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Chmiel P, Rutkowski P, Spałek M, Szumera-Ciećkiewicz A, Czarnecka AM. What is the Optimal Treatment Strategy after Sarcoma R2 Surgery? Curr Treat Options Oncol 2024; 25:798-812. [PMID: 38809411 PMCID: PMC11222198 DOI: 10.1007/s11864-024-01218-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 05/30/2024]
Abstract
OPINION STATEMENT Soft tissue sarcomas (STS) are rare tumours of mesenchymal origin, most commonly occurring in the extremity but also in the retroperitoneum. The curative treatment for STS is radical surgery with wide margins, in some cases in combination with perioperative radiotherapy and chemotherapy. Nonradical resection (R2) of STS has been an emerging issue in recent decades, as optimal subsequent management remains debatable. Similarly, there is still no consensus on optimal surgical margins. Combining multiple treatment modalities in adjuvant therapy can achieve local and distant control in patients following surgery with positive margins. Patients who have undergone nonradical resection therefore require additional surgical interventions, and adjuvant radiotherapy resulting in a better prognosis but a higher number of complications. Following non-radical treatment, patients with limb and trunk wall sarcomas and retroperitoneal sarcomas should also undergo increased oncological surveillance. Given the potential issues that may emerge in such clinical situations, it is crucial to up-date the current guidelines to enhance the long-term prognosis of these patients.
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Affiliation(s)
- Paulina Chmiel
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland
- Faculty of Medicine, Medical University of Warsaw, 02-091, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland
| | - Mateusz Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland
- Department of Radiotherapy I, Maria Sklodowska-Curie National Research Institute of Oncology, 02-718, Warsaw, Poland
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland
- Biobank Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland
| | - Anna M Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland.
- Department of Experimental Pharmacology, Mossakowski Medical Research Institute Polish Academy of Sciences, 02-106, Warsaw, Poland.
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Pedicled Functional Latissimus Flaps for Reconstruction of the Upper Extremity following Resection of Soft-Tissue Sarcomas. Curr Oncol 2023; 30:3138-3148. [PMID: 36975450 PMCID: PMC10047364 DOI: 10.3390/curroncol30030237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
(1) Background: Resection of soft-tissue sarcomas (STS) of the upper extremity can result in substantial functional impairment with limited options for functional reconstruction. Free functional latissimus flaps have been utilized to restore function of the thigh; however, there is limited data on the use of latissimus flaps for functional reconstruction in the upper extremity. As such, we sought to evaluate our institutional experience with these flaps. (2) Methods: We reviewed ten (seven male; three female; and a mean age of 63 years) patients undergoing soft-tissue sarcoma resection involving the triceps (n = 4), biceps (n = 4), and deltoid (n = 2) reconstructed with a pedicled functional latissimus flap. All surviving patients had at least 1 year of follow-up, with a mean follow-up of 5 years. (3) Results: The mean elbow range of motion and shoulder elevation were 105° and 150°. The mean Musculoskeletal Tumor Society score was 88%, and the muscle strength was four. Four patients had a recipient site wound complication. There were no flap losses. One patient sustained a radiation-associated humerus fracture 5 years postoperatively, treated nonoperatively. (4) Conclusions: Although early complications are high, pedicled functional latissimus flaps allow for wound coverage, potential space obliteration, and restoration of function in the upper extremity following resection of large soft tissue sarcomas.
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Andreani L, Ipponi E, Mani O, Bayon G, Ruinato AD, Cosseddu F, D'Arienzo A, Capanna R. Synovial sarcomas: A single surgeon experience of 130 cases. J Surg Oncol 2022; 126:793-797. [PMID: 35670050 PMCID: PMC9544735 DOI: 10.1002/jso.26976] [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: 04/30/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Abstract
Background Synovial sarcoma is a rare malignant tumor that generally requires a multidisciplinary therapeutic approach. In this study we report the experience of a single surgeon, evaluating surgical and oncological outcomes of the cases he treated through his 30 years carrier. Methods We enrolled patients treated surgically between 1988 and 2018. Surgical and medical treatments, as well as surgical and oncological results, were investigated. Results One hundred and thirty cases were included. Surgical resection was carried out achieving wide margins in 90% of the cases. At their latest follow‐up, 76 patients were continuously disease free, 16 were no evidence of disease, and other 16 were alive with disease. Twenty cases were dead of disease and two dead of other causes. Twenty‐five patients (19%) had local recurrence of synovial sarcoma through their postoperative intercourse. Thirty‐seven patients (28%) were diagnosed with at least a metastasis during their follow‐up. The global survival of our population, at each patient's latest follow‐up, was 82%. Cases with tumor size above 5 cm had a significantly higher risk to develop metastasis (p = 0.002). Conclusions Synovial sarcoma is a threatening disease and represents a challenge for oncological physicians and surgeons. Early diagnosis and multidisciplinary approach are mandatory to limit the spread of synovial sarcomas, maximizing the effectiveness of surgery and the other treatments.
