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Makris EA, Tran TB, Delitto DJ, Lee B, Ethun CG, Grignol V, Harrison Howard J, Bedi M, Clark Gamblin T, Tseng J, Roggin KK, Chouliaras K, Votanopoulos K, Cullinan D, Fields RC, Cardona K, Poultsides G, Kirane A. Natural history of undifferentiated pleomorphic sarcoma: Experience from the US Sarcoma Collaborative. J Surg Oncol 2024; 129:1354-1363. [PMID: 38562002 DOI: 10.1002/jso.27620] [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: 01/10/2024] [Accepted: 02/13/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Undifferentiated pleomorphic sarcoma (UPS) is a relatively rare but aggressive neoplasm. We sought to utilize a multi-institutional US cohort of sarcoma patients to examine predictors of survival and recurrence patterns after resection of UPS. METHODS From 2000 to 2016, patients with primary UPS undergoing curative-intent surgical resection at seven academic institutions were retrospectively reviewed. Epidemiologic and clinicopathologic factors were reviewed by site of origin. Overall survival (OS), recurrence-free survival (RFS), time-to-locoregional (TTLR), time-to-distant recurrence (TTDR), and patterns of recurrence were analyzed. RESULTS Of the 534 UPS patients identified, 53% were female, with a median age of 60 and median tumor size of 8.5 cm. The median OS, RFS, TTLR, and TTDR for the entire cohort were 109, 49, 86, and 46 months, respectively. There were no differences in these survival outcomes between extremity and truncal UPS. Compared with truncal, extremity UPS were more commonly amenable to R0 resection (87% vs. 75%, p = 0.017) and less commonly associated with lymph node metastasis (1% vs. 6%, p = 0.031). R0 resection and radiation treatment, but not site of origin (extremity vs. trunk) were independent predictors of OS and RFS. TTLR recurrence was shorter for UPS resected with a positive margin and for tumors not treated with radiation. CONCLUSION For patients with resected extremity and truncal UPS, tumor size >5 cm and positive resection margin are associated with worse survival OS and RFS, irrespectively the site of origin. R0 surgical resection and radiation treatment may help improve these survival outcomes.
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Affiliation(s)
| | - Thuy B Tran
- Surgical Oncology, Stanford University, Stanford, California, USA
| | - Daniel J Delitto
- Surgical Oncology, Stanford University, Stanford, California, USA
| | - Byrne Lee
- Surgical Oncology, Stanford University, Stanford, California, USA
| | - Cecilia G Ethun
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Valerie Grignol
- Surgical Oncology, The Ohio State University, Columbus, Ohio, USA
| | | | - Meena Bedi
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Jennifer Tseng
- Surgical Oncology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Kevin K Roggin
- Surgical Oncology, University of Chicago Medicine, Chicago, Illinois, USA
| | | | | | - Darren Cullinan
- Surgical Oncology, Washington University, St. Louis, Missouri, USA
| | - Ryan C Fields
- Surgical Oncology, Washington University, St. Louis, Missouri, USA
| | - Kenneth Cardona
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | | | - Amanda Kirane
- Surgical Oncology, Stanford University, Stanford, California, USA
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Díaz Casas SE, Villacrés JM, Lehmann Mosquera C, García Mora M, Mariño Lozano I, Ángel Aristizábal J, Suarez Rodríguez R, Duarte Torres CA, Sánchez Pedraza R. Prognostic Factors Associated with Tumor Recurrence and Overall Survival in Soft Tissue Sarcomas of the Extremities in a Colombian Reference Cancer Center. Curr Oncol 2024; 31:1725-1738. [PMID: 38668034 PMCID: PMC11049252 DOI: 10.3390/curroncol31040131] [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: 01/18/2024] [Revised: 02/28/2024] [Accepted: 03/02/2024] [Indexed: 04/28/2024] Open
Abstract
Introduction: Soft tissue sarcomas (STS) are low-incidence tumors whose clinical and histopathological factors are associated with adverse oncological outcomes. This study evaluated prognostic factors (PF) associated with tumor recurrence and overall survival (OS) in patients diagnosed with STS of the extremities, treated at the Instituto Nacional de Cancerología (INC), Bogotá, Colombia. Materials and Methods: An analytical observational study of a historical cohort was carried out, including patients diagnosed with STS and managed surgically in the Functional Unit for Breast and Soft Tissue Tumors of the INC from January 2008 to December 2018. Results: A total of 227 patients were included; 74.5% had tumors greater than 5 cm. Most patients (29.1%) were in stage IIIB at diagnosis. Age was associated with higher mortality (HR = 1.01; CI95%: 1-1.02; p = 0.048). Tumor persistence at admission to the INC (HR = 2.34; CI95%: 1.25-4.35; p = 0.007) and histologic grade III (HR = 5.36; CI95%: 2.29-12.56; p = <0.001) showed statistical significance in the multivariate analysis for recurrence of any type, as did the PFs associated with a higher risk of local recurrence (HR = 2.85; CI95%: 1.23-6.57; p = 0.014 and HR = 6.09; CI95%: 2.03-18.2; p = 0.001), respectively. Tumor size (HR = 1.03; CI95%: 1-1.06; p = 0.015) and histologic grade III (HR = 4.53; CI95%: 1.42-14.49; p = 0.011) were associated with a higher risk of distant recurrence. Conclusions: This cohort showed that in addition to histologic grade and tumor size, tumor persistence at the time of admission has an impact on disease recurrence, so STS should be managed by a multidisciplinary team with experience in this pathology in high-volume reference centers.
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Affiliation(s)
- Sandra E. Díaz Casas
- Functional Unit for Breast and Soft Tissue Tumors, Instituto Nacional de Cancerología, Bogotá 111511, Colombia (J.Á.A.); (R.S.R.); (C.A.D.T.)
| | | | - Carlos Lehmann Mosquera
- Functional Unit for Breast and Soft Tissue Tumors, Instituto Nacional de Cancerología, Bogotá 111511, Colombia (J.Á.A.); (R.S.R.); (C.A.D.T.)
| | - Mauricio García Mora
- Functional Unit for Breast and Soft Tissue Tumors, Instituto Nacional de Cancerología, Bogotá 111511, Colombia (J.Á.A.); (R.S.R.); (C.A.D.T.)
| | - Iván Mariño Lozano
- Functional Unit for Breast and Soft Tissue Tumors, Instituto Nacional de Cancerología, Bogotá 111511, Colombia (J.Á.A.); (R.S.R.); (C.A.D.T.)
| | - Javier Ángel Aristizábal
- Functional Unit for Breast and Soft Tissue Tumors, Instituto Nacional de Cancerología, Bogotá 111511, Colombia (J.Á.A.); (R.S.R.); (C.A.D.T.)
| | - Raúl Suarez Rodríguez
- Functional Unit for Breast and Soft Tissue Tumors, Instituto Nacional de Cancerología, Bogotá 111511, Colombia (J.Á.A.); (R.S.R.); (C.A.D.T.)
| | - Carlos Alfonso Duarte Torres
- Functional Unit for Breast and Soft Tissue Tumors, Instituto Nacional de Cancerología, Bogotá 111511, Colombia (J.Á.A.); (R.S.R.); (C.A.D.T.)
