Tumor (BSTT) registry is a nationwide, organ-specific cancer registry for bone and soft-tissue tumors in Japan. The aim of this study was to elucidate the incidence and risk factors for UEs using data from the BSTT registry. METHODS Our study comprised 8761 patients with STS including 4826 males and 3935 females, with a mean age of 59 years (range, 0-105 years). Patients were classified into primary STS and UE groups. RESULTS Superficial and deep tumors were found in 2533 and 6120 patients, respectively. The mean STS size was 8.6 cm (range, 0.2-49 cm). We identified 6610 patients with high-grade, and 1758 patients with low-grade STS. Of the total 8761 patients, 7770 patients had primary STSs, whereas 991 patients were referred after undergoing UE. The UE mean incidence rate over 11 years was 11.3%. The UE incidence rates for leiomyosarcoma (LMS) (odds ratio [OR] = 1.75, p < 0.0001), fibrosarcoma (FS) (OR = 2.28, p < 0.0001), and epithelioid sarcoma (OR = 1.82, p = 0.01) were higher than the mean UE incidence rate (11.3%). Of 757 patients who underwent UE, 354 (47%) patients had superficial (≤5 cm) STSs, whereas 156 (20.6%) of patients had deep STSs (>5 cm) (p < 0.0001). Logistic regression analysis revealed that UE was frequently associated with males and small, superficial, and trunk STSs. CONCLUSIONS In the present study, the mean UE incidence rate (11.3%) was significantly different from the individual UE incidence rates of histological diagnoses suggesting that surgeons should consider STS, even with small tumors. Continuous education during training for medical students and surgeons is essential to ensure awareness and correct diagnostic procedures for STS.
Collapse
Affiliation(s)
- Tomoki Nakamura
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-city, Mie, 514-8507, Japan.
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, 104-0045, Japan
| | - Akihiro Sudo
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-city, Mie, 514-8507, Japan
| |
Collapse
|
20
|
Tirotta F, Sayyed R, Jones RL, Hayes AJ. Risk factors for the development of local recurrence in extremity soft-tissue sarcoma. Expert Rev Anticancer Ther 2021; 22:83-95. [PMID: 34822313 DOI: 10.1080/14737140.2022.2011723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Local recurrence (LR) is one of the main pitfalls in surgery for extremities soft tissue sarcoma (eSTS). Achieving clear histopathological margins is the most important factor to reduce the risk of LR, but the ability to do so depends on not only surgical technique but also the interplay between tumor biology, anatomical location and surgical approach. The balance between postoperative morbidity and oncological benefits in reducing the risk of LR needs to be considered. AREAS COVERED This review will cover which etiological factors for the development of eSTS lead to an increased risk of LR and discuss histological subtypes that have a high risk of LR and which surgical and neoadjuvant therapeutic strategies can minimize the risk of LR. EXPERT OPINION The traditional view that surgical radicality always results in low rates of LR, while marginality alone always leads to high rates of relapse, is outdated. In the modern era of surgical oncology, limb salvage and high-level function after resectional surgery are the key surgical goals. The best results are achieved by combining effective neoadjuvant treatments with planned bespoke oncological operations that consider the biological and anatomical factors of each individual sarcoma.
Collapse
Affiliation(s)
- Fabio Tirotta
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Raza Sayyed
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Andrew J Hayes
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
21
|
Nakamura T, Kawai A, Hagi T, Asanuma K, Sudo A. A comparison of clinical outcomes between additional excision after unplanned and planned excisions in patients with soft-tissue sarcoma of the limb : a propensity matching cohort study. Bone Joint J 2021; 103-B:1809-1814. [PMID: 34847719 DOI: 10.1302/0301-620x.103b12.bjj-2021-0037.r1] [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] [Indexed: 01/26/2023]
Abstract
AIMS Patients with soft-tissue sarcoma (STS) who undergo unplanned excision (UE) are reported to have worse outcomes than those who undergo planned excision (PE). However, others have reported that patients who undergo UE may have similar or improved outcomes. These discrepancies are likely to be due to differences in characteristics between the two groups of patients. The aim of the study is to compare patients who underwent UE and PE using propensity score matching, by analyzing data from the Japanese Bone and Soft Tissue Tumor (BSTT) registry. METHODS Data from 2006 to 2016 was obtained from the BSTT registry. Only patients with STS of the limb were included in the study. Patients with distant metastasis at the initial presentation and patients with dermatofibrosarcoma protuberans and well-differentiated liposarcoma were excluded from the study. RESULTS A total of 4,483 patients with STS of the limb were identified before propensity score matching. There were 355 patients who underwent UE and 4,128 patients who underwent PE. The five-year disease-specific survival (DSS) rate was significantly better in the patients who received additional excision after UE than in those who underwent PE. There was no significant difference in local recurrence-free survival (LRFS) between the two groups. After propensity score matching, a new cohort of 355 patients was created for both PE and UE groups, in which baseline covariates were appropriately balanced. Reconstruction after tumour excision was frequently performed in patients who underwent additional excision after UE. There were no significant differences in DSS and LRFS between the patients who underwent PE and those who had an additional excision after UE. CONCLUSION Using propensity score matching, patients with STS of the limb who underwent additional excision after UE did not experience higher mortality and local failure than those who underwent PE. Reconstruction may be necessary when additional excision is performed. Cite this article: Bone Joint J 2021;103-B(12):1809-1814.
Collapse
Affiliation(s)
- Tomoki Nakamura
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine Faculty of Medicine, Tsu, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomohito Hagi
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine Faculty of Medicine, Tsu, Japan
| | - Kunihiro Asanuma
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine Faculty of Medicine, Tsu, Japan
| | - Akihiro Sudo
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine Faculty of Medicine, Tsu, Japan
| |
Collapse
|
22
|
Melis AS, Vos M, Schuurman MS, van Dalen T, van Houdt WJ, van der Hage JA, Schrage YM, Been LB, Bonenkamp JB, Bemelmans MHA, Grünhagen DJ, Verhoef C, Ho VKY. Incidence of unplanned excisions of soft tissue sarcomas in the Netherlands: A population-based study. Eur J Surg Oncol 2021; 48:994-1000. [PMID: 34848102 DOI: 10.1016/j.ejso.2021.11.123] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/09/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Timely recognition of soft tissue sarcomas (STS) remains challenging, potentially leading to unplanned excisions (also known as 'whoops procedures'). This population-based study charted the occurrence of unplanned excisions and identified associated patient, tumour, and treatment-related characteristics. Furthermore, it presents an overview of the outcomes and clinical management following an unplanned excision. METHODS From the Netherlands Cancer Registry (NCR) database, information was obtained on 2187 adult patients diagnosed with STS in 2016-2019 who underwent surgery. Tumours located in the mediastinum, heart or retroperitoneum were excluded, as well as incidental findings. Differences between patients with planned and unplanned excisions were assessed with chi-square tests and a multivariable logistic regression model. RESULTS Overall, unplanned excisions comprise 18.2% of all first operations for STS, with a quarter of them occurring outside a hospital. Within hospitals, the unplanned excision rate was 14.4%. Unplanned excisions were more often performed on younger patients, and tumours unsuspected of being STS prior to surgery were generally smaller (≤5 cm) and superficially located. Preoperative imaging was omitted more frequently in these cases. An unplanned excision more often resulted in positive margins, requiring re-excision. Patients who had an unplanned excision outside of a sarcoma centre were more often discussed at or referred to a sarcoma centre, particularly in case of residual tumour. DISCUSSION Potential improvement in preventing unplanned excisions may be achieved by better compliance to preoperative imaging and referral guidelines, and stimulating continuous awareness of STS among general surgeons, general practitioners and private practices.