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Affiliation(s)
- Lorenzo Andreani
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Edoardo Ipponi
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Olimpia Mani
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Ginevra Bayon
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | | | - Fabio Cosseddu
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Antonio D'Arienzo
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Rodolfo Capanna
- Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa, Italy
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Brookes MJ, Chan CD, Nicoli F, Crowley TP, Ghosh KM, Beckingsale T, Saleh D, Dildey P, Gupta S, Ragbir M, Rankin KS. Intraoperative Near-Infrared Fluorescence Guided Surgery Using Indocyanine Green (ICG) for the Resection of Sarcomas May Reduce the Positive Margin Rate: An Extended Case Series. Cancers (Basel) 2021; 13:cancers13246284. [PMID: 34944902 PMCID: PMC8699240 DOI: 10.3390/cancers13246284] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/03/2021] [Accepted: 12/11/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Sarcomas are rare, aggressive cancers which can occur in any region of the body. Surgery is usually the cornerstone of curative treatment, with negative surgical margins associated with decreased local recurrence and improved overall survival. Indocyanine green (ICG) is a fluorescent dye which accumulates in sarcoma tissue and can be imaged intraoperatively using handheld near-infrared (NIR) cameras, theoretically helping guide the surgeon's resection margins. METHODS Patients operated on between 20 February 2019 and 20 October 2021 for intermediate to high grade sarcomas at our centres received either conventional surgery, or were administered ICG pre-operatively followed by intra-operative NIR fluorescence guidance during the procedure. Differences between the unexpected positive margin rates were compared. RESULTS 115 suitable patients were identified, of which 39 received ICG + NIR fluorescence guided surgery, and 76 received conventional surgery. Of the patients given ICG, 37/39 tumours fluoresced, and surgeons felt the procedure was guided by the intra-operative images in 11 cases. Patients receiving ICG had a lower unexpected positive margin rate (5.1% vs. 25.0%, p = 0.01). CONCLUSIONS The use of NIR fluorescence cameras in combination with ICG may reduce the unexpected positive margin rate for high grade sarcomas. A prospective, multi-centre randomised control trial is now needed to validate these results.
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Affiliation(s)
- Marcus J. Brookes
- North of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK; (C.D.C.); (F.N.); (T.P.C.); (K.M.G.); (T.B.); (D.S.); (P.D.); (M.R.)
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
- Correspondence: (M.J.B.); (K.S.R.)
| | - Corey D. Chan
- North of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK; (C.D.C.); (F.N.); (T.P.C.); (K.M.G.); (T.B.); (D.S.); (P.D.); (M.R.)
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Fabio Nicoli
- North of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK; (C.D.C.); (F.N.); (T.P.C.); (K.M.G.); (T.B.); (D.S.); (P.D.); (M.R.)
| | - Timothy P. Crowley
- North of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK; (C.D.C.); (F.N.); (T.P.C.); (K.M.G.); (T.B.); (D.S.); (P.D.); (M.R.)
| | - Kanishka M. Ghosh
- North of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK; (C.D.C.); (F.N.); (T.P.C.); (K.M.G.); (T.B.); (D.S.); (P.D.); (M.R.)
| | - Thomas Beckingsale
- North of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK; (C.D.C.); (F.N.); (T.P.C.); (K.M.G.); (T.B.); (D.S.); (P.D.); (M.R.)
| | - Daniel Saleh
- North of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK; (C.D.C.); (F.N.); (T.P.C.); (K.M.G.); (T.B.); (D.S.); (P.D.); (M.R.)
| | - Petra Dildey
- North of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK; (C.D.C.); (F.N.); (T.P.C.); (K.M.G.); (T.B.); (D.S.); (P.D.); (M.R.)
| | - Sanjay Gupta
- Department of Musculoskeletal Oncology Surgery, Glasgow Royal Infirmary, 84 Castle St., Glasgow G4 0SF, UK;
| | - Maniram Ragbir
- North of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK; (C.D.C.); (F.N.); (T.P.C.); (K.M.G.); (T.B.); (D.S.); (P.D.); (M.R.)
| | - Kenneth S. Rankin
- North of England Bone and Soft Tissue Tumour Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK; (C.D.C.); (F.N.); (T.P.C.); (K.M.G.); (T.B.); (D.S.); (P.D.); (M.R.)
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
- Correspondence: (M.J.B.); (K.S.R.)
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Synovial Sarcoma: A Clinical Review. ACTA ACUST UNITED AC 2021; 28:1909-1920. [PMID: 34069748 PMCID: PMC8161765 DOI: 10.3390/curroncol28030177] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 01/26/2023]
Abstract
Synovial sarcomas (SS) represent a unique subset of soft tissue sarcomas (STS) and account for 5–10% of all STS. Synovial sarcoma differs from other STS by the relatively young age at diagnosis and clinical presentation. Synovial sarcomas have unique genomic characteristics and are driven by a pathognomonic t(X;18) chromosomal translocation and subsequent formation of the SS18:SSX fusion oncogenes. Similar to other STS, diagnosis can be obtained from a combination of history, physical examination, magnetic resonance imaging, biopsy and subsequent pathology, immunohistochemistry and molecular analysis. Increasing size, age and tumor grade have been demonstrated to be negative predictive factors for both local disease recurrence and metastasis. Wide surgical excision remains the standard of care for definitive treatment with adjuvant radiation utilized for larger and deeper lesions. There remains controversy surrounding the role of chemotherapy in the treatment of SS and there appears to be survival benefit in certain populations. As the understanding of the molecular and immunologic characteristics of SS evolve, several potential systematic therapies have been proposed.
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Zhao YX, Hu XY, Zhong X, Shen H, Yuan Y. High-intensity focused ultrasound treatment as an alternative regimen for myxofibrosarcoma. Dermatol Ther 2021; 34:e14816. [PMID: 33497505 DOI: 10.1111/dth.14816] [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] [Received: 09/28/2020] [Revised: 12/05/2020] [Accepted: 01/17/2021] [Indexed: 11/29/2022]
Abstract
Myxofibrosarcoma is a common soft-tissue sarcoma in elderly patients, characterized by an infiltrative growth pattern and a high risk for persistent local recurrence. A 35-years-old woman was diagnosed with myxofibrosarcoma on the right upper arm and the tumor is surgically resected. The tumor relapsed 7 months later. Then the patient received five cycles of low power cumulative high-intensity focused ultrasound (HIFU) treatments, which completely ablated the tumor without complications. Now the patient is disease free with a high quality of life more than 30 months. This case indicates HIFU ablation might be a novel, promising therapy for recurrent myxofibrosarcoma.
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Affiliation(s)
- Ying-Xin Zhao
- Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,The Cancer Institute Key Laboratory of Cancer Prevention and Intervention, Chinese National Ministry of Education, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xiao-Ye Hu
- Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xian Zhong
- Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Hong Shen
- Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ying Yuan
- Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,The Cancer Institute Key Laboratory of Cancer Prevention and Intervention, Chinese National Ministry of Education, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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7
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Noebauer-Huhmann IM, Chaudhary SR, Papakonstantinou O, Panotopoulos J, Weber MA, Lalam RK, Albtoush OM, Fueger BJ, Szomolanyi P, Grieser T, Bloem JL. Soft Tissue Sarcoma Follow-up Imaging: Strategies to Distinguish Post-treatment Changes from Recurrence. Semin Musculoskelet Radiol 2020; 24:627-644. [PMID: 33307581 DOI: 10.1055/s-0040-1721464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Soft tissue sarcomas encompass multiple entities with differing recurrence rates and follow-up intervals. The detection of recurrences and their differentiation from post-therapeutic changes is therefore complex, with a central role for the clinical radiologist. This article describes approved recommendations. Prerequisite is a precise knowledge of the current clinical management and surgical techniques. We review recurrence rates and treatment modalities. An adequate imaging technique is paramount, and comparison with previous imaging is highly recommended. We describe time-dependent therapy-related complications on magnetic resonance imaging compared with the spectrum of regular post-therapeutic changes. Early complications such as seromas, hematomas, and infections, late complications such as edema and fibrosis, and inflammatory pseudotumors are elucidated. The appearance of recurrences and radiation-associated sarcomas is contrasted with these changes. This systematic approach in follow-up imaging of soft tissue sarcoma patients will facilitate the differentiation of post-therapeutic changes from recurrences.
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Affiliation(s)
- Iris-M Noebauer-Huhmann
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Snehansh R Chaudhary
- Department of Clinical Radiology, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Joannis Panotopoulos
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Radhesh K Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - Omar M Albtoush
- Department of Radiology, University of Jordan, and Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Barbara J Fueger
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pavol Szomolanyi
- High Field MR Center, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Grieser
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Johan L Bloem
- Department of radiology, Leiden University Medical Center, Leiden, The Netherlands
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8
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The Role of Plastic Reconstructive Surgery in Surgical Therapy of Soft Tissue Sarcomas. Cancers (Basel) 2020; 12:cancers12123534. [PMID: 33256182 PMCID: PMC7760015 DOI: 10.3390/cancers12123534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Soft tissue sarcoma (STS) treatment is an interdisciplinary challenge. Along with radio(chemo)therapy, surgery plays the central role in STS treatment. Little is known about the impact of reconstructive surgery on STS, particularly whether reconstructive surgery enhances STS resection success with the usage of flaps. Here, we analyzed the 10-year experience at a university hospital's Comprehensive Cancer Center, focusing on the role of reconstructive surgery. METHODS We performed a retrospective analysis of STS-patients over 10 years. We investigated patient demographics, diagnosis, surgical management, tissue/function reconstruction, complication rates, resection status, local recurrence and survival. RESULTS Analysis of 290 patients showed an association between clear surgical margin (R0) resections and higher-grade sarcoma in patients with free flaps. Major complications were lower with primary wound closure than with flaps. Comparison of reconstruction techniques showed no significant differences in complication rates. Wound healing was impaired in STS recurrence. The local recurrence risk was over two times higher with primary wound closure than with flaps. CONCLUSION Defect reconstructions in STS are reliable and safe. Plastic surgeons should have a permanent place in interdisciplinary surgical STS treatment, with the full armamentarium of reconstruction methods.
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9
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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.
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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
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10
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Wilson DAJ, Gazendam A, Visgauss J, Perrin D, Griffin AM, Chung PW, Catton CN, Shultz D, Ferguson PC, Wunder JS. Designing a Rational Follow-Up Schedule for Patients with Extremity Soft Tissue Sarcoma. Ann Surg Oncol 2020; 27:2033-2041. [PMID: 32152780 DOI: 10.1245/s10434-020-08240-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE The risk of tumor recurrence after resection of soft tissue sarcoma (STS) necessitates surveillance in follow-up. The objective of this study was to determine the frequency/timing of metastasis and local recurrence following treatment for soft tissue sarcoma, and to use these data to justify an evidence-based follow-up schedule. METHODS Utilizing a prospective database, a retrospective single center review was performed of all patients with minimum 2-year follow-up after resection of a localized extremity STS. Kaplan-Meier estimates were used to calculate the incidence of local recurrence and metastases on an annual basis for 10 years. RESULTS We identified a total of 230 low-grade, 626 intermediate-grade and 940 high-grade extremity STS and a total of 721 events, 150 local recurrences and 571 metastases. Based on tumor size and grade, follow-up cohorts were developed that had similar metastatic risk. Using pre-determined thresholds for metastatic event, a follow-up schedule was established for each cohort. CONCLUSION Based on our results we recommend that patients with small low-grade tumors undergo annual follow-up for 5 years following definitive local treatment. Patients with large low-grade tumors, small intermediate-grade and small high-grade tumors should have follow-up every 6 months for the first 2 years, then yearly to 10 years. Only patients with large intermediate- or high-grade tumors require follow-up every 3 months for the first 2 years, then every 6 months for years 3-5, followed by annually until 10 years.
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Affiliation(s)
- David A J Wilson
- Division of Orthopaedic Surgery, Department of Surgery, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada.
| | - Aaron Gazendam
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Julia Visgauss
- Department of Orthopedic Surgery, Duke University Medical Center, Duke University, Durham, NC, USA
| | - David Perrin
- University Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Anthony M Griffin
- University Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Peter W Chung
- Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Charles N Catton
- Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - David Shultz
- Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Peter C Ferguson
- University Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Jay S Wunder
- University Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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11
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Gladdy RA, Wunder JS. Risk‐stratified surveillance in dermatofibrosarcoma protuberans: Less is more. Cancer 2019; 125:670-672. [DOI: 10.1002/cncr.31922] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/14/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Rebecca A. Gladdy
- Division of General Surgery Mount Sinai Hospital Toronto Ontario Canada
- Sarcoma Site Group, Princess Margaret Cancer Centre and Department of Surgery University of Toronto Toronto Ontario Canada
| | - Jay S. Wunder
- Sarcoma Site Group, Princess Margaret Cancer Centre and Department of Surgery University of Toronto Toronto Ontario Canada
- Division of Orthopedic Surgery Mount Sinai Hospital Toronto Ontario Canada
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital Toronto Ontario Canada
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12
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Milgrom DP, Sehdev A, Kays JK, Koniaris LG. Integrating therapies for surgical adult soft tissue sarcoma patients. Transl Gastroenterol Hepatol 2018; 3:88. [PMID: 30603724 PMCID: PMC6286915 DOI: 10.21037/tgh.2018.10.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 12/25/2022] Open
Abstract
Sarcomas are an uncommon group of over 50 different individual histological malignancies arising from mesenchymal (non-epithelial or connective) tissues. Overall, they constitute 1% of human malignancies with an annual incidence rate of fewer than 5 patients per million. Sarcoma may arise from any mesenchymal cell lineages including fat, muscle, or other connective tissues. Due to the rarity of these groups of malignancies, many subtypes were, and still today, are managed as a single entity. This review focused on soft tissue sarcomas with an emphasis on how to integrate therapies for patients with this rare disorder. The role for surgical resection in cure and palliation as well as the relative benefits of adjuvant therapies such as chemotherapy and radiation therapy are discussed.
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Affiliation(s)
- Daniel P. Milgrom
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Amikar Sehdev
- Division of Medical Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Joshua K. Kays
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Leonidas G. Koniaris
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Traub F, Griffin AM, Wunder JS, Ferguson PC. Influence of unplanned excisions on the outcomes of patients with stage III extremity soft-tissue sarcoma. Cancer 2018; 124:3868-3875. [DOI: 10.1002/cncr.31648] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/07/2018] [Accepted: 05/24/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Frank Traub
- University of Toronto Musculoskeletal Oncology Unit; Mount Sinai Hospital; Toronto Ontario Canada
- Department of Orthopaedic Surgery, Faculty of Medicine; Eberhard Karls University of Tübingen; Tübingen Germany
| | - Anthony M. Griffin
- University of Toronto Musculoskeletal Oncology Unit; Mount Sinai Hospital; Toronto Ontario Canada
| | - Jay S. Wunder
- University of Toronto Musculoskeletal Oncology Unit; Mount Sinai Hospital; Toronto Ontario Canada
- Division of Orthopaedic Surgery, Department of Surgery; University of Toronto; Toronto Ontario Canada
- Sarcoma Site Group, Princess Margaret Cancer Center; Toronto Ontario Canada
| | - Peter C. Ferguson
- University of Toronto Musculoskeletal Oncology Unit; Mount Sinai Hospital; Toronto Ontario Canada
- Division of Orthopaedic Surgery, Department of Surgery; University of Toronto; Toronto Ontario Canada
- Sarcoma Site Group, Princess Margaret Cancer Center; Toronto Ontario Canada
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14
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Gundle KR, Griffin AM, Dickson BC, Chung PW, Catton CN, O’Sullivan B, Wunder JS, Ferguson PC. Reply to A. Levy et al. J Clin Oncol 2018; 36:2358-2359. [DOI: 10.1200/jco.2018.78.7325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kenneth R. Gundle
- Kenneth R. Gundle, Oregon Health & Science University; Portland VA Medical Center, Portland, OR; and Anthony M. Griffin, Brendan C. Dickson, Peter W. Chung, Charles N. Catton, Brian O’Sullivan, Jay S. Wunder, and Peter C. Ferguson, University of Toronto, Toronto, Ontario, Canada
| | - Anthony M. Griffin
- Kenneth R. Gundle, Oregon Health & Science University; Portland VA Medical Center, Portland, OR; and Anthony M. Griffin, Brendan C. Dickson, Peter W. Chung, Charles N. Catton, Brian O’Sullivan, Jay S. Wunder, and Peter C. Ferguson, University of Toronto, Toronto, Ontario, Canada
| | - Brendan C. Dickson
- Kenneth R. Gundle, Oregon Health & Science University; Portland VA Medical Center, Portland, OR; and Anthony M. Griffin, Brendan C. Dickson, Peter W. Chung, Charles N. Catton, Brian O’Sullivan, Jay S. Wunder, and Peter C. Ferguson, University of Toronto, Toronto, Ontario, Canada
| | - Peter W. Chung
- Kenneth R. Gundle, Oregon Health & Science University; Portland VA Medical Center, Portland, OR; and Anthony M. Griffin, Brendan C. Dickson, Peter W. Chung, Charles N. Catton, Brian O’Sullivan, Jay S. Wunder, and Peter C. Ferguson, University of Toronto, Toronto, Ontario, Canada
| | - Charles N. Catton
- Kenneth R. Gundle, Oregon Health & Science University; Portland VA Medical Center, Portland, OR; and Anthony M. Griffin, Brendan C. Dickson, Peter W. Chung, Charles N. Catton, Brian O’Sullivan, Jay S. Wunder, and Peter C. Ferguson, University of Toronto, Toronto, Ontario, Canada
| | - Brian O’Sullivan
- Kenneth R. Gundle, Oregon Health & Science University; Portland VA Medical Center, Portland, OR; and Anthony M. Griffin, Brendan C. Dickson, Peter W. Chung, Charles N. Catton, Brian O’Sullivan, Jay S. Wunder, and Peter C. Ferguson, University of Toronto, Toronto, Ontario, Canada
| | - Jay S. Wunder
- Kenneth R. Gundle, Oregon Health & Science University; Portland VA Medical Center, Portland, OR; and Anthony M. Griffin, Brendan C. Dickson, Peter W. Chung, Charles N. Catton, Brian O’Sullivan, Jay S. Wunder, and Peter C. Ferguson, University of Toronto, Toronto, Ontario, Canada
| | - Peter C. Ferguson
- Kenneth R. Gundle, Oregon Health & Science University; Portland VA Medical Center, Portland, OR; and Anthony M. Griffin, Brendan C. Dickson, Peter W. Chung, Charles N. Catton, Brian O’Sullivan, Jay S. Wunder, and Peter C. Ferguson, University of Toronto, Toronto, Ontario, Canada
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Levy A, Bonvalot S, Callegaro D, Botticella A, Le Cesne A, Gronchi A, Le Péchoux C. Consistent Margin-Status Reporting in Soft Tissue Sarcoma Is Essential to Establish Risk-Adapted Strategies Integrating Biology and Histotype in Perioperative Treatments. J Clin Oncol 2018; 36:2357-2358. [PMID: 29878864 DOI: 10.1200/jco.2018.78.6657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Antonin Levy
- Antonin Levy, Gustave Roussy Cancer Campus; INSERM U1030, Molecular Radiotherapy, Villejuif, France; Sylvie Bonvalot, Institut Curie; PSL Research University, Paris, France; Dario Callegaro, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Angela Botticella, Axel Le Cesne, Gustave Roussy Cancer Campus Villejuif, France; Alessandro Gronchi, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; and Cécile Le Péchoux, Gustave Roussy Cancer Campus Villejuif, France
| | - Sylvie Bonvalot
- Antonin Levy, Gustave Roussy Cancer Campus; INSERM U1030, Molecular Radiotherapy, Villejuif, France; Sylvie Bonvalot, Institut Curie; PSL Research University, Paris, France; Dario Callegaro, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Angela Botticella, Axel Le Cesne, Gustave Roussy Cancer Campus Villejuif, France; Alessandro Gronchi, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; and Cécile Le Péchoux, Gustave Roussy Cancer Campus Villejuif, France
| | - Dario Callegaro
- Antonin Levy, Gustave Roussy Cancer Campus; INSERM U1030, Molecular Radiotherapy, Villejuif, France; Sylvie Bonvalot, Institut Curie; PSL Research University, Paris, France; Dario Callegaro, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Angela Botticella, Axel Le Cesne, Gustave Roussy Cancer Campus Villejuif, France; Alessandro Gronchi, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; and Cécile Le Péchoux, Gustave Roussy Cancer Campus Villejuif, France
| | - Angela Botticella
- Antonin Levy, Gustave Roussy Cancer Campus; INSERM U1030, Molecular Radiotherapy, Villejuif, France; Sylvie Bonvalot, Institut Curie; PSL Research University, Paris, France; Dario Callegaro, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Angela Botticella, Axel Le Cesne, Gustave Roussy Cancer Campus Villejuif, France; Alessandro Gronchi, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; and Cécile Le Péchoux, Gustave Roussy Cancer Campus Villejuif, France
| | - Axel Le Cesne
- Antonin Levy, Gustave Roussy Cancer Campus; INSERM U1030, Molecular Radiotherapy, Villejuif, France; Sylvie Bonvalot, Institut Curie; PSL Research University, Paris, France; Dario Callegaro, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Angela Botticella, Axel Le Cesne, Gustave Roussy Cancer Campus Villejuif, France; Alessandro Gronchi, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; and Cécile Le Péchoux, Gustave Roussy Cancer Campus Villejuif, France
| | - Alessandro Gronchi
- Antonin Levy, Gustave Roussy Cancer Campus; INSERM U1030, Molecular Radiotherapy, Villejuif, France; Sylvie Bonvalot, Institut Curie; PSL Research University, Paris, France; Dario Callegaro, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Angela Botticella, Axel Le Cesne, Gustave Roussy Cancer Campus Villejuif, France; Alessandro Gronchi, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; and Cécile Le Péchoux, Gustave Roussy Cancer Campus Villejuif, France
| | - Cécile Le Péchoux
- Antonin Levy, Gustave Roussy Cancer Campus; INSERM U1030, Molecular Radiotherapy, Villejuif, France; Sylvie Bonvalot, Institut Curie; PSL Research University, Paris, France; Dario Callegaro, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Angela Botticella, Axel Le Cesne, Gustave Roussy Cancer Campus Villejuif, France; Alessandro Gronchi, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; and Cécile Le Péchoux, Gustave Roussy Cancer Campus Villejuif, France
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Gundle KR, Kafchinski L, Gupta S, Griffin AM, Dickson BC, Chung PW, Catton CN, O'Sullivan B, Wunder JS, Ferguson PC. Analysis of Margin Classification Systems for Assessing the Risk of Local Recurrence After Soft Tissue Sarcoma Resection. J Clin Oncol 2018; 36:704-709. [PMID: 29346043 DOI: 10.1200/jco.2017.74.6941] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose To compare the ability of margin classification systems to determine local recurrence (LR) risk after soft tissue sarcoma (STS) resection. Methods Two thousand two hundred seventeen patients with nonmetastatic extremity and truncal STS treated with surgical resection and multidisciplinary consideration of perioperative radiotherapy were retrospectively reviewed. Margins were coded by residual tumor (R) classification (in which microscopic tumor at inked margin defines R1), the R+1mm classification (in which microscopic tumor within 1 mm of ink defines R1), and the Toronto Margin Context Classification (TMCC; in which positive margins are separated into planned close but positive at critical structures, positive after whoops re-excision, and inadvertent positive margins). Multivariate competing risk regression models were created. Results By R classification, LR rates at 10-year follow-up were 8%, 21%, and 44% in R0, R1, and R2, respectively. R+1mm classification resulted in increased R1 margins (726 v 278, P < .001), but led to decreased LR for R1 margins without changing R0 LR; for R0, the 10-year LR rate was 8% (range, 7% to 10%); for R1, the 10-year LR rate was 12% (10% to 15%) . The TMCC also showed various LR rates among its tiers ( P < .001). LR rates for positive margins on critical structures were not different from R0 at 10 years (11% v 8%, P = .18), whereas inadvertent positive margins had high LR (5-year, 28% [95% CI, 19% to 37%]; 10-year, 35% [95% CI, 25% to 46%]; P < .001). Conclusion The R classification identified three distinct risk levels for LR in STS. An R+1mm classification reduced LR differences between R1 and R0, suggesting that a negative but < 1-mm margin may be adequate with multidisciplinary treatment. The TMCC provides additional stratification of positive margins that may aid in surgical planning and patient education.
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Affiliation(s)
- Kenneth R Gundle
- Kenneth R. Gundle, Oregon Health & Science University and Portland VA Medical Center, Portland, OR; Lisa Kafchinski, Texas Tech University Health Sciences Center El Paso, El Paso, TX; Sanjay Gupta, University of Glasgow, Glasgow, United Kingdom; Anthony M. Griffin, Brendan C. Dickson, Jay S. Wunder, and Peter C. Ferguson, Mount Sinai Hospital, University of Toronto; and Peter W. Chung, Charles N. Catton and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Kafchinski
- Kenneth R. Gundle, Oregon Health & Science University and Portland VA Medical Center, Portland, OR; Lisa Kafchinski, Texas Tech University Health Sciences Center El Paso, El Paso, TX; Sanjay Gupta, University of Glasgow, Glasgow, United Kingdom; Anthony M. Griffin, Brendan C. Dickson, Jay S. Wunder, and Peter C. Ferguson, Mount Sinai Hospital, University of Toronto; and Peter W. Chung, Charles N. Catton and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sanjay Gupta
- Kenneth R. Gundle, Oregon Health & Science University and Portland VA Medical Center, Portland, OR; Lisa Kafchinski, Texas Tech University Health Sciences Center El Paso, El Paso, TX; Sanjay Gupta, University of Glasgow, Glasgow, United Kingdom; Anthony M. Griffin, Brendan C. Dickson, Jay S. Wunder, and Peter C. Ferguson, Mount Sinai Hospital, University of Toronto; and Peter W. Chung, Charles N. Catton and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anthony M Griffin
- Kenneth R. Gundle, Oregon Health & Science University and Portland VA Medical Center, Portland, OR; Lisa Kafchinski, Texas Tech University Health Sciences Center El Paso, El Paso, TX; Sanjay Gupta, University of Glasgow, Glasgow, United Kingdom; Anthony M. Griffin, Brendan C. Dickson, Jay S. Wunder, and Peter C. Ferguson, Mount Sinai Hospital, University of Toronto; and Peter W. Chung, Charles N. Catton and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Brendan C Dickson
- Kenneth R. Gundle, Oregon Health & Science University and Portland VA Medical Center, Portland, OR; Lisa Kafchinski, Texas Tech University Health Sciences Center El Paso, El Paso, TX; Sanjay Gupta, University of Glasgow, Glasgow, United Kingdom; Anthony M. Griffin, Brendan C. Dickson, Jay S. Wunder, and Peter C. Ferguson, Mount Sinai Hospital, University of Toronto; and Peter W. Chung, Charles N. Catton and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Peter W Chung
- Kenneth R. Gundle, Oregon Health & Science University and Portland VA Medical Center, Portland, OR; Lisa Kafchinski, Texas Tech University Health Sciences Center El Paso, El Paso, TX; Sanjay Gupta, University of Glasgow, Glasgow, United Kingdom; Anthony M. Griffin, Brendan C. Dickson, Jay S. Wunder, and Peter C. Ferguson, Mount Sinai Hospital, University of Toronto; and Peter W. Chung, Charles N. Catton and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Charles N Catton
- Kenneth R. Gundle, Oregon Health & Science University and Portland VA Medical Center, Portland, OR; Lisa Kafchinski, Texas Tech University Health Sciences Center El Paso, El Paso, TX; Sanjay Gupta, University of Glasgow, Glasgow, United Kingdom; Anthony M. Griffin, Brendan C. Dickson, Jay S. Wunder, and Peter C. Ferguson, Mount Sinai Hospital, University of Toronto; and Peter W. Chung, Charles N. Catton and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Kenneth R. Gundle, Oregon Health & Science University and Portland VA Medical Center, Portland, OR; Lisa Kafchinski, Texas Tech University Health Sciences Center El Paso, El Paso, TX; Sanjay Gupta, University of Glasgow, Glasgow, United Kingdom; Anthony M. Griffin, Brendan C. Dickson, Jay S. Wunder, and Peter C. Ferguson, Mount Sinai Hospital, University of Toronto; and Peter W. Chung, Charles N. Catton and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jay S Wunder
- Kenneth R. Gundle, Oregon Health & Science University and Portland VA Medical Center, Portland, OR; Lisa Kafchinski, Texas Tech University Health Sciences Center El Paso, El Paso, TX; Sanjay Gupta, University of Glasgow, Glasgow, United Kingdom; Anthony M. Griffin, Brendan C. Dickson, Jay S. Wunder, and Peter C. Ferguson, Mount Sinai Hospital, University of Toronto; and Peter W. Chung, Charles N. Catton and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Peter C Ferguson
- Kenneth R. Gundle, Oregon Health & Science University and Portland VA Medical Center, Portland, OR; Lisa Kafchinski, Texas Tech University Health Sciences Center El Paso, El Paso, TX; Sanjay Gupta, University of Glasgow, Glasgow, United Kingdom; Anthony M. Griffin, Brendan C. Dickson, Jay S. Wunder, and Peter C. Ferguson, Mount Sinai Hospital, University of Toronto; and Peter W. Chung, Charles N. Catton and Brian O'Sullivan, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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Weichteilsarkome: Wie lassen sich posttherapeutische Veränderungen von Rezidiven unterscheiden? Radiologe 2017; 57:923-937. [DOI: 10.1007/s00117-017-0310-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Preoperative Factors Associated with Infiltrative Histologic Growth Patterns in Extremity Soft Tissue Sarcoma. Sarcoma 2017; 2017:5419394. [PMID: 28808411 PMCID: PMC5541793 DOI: 10.1155/2017/5419394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/06/2017] [Accepted: 06/19/2017] [Indexed: 12/19/2022] Open
Abstract
Soft tissue sarcoma (STS) with an infiltrative histologic growth pattern, when compared to STS with an expansile pattern, may pose difficulties in local control. Preoperative assessment of the presence of infiltrative histologic growth pattern would be helpful in deciding treatment strategies. A review of 144 patients who underwent surgery for extremity STS was performed. Microscopically, the histologic growth pattern was defined as infiltrative if the penetration of the tumor cells into the surrounding tissue was observed. Possible clinicopathologic factors that might be associated with infiltrative histologic growth pattern were investigated with regard to patient demographics, tumor characteristics, and MRI findings. Of the 144 tumors, 71 (49%) showed infiltrative histologic growth pattern. On multivariate analysis, histological subtypes other than liposarcoma (OR = 4.57, p = 0.02) and infiltrative border on MRI (OR = 2.48, p = 0.01) were independent factors associated with infiltrative histologic growth pattern. Predictive index based on these two factors showed a significant improved accuracy (ROC-AUC = 0.647) for predicting infiltrative histologic growth pattern compared to either factor alone. Our data suggests that liposarcoma histology and tumor border on MRI can predict histologic growth pattern in extremity STS.
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