| | - Ricardo Sánchez Pedraza
- Instituto Nacional de Cancerología (INC)—Empresa Social del Estado, Universidad Nacional de Colombia, Bogotá 111511, Colombia;
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Smolle MA, Andreou D, Wölfel J, Acem I, Aj Van De Sande M, Jeys L, Bonenkamp H, Pollock R, Tunn PU, Haas R, Posch F, Van Ginkel RJ, Verhoef C, Liegl-Atzwanger B, Moustafa-Hubmer D, Jost PJ, Leithner A, Szkandera J. Effect of radiotherapy on local recurrence, distant metastasis and overall survival in 1200 extremity soft tissue sarcoma patients. Retrospective analysis using IPTW-adjusted models. Radiother Oncol 2023; 189:109944. [PMID: 37832791 DOI: 10.1016/j.radonc.2023.109944] [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: 07/01/2023] [Revised: 09/18/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND AND PURPOSE Neoadjuvant (NRTX) and adjuvant radiotherapy (ARTX) reduce local recurrence (LR) risk in extremity soft tissue sarcoma (eSTS), yet their impact on distant metastasis (DM) and overall survival (OS) is less well defined. This study aimed at analysing the influence of NRTX/ARTX on all three endpoints using a retrospective, multicentre eSTS cohort. MATERIALS AND METHODS 1200 patients (mean age: 60.7 ± 16.8 years; 44.4 % females) were retrospectively included, treated with limb sparing surgery and curative intent for localised, high grade (G2/3) eSTS. 194 (16.2 %), 790 (65.8 %), and 216 (18.0 %) patients had received NRTX, ARTX and no RTX, respectively. For the resulting three groups (no RTX vs. NRTX, no RTX vs. ARTX, NRTX vs. ARTX) Fine&Gray models for LR and DM, and Cox-regression models for OS were calculated, with IPTW-modelling adjusting for imbalances between groups. RESULTS In the IPTW-adjusted analysis, NRTX was associated with lower LR-risk in comparison to no RTX (SHR [subhazard ratio]: 0.236; p = 0.003), whilst no impact on DM-risk (p = 0.576) or OS (p = 1.000) was found. IPTW-weighted analysis for no RTX vs. ARTX revealed a significant positive association between ARTX and lower LR-risk (SHR: 0.479, p = 0.003), but again no impact on DM-risk (p = 0.363) or OS (p = 0.534). IPTW-weighted model for NRTX vs. ARTX showed significantly lower LR-risk for NRTX (SHR for ARTX: 3.433; p = 0.003) but no difference regarding DM-risk (p = 1.000) or OS (p = 0.639). CONCLUSION NRTX and ARTX are associated with lower LR-risk, but do not seem to affect DM-risk or OS. NRTX may be favoured over ARTX as our results indicate better local control rates.
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Affiliation(s)
- Maria A Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5 8036, Graz, Austria
| | - Dimosthenis Andreou
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5 8036, Graz, Austria
| | - Judith Wölfel
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5 8036, Graz, Austria
| | - Ibtissam Acem
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40 3015 GD, Rotterdam, the Netherlands; Department of Orthopedic Surgery, Leiden University Medical Centre, Albinusdreef 2 2333 ZA, Leiden, the Netherlands
| | - Michiel Aj Van De Sande
- Department of Orthopedic Surgery, Leiden University Medical Centre, Albinusdreef 2 2333 ZA, Leiden, the Netherlands.
| | - Lee Jeys
- The Royal Orthopaedic Hospital, NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, United Kingdom
| | - Han Bonenkamp
- Radboud University Medical Center, Department of Surgery, Nijmegen 6525GA, the Netherlands
| | - Rob Pollock
- Department of Orthopaedic Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom
| | - Per-Ulf Tunn
- Tumour Orthopaedics, HELIOS Klinikum Berlin-Buch, Schwanebecker Chaussee 50 13125, Berlin, Germany
| | - Rick Haas
- Department of Radiotherapy , The Netherlands Cancer Institute, Plesmanlaan 121 1066 CX, Amsterdam, the Netherlands
| | - Florian Posch
- Division of Clinical Oncology, Internal Medicine, Medical University of Graz, Auenbruggerplatz 15 8036, Graz, Austria
| | - Robert J Van Ginkel
- University of Groningen, University Medical Center Groningen (UMCG), Department of Surgery, Laboratory for Translational Surgical Oncology, Hanzeplein 1 9713 GZ, Groningen, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40 3015 GD, Rotterdam, the Netherlands
| | - Bernadette Liegl-Atzwanger
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstraße 6 8010, Graz, Austria
| | - Dalia Moustafa-Hubmer
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Auenbruggerplatz 32 8036, Graz, Austria
| | - Philipp J Jost
- Division of Clinical Oncology, Internal Medicine, Medical University of Graz, Auenbruggerplatz 15 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5 8036, Graz, Austria
| | - Joanna Szkandera
- Division of Clinical Oncology, Internal Medicine, Medical University of Graz, Auenbruggerplatz 15 8036, Graz, Austria
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Lebas A, Le Fèvre C, Waissi W, Chambrelant I, Brinkert D, Noël G. Prognostic Factors in Extremity Soft Tissue Sarcomas Treated with Radiotherapy: Systematic Review of the Literature. Cancers (Basel) 2023; 15:4486. [PMID: 37760456 PMCID: PMC10526842 DOI: 10.3390/cancers15184486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Soft tissue sarcomas of the extremities are rare tumors with various prognostic factors. Their management is debatable due to their inconsistent results within the literature and the lack of large prospective studies. The objective of this systematic review is to analyze the available scientific data on prognostic factors concerning the characteristics of the patients, the disease and the treatments performed, as well as their potential complications, on studies with a median follow-up of 5 years at minimum. A search of articles following the "PRISMA method" and using the PubMed search engine was conducted to select the most relevant studies. Twenty-five articles were selected, according to preestablished criteria. This review provides a better understanding of the prognosis and disease outcome of these tumors. Many factors were described comparing the frequency of occurrence according to the studies, which remain heterogeneous between them. Significant factors that could orient patients to radiotherapy were highlighted. These positive prognostic factors provide valuable insight to optimize radiotherapy treatments for patients treated for soft tissue sarcoma of the extremities.
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Affiliation(s)
- Arthur Lebas
- Radiotherapy Department, ICANS, 17 Rue Albert Calmette, 67100 Strasbourg, France; (A.L.); (C.L.F.); (I.C.)
| | - Clara Le Fèvre
- Radiotherapy Department, ICANS, 17 Rue Albert Calmette, 67100 Strasbourg, France; (A.L.); (C.L.F.); (I.C.)
| | - Waisse Waissi
- Radiotherapy Department, Léon Bérard Center, 28 Rue Laennec, 69008 Lyon, France;
| | - Isabelle Chambrelant
- Radiotherapy Department, ICANS, 17 Rue Albert Calmette, 67100 Strasbourg, France; (A.L.); (C.L.F.); (I.C.)
| | - David Brinkert
- Orthopedic Surgery Department, University Hospital of Hautepierre, 1 Rue Molière, 67200 Strasbourg, France;
| | - Georges Noël
- Radiotherapy Department, ICANS, 17 Rue Albert Calmette, 67100 Strasbourg, France; (A.L.); (C.L.F.); (I.C.)
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5
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van Ravensteijn SG, Nederkoorn MJL, Wal TCP, Versleijen-Jonkers YMH, Braam PM, Flucke UE, Bonenkamp JJ, Schreuder BHW, van Herpen CML, de Wilt JHW, Desar IME, de Rooy JWJ. The Prognostic Relevance of MRI Characteristics in Myxofibrosarcoma Patients Treated with Neoadjuvant Radiotherapy. Cancers (Basel) 2023; 15:2843. [PMID: 37345181 DOI: 10.3390/cancers15102843] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 06/23/2023] Open
Abstract
To improve local control, neoadjuvant radiotherapy (nRT) followed by surgery is the standard of care in myxofibrosarcoma (MFS) because of its infiltrative growth pattern. Nevertheless, local recurrence rates are high. Data on prognostic factors for poor clinical outcomes are lacking. This retrospective study thus investigates the prognostic relevance of magnetic resonance imaging (MRI) characteristics before and after nRT in 40 MFS patients, as well as their association with disease-free survival (DFS) and overall survival (OS). A vascular pedicle, defined as extra-tumoral vessels at the tumor periphery, was observed in 12 patients (30.0%) pre-nRT and remained present post-nRT in all cases. Patients with a vascular pedicle had worse DFS (HR 5.85; 95% CI 1.56-21.90; p = 0.009) and OS (HR 9.58; 95% CI 1.91-48.00; p = 0.006). An infiltrative growth pattern, referred to as a tail sign, was observed in 22 patients (55.0%) pre-nRT and in 19 patients (47.5%) post-nRT, and was associated with worse DFS post-nRT (HR 6.99; 95% CI 1.39-35.35; p = 0.019). The percentage of tumor necrosis estimated by MRI was increased post-nRT, but was not associated with survival outcomes. The presence of a tail sign or vascular pedicle on MRI could support the identification of patients at risk for poor clinical outcomes after nRT.