Collapse
Affiliation(s)
- Annemarie S Melis
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Melissa Vos
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Melinda S Schuurman
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Thijs van Dalen
- Department of Surgical Oncology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Winan J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jos A van der Hage
- Department of Surgical Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Yvonne M Schrage
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Lukas B Been
- Department of Surgical Oncology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Johannes B Bonenkamp
- Department of Surgical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Marc H A Bemelmans
- Department of Surgical Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Vincent K Y Ho
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
| | | |
Collapse
|
23
|
Fujiwara T, Evans S, Stevenson J, Tsuda Y, Gregory J, Grimer R, Abudu A. Impact of the national sarcoma guidelines on the prevalence and outcome of inadvertent excisions of soft tissue sarcomas: An observational study from a UK tertiary referral centre. Eur J Surg Oncol 2021; 48:533-540. [PMID: 34838395 DOI: 10.1016/j.ejso.2021.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/29/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES This study aims to investigate the impact of the national guideline on the prevalence and outcome in patients with soft-tissue sarcoma (STS) who had undergone inadvertent excisions. METHODS A total of 2336 patients were referred to a tertiary sarcoma centre from six regions (North East, North West, East Midlands, West Midlands, Wales, and South West) in the United Kingdom with a diagnosis of STS between 1996 and 2016, of whom 561 patients (24.0%) had undergone inadvertent excisions. Patients were categorised into two groups of 10-year periods pre and post the National Institute for Health and Clinical Excellence (NICE) guideline implementation in 2006. RESULTS The proportion of inadvertent excisions decreased after the NICE guideline implementation: 27.2% (pre-NICE) versus 19.8% (post-NICE) (p = 0.001). A substantial regional variation (17.4%-34.5%) in the proportion of inadvertent excisions in the pre-NICE era was reduced in the post-NICE era (14.3%-22.4%). The 5-year disease-specific survival was 77.7% (pre-NICE) versus 75.6% (post-NICE) (p = 0.961) and there was a trend toward lower incidence of local recurrence in the post-NICE era; 13.5% (pre-NICE) versus 10.5% (post-NICE) (p = 0.522). Multivariate analyses revealed that residual tumours in re-resection specimens were independently associated with an increased risk of disease-specific mortality (HR, 3.35; p < 0.001) and local recurrence (HR, 1.99; p = 0.017), which was significantly reduced after the NICE guideline implementation (53.2% versus 42.0%; p = 0.022). CONCLUSIONS The NICE guideline implementation reduced the proportion of patients with STS who had undergone inadvertent excisions and residual tumour in re-resection specimens, indicating an improved pre-referral management of STSs.
Collapse
Affiliation(s)
- Tomohiro Fujiwara
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK; Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Scott Evans
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan Stevenson
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Yusuke Tsuda
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan Gregory
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Robert Grimer
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Adesegun Abudu
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
24
|
Müller M, Posch F, Kiem D, Barth D, Horvath L, Stotz M, Schaberl-Moser R, Pichler M, Greil R, Jost PJ, Seeber A, Amann A, Schlick K, Gerger A, Riedl JM. Benefit of second-line therapy for advanced esophageal squamous cell carcinoma: a tri-center propensity score analysis. Ther Adv Med Oncol 2021; 13:17588359211039930. [PMID: 34616490 PMCID: PMC8488508 DOI: 10.1177/17588359211039930] [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: 03/25/2021] [Accepted: 07/26/2021] [Indexed: 12/24/2022] Open
Abstract
Background The level of evidence for palliative second-line therapy in advanced esophageal squamous cell carcinoma (aESCC) is limited. This is the first study that reports efficacy data comparing second-line therapy + active symptom control (ASC) versus ASC alone in aESCC. Methods We conducted a tri-center retrospective cohort study (n = 166) including patients with aESCC who had experienced disease progression on palliative first-line therapy. A propensity score model using inverse probability of treatment weighting (IPTW) was implemented for comparative efficacy analysis of overall survival (OS) in patients with second-line + ASC (n = 92, 55%) versus ASC alone (n = 74, 45%). Results The most frequent second-line regimens used were docetaxel (36%) and paclitaxel (18%). In unadjusted primary endpoint analysis, second-line + ASC was associated with significantly longer OS compared with ASC alone [hazard ratio (HR) = 0.49, 95% confidence interval (CI): 0.35-0.69, p < 0.0001]. However, patients in the second-line + ASC group were characterized by more favorable baseline features including a better Eastern Cooperative Oncology Group (ECOG) performance status, a longer first-line treatment duration and lower C-reactive protein levels. After rigorous adjusting for baseline confounders by re-weighting the data with the IPTW the favorable association between second-line and longer OS weakened but prevailed. The median OS was 6.1 months in the second-line + ASC group and 3.2 months in the ASC group, respectively (IPTW-adjusted HR = 0.40, 95% CI: 0.24-0.69, p = 0.001). Importantly, the benefit of second-line was consistent across several clinical subgroups, including patients with ECOG performance status ⩾1 and age ⩾65 years. The most common grade 3 or 4 adverse events associated with palliative second-line therapy were hematological toxicities. Conclusion This real-world study supports the concept that systemic second-line therapy prolongs survival in patients with aESCC.
Collapse
Affiliation(s)
- Moritz Müller
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florian Posch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Dominik Kiem
- IIIrd Medical Department of Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectious Disease, Salzburg Cancer Research Institute, Paracelsus Medical University, Salzburg, Austria
| | - Dominik Barth
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Lena Horvath
- Department of Internal Medicine V: Hematology and Oncology, Comprehensive Cancer Center Innsbruck, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Stotz
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Renate Schaberl-Moser
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Martin Pichler
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Richard Greil
- IIIrd Medical Department of Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectious Disease, Salzburg Cancer Research Institute, Paracelsus Medical University, Salzburg, Austria
| | - Philipp J Jost
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Andreas Seeber
- Department of Internal Medicine V: Hematology and Oncology, Comprehensive Cancer Center Innsbruck, Medical University of Innsbruck, Innsbruck, Austria
| | - Arno Amann
- Department of Internal Medicine V: Hematology and Oncology, Comprehensive Cancer Center Innsbruck, Medical University of Innsbruck, Innsbruck, Austria
| | - Konstantin Schlick
- IIIrd Medical Department of Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectious Disease, Salzburg Cancer Research Institute, Paracelsus Medical University, Salzburg, Austria
| | - Armin Gerger
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jakob M Riedl
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz 8036, Austria
| |
Collapse
|
25
|
Salerno KE, Alektiar KM, Baldini EH, Bedi M, Bishop AJ, Bradfield L, Chung P, DeLaney TF, Folpe A, Kane JM, Li XA, Petersen I, Powell J, Stolten M, Thorpe S, Trent JC, Voermans M, Guadagnolo BA. Radiation Therapy for Treatment of Soft Tissue Sarcoma in Adults: Executive Summary of an ASTRO Clinical Practice Guideline. Pract Radiat Oncol 2021; 11:339-351. [PMID: 34326023 DOI: 10.1016/j.prro.2021.04.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE This guideline provides evidence-based recommendations addressing the indications for radiation therapy (RT), sequencing of local therapies, and appropriate dose and planning techniques for management of primary, operable, localized, soft tissue sarcoma (STS) in adults. METHODS The American Society for Radiation Oncology convened a task force to address 5 key questions focused on the use of RT for management of STS. These questions included indications for RT for STS of the extremity and superficial trunk; considerations for sequencing of RT with respect to surgery, dose of RT, appropriate treatment volumes and techniques; and the role of RT in management of retroperitoneal sarcoma. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS Multidisciplinary evaluation and decision making are recommended for all cases of STS. RT is recommended for patients in whom there is increased risk of local recurrence of resected STS, particularly if close or microscopically positive margins are anticipated or have occurred. When RT is indicated, preoperative RT is strongly recommended over postoperative RT. Postoperative RT is conditionally recommended in specific clinical circumstances (eg, uncontrolled pain or bleeding) or when the risk of wound complications outweighs that of late toxicity from RT. Routine use of RT in addition to oncologic resection for retroperitoneal sarcoma is conditionally not recommended. When RT is used for retroperitoneal sarcoma, preoperative RT is recommended, whereas postoperative RT is not recommended. CONCLUSIONS Based on currently published data, the American Society for Radiation Oncology task force has proposed evidence-based recommendations regarding the use of RT for STS in adults. Future studies will ascertain whether alterations in dosing and sequencing may optimize outcomes and quality of life.
Collapse
Affiliation(s)
- Kilian E Salerno
- Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland.
| | - Kaled M Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Elizabeth H Baldini
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Manpreet Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andrew J Bishop
- Department of Radiation Oncology, UT-MD Anderson Cancer Center, Houston, Texas
| | - Lisa Bradfield
- American Society for Radiation Oncology, Arlington, Virginia
| | - Peter Chung
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew Folpe
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota
| | - John M Kane
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ivy Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - John Powell
- Department of Radiation Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Michael Stolten
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Steven Thorpe
- Department of Orthopedic Surgery, UC Davis Medical Center, Sacramento, California
| | - Jonathan C Trent
- Division of Medical Oncology, Sylvester Comprehensive Cancer Center, The University of Miami Health System, Miami, Florida
| | - Maria Voermans
- Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin
| | | |
Collapse
|
26
|
Sacchetti F, Alsina AC, Morganti R, Innocenti M, Andreani L, Muratori F, Scoccianti G, Totti F, Campanacci DA, Capanna R. Re-excision after unplanned excision of soft tissue sarcoma: A systematic review and metanalysis. The rationale of systematic re-excision. J Orthop 2021; 25:244-251. [PMID: 34099954 PMCID: PMC8165293 DOI: 10.1016/j.jor.2021.05.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/09/2021] [Indexed: 01/14/2023] Open
Abstract
In Soft Tissue Sarcomas (STS) referral centre many patients have already had an incomplete tumour resection. In the majority of specimen, tumoral residual is detected and linked to a worsen prognosis. Systematic surgical re-resection of the scar tissue area is often performed. Some authors suggested to postpone re-resections until a clinically evident local recurrence is detected. A searching strategy was applied to Pubmed-Central and Ovid Medline. Odds ratio (OR) for local recurrence (LR), distant metastasis (MTS) or overall survival (OS) were calculated comparing patients who had tumour residual to people who hadn't. OR of local recurrences, distant metastasis and OS were calculated in planned vs unplanned-excisions groups. OR to develop a metastasis and OS after a local recurrences were calculated. Residual tumour led to an OR for LR of 3,56, OR of MTS was 3,42; OR of decreased OS was 3,42. Having a LR lead to a OR of 1,55 for MTS and to a OR of decreased OS of 2,32. Patients who underwent a re-excision compared to planned surgery did not have an increased OR of LR and had an OR to develop a MTS of 0,56. Our data confirm that there is a strong correlation between local recurrences, distant relapses and overall survival. Although there is a selection bias; this analysis highlights the optimal oncological outcome in patients who underwent re-resection. The rationale for systematic re-resection after unplanned excision of soft tissue sarcomas is very strong and this treatment remains the gold standard of care in these patients.
Collapse
Affiliation(s)
| | | | - Riccardo Morganti
- Department of Statistics for Clinical Study, University Hospital of Cisanello, Pisa, Italy
| | - Matteo Innocenti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lorenzo Andreani
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Italy
| | - Francesco Muratori
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Guido Scoccianti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesca Totti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Domenico Andrea Campanacci
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Rodolfo Capanna
- Department of Orthopaedic and Trauma Surgery, University of Pisa, Italy
| |
Collapse
|
27
|
Soft-tissue Sarcoma of the Hand: Patient Characteristics, Treatment, and Oncologic Outcomes. J Am Acad Orthop Surg 2021; 29:e297-e307. [PMID: 32932303 DOI: 10.5435/jaaos-d-20-00434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/28/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The aim of this study was to describe patient characteristics, treatment, and oncologic outcomes of soft-tissue sarcomas (STSs) of the hand. METHODS Sixty-nine STSs of the hand in adult patients treated at a tertiary referral center were retrospectively included. We describe patient and tumor characteristics along with oncologic outcomes. RESULTS Epithelioid sarcoma (23%) was the most common histologic subtype, followed by synovial sarcoma (15%). Of all tumors, 17 (25%) were grade I, 22 (32%) were grade II, and 30 (44%) were grade III. The 5-year disease-free survival for epithelioid sarcomas was 75% with a disease survival of 100%, along with a metastatic rate of 15%. Of the patients with a synovial sarcoma, 40% developed metastases, and the 5-year disease-free survival was 68% and the 5-year disease survival was 73%. CONCLUSION Hand STSs are aggressive tumors with a high metastatic potential. Even with adequate oncologic treatment, long-term clinical follow-up (10 years) in these tumors is advised. The treating surgical oncologist should not be deceived by their smaller size.
Collapse
|
28
|
Danieli M, Barretta F, Fiore M, Radaelli S, Sangalli C, Barisella M, Stacchiotti S, Palassini E, Miceli R, Callegaro D, Casali PG, Gronchi A. Unplanned Excision of Extremity and Trunk Wall Soft Tissue Sarcoma: To Re-resect or Not to Re-resect? Ann Surg Oncol 2021; 28:4706-4717. [PMID: 33511543 DOI: 10.1245/s10434-020-09564-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/21/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE The need for systematic reexcision in patients who underwent unplanned excision (UE) for extremity and superficial trunk soft tissue sarcoma (ESTSTS) has been questioned. We investigated the outcome of patients who underwent reexcision for ESTSTS compared with primarily resected at our institution and the prognostic impact of microscopic residual disease (MR) in the reexcision specimen. METHODS Primary ESTSTS patients surgically treated at our institution between 1997 and 2017 were divided in three groups: primarily resected (A), reexcised after macroscopically complete UE (B), and incomplete UE (C). Weighted overall survival (OS), crude cumulative incidence of local relapse (CCI-LR), and distant metastasis (CCI-DM) were calculated and compared. In group B, multivariable models were performed to assess factors associated with the outcomes. RESULTS A total of 1962 patients were identified: 1076, 697 and 189 in groups A, B, and C, respectively. Overall median follow-up was 85 months. Seven-year weighted-OS was 73.8%, 84.1%, and 80.7% (p < 0.001) for groups A, B, and C respectively. Seven-year CCI-LR and DM were 5.0% and 25.3%, 12.1% and 15.8%, and 13.6% and 29.4% (both p < 0.001) for groups A, B, and C, respectively. At multivariable analysis, the presence MR was associated with LR (p < 0.001) but not with OS nor CCI-DM. CONCLUSIONS UE and the presence of MR at pathology in reexcision specimen are associated to a higher risk of LR but not to a higher risk of DM or lower OS. After macroscopic complete UE, postponing reexcision until a LR occurs may be considered on an individualized basis.
Collapse
Affiliation(s)
- Maria Danieli
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Barretta
- Department of Clinical Epidemiology and Trial Organisation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Radaelli
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Sangalli
- Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Barisella
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Palassini
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosalba Miceli
- Department of Clinical Epidemiology and Trial Organisation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Giovanni Casali
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| |
Collapse
|
29
|
Liang Y, Guo TH, Xu BS, Hong DC, Qiu HB, Zhou ZW, Zhang X. The Impact of Unplanned Excision on the Outcomes of Patients With Soft Tissue Sarcoma of the Trunk and Extremity: A Propensity Score Matching Analysis. Front Oncol 2021; 10:617590. [PMID: 33552992 PMCID: PMC7862753 DOI: 10.3389/fonc.2020.617590] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/18/2020] [Indexed: 11/27/2022] Open
Abstract
Background Unplanned excision (UPE) of soft tissue sarcoma (STS) is often chosen in the early phase by general physicians without any radiological evaluation. Purpose The present study aimed to evaluate the impact of UPE on the clinical outcomes of patients with STS of the trunk and extremity. Materials and Methods Patients with STS of the trunk and extremity who underwent R0 resection between 1998 and 2016 were included and divided into the UPE and planned excision (PE) groups. Propensity score matching (PSM) was used to control the selection bias. The endpoints were disease-specific survival (DSS), local recurrence-free survival (LRFS), and metastasis-free survival (MFS). Results In total, 458 patients (277 males, 181 females; median age: 43 years) were included: 329 (71.8%) in the PE group and 129 (28.2%) in the UPE group. The follow-up time ranged from 7.1 to 313.78 months, with a median of 112.18 months. UPE patients were more likely to have a smaller or superficial lesion and were more frequently administered adjuvant therapy. After PSM, compared with the PE group, the UPE group had a longer LRFS (P=0.015), but there was no difference between the two groups regarding DSS and MFS. Residual disease was observed in 77.5% of the re-resected specimens in the UPE group and was a risk factor for DSS (P = 0.046) and MFS (P = 0.029) but was not associated with local recurrence (LR) (P=0.475) or LRFS (P=0.334). Moreover, we found no difference in DSS, LRFS or MFS according to the interval from UPE to definitive resection. Conclusion STS treated with UPE had distinct characteristics. Patients who undergo UPE followed by an additional wide R0 resection have similar oncological survival compared to patients who undergo an initial PE, although the high incidence of residual tumor in the UPE group leads to an unfavorable clinical course.
Collapse
Affiliation(s)
- Yao Liang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Tian-Hui Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Melanoma and Sarcoma Medical Oncology Unit, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Bu-Shu Xu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Melanoma and Sarcoma Medical Oncology Unit, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Dong-Chun Hong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Melanoma and Sarcoma Medical Oncology Unit, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hai-Bo Qiu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhi-Wei Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xing Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Melanoma and Sarcoma Medical Oncology Unit, Sun Yat-sen University Cancer Center, Guangzhou, China
| |
Collapse
|
30
|
Calleja M, Afzaal Q, Saifuddin A. The safety of primary surgical excision of small deep indeterminate musculoskeletal soft tissue masses. Br J Radiol 2021; 94:20200713. [PMID: 33095649 DOI: 10.1259/bjr.20200713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the suitability of primary excision of small indeterminate deep soft tissue masses presenting to a tertiary musculoskeletal oncology service. METHODS AND MATERIALS Review of all patients referred to a specialist musculoskeletal oncology service over a 20-month period with a deep indeterminate soft tissue mass by non-contrast MRI criteria that was recommended for primary surgical excision due to relatively small size (<30 mm). Data collected included age, gender, site and maximal size of the lesion, and final histological diagnosis for excised lesions. RESULTS 85 patients were included, mean lesion size being 12 mm (range 5-29 mm). Primary surgical resection had been undertaken in 69 cases (81.2%) by the conclusion of data collection, 36 males and 33 females with mean age of 45.6 years (range 11-80 years). Of these, 11 cases (15.9%) were non-neoplastic, 53 (76.8%) were benign, 1 (1.4%) was intermediate grade, while 4 (5.8%) were malignant including 3 synovial sarcomas. Two of these were treated with re-excision of the tumour bed showing no residual disease, with no evidence of local recurrence at a mean of 10.7 months post-excision. CONCLUSION Primary surgical excision of small deep soft tissue masses that are indeterminate by non-contrast MRI criteria is considered a safe procedure when undertaken in a specialist musculoskeletal oncology service, with only 4 of 69 cases (5.8%) being malignant. ADVANCES IN KNOWLEDGE Small indeterminate deep soft tissue masses can safely be treated with primary excision in the setting of a specialist musculoskeletal oncology service.
Collapse
Affiliation(s)
- Michèle Calleja
- Department of Radiology, Royal National orthopaedic Hospital, Brockley Hill, Stanmore, London, UK
| | - Qasim Afzaal
- Department of Urology, Northampton General Hospital, Cliftonville, Northampton, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National orthopaedic Hospital, Brockley Hill, Stanmore, London, UK
| |
Collapse
|
31
|
Hoftiezer YAJ, Lans J, Freniere BB, Eberlin KR, Chen NC, Lozano-Calderón SA. Factors associated with 30-day soft tissue complications following upper extremity sarcoma surgery. J Surg Oncol 2020; 123:521-531. [PMID: 33333594 DOI: 10.1002/jso.26311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 10/18/2020] [Accepted: 11/09/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES The incidence of soft tissue complications following sarcoma surgery in the upper extremity is reportedly high. Therefore, this study assessed the National Surgical Quality Improvement Program (NSQIP) database to identify independent risk factors, while also reporting the incidence of soft tissue complications in the first 30 days after surgery. METHODS A total of 620 patients that underwent surgical treatment for upper extremity sarcoma were included from the NSQIP database. Soft tissue complications were defined as surgical site infection, wound dehiscence, or soft-tissue related reoperations. Clinically relevant patient and treatment characteristics were selected and analyzed. RESULTS The 30-day soft tissue complication rate was 4.7%. In the multivariable analysis, higher body mass index (p = .047) and longer operative times (p = .002) were independently associated with soft tissue complications. CONCLUSIONS Higher body mass index and longer operative times are risk factors for soft tissue complications following upper extremity sarcoma surgery. The soft-tissue complication rate following resection of upper extremity tumors is low in this national cohort, possibly due to the relatively small tumor size and low prevalence of radiotherapy.
Collapse
Affiliation(s)
- Yannick A J Hoftiezer
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jonathan Lans
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brian B Freniere
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kyle R Eberlin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Neal C Chen
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | |
Collapse
|
32
|
Improta L, Valeri S, Alloni R, Pagnoni C, Mallozzi Santa Maria F, Brunetti B, Greco C, Aprile I, Maselli M, Vincenzi B, Gronchi A. Locally recurrent extraskeletal myxoid chondrosarcoma of the shoulder: a case of complete neoadjuvant radiotherapy response. Clin Sarcoma Res 2020; 10:27. [PMID: 33308312 PMCID: PMC7731621 DOI: 10.1186/s13569-020-00150-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue tumor that typically affects the lower limbs of men between the ages of 50 and 60. EMC of the shoulder is rare with a high risk of local recurrence and distant metastasis. A planned surgical excision in sarcoma referral centers (SRCs) is mandatory to obtain the best outcome. The role of chemotherapy (CHT) and Radiotherapy (RT) on soft tissue chondrosarcoma is still controversial. CASE PRESENTATION A 47-year-old man presented to our referral center with a history of EMC in the right shoulder excised with microscopic positive surgical margins in a non-referral center. Staging imaging exams did not reveal distant metastasis or residual disease, but during follow-up a local recurrence was detected. After a multidisciplinary discussion, preoperative radiotherapy was administered with a total dose of 50 Gy, and then the patient underwent wide surgical excision. Histological examination was negative for viable tumor cells. No relapse occurred in a 24-months post-operative follow up. CONCLUSIONS The case here described suggests the importance of patient's management in SRCs. A planned combined treatments with both surgery and RT seems to be the best choice to improve local control. RT seems to be promising within this specific histotype. Further studies are needed to confirm if the observed efficacy of combined treatments reflects in a consistent survival benefit for EMC patients.
Collapse
Affiliation(s)
- Luca Improta
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Roma, RM, Italy
| | - Sergio Valeri
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Roma, RM, Italy.
| | - Rossana Alloni
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Roma, RM, Italy
| | - Chiara Pagnoni
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Roma, RM, Italy
| | | | - Beniamino Brunetti
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Roma, RM, Italy
| | - Carlo Greco
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Roma, RM, Italy
| | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
| | - Mirella Maselli
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Roma, RM, Italy
| | - Bruno Vincenzi
- Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Roma, RM, Italy
| | - Alessandro Gronchi
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian, 1, 20133, Milan, MI, Italy
| |
Collapse
|
33
|
Callegaro D, Raut CP, Keung EZ, Kim T, Le Pechoux C, Martin-Broto J, Gronchi A, Swallow C, Gladdy R. Strategies for care of patients with gastrointestinal stromal tumor or soft tissue sarcoma during COVID-19 pandemic: A guide for surgical oncologists. J Surg Oncol 2020; 123:12-23. [PMID: 33022754 PMCID: PMC7675701 DOI: 10.1002/jso.26246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 12/15/2022]
Abstract
The coronavirus disease-2019 (COVID-19) pandemic is deeply impacting the accessibility of cancer patients to surgery. In resource-limited conditions, the standard of care might not be deliverable, but evidence to support alternative management strategies often exists. By revisiting available treatment options, this review provides surgical oncologists with an evidence-based framework for treating patients with gastrointestinal stromal tumor, extremity/truncal soft tissue sarcoma, and retroperitoneal sarcoma to rapidly adapt their decision-making to the constant evolution of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Dario Callegaro
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Emily Z Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Teresa Kim
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | | | - Javier Martin-Broto
- Medical Oncology Department in University Hospital Virgen del Rocio and Institute of Biomedicine of Sevilla (IBIS) (HUVR, CSIC), University of Sevilla, Sevilla, Spain
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Carol Swallow
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Rebecca Gladdy
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
34
|
Gilg MM, Sunitsch S, Leitner L, Bergovec M, Szkandera J, Leithner A, Liegl-Atzwanger B. Tumor-associated mortality and prognostic factors in myxofibrosarcoma - A retrospective review of 109 patients. Orthop Traumatol Surg Res 2020; 106:1059-1065. [PMID: 32778437 DOI: 10.1016/j.otsr.2020.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Myxofibrosarcoma (MFS) is one of the most common sarcoma subtype in elderly patients. They are reported to recur locally independently of the tumour grade in 30-40% of cases and metastases are reported to develop in high-grade tumours in 20-35% cases. As MFS is a rare diagnosis, data investigating specific survival and independent risk factors are lacking and have mostly been limited to single orthopaedic oncology centre studies so far. Thus we set up a pathology-based retrospective study and analyzed all MFS diagnosed in our institution with the following aims: (1) analysis of independent risk factors for overall survival, disease specific survival, local recurrence-free survival and distant metastasis free survival following resection of MFS; (2) analysis of resection margin status. HYPOTHESIS High-grade MFS have a low survival distant metastasis free survival and local recurrence free survival is dependent on surgical margin status. PATIENTS AND METHODS We retrospectively analysed 109 patients (median 66 years [range, 21-96]) diagnosed with MFS and a median follow-up of 42 months at one centre between 1990 and 2014. Tumor-associated survival, including competing risk analysis, and prognostic factors for local recurrence, metastatic disease and death from disease were investigated and included in a multivariate analysis. RESULTS Overall survival was 79% [95%CI: 71.9-87.5] at 3 years and 76% [95%CI: 67.4-84.6] at 5 years. Disease specific survival was 85% [95%CI: 78.4-92.2] at 3 years and 80% [95%CI: 72.2-88.2] at 5 years. There were local recurrences in 11/109 patients (10%). Local recurrence free survival (LRFS) was 95% [95%CI: 92.0-99.8] at 3 and 88% [95%CI: 84.3-96.4] at 5 years. Metastatic disease (n=25; 23%) occurred after a median follow-up of 10 months. Distant metastasis free survival was 78% [95%CI: 69.9-85.9] at 3 and 77% [95%CI: 68.4-84.8] at 5 years. R1 status at primary resection was an independent risk factor for decreased Local Recurrence-free survival (OR: 8.5, 95%CI: 1.59-49.79 [p=0.01]). Grading was an independent risk factor for decreased Disease specific survival (OR 13.4, 95%CI: 1.65-1734.84 [p=0.01]) and Distant metastasis free survival (OR 16.2, 95%CI: 2.0-2110.5 [p=0.004]). Primary resection achieved R0 margins in 63 (58%) of 109 patients. Margins were adequate significantly more often (p<0.001) in patients treated primarily at a sarcoma centre (R0=58/68, 85%) than in those treated primarily at non-sarcoma centres (R0= 5/41, 12%), whereby the latter significantly more often treated superficial tumours (p=0.001) with a size of less than 5cm (p<0.001). DISCUSSION Patients with high-grade MFS had a poorer prognosis with respect to Disease specific survival/Distant metastasis free survival than low-grade MFS. Local recurrence did not significantly affect disease specific survival. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Magdalena M Gilg
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 6, 8036 Graz, Austria.
| | - Sandra Sunitsch
- Institute of Pathology, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria
| | - Lukas Leitner
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 6, 8036 Graz, Austria
| | - Marko Bergovec
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 6, 8036 Graz, Austria
| | - Joanna Szkandera
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Andreas Leithner
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 6, 8036 Graz, Austria
| | | |
Collapse
|
35
|
Erol B, Baysal Ö. Does Unplanned Soft Tissue Sarcoma Surgery Have a Negative Effect on Prognosis? J INVEST SURG 2020; 35:38-43. [PMID: 32862737 DOI: 10.1080/08941939.2020.1813852] [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: 01/23/2023]
Abstract
BACKGROUND We aimed to compare the oncological outcomes of patients who underwent re-excision following unplanned surgery and those who underwent planned surgery. METHODS Patients who were referred to our hospital after a mass was inappropriately resected and reported to have a malignant pathology with a positive surgical margin, as well as patients diagnosed with malignant soft tissue tumors, and operated on following a multidisciplinary assessment and staging between 2012 and 2018. All patients were followed up at least 6 months. RESULTS Our study included a total of 125 patients. Forty percent (n = 50) underwent unplanned excision and sixty percent (n = 75) underwent planned excision.There was no statistically significant difference in the survival curves between the two groups (p = 0.248). Tumor size was larger, and the rate of deep-localized tumors was higher in patients undergoing planned surgery than in the unplanned surgery group (p = 0.001). The rate of tumors localized in the upper extremities was significantly higher in the unplanned surgery group than in the planned surgery (p = 0.033). MRI examinations could detect residual tumors with an accuracy of 80%. Age (>48 years), tumor size (>8 cm), tumor grade (grade 3), and distant organ metastasis at follow-up, which were among risk factors found to have a significant effect on mortality. CONCLUSION Patients undergoing re-excision after an inappropriate resection and undergoing planned resection had a similar prognosis. Superficial, upper extremity-localized, and relatively small-size tumors are more prone to inadequate surgical resection. MRI can be used to detect residual tumors at a high rate in patients who have undergone unplanned surgery. Distant organ metastasis is the most important factor affecting survival.
Collapse
Affiliation(s)
- Bülent Erol
- Department of Orthopaedic and Traumatology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Özgür Baysal
- Department of Orthopaedic and Traumatology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
36
|
Estimation versus measurement of the glomerular filtration rate for kidney function assessment in patients with cancer undergoing cisplatin-based chemotherapy. Sci Rep 2020; 10:11219. [PMID: 32641710 PMCID: PMC7343883 DOI: 10.1038/s41598-020-68010-5] [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: 03/19/2019] [Accepted: 05/29/2020] [Indexed: 01/07/2023] Open
Abstract
Glomerular filtration rate (GFR) assessment is indicated before every administration of cisplatin. The optimal modality for this purpose [GFR measurement by urinary Creatinine Clearance (uCrCl) versus GFR estimation (eGFR) by the CKD-EPI formula versus both] is unclear. We investigated whether eGFR only is safe in this setting. Paired uCrCl and eGFR determinations from 470 cisplatin cycles from 121 patients were analyzed [median age: 55 years; most frequent tumor site: genitourinary (45%); palliative treatment: n = 41 (34%)]. Primary endpoint was the proportion of cycles with uCrCl < 50 ml/min/1.73m2 and eGFR ≥ 50 ml/min/1.73m2 (i.e. a "false negative" result when only determining eGFR). The primary endpoint occurred in 8 of 470 cisplatin cycles (1.7%, 95%CI 0.5-2.9). In all 8 events, uCrCl was lower than eGFR (mean uCrCl vs. eGFR: 43 versus 112 ml/min/1.73m2). The uCrCl was re-measured in all patients, and showed normal results in all but 1 patient. None of these events precluded the administration of cisplatin at the planned date, and no subsequent cases of acute nephrotoxicity occurred. Overall agreement between uCrCl and eGFR was low, with qualitative analysis suggesting frequent incompliance with 24-h urine collection. We conclude that an eGFR is sufficient for assessing kidney function in patients with cancer undergoing cisplatin therapy.
Collapse
|
37
|
Gamboa AC, Gronchi A, Cardona K. Soft-tissue sarcoma in adults: An update on the current state of histiotype-specific management in an era of personalized medicine. CA Cancer J Clin 2020; 70:200-229. [PMID: 32275330 DOI: 10.3322/caac.21605] [Citation(s) in RCA: 253] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 12/13/2022] Open
Abstract
Soft-tissue sarcomas (STS) are rare tumors that account for 1% of all adult malignancies, with over 100 different histologic subtypes occurring predominately in the trunk, extremity, and retroperitoneum. This low incidence is further complicated by their variable presentation, behavior, and long-term outcomes, which emphasize the importance of centralized care in specialized centers with a multidisciplinary team approach. In the last decade, there has been an effort to improve the quality of care for patients with STS based on anatomic site and histology, and multiple ongoing clinical trials are focusing on tailoring therapy to histologic subtype. This report summarizes the latest evidence guiding the histiotype-specific management of extremity/truncal and retroperitoneal STS with regard to surgery, radiation, and chemotherapy.
Collapse
Affiliation(s)
- Adriana C Gamboa
- Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, Georgia
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Kenneth Cardona
- Division of Surgical Oncology, Winship Cancer Institute, Emory University Hospital Midtown, Atlanta, Georgia
| |
Collapse
|
38
|
Smolle MA, Schaffler A, Leithner A, Van Praag VM, Bergovec M, Szkandera J, Liegl-Atzwanger B, Niethard M, Tunn PU, Van De Sande M, Andreou D. Incidence, treatment and outcome of abdominal metastases in extremity soft tissue sarcoma: Results from a multi-centre study. J Surg Oncol 2020; 121:605-611. [PMID: 32003475 PMCID: PMC7065201 DOI: 10.1002/jso.25856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 01/16/2020] [Indexed: 01/12/2023]
Abstract
Background and Objectives Abdominal metastases (AM) from soft tissue sarcoma (STS) are rare and prognosis is poor. The aims of the study were to (a) identify risk factors for the development of AM and to (b) investigate the outcome of AM‐patients. Methods Seven‐hundred‐sixty‐nine STS‐patients with localised disease at diagnosis treated at three tumour centres (2000‐2016) were retrospectively included (409 males; mean age, 55.6 years [range, 8‐96 years]; median follow‐up, 4.1 years [interquartile‐range, 2.5‐6.6 years]). Results Two‐hundred‐two patients (26.3%) developed secondary metastases, and 24 of them AM (3.1%). Ten patients developed first AM (FAM) after a mean of 2.4 years and 14 patients late AM (LAM, after being diagnosed with metastases to other sites) after a mean of 2.0 years. Patients with liposarcoma had a significantly higher risk of developing AM (P = .007), irrespective of grading. There was no difference in post‐metastasis‐survival (PMS) between patients with AM at any time point and those with metastases to other sites (P = .585). Patients with LAM or FAM showed no difference in post‐abdominal‐metastasis‐survival (P = .884). Conclusions Survival in patients with AM is poor, irrespective of whether they develop secondarily to other metastases or not. Patients at high‐risk of AM (ie, liposarcoma) may be followed‐up regularly by abdominal‐ultrasound/CT.
Collapse
Affiliation(s)
- Maria A Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | | | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Veroniek M Van Praag
- Department of Orthopaedics, Leiden University Medical Centre, ZA Leiden, The Netherlands
| | - Marko Bergovec
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Joanna Szkandera
- Division of Clinical Oncology, Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Maya Niethard
- Department of Orthopaedic Oncology, HELIOS-Klinikum Berlin-Buch, Berlin, Germany
| | - Per-Ulf Tunn
- Department of Orthopaedic Oncology, HELIOS-Klinikum Berlin-Buch, Berlin, Germany
| | - Michiel Van De Sande
- Department of Orthopaedics, Leiden University Medical Centre, ZA Leiden, The Netherlands
| | - Dimosthenis Andreou
- Tumour Orthopaedics and Sarcoma Surgery, HELIOS Klinikum Bad Saarow, Bad Saarow, Germany
| |
Collapse
|
39
|
Oncological outcome, functional results and costs after unplanned excision of musculoskeletal soft tissue sarcoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:898-904. [PMID: 32037016 DOI: 10.1016/j.ejso.2020.01.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/05/2020] [Accepted: 01/17/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Treatment of soft tissue sarcomas (STS) should only be initiated once the diagnosis is fully established. Resection of tumors of unknown nature should be avoided. Nevertheless, specialized centers continue to face numbers of unplanned excisions (UPE) in STS. AIM To compare oncologic and functional outcomes, number of surgeries, length of hospital stay and treatment costs of UPE versus planned excision (PE) in STS. METHOD A retrospective single tertiary center study was performed on 201 patients. Survival, local and distant recurrence rates were compared between PE (n = 137) and UPE (n = 64). In a subgroup analysis of 60 patients, functional outcome (MSTS and TESS scores), and socio-economic impact (number of surgeries, length of hospital stay and treatment costs) in "functional planned excision" (fPE) group (n = 30) and "functional unplanned excision" (fUPE) group (n = 29) were compared. RESULTS There was no significant difference in oncological outcome between PE and UPE. In the subgroup analysis, we found a non-significant difference in functional outcome. Patients in the fUPE had significantly more surgeries (3.5 vs. 1.4; p < 0.00001) and costs of their management was 64% higher than fPE (p = 0.048). Hospital stay was longer after fUPE but not statistically significant (18.3 days vs. 11.8 days; p = 0.13). CONCLUSION Even though oncological and functional outcomes are comparable after PE and UPE of STS, the number of surgeries, length of hospital stay and treatment costs were higher in patients with UPE. Our data underscore the importance of specialized STS treatment centers including multidisciplinary management.
Collapse
|
40
|
Collignon C, Carton M, Brisse HJ, Pannier S, Gauthier A, Sarnacki S, Tiléa B, Savignoni A, Helfre S, Philippe-Chomette P, Cardoen L, Boccara O, Pierron G, Orbach D. Soft tissue sarcoma in children, adolescents and young adults: Outcomes according to compliance with international initial care guidelines. Eur J Surg Oncol 2019; 46:1277-1286. [PMID: 31839437 DOI: 10.1016/j.ejso.2019.11.518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/14/2019] [Accepted: 11/29/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Outcomes for adults with soft tissue sarcoma are better when managed at referral centers. Care guidelines advise for 5 main criteria: 1-Imaging before biopsy; 2-Tumor biopsy before surgery; 3-Multidiscipinary team discussion (MTD) before biopsy; 4-Biopsy in "expert centers"; 5-Somatic molecular biology feasible. The aim is to describe and assess the prognostic impact of initial management of STS according to the type of referring centers and the number of optimal criteria. METHODS Monocentric retrospective analysis of the management of 127 youths (0-25 years) with localized STS treated from 2006 to 2015. RESULTS Median age at diagnosis was 9.6 years (range: 025). Overall, only 41% patients had 5/5, 28% 3-4, 31% ≤2. No adequate imaging was performed before surgery/biopsy for 18% patients, no biopsy before treatment for 29%. Patients referred by "expert centers" had higher compliance to guidelines (P = 0.025). Upfront surgery was performed in 59/127 patients. Immediate re-operation was inversely related to the number of criteria (0% when 5 criteria vs. 14% for 3-4, 46% if ≤ 2; P < 0.001). For malignant tumors, outcome was better when 5 criteria were reached: 5 year EFS 90.8% (81.4-100.0%) vs. 71.6 for (60.4-84.9%; ≤4 criteria; p = 0.033), OS 93.6% (85.5-100%) vs. 79.5% (68.9-91.8%; p = 0.11), and LRFFS 90.6% (81.0-100.0) vs. 73.1% (62.0-86.3%; p = 0.047). CONCLUSION Less than half of the youths with STS are initially managed according to international guidelines, highlighting the need for better information about optimal management. These results plead for immediate management in reference centers to reduce initial burden of therapy.
Collapse
Affiliation(s)
- C Collignon
- SIREDO Oncology Center Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer Institut Curie, PSL University, Paris, France.
| | - M Carton
- Department of Biostatistics, Institut Curie, PSL University, Paris, France
| | - H J Brisse
- Imaging Department, Institut Curie, Paris, France
| | - S Pannier
- Department of Orthopedic Pediatric Surgery, Necker Enfants Malades Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - A Gauthier
- Department of Pathology, Institut Curie, Paris, France
| | - S Sarnacki
- Department of Pediatric Surgery and Urology, Necker Enfants Malades Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - B Tiléa
- Department of Radiology, Robert Debré́ Hospital, Paris, France
| | - A Savignoni
- Department of Biostatistics, Institut Curie, PSL University, Paris, France
| | - S Helfre
- Department of Radiotherapy, Institut Curie, Paris, France
| | | | - L Cardoen
- Imaging Department, Institut Curie, Paris, France
| | - O Boccara
- Department of Dermatology and Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Université Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, France
| | - G Pierron
- Department of Somatic Genetics, Institut Curie, Paris, France
| | - D Orbach
- SIREDO Oncology Center Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer Institut Curie, PSL University, Paris, France
| |
Collapse
|
41
|
Decanter G, Bonvalot S. ASO Author Reflections: Does a Nonsystematic Regarding Excision Approach After Complete Unplanned Excision of a Soft Tissue Sarcoma Impact Amputation Rate, Metastatic Risk, or Overall Survival? Ann Surg Oncol 2019; 26:768-769. [PMID: 31602576 DOI: 10.1245/s10434-019-07919-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Gauthier Decanter
- Department of Medical Oncology, Oscar Lambret Center, Lille, France. .,Department of Surgical Oncology, Oscar Lambret Center, Lille, France.
| | - Sylvie Bonvalot
- Department of Medical Oncology and Surgery, Gustave Roussy Institute, Villejuif, France
| |
Collapse
|
42
|
Rath B, Hardes J, Tingart M, Braunschweig T, Eschweiler J, Migliorini F. [Resection margins in soft tissue sarcomas]. DER ORTHOPADE 2019; 48:768-775. [PMID: 31463543 DOI: 10.1007/s00132-019-03795-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Soft tissue sarcomas (STS) are a rare and heterogeneous group of malignant tumors that arise from the mesenchymal tissue. STS can form anywhere in the human body, with the extremities being preferred sites of predilection. TREATMENT A fundamental pillar of treatment is the surgical resection of soft tissue sarcomas. The goal is always an R0 resection with a safety margin. There is no consensus in the literature about the desired tumor-free resection margin. The decisive factors for these resection margins are histopathology, presence of anatomical barriers (capsule, tendon, fascia, cartilage, periosteum) and possibilities of (neo-) adjuvant therapy. DISCUSSION References in the literature support the role of resection margins as a predictor of local recurrence. Regarding the role of resection margins in overall survival, available data is divergent. There are known prognostic factors that influence overall survival, such as histological subtype, tumor size, tumor grading, and presence of metastases. So far, several studies have attempted to quantify the margins of resection, but no consensus has been reached, and debates are ongoing. When analyzing all the results of the data in the literature, it seems appropriate to aim for a negative resection margin >1 mm including an anatomical border structure, if possible.
Collapse
Affiliation(s)
- B Rath
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - J Hardes
- Abteilung für Tumororthopädie und Sarkomchirurgie, Westdeutsches Tumorzentrum, Universitätsklinikum Essen, Essen, Deutschland
| | - M Tingart
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - T Braunschweig
- Institut für Pathologie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - J Eschweiler
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - F Migliorini
- Klinik für Orthopädie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| |
Collapse
|
43
|
Decanter G, Stoeckle E, Honore C, Meeus P, Mattei JC, Dubray-Longeras P, Ferron G, Carrere S, Causeret S, Guilloit JM, Fau M, Rosset P, Machiavello JC, Delhorme JB, Regenet N, Gouin F, Blay JY, Coindre JM, Penel N, Bonvalot S. Watch and Wait Approach for Re-excision After Unplanned Yet Macroscopically Complete Excision of Extremity and Superficial Truncal Soft Tissue Sarcoma is Safe and Does Not Affect Metastatic Risk or Amputation Rate. Ann Surg Oncol 2019; 26:3526-3534. [DOI: 10.1245/s10434-019-07494-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Indexed: 01/07/2023]
|
44
|
Lans J, Yue KLC, Castelein RM, Chen NC, Lozano-Calderon SA. Soft tissue sarcoma of the hand: Is unplanned excision a problem? Eur J Surg Oncol 2019; 45:1281-1287. [DOI: 10.1016/j.ejso.2019.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/11/2019] [Accepted: 03/16/2019] [Indexed: 11/16/2022] Open
|
45
|
Nessim C. When Is Watchful Waiting Warranted? Advances in Soft Tissue Sarcoma-An Editorial Commentary. Ann Surg Oncol 2019; 26:3420-3422. [PMID: 31209668 DOI: 10.1245/s10434-019-07496-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Carolyn Nessim
- Department of Surgery, The Ottawa Hospital Research Institute, 501 Smyth Rd, CCW 1617d, Ottawa, ON, K1H 8L6, Canada.
| |
Collapse
|
46
|
Zaidi MY, Ethun CG, Liu Y, Poultsides G, Howard JH, Mogal H, Tseng J, Votanopoulos K, Fields RC, Cardona K. The impact of unplanned excisions of truncal/extremity soft tissue sarcomas: A multi‐institutional propensity score analysis from the US Sarcoma Collaborative. J Surg Oncol 2019; 120:332-339. [DOI: 10.1002/jso.25521] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Mohammad Y. Zaidi
- Division of Surgical Oncology, Winship Cancer InstituteEmory University Atlanta Georgia
| | - Cecilia G. Ethun
- Division of Surgical Oncology, Winship Cancer InstituteEmory University Atlanta Georgia
| | - Yuan Liu
- Department of Biostatistics and BioinformaticsEmory University Atlanta Georgia
| | - George Poultsides
- Department of SurgeryStanford University Medical Center Palo Alto California
| | - J. Harrison Howard
- Department of Surgery, Division of Surgical OncologyThe Ohio State University Columbus Ohio
| | - Harveshp Mogal
- Department of SurgeryMedical College of Wisconsin Milwaukee Wisconsin
| | - Jennifer Tseng
- Department of SurgeryUniversity of Chicago Medicine Chicago Illinois
| | | | - Ryan C. Fields
- Department of SurgeryWashington University School of Medicine St. Louis Missouri
| | - Kenneth Cardona
- Division of Surgical Oncology, Winship Cancer InstituteEmory University Atlanta Georgia
| |
Collapse
|
47
|
Abstract
Inadvertent excision of lumps which turn out to be sarcomas is not uncommon.Imaging has a limited role in detecting microscopic residual disease but can show the extent of the previous surgical field.Standard treatment is wide re-excision, usually combined with radiotherapy.Residual tumour is found in an average of 50% of reported cases.The presence of residual disease is an adverse prognostic factor.All lumps bigger than a golf ball should have a diagnosis prior to excision. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180060.
Collapse
|
48
|
Jain N, Roy J, Das B, Mallick B. miR-197-5p inhibits sarcomagenesis and induces cellular senescence via repression of KIAA0101. Mol Carcinog 2019; 58:1376-1388. [PMID: 31001891 DOI: 10.1002/mc.23021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/16/2019] [Accepted: 03/28/2019] [Indexed: 12/14/2022]
Abstract
The abnormal expressions of microRNAs (miRNAs) are known to be associated with various pathophysiological processes that lead to the development of a plethora of diseases including cancer. Among several miRNAs studied so far, miR-197 has been reported to play a vital role either as an oncogene or tumor suppressor in different cancers. However, its role in carcinogenesis of fibrosarcoma has not yet been elucidated. Therefore, the current study investigated the role of miR-197-5p, which is significantly downregulated in HT1080 fibrosarcoma cells compared to IMR90-tert fibroblast cells. The transient overexpression of miR-197-5p causes a significant decrease in viability and proliferation of fibrosarcoma cells in both concentration- and time-dependent manners. Interestingly, we did not observe any significant changes in cell cycle pattern or apoptotic cell populations, but rather noticed cellular senescence of fibrosarcoma cells upon overexpression of miR-197-5p. Further, this miRNA suppresses the metastatic properties, such as migration, invasion, and anchorage-independent growth of fibrosarcoma possibly through targeting KIAA0101, which is a proliferating cell nuclear antigen-associated factor and overexpressed in the malignancy. In nutshell, our result revealed that miR-197-5p acts as an oncosuppressor miRNA in fibrosarcoma through target regulation of KIAA0101, which can be exploited for developing RNA-based therapeutic strategies for the cure of this malignancy.
Collapse
Affiliation(s)
- Neha Jain
- RNAi and Functional Genomics Lab, Department of Life Science, National Institute of Technology, Rourkela, Odisha, India
| | - Jyoti Roy
- RNAi and Functional Genomics Lab, Department of Life Science, National Institute of Technology, Rourkela, Odisha, India
| | - Basudeb Das
- RNAi and Functional Genomics Lab, Department of Life Science, National Institute of Technology, Rourkela, Odisha, India
| | - Bibekanand Mallick
- RNAi and Functional Genomics Lab, Department of Life Science, National Institute of Technology, Rourkela, Odisha, India
| |
Collapse
|
49
|
Moik F, Riedl JM, Winder T, Terbuch A, Rossmann CH, Szkandera J, Bauernhofer T, Kasparek AK, Schaberl-Moser R, Reicher A, Prinz F, Pichler M, Stöger H, Stotz M, Gerger A, Posch F. Benefit of second-line systemic chemotherapy for advanced biliary tract cancer: A propensity score analysis. Sci Rep 2019; 9:5548. [PMID: 30944390 PMCID: PMC6447553 DOI: 10.1038/s41598-019-42069-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 03/21/2019] [Indexed: 02/08/2023] Open
Abstract
Whether 2nd-line-chemotherapy (2LCTX) + best-supportive-care (BSC) benefits patients with advanced biliary tract cancer (aBTC) more than BSC alone is unclear. We therefore conducted a propensity-score-based comparative effectiveness analysis of overall survival (OS) outcomes in 80 patients with metastatic, recurrent, or inoperable aBTC, of whom 38 (48%) were treated with BSC + 2LCTX and 42 (52%) with BSC alone. After a median follow-up of 14.8 months and 49 deaths, the crude 6-, 12-, and 18-month Kaplan-Meier OS estimates were 77%, 53% and 23% in the BSC + 2LCTX group, and 29%, 21%, and 14% in patients in the BSC group (p = 0.0003; Hazard ratio (HR) = 0.36, 95%CI:0.20-0.64, p = 0.001). An inverse-probability-of-treatment-weighted (IPTW) analysis was conducted to rigorously account for the higher prevalence of favorable prognostic variables in the 2LCTX + BSC group. After IPTW-weighting, the favorable association between 2LCTX and OS prevailed (adjusted HR = 0.40, 95%CI: 0.17-0.95, p = 0.037). IPTW-weighted 6-, 12-, and 18-month OS estimates were 77%, 58% and 33% in the BSC + 2LCTX group, and 39%, 28% and 22% in the BSC group (p = 0.037). Moreover, the benefit of 2LCTX was consistent across several clinically-relevant subgroups. Within the limitations of an observational study, these findings support the concept that 2LCTX + BSC is associated with an OS benefit over BSC alone in aBTC.
Collapse
Affiliation(s)
- Florian Moik
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
- Clinical Division of Haematology & Haemostaseology, Department of Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Jakob M Riedl
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Thomas Winder
- Division of Oncology, Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Angelika Terbuch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Christopher H Rossmann
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Joanna Szkandera
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Thomas Bauernhofer
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Anne-Katrin Kasparek
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Renate Schaberl-Moser
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Andreas Reicher
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
- Research Center for Molecular Medicine (CeMM) of the Austrian Academy of Sciences, Lazarettgasse 14, 1090, Vienna, Austria
| | - Felix Prinz
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Martin Pichler
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, 1901 East Road, Room 3SCR4.3424, Houston, Texas, 77054, USA
| | - Herbert Stöger
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Michael Stotz
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Armin Gerger
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Stiftingtalstrasse 5, 8010, Graz, Austria
| | - Florian Posch
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
- Center for Biomarker Research in Medicine (CBmed), Stiftingtalstrasse 5, 8010, Graz, Austria.
| |
Collapse
|
50
|
[Systematic planning of surgery for soft tissue sarcoma of the extremities]. Chirurg 2019; 90:441-446. [PMID: 30848291 DOI: 10.1007/s00104-019-0921-5] [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: 10/27/2022]
Abstract
Soft tissue sarcomas of the extremities are rarely malignant tumors. They are best treated by an experienced interdisciplinary sarcoma team. A preoperative biopsy and imaging are prerequisites for successful sarcoma treatment. Before surgery the multimodal treatment and the extent of resection and, if necessary, plastic reconstruction should be discussed in a multidisciplinary tumor board. The aim is always a complete R0 resection with optimal preservation of function. The preservation of critical structures (e. g. sciatic nerve) by a planned focal marginal resection along the critical structure can be performed by an experienced team in a multidisciplinary treatment setting.
Collapse
|