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Affiliation(s)
- Stefan G van Ravensteijn
- Department of Medical Oncology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Maikel J L Nederkoorn
- Department of Medical Oncology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Tom C P Wal
- Department of Medical Oncology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | | | - Pètra M Braam
- Department of Radiotherapy, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Uta E Flucke
- Department of Pathology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Johannes J Bonenkamp
- Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Bart H W Schreuder
- Department of Orthopedics, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Carla M L van Herpen
- Department of Medical Oncology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Ingrid M E Desar
- Department of Medical Oncology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Jacky W J de Rooy
- Department of Radiology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
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Schopow N, Hohenberger P, Gockel I, Osterhoff G. [Multimodal treatment of localized high-grade soft tissue sarcomas of the extremities : Summary and discussion of the current S3 guidelines on adult soft tissue sarcomas and the ESMO guidelines on soft tissue and visceral sarcomas]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:424-431. [PMID: 37041391 DOI: 10.1007/s00104-023-01872-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 04/13/2023]
Abstract
Soft tissue sarcomas are rare, heterogeneous tumors that are frequently in the extremities. Treatment includes surgical resection, combination chemotherapy and/or radiotherapy, as well as supplementary procedures such as isolated limb perfusion and regional deep hyperthermia. The prognosis depends on the tumor stage and the approximately 70 histological subtypes, with specific treatment approaches existing only for some subtypes. This review summarizes the recommendations of the German S3 guideline "Adult Soft Tissue Sarcomas" and the European Society for Medical Oncology (ESMO) guideline "Soft tissue and visceral sarcomas" regarding the diagnostic workup and therapy of soft tissue sarcomas of the extremities.
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Affiliation(s)
- Nikolas Schopow
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - Peter Hohenberger
- Sektion Spezielle chirurgische Onkologie und Thoraxchirurgie, Chirurgische Klinik, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Ines Gockel
- Klinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - Georg Osterhoff
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland.
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7
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Kerrison WGJ, Thway K, Jones RL, Huang PH. The biology and treatment of leiomyosarcomas. Crit Rev Oncol Hematol 2023; 184:103955. [PMID: 36893945 DOI: 10.1016/j.critrevonc.2023.103955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023] Open
Abstract
Leiomyosarcoma (LMS) is a soft tissue sarcoma of smooth muscle origin that can arise in multiple anatomical sites and is broadly classified as extra-uterine LMS or uterine LMS. There is substantial interpatient heterogeneity within this histological subtype, and despite multi-modal therapy, clinical management remains challenging with poor patient prognosis and few new therapies available. Here we discuss the current treatment landscape of LMS in both the localised and advanced disease setting. We further describe the latest advances in our evolving understanding of the genetics and biology of this group of heterogeneous diseases and summarise the key studies delineating the mechanisms of acquired and intrinsic chemotherapy resistance in this histological subtype. We conclude by providing a perspective on how novel targeted agents such as PARP inhibitors may usher in a new paradigm of biomarker-driven therapies that will ultimately impact the outcomes of patients with LMS.
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Affiliation(s)
- William G J Kerrison
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
| | - Khin Thway
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Robin L Jones
- The Royal Marsden NHS Foundation Trust, London, United Kingdom; Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Paul H Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom.
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8
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Ryu JH, Rahman J, Deo S, Flint M. Effects of time to treatment initiation on outcomes for soft tissue sarcomas. J Surg Oncol 2023; 127:1174-1186. [PMID: 36939055 DOI: 10.1002/jso.27237] [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: 01/23/2023] [Accepted: 03/01/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND AND OBJECTIVES Few studies have investigated the effects of time to treatment initiation (TTI) for soft tissue sarcomas (STS). Our objective was to investigate the risk factors for prolonged TTI and the effects of prolonged TTI on local recurrence free survival (LRFS), distant metastasis free survival (DMFS), and disease specific survival (DSS). METHOD Patients diagnosed with high-grade STS of the extremities and trunk from 2011 to 2020 were included. TTI was grouped into two groups (treatment provided in less than vs. more than or equal to 30 days). Two-year and 5-year survival probabilities were calculated for LRFS, DMFS, and DSS. Cox regression and Kruskal-Wallis tests in univariate analysis were conducted to find risk factors affecting TTI and the survival outcomes. RESULTS In the univariate analysis, diagnosis in the later 5-year period of the study, tumor size, and treatment modality were associated with prolonged TTI. TTI ≥30 days was associated with higher DMFS but no association was found with LRFS or DSS. Tumor size, surgical margins, and provision of surgery were associated with DSS. CONCLUSION Despite the delay in treatment for STS patients caused by the COVID-19 pandemic, our study showed TTI of more than 30 days does not negatively impact patients.
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Affiliation(s)
- Jae Hong Ryu
- Department of Orthopaedic Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Juma Rahman
- Research and Evaluation Office, Counties Manukau Health, Auckland, New Zealand
| | - Shaneel Deo
- Department of Orthopaedic Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Michael Flint
- Department of Orthopaedic Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
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9
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Lawrenz JM, Johnson SR, Hajdu KS, Chi A, Bendfeldt GA, Kang H, Halpern JL, Holt GE, Schwartz HS. Is the Number of National Database Research Studies in Musculoskeletal Sarcoma Increasing, and Are These Studies Reliable? Clin Orthop Relat Res 2023; 481:491-508. [PMID: 35767810 PMCID: PMC9928832 DOI: 10.1097/corr.0000000000002282] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/27/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Large national databases have become a common source of information on patterns of cancer care in the United States, particularly for low-incidence diseases such as sarcoma. Although aggregating information from many hospitals can achieve statistical power, this may come at a cost when complex variables must be abstracted from the medical record. There is a current lack of understanding of the frequency of use of the Surveillance, Epidemiology, and End Results (SEER) database and the National Cancer Database (NCDB) over the last two decades in musculoskeletal sarcoma research and whether their use tends to produce papers with conflicting findings. QUESTIONS/PURPOSES (1) Is the number of published studies using the SEER and NCDB databases in musculoskeletal sarcoma research increasing over time? (2) What are the author, journal, and content characteristics of these studies? (3) Do studies using the SEER and the NCDB databases for similar diagnoses and study questions report concordant or discordant key findings? (4) Are the administrative data reported by our institution to the SEER and the NCDB databases concordant with the data in our longitudinally maintained, physician-run orthopaedic oncology dataset? METHODS To answer our first three questions, PubMed was searched from 2001 through 2020 for all studies using the SEER or the NCDB databases to evaluate sarcoma. Studies were excluded from the review if they did not use these databases or studied anatomic locations other than the extremities, nonretroperitoneal pelvis, trunk, chest wall, or spine. To answer our first question, the number of SEER and NCDB studies were counted by year. The publication rate over the 20-year span was assessed with simple linear regression modeling. The difference in the mean number of studies between 5-year intervals (2001-2005, 2006-2010, 2011-2015, 2016-2020) was also assessed with Student t-tests. To answer our second question, we recorded and summarized descriptive data regarding author, journal, and content for these studies. To answer our third question, we grouped all studies by diagnosis, and then identified studies that shared the same diagnosis and a similar major study question with at least one other study. We then categorized study questions (and their associated studies) as having concordant findings, discordant findings, or mixed findings. Proportions of studies with concordant, discordant, or mixed findings were compared. To answer our fourth question, a coding audit was performed assessing the concordance of nationally reported administrative data from our institution with data from our longitudinally maintained, physician-run orthopaedic oncology dataset in a series of patients during the past 3 years. Our orthopaedic oncology dataset is maintained on a weekly basis by the senior author who manually records data directly from the medical record and sarcoma tumor board consensus notes; this dataset served as the gold standard for data comparison. We compared date of birth, surgery date, margin status, tumor size, clinical stage, and adjuvant treatment. RESULTS The number of musculoskeletal sarcoma studies using the SEER and the NCDB databases has steadily increased over time in a linear regression model (β = 2.51; p < 0.001). The mean number of studies per year more than tripled during 2016-2020 compared with 2011-2015 (39 versus 13 studies; mean difference 26 ± 11; p = 0.03). Of the 299 studies in total, 56% (168 of 299) have been published since 2018. Nineteen institutions published more than five studies, and the most studies from one institution was 13. Orthopaedic surgeons authored 35% (104 of 299) of studies, and medical oncology journals published 44% (130 of 299). Of the 94 studies (31% of total [94 of 299]) that shared a major study question with at least one other study, 35% (33 of 94) reported discordant key findings, 29% (27 of 94) reported mixed key findings, and 44% (41 of 94) reported concordant key findings. Both concordant and discordant groups included papers on prognostic factors, demographic factors, and treatment strategies. When we compared nationally reported administrative data from our institution with our orthopaedic oncology dataset, we found clinically important discrepancies in adjuvant treatment (19% [15 of 77]), tumor size (21% [16 of 77]), surgery date (23% [18 of 77]), surgical margins (38% [29 of 77]), and clinical stage (77% [59 of 77]). CONCLUSION Appropriate use of databases in musculoskeletal cancer research is essential to promote clear interpretation of findings, as almost two-thirds of studies we evaluated that asked similar study questions produced discordant or mixed key findings. Readers should be mindful of the differences in what each database seeks to convey because asking the same questions of different databases may result in different answers depending on what information each database captures. Likewise, differences in how studies determine which patients to include or exclude, how they handle missing data, and what they choose to emphasize may result in different messages getting drawn from large-database studies. Still, given the rarity and heterogeneity of sarcomas, these databases remain particularly useful in musculoskeletal cancer research for nationwide incidence estimations, risk factor/prognostic factor assessment, patient demographic and hospital-level variable assessment, patterns of care over time, and hypothesis generation for future prospective studies. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Joshua M. Lawrenz
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Samuel R. Johnson
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katherine S. Hajdu
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew Chi
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gabriel A. Bendfeldt
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hakmook Kang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer L. Halpern
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ginger E. Holt
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Herbert S. Schwartz
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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10
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Hatoum GF, Temple HT, Garcia SA, Zheng Y, Kfoury F, Kinley J, Wu X. Neoadjuvant Radiation Therapy with Interdigitated High-Dose LRT for Voluminous High-Grade Soft-Tissue Sarcoma. Cancer Manag Res 2023; 15:113-122. [PMID: 36776730 PMCID: PMC9910204 DOI: 10.2147/cmar.s393934] [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: 10/18/2022] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
Purpose To report a case of large extremity soft tissue sarcoma (2933 cc), safely treated with a novel approach of interdigitating high-dose LATTICE radiation therapy (LRT) with standard radiation therapy as a neoadjuvant treatment to surgery. Patients and Methods Four sessions of high-dose LRT were delivered in a weekly interval, interdigitated with standard radiation therapy. The LRT plan consisted of 15 high-dose vertices receiving a dose >12 Gy per session, with 2-3 Gy to the peripheral margin of the tumor. The patient underwent surgical excision 2 months after the new regimen of induction radiation therapy. Results and Discussion The patient tolerated the radiation therapy regimen well. The post-operative assessment revealed a negative surgical margin and over 95% necrosis of the total tumor volume. The post-surgical wound complication was mitigated by outpatient wound care. Interdigitating multiple sessions of high-dose LATTICE radiation treatments with standard neoadjuvant radiation therapy as a neoadjuvant therapy for soft tissue sarcoma was feasible and did not incur additional toxicity in this clinical case. A phase-I/II trial will be conducted to further evaluate the toxicity and efficacy of the new treatment strategy with the intent to increase the rate of pathologic necrosis, which has been shown to positively correlate with the overall survival.
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Affiliation(s)
- Georges F Hatoum
- Department of Radiation Oncology, HCA Florida JFK Medical Center Comprehensive Cancer Institute, Lake Worth, FL, USA
| | - H Thomas Temple
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Silvio A Garcia
- Department of Radiation Oncology, HCA Florida JFK Medical Center Comprehensive Cancer Institute, Lake Worth, FL, USA
| | - Yi Zheng
- Department of Radiation Oncology, HCA Florida JFK Medical Center Comprehensive Cancer Institute, Lake Worth, FL, USA,Department of Research and Development, Executive Medical Physics Associates, North Miami Beach, FL, USA
| | - Fouad Kfoury
- Pharmacy Department, South Miami Hospital, South Miami, FL, USA
| | - Jill Kinley
- Department of Clinical Research, HCA Florida JFK Medical Center, Atlantis, FL, USA
| | - Xiaodong Wu
- Department of Radiation Oncology, HCA Florida JFK Medical Center Comprehensive Cancer Institute, Lake Worth, FL, USA,Department of Research and Development, Executive Medical Physics Associates, North Miami Beach, FL, USA,Correspondence: Xiaodong Wu, Executive Medical Physics Associates, 19470 NE 22nd Road, North Miami Beach, FL, 33179, USA, Tel +1 305 775 0333, Email
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11
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Willner A, Agaimy A, Fechner K, Ott O, Denz A, Weissmann T, Meidenbauer N, Höfler D, Gaipl U, Frey B, Schmidt M, Haller F, Horch R, Hartmann A, Grützmann R, Fietkau R, Semrau S. Chemoradiotherapy plus hyperthermia (CRTH) versus chemoradiotherapy (CRT) alone in neoadjuvant treatment of soft tissue sarcoma: tumor response, treatment toxicity and disease control. Int J Hyperthermia 2023; 40:2248424. [PMID: 37611915 DOI: 10.1080/02656736.2023.2248424] [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: 05/17/2023] [Revised: 08/01/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION Neoadjuvant chemotherapy and radiotherapy for the management of soft tissue sarcomas (STS) are still preferably delivered sequentially, with or without concurrent hyperthermia. Concurrent delivery of chemo-, radio- and thermotherapy may produce synergistic effects and reduce chemotherapy-free intervals. The few available studies suggest that concurrent chemoradiation (CRT) has a greater local effect. Data on the efficacy and toxicity of adding hyperthermia to CRT (CRTH) are sparse. MATERIALS AND METHODS A cohort of 101 patients with STS of the extremities and trunk who received CRT (n = 33) or CRTH (n = 68) before resection of macroscopic tumor (CRT: n = 19, CRTH: n = 49) or re-resection following a non-oncological resection, so called 'whoops procedure', (CRT: n = 14, CRTH: n = 19) were included in this retrospective study. CRT consisted of two cycles of doxorubicine (50 mg/m2 on d2) plus ifosfamide (1500 mg/m2 on d1-5, q28) plus radiation doses of up to 60 Gy. Hyperthermia was delivered in two sessions per week. RESULTS All patients received the minimum dose of 50 Gy. Median doses of ifosfamide and doxorubicin were comparable between CRT (75%/95%) and CRTH (78%/97%). The median number of hyperthermia sessions was seven. There were no differences in acute toxicities. Major wound complications occurred in 15% (CRT) vs. 25% (CRTH) (p = 0.19). In patients with macroscopic disease, the addition of hyperthermia resulted in a tendency toward improved remission: regression ≥90% occurred in 21/48 (CRTH) vs. 4/18 (CRT) patients (p = 0.197). With a median postoperative follow-up of 72 months, 6-year local control and overall survival rates for CRTH vs. CRT alone were 85 vs. 78% (p = 0.938) and 79 vs. 71% (p = 0.215). CONCLUSIONS Both CRT and CRTH are well tolerated with an expected rate of wound complications. The results suggest that adding hyperthermia may improve tumor response.
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Affiliation(s)
- Alexander Willner
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Katja Fechner
- Department of Haematology and Oncology, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Oliver Ott
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Axel Denz
- Department of Haematology and Oncology, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Thomas Weissmann
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Norbert Meidenbauer
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Daniel Höfler
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Udo Gaipl
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Benjamin Frey
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Manfred Schmidt
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Florian Haller
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Raymund Horch
- Department of Hand- and Plastic Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Robert Grützmann
- Department of Haematology and Oncology, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sabine Semrau
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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12
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Demir M, Güven D, Aktaş BY, Güner G, Aktepe OH, Taban H, Karakaş Y, Kılıçkap S, Kars A, Türker A, Dizdar Ö. Prognosis of Liposarcoma Patients in Modern ERA: Single-Center Experience. South Asian J Cancer 2022; 11:287-292. [PMID: 36756104 PMCID: PMC9902100 DOI: 10.1055/s-0042-1755467] [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] [Indexed: 11/17/2022] Open
Abstract
Objective Liposarcomas are relatively rare tumors. Prognostic and predictive factors and treatment options are limited. We herein presented our 10-year experience with liposarcomas. Materials and Methods Adult patients with liposarcoma treated between 2005 and 2015 in our center were included. Demographic and clinicopathologic features of patients were retrieved from patient files. Statistical Analyses Outcomes in terms of disease-free survival (DFS) and overall survival (OS) were assessed along with potential prognostic factors using Kaplan-Meier analyses. Results A total of 88 patients were included. The median age was 52. Rates of well-differentiated (WDLS), dedifferentiated (DDLS), myxoid (MLS), and pleomorphic liposarcomas (PLS) were 42, 9.1, 37.5, and 4.5%, respectively. Only 10% of patients had high-grade tumors and 93% had localized disease. Ninety-six percent of patients ( n = 84) underwent surgery. Adjuvant chemotherapy was delivered to 16 patients. The most common regimen was ifosfamide-doxorubicin. Recurrences were observed in 30 patients, 21 had local, and 9 had distant metastasis. Five-year DFS of patients with the localized disease was 68%. All patients with PLS had relapses and those had the highest distant relapse rates among all subtypes. Multivariate analysis showed T stage and grade were associated with DFS. Five-year OS of the entire population was 68%. Five-year OS was 79, 76, 50, and 0% in WDLS, MLS, DDLS, and PLS, respectively ( p = 0.002). Conclusion Management of liposarcomas is still challenging. Surgery is the mainstay of treatment. Novel effective therapies are needed, particularly in advanced disease settings.
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Affiliation(s)
- Metin Demir
- Department of Oncology, Hacettepe University Cancer Institute, Ankara, Turkey,Address for correspondence Metin Demir, MD Department of Oncology, Hacettepe University Cancer InstituteAnkara 06100Turkey
| | - Denizcan Güven
- Department of Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Burak Yasin Aktaş
- Department of Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Gürkan Güner
- Department of Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Oktay Halit Aktepe
- Department of Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Hakan Taban
- Department of Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Yusuf Karakaş
- Department of Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Sadettin Kılıçkap
- Department of Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Ayşe Kars
- Department of Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Alev Türker
- Department of Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Ömer Dizdar
- Department of Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
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13
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Gurusamy VM, Al-Hammadi N, Caparrotti P, Divakar SR, Hammoud RW, Shaikh G. Real-world clinical outcomes with daily image-guided IMRT in extremity soft tissue sarcomas. Cancer Treat Res Commun 2022; 33:100655. [PMID: 36356354 DOI: 10.1016/j.ctarc.2022.100655] [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: 09/22/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE We report the clinical outcomes of patients with soft tissue sarcomas (STS) arising in extremities treated with image-guided intensity modulated radiotherapy (IG-IMRT) at our institute. Local control of the tumors treated with RT was the primary end point of this study. Analyzing overall survival and long-term toxicities were the secondary objectives. METHODS AND MATERIALS The database of the patients with STS who received wide local excision and IG-IMRT at our institution from January 2012 to December 2020 was reviewed. Radiation was offered either preoperatively or postoperatively as part of multi-modality treatment. RESULTS Thirty-three consecutive patients were identified and included for analysis. Twenty-eight patients (84.8%) received postoperative adjuvant radiotherapy. Dedicated MRI simulation studies were performed in 31 patients (93.9%) in the treatment position. RapidArc IMRT technique was used in 31 patients (93.9%). A total of 2954 images were acquired during 991 treatment sessions. Errors exceeding 1 mm in the x, y and z directions were corrected online before the treatment. With a median follow-up of 36 months, two patients (6.1%) developed local recurrence. The 3-year local control was 90.9% (95% CI, 0.76 - 0.98), and the 5-year overall survival was 71.7% (95% CI, 0.44 - 0.88). One patient (3.03%) sustained a pathological fracture during the follow-up period. CONCLUSION Our results showed that IMRT with daily imaging offered excellent local control with acceptable long-term toxicity, as well as being feasible and practical to implement in our routine clinical practice.
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Affiliation(s)
- Venkada Manickam Gurusamy
- Department of Radiation Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar.
| | - Noora Al-Hammadi
- Department of Radiation Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Palmira Caparrotti
- Department of Radiation Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Saju Raveendran Divakar
- Department of Radiation Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Rabih Wafiq Hammoud
- Department of Radiation Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Ghazia Shaikh
- Department of Radiation Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
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14
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Retroperitoneal Sarcomas: Histology Is Everything. Surg Clin North Am 2022; 102:601-614. [PMID: 35952690 DOI: 10.1016/j.suc.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Retroperitoneal sarcomas (RPS) are a rare subset of soft tissue sarcoma that are composed of only a few histologic subtypes, each with a distinct tumor biology, clinical presentation, preferred treatment strategy, recurrence risk, and surveillance plan. In the modern era of precision medicine, our understanding of the implications of subtype tumor biology and anatomic location has led to a more nuanced, histology-specific approach to therapy, including surgery, neoadjuvant radiation therapy, and/or chemotherapy. This article provides a summary of recent updates to the management of RPS.
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15
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Arthur A, Johnston EW, Winfield JM, Blackledge MD, Jones RL, Huang PH, Messiou C. Virtual Biopsy in Soft Tissue Sarcoma. How Close Are We? Front Oncol 2022; 12:892620. [PMID: 35847882 PMCID: PMC9286756 DOI: 10.3389/fonc.2022.892620] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/31/2022] [Indexed: 12/13/2022] Open
Abstract
A shift in radiology to a data-driven specialty has been unlocked by synergistic developments in imaging biomarkers (IB) and computational science. This is advancing the capability to deliver “virtual biopsies” within oncology. The ability to non-invasively probe tumour biology both spatially and temporally would fulfil the potential of imaging to inform management of complex tumours; improving diagnostic accuracy, providing new insights into inter- and intra-tumoral heterogeneity and individualised treatment planning and monitoring. Soft tissue sarcomas (STS) are rare tumours of mesenchymal origin with over 150 histological subtypes and notorious heterogeneity. The combination of inter- and intra-tumoural heterogeneity and the rarity of the disease remain major barriers to effective treatments. We provide an overview of the process of successful IB development, the key imaging and computational advancements in STS including quantitative magnetic resonance imaging, radiomics and artificial intelligence, and the studies to date that have explored the potential biological surrogates to imaging metrics. We discuss the promising future directions of IBs in STS and illustrate how the routine clinical implementation of a virtual biopsy has the potential to revolutionise the management of this group of complex cancers and improve clinical outcomes.
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Affiliation(s)
- Amani Arthur
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom
| | - Edward W. Johnston
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Jessica M. Winfield
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Matthew D. Blackledge
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom
| | - Robin L. Jones
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Paul H. Huang
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton, United Kingdom
- *Correspondence: Paul H. Huang, ; Christina Messiou,
| | - Christina Messiou
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- *Correspondence: Paul H. Huang, ; Christina Messiou,
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16
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Zhou C, Chen X, Huang Y, Zhang Q, Zhu S, Fu W. Nanomaterial Technology and Soft Tissue Sarcomas. Front Oncol 2022; 12:921983. [PMID: 35814363 PMCID: PMC9257037 DOI: 10.3389/fonc.2022.921983] [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: 04/17/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022] Open
Abstract
Soft tissue sarcomas (STSs) are relatively rare heterogeneous solid tumors of the mesenchymal origin. They account for approximately 1% of all malignant tumors in adults and have more than 70 histological subtypes. Consequently, the rarity and heterogeneity of STSs make their diagnosis and treatment very challenging. Nanotechnology has attracted increasing attention from researchers due to the unique physicochemical and biological properties of nanomaterials with potential medical applications as nanoprobes, drug delivery systems, photosensitizers, radioenhancers, antitumor agents, and their combinations for cancer diagnosis and treatment. This review discusses the progress made in the use of nanotechnology for the diagnosis and treatment of STSs and highlights future prospects of the STS multimodality therapy.
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Affiliation(s)
- Changkai Zhou
- Department of Burn and Plastic Surgery, Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, Nantong, China
| | - Xue Chen
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Huang
- Department of Operation Room, Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, Nantong, China
| | - Qi Zhang
- Department of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Wei Fu, ; Shu Zhu, ; Qi Zhang,
| | - Shu Zhu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Wei Fu, ; Shu Zhu, ; Qi Zhang,
| | - Wei Fu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Wei Fu, ; Shu Zhu, ; Qi Zhang,
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17
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Brügemann D, Lehner B, Kieser M, Krisam J, Hommertgen A, Jaekel C, Harrabi SB, Herfarth K, Mechtesheimer G, Sedlaczek O, Egerer G, Geisbüsch A, Uhl M, Debus J, Seidensaal K. Neoadjuvant irradiation of extremity soft tissue sarcoma with ions (Extrem-ion): study protocol for a randomized phase II pilot trial. BMC Cancer 2022; 22:538. [PMID: 35550036 PMCID: PMC9097299 DOI: 10.1186/s12885-022-09560-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The standard of care treatment for soft tissue sarcoma of the extremities is a wide resection in combination with pre- or postoperative radiotherapy with high local control rates, sparing patients the necessity of amputation without compromising on overall survival rates. The currently preferred timing of radiotherapy is under debate. Albeit having higher rates of acute wound complications, late side effects like fibrosis, joint stiffness or edema are less frequent in preoperative compared to postoperative radiotherapy. This can be explained in smaller treatment volumes and a lower dose in the preoperative setting. Particles allow better sparing of surrounding tissues at risk, and carbon ions additionally offer biologic advantages and are preferred in less radiosensitive tumors. Hypofractionation allows for a significantly shorter treatment duration. METHODS Extrem-ion is a prospective, randomized, monocentric phase II trial. Patients with resectable or marginally resectable, histologically confirmed soft tissue sarcoma of the extremities will be randomized between neoadjuvant proton or neoadjuvant carbon ion radiotherapy in active scanning beam application technique (39 Gy [relative biological effectiveness, RBE] in 13 fractions [5-6 fractions per week] in each arm). The primary objective is the proportion of therapies without wound healing disorder the first 120 days after surgery or discontinuation of treatment for any reason related to the treatment. The secondary endpoints of the study consist of local control, local progression-free survival, disease-free survival, overall survival, and quality of life. DISCUSSION The aim of this study is to confirm that hypofractionated, preoperative radiotherapy is safe and feasible. The potential for reduced toxicity by the utilization of particle therapy is the rational of this trial. A subsequent randomized phase III trial will compare the hypofractionated proton and carbon ion irradiation in regards to local control. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04946357 ; Retrospectively registered June 30, 2021.
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Affiliation(s)
- D Brügemann
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany
| | - B Lehner
- Center for Orthopedics, Trauma Surgery and Paraplegiology, University of Heidelberg, Heidelberg, Germany
| | - M Kieser
- Institute for Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - J Krisam
- Institute for Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - A Hommertgen
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - C Jaekel
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - S B Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - K Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - G Mechtesheimer
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - O Sedlaczek
- Department of Radiology, University of Heidelberg, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - G Egerer
- Department of Hematology, Oncology and Rheumatology, Heidelberg University, Heidelberg, Germany
| | - A Geisbüsch
- Center for Orthopedics, Trauma Surgery and Paraplegiology, University of Heidelberg, Heidelberg, Germany
| | - M Uhl
- Department of Radiation Oncology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - J Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - K Seidensaal
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.
- National Center for Tumor diseases (NCT), Heidelberg, Germany.
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany.
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18
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Einck JP, Sanghvi P. Don't Panic and Rely on Data. Int J Radiat Oncol Biol Phys 2022; 112:39. [PMID: 34919881 DOI: 10.1016/j.ijrobp.2021.07.1702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 12/01/2022]
Affiliation(s)
- John P Einck
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Parag Sanghvi
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
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19
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Bleckman RF, Acem I, van Praag VM, Dorleijn DMJ, Verhoef C, Schrage YM, Haas RML, van de Sande MAJ. Multimodality treatment of undifferentiated pleomorphic soft tissue sarcoma of the extremity (eUPS) in the elderly. Eur J Surg Oncol 2021; 48:985-993. [PMID: 34930647 DOI: 10.1016/j.ejso.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/28/2021] [Accepted: 12/06/2021] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION This subgroup analysis of undifferentiated pleomorphic soft tissue sarcoma of the extremity (eUPS) from the PERSARC collaborative group aimed to achieve a more personalized multimodality treatment approach for primary eUPS in elderly patients. MATERIAL AND METHODS A multicenter retrospective study including primary high-grade eUPS surgically treated with curative intent between 2000 and 2016. Overall survival (OS), local recurrence (LR) and distant metastasis (DM) curves were calculated by Kaplan Meier analysis. Cox proportional hazard models were used to determine the effect of radiotherapy. RESULTS From a total of 2511 patients with extremity soft tissue sarcoma (eSTS) of the PERSARC study collaborative; 703 patients with eUPS were included in this study. In elderly patients with eUPS 5-year OS, LR and DM were 35.4 (95%CI 29.3-42.8), 17.7 (95%CI 12.7-22.6) and 24.6 (95%CI 19.1-30.1). eUPS was significantly less treated with radiotherapy compared with other eSTS, especially in elderly patients. Patients with R1-R2 margins treated with radiotherapy had about half the risk of developing LR compared with patients treated without radiotherapy (HR = 0.454, p = 0.033). CONCLUSION Elderly patients with eUPS were less often treated with radiotherapy and showed higher LR. Nowadays, given an increasing life expectancy in elderly patients, multimodality treatment should be considered.
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Affiliation(s)
- Roos F Bleckman
- Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands; Department of Surgical Oncology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands.
| | - Ibtissam Acem
- Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands; Department of Surgical Oncology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands; Department of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands; Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Veroniek M van Praag
- Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Desirée M J Dorleijn
- Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Yvonne M Schrage
- Department of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - Rick M L Haas
- Department of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - Michiel A J van de Sande
- Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
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20
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Qiu X, He H, Zeng H, Tong X, Liu Q. The Role of Radiotherapy in Soft Tissue Sarcoma on Extremities With Lymph Nodes Metastasis: An IPTW Propensity Score Analysis of the SEER Database. Front Oncol 2021; 11:751180. [PMID: 34745979 PMCID: PMC8566919 DOI: 10.3389/fonc.2021.751180] [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: 08/04/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background Soft tissue sarcomas on extremities with regional lymph nodes metastasis (STSE-RLNM) is a devastating situation. Optimizing therapeutic approaches is vital but hampered by a shortage of randomized trials. We used a population-level database to evaluate radiotherapy’s impact on sarcoma-specific survival (SSS) and overall survival (OS) for surgery for STSE-RLNM. Methods We retrospectively screened data from the SEER database (2004–2015), and 265 patients with STSE-RLNM who received surgery, with (134) or without (131) radiotherapy, were enrolled in this study. A propensity-score-matched analysis with the inverse probability of treatment weighting (IPTW) Kaplan–Meier curve was created. The log-rank test and Cox regression analysis were performed to compare SSS and OS in patients with and without radiotherapy. Further analysis of radiotherapy time was conducted, and the Kaplan–Meier curve and the log-rank test were done. Landmark analysis was introduced to attenuate the immortal bias. Results In the original unadjusted cohort, the radiotherapy + surgery group is associated with improved SSS [hazard ratio (HR), 0.66; 95% CI, 0.47–0.91; p = 0.011] and OS (HR, 0.64; 95% CI, 0.47–0.88; p = 0.006). This significant treatment effect was also noted in IPTW-adjusted Cox regression either on SSS (HR, 0.65; 95% CI, 0.45–0.93; p = 0.020) or on OS (HR, 0.64; 95% CI, 0.46–0.91; p = 0.013). The Kaplan–Meier curve and log-rank test showed that pre- and postoperative radiotherapy was not related to SSS (p = 0.980 or OS (p = 0.890). Conclusion Radiotherapy and surgery has a significant benefit on the prognosis of patients with STSE-RLNM compared to surgery alone. These findings should be considered when making treatment decisions for them.
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Affiliation(s)
- Xinzhu Qiu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hongbo He
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaopeng Tong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Qing Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
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21
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The effect of preoperative radiotherapy on surgical resectability, tumor volume and the necrosis rate of soft tissue sarcomas: A retrospective single-center analysis. Surg Oncol 2021; 39:101668. [PMID: 34653769 DOI: 10.1016/j.suronc.2021.101668] [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: 06/25/2021] [Revised: 09/09/2021] [Accepted: 10/03/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The mainstay of soft tissue sarcoma treatment is limb preserving resection, often combined with radiotherapy, preferably preoperative radiotherapy. The goal of this study is to retrospectively assess the effect of preoperative (neoadjuvant) radiotherapy on the minimal distance to critical neurovascular structures, on tumor volume and the necrosis rate. MATERIAL AND METHODS The data of fifty-one patients treated for a localized soft tissue sarcoma (STS) of the extremity or the trunk were retrospectively reviewed. All patients were analyzed with MR imaging before and after preoperative radiotherapy to determine the impact of radiotherapy on the precise planning and execution of the surgical excision of the tumor. The volume of the tumor as well as the distance to anatomically relevant structures were measured on MRI. Tumor type, characteristics and necrosis rate were obtained from the pathology report. RESULTS At latest follow-up (median 51 months (range 6-113)) 32/51 (63%) patients were alive. The minimal distance between the myxoid liposarcomas (n = 12) and the vessels was significantly increased by preoperative radiotherapy from 1.09 mm [0-21.1] to 5.23 mm [0-32.70] (P = 0.045). High-grade tumors showed a significant increase in tumor volume after irradiation (p = 0.03) and a significantly greater necrosis rate than low-grade tumors (p < 0.001). CONCLUSION Preoperative radiotherapy significantly increases the minimal distance from myxoid liposarcomas to the vessel. In the subgroup of STS that demonstratea volume reduction the distance to nerves and vessels increases, but with the low number of cases, this increase is not statistically significant. The effect of preoperative radiotherapy on the tumor volume varies greatly, whereas the subtype of myxoid liposarcoma shows a significant volume reduction in all cases.
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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.
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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
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Chang X, Li Y, Xue X, Zhou H, Hou L. The current management of alveolar soft part sarcomas. Medicine (Baltimore) 2021; 100:e26805. [PMID: 34397835 PMCID: PMC8341245 DOI: 10.1097/md.0000000000026805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/18/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Alveolar soft part sarcomas (ASPS) which has high potential ability of metastasis, is a rare and slowly growing malignant tumor, and mainly primary localized in limbs. To date, little is known about the best treatment of ASPS. This study aims to review the current management and advance of ASPS. METHODS WANFANG MED ONLINE, CNKI, and NCBI PUBMED were used to search literature spanning from 1963 to 2020, and all cases of ASPS about "ASPS, diagnosis, treatment, surgery, radiotherapy, chemotherapy, target therapy or immune therapy" with detailed data were included. RESULTS Complete surgical resection remained the standard management strategy, radiotherapy was reported to be used for the patients of micro- or macroscopical incomplete residue or the surgical margin was questionable. Chemotherapy was controversial. Some target drugs and immune checkpoint inhibitors had produced antitumor activity. CONCLUSION Complete surgical resection is the cure treatment for ASPS, and adjuvant chemotherapy is not recommended excepted clinical trials. For the patients with micro- or macroscopical incomplete residue, radiotherapy should be appreciated. Furthermore, for recurrence, distant metastasis, and refractory of ASPS, combination therapy, especially combination with multiple target agents and/or immune checkpoint inhibitors may prolong survival time.
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Affiliation(s)
- Xiaojing Chang
- Department of Radiotherapy, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuehong Li
- Department of Pathology, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaoying Xue
- Department of Radiotherapy, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huandi Zhou
- Department of Radiotherapy, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Liubing Hou
- Department of Radiotherapy, the Second Hospital of Hebei Medical University, Shijiazhuang, China
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24
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Dammerer D, VAN Beeck A, Schneeweiss V, Schwabegger A. Follow-up Strategies for Primary Extremity Soft-tissue Sarcoma in Adults: A Systematic Review of the Published Literature. In Vivo 2021; 34:3057-3068. [PMID: 33144410 DOI: 10.21873/invivo.12140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 01/22/2023]
Abstract
AIM Follow-up strategies for primary extremity soft-tissue sarcomas (eSTS) in adults were evaluated in a systematic review of the published literature. MATERIAL AND METHODS The published literature was reviewed using PubMed. Of 136,646 studies published between 1985 and 2019, 78 original articles met the inclusion criteria. Articles were selected on the basis of the PRISMA guidelines. The selected articles were then cross-searched to identify further publications. August 1, 2019 was used as the concluding date of publication. RESULTS A variety of follow-up schedules have been reported in recently published literature. Two official guidelines have been approved by international societies. The guidelines distinguish between high- and low-grade STS, but mention a wide range of follow-up intervals. Established tools of follow-up include computed tomograph, X-rays of the chest, and magnetic resonance imaging of the primary tumor site in addition to clinical observation and physical examination. CONCLUSION Further research will be needed to establish evidence-based guidelines and schedules for follow-up strategies in patients with eSTS.
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Affiliation(s)
- Dietmar Dammerer
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Viktoria Schneeweiss
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anton Schwabegger
- Department of Plastic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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25
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Abstract
Surgical resection with wide margins and perioperative radiation therapy is the standard treatment of extremity soft tissue sarcomas. This combination often results in complex wounds and functional compromise. Reconstructive surgery is integral to limb salvage after sarcoma resection. Advances in adjuvant therapy and reconstructive surgical techniques have made functional limb salvage, instead of amputation, possible for most patients. This article reviews key concepts in the multidisciplinary care of patients with extremity soft tissue sarcomas and details reconstructive surgical techniques, including locoregional and free tissue transfer, free functional muscle transfer, and vascularized bone transfer, to optimize functional limb restoration after sarcoma resection.
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Affiliation(s)
- Rajiv P Parikh
- Plastic and Reconstructive Surgical Service, Center for Advanced Reconstruction, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Justin M Sacks
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, Suite 1150 NWT, St Louis, MO 63110, USA.
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26
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Neoadjuvant Radiotherapy-Related Wound Morbidity in Soft Tissue Sarcoma: Perspectives for Radioprotective Agents. Cancers (Basel) 2020; 12:cancers12082258. [PMID: 32806601 PMCID: PMC7465163 DOI: 10.3390/cancers12082258] [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: 06/17/2020] [Revised: 07/10/2020] [Accepted: 08/10/2020] [Indexed: 12/18/2022] Open
Abstract
Historically, patients with localized soft tissue sarcomas (STS) of the extremities would undergo limb amputation. It was subsequently determined that the addition of radiation therapy (RT) delivered prior to (neoadjuvant) or after (adjuvant) a limb-sparing surgical resection yielded equivalent survival outcomes to amputation in appropriate patients. Generally, neoadjuvant radiation offers decreased volume and dose of high-intensity radiation to normal tissue and increased chance of achieving negative surgical margins-but also increases wound healing complications when compared to adjuvant radiotherapy. This review elaborates on the current neoadjuvant/adjuvant RT approaches, wound healing complications in STS, and the potential application of novel radioprotective agents to minimize radiation-induced normal tissue toxicity.
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Tagliaferri L, Vavassori A, Lancellotta V, Sanctis VD, Vidali C, Casà C, Aristei C, Genovesi D, Jereczek-Fossa BA, Morganti AG, Kovács G, Guinot JL, Rembielak A, Greto D, Gambacorta MA, Valentini V, Donato V, Corvò R, Magrini SM, Livi L. INTERACTS (INTErventional Radiotherapy ACtive Teaching School) consensus conference on sarcoma interventional radiotherapy (brachytherapy) endorsed by AIRO (Italian Association of Radiotherapy and Clinical Oncology). J Contemp Brachytherapy 2020; 12:397-404. [PMID: 33293980 PMCID: PMC7690224 DOI: 10.5114/jcb.2020.98120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To report the results of INTERACTS (INTErventional Radiotherapy ACtive Teaching School) consensus conference on sarcoma interventional radiotherapy (brachytherapy). MATERIAL AND METHODS An international board of multidisciplinary experts was invited to a consensus conference on the state-of-the-art of sarcoma interventional oncology during the 9th Rome INTER-MEETING (INTERventional Radiotherapy Multidisciplinary Meeting), proposing 3 statements for each one speech. At the end of each lecture, the entire group of experts was invited to vote with an electronic device. The preliminary results were presented and discussed at the end of the meeting, during a dedicated session. After the meeting, a survey was distributed within the consensus conference board to share and definitively vote the statements. RESULTS All the invited authors of the consensus conference board completed the final survey. All the 38 statements received more than 70% of agreement, 31 statements (82%) obtained an agreement of level higher or equal to 90%, 6 statements (15.8%) received an agreement level between 80% and 90%, and 1 statement (2.6%) had less than 80% of agreement. CONCLUSIONS The consensus conference demonstrated that interventional radiotherapy must be considered by a multidisciplinary management of patients affected by sarcoma.
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Affiliation(s)
- Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,
| | - Andrea Vavassori
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy,
| | - Valentina Lancellotta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,
- Address for correspondence: Valentina Lancellotta, MD, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy, e-mail:
| | - Vitaliana De Sanctis
- Department of Radiation Oncology, Faculty of Medicina e Psicologia, Sant’Andrea Hospital, University of Rome “La Sapienza”, Rome, Italy,
| | - Cristiana Vidali
- Former Deputy Chair of Interventional Radiotherapy AIRO working Group – IntraOperative RadioTherapy, Trieste, Italy,
| | | | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgery and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy,
| | - Domenico Genovesi
- Department of Radiation Oncology, Santissima Annunziata Hospital, Gabriele D’Annunzio University of Chieti-Pescara, Chieti, Italy,
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy,
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy,
| | - Alessio Giuseppe Morganti
- Department of Experimental, Diagnostic and Specialty Medicine – DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy,
| | | | - Jose Luis Guinot
- Foundation Instituto Valenciano de Oncologia (I.V.O.), Valencia, Spain,
| | - Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester and Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom,
| | - Daniela Greto
- Radiotherapy Department, University of Florence, Florence, Italy,
| | - Maria Antonietta Gambacorta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,
- Università Cattolica del Sacro Cuore, Rome, Italy,
| | - Vincenzo Valentini
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,
- Università Cattolica del Sacro Cuore, Rome, Italy,
| | - Vittorio Donato
- Radiation Oncology Department, Azienda Ospedaliera San Camillo-Forlanini, Roma, Italy,
| | - Renzo Corvò
- Radiation Oncology, IRCCS Ospedale Policlinico San Martino and Department of Health Science, University of Genoa, Italy,
| | - Stefano Maria Magrini
- Radiation Oncology Department, Ospedali Civili Hospital and Brescia University, Brescia, Italy
| | - Lorenzo Livi
- Radiotherapy Department, University of Florence, Florence, Italy,
| | - Consensus Conference Board
- Consensus Conference Board: Rosa Autorino (radiation oncologist, Rome), Carmelo Caldarella (nuclear medicine physician, Rome), Annamaria Cerrotta (radiation oncologist, Milan), Antonino De Paoli (radiation oncologist, Aviano), Vitaliana De Sanctis (radiation oncologist, Rome), Nicola Dinapoli (radiation oncologist, Rome), Vittorio Donato (radiation oncologist, Rome), Martina Ferioli (radiation oncologist, Bologna), Vincenzo Fusco (radiation oncologist, Rionero in Vulture), Maria Antonietta Gambacorta (radiation oncologist, Rome), Domenico Genovesi (radiation oncologist, Chieti), Daniela Greto (radiation oncologist, Florence), Jose Luis Guinot (radiation oncologist, València), Roberto Iezzi (interventional radiologist, Rome), Barbara Alicja Jereczek-Fossa (radiation oncologist, Milan), György Kovács (radiation oncologist, Rome and Lübeck), Valentina Lancellotta (radiation oncologist, Rome), Antonio Leone (radiologist, Rome), Giulio Maccauro (orthopedic surgeon, Rome), Stefano Maria Magrini (radiation oncologist, Brescia), Alessio Giuseppe Morganti (radiation oncologist, Bologna), Michela Quirino (medical oncologist, Rome), Agata Rembielak (clinical and radiation oncologist, Manchester), Umberto Ricardi (radiation oncologist, Turin), Vittoria Rufini (nuclear medicine physician, Rome), Giuseppe Sanguineti (radiation oncologist, Rome), Luca Tagliaferri (radiation oncologist, Rome), Andrea Vavassori (radiation oncologist, Milan), Cristiana Vidali (radiation oncologist, Trieste)
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Gingrich AA, Marrufo AS, Liu Y, Li CS, Darrow MA, Monjazeb AM, Thorpe SW, Canter RJ. Radiotherapy is Associated With Improved Survival in Patients With Synovial Sarcoma Undergoing Surgery: A National Cancer Database Analysis. J Surg Res 2020; 255:378-387. [PMID: 32599458 DOI: 10.1016/j.jss.2020.05.075] [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: 10/17/2019] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Previous studies have demonstrated an association of perioperative radiotherapy (RT) with improved survival in patients with synovial sarcoma (SS) undergoing surgery, but the mechanism for this is unknown. In this study, we sought to further analyze this association using a hospital-based data set where data on chemotherapy administration and surgical margin status are available. METHODS Using the National Cancer Database, we identified 1216 patients with SS (aged ≥18 y) from 2004-2012 undergoing surgery. Cox proportional hazards analysis was used to study the effect of clinicopathologic variables on overall survival (OS). RESULTS Mean age at diagnosis was 41.5 y (range 18-90), and 71.3% of tumors were high grade; 22.9% underwent surgery alone, 59.6% received RT with surgery, 44.2% received chemotherapy with surgery, and 26.3% received trimodality therapy. Age, sex, grade, Charlson-Deyo score, and RT (hazard ratio, 0.676; 95% confidence interval, 0.519-0.880; P = 0.004) were associated with improved OS, whereas chemotherapy (hazard ratio, 1.20; 95% confidence interval, 0.899-1.60; P = 0.217) and surgical margin status were not. Trimodality therapy with surgery, RT, and chemotherapy was associated with improved OS when compared with therapy with surgery and chemotherapy alone. CONCLUSIONS In patients with SS undergoing surgery, we observed a significant improved association of OS with the addition of RT when adjusting for comorbidity score, margin status, and receipt of chemotherapy. These data further support routine implementation of RT in the treatment of patients with SS, including those receiving aggressive multimodality and trimodality care.
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Affiliation(s)
- Alicia A Gingrich
- Department of Surgery, University of California Davis, Sacramento, California
| | - Angelica S Marrufo
- Department of Surgery, University of California Davis, Sacramento, California
| | - Yu Liu
- Department of Public Health Sciences, University of California Davis, Davis, California
| | - Chin-Shang Li
- Department of Public Health Sciences, University of California Davis, Davis, California
| | - Morgan A Darrow
- Department of Pathology, University of California Davis, Sacramento, California
| | - Arta M Monjazeb
- Department of Radiation Oncology, University of California Davis, Sacramento, California
| | - Steven W Thorpe
- Department of Orthopedic Surgery, University of California Davis, Sacramento, California
| | - Robert J Canter
- Department of Surgery, University of California Davis, Sacramento, California.
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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: 262] [Impact Index Per Article: 65.5] [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.
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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
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Shelby RD, Suarez-Kelly LP, Yu PY, Hughes TM, Ethun CG, Tran TB, Poultsides G, King DM, Bedi M, Mogal H, Clarke C, Tseng J, Roggin KK, Chouliaras K, Votanopoulos K, Krasnick BA, Fields RC, Pollock RE, Howard JH, Cardona K, Grignol V. Neoadjuvant radiation improves margin-negative resection rates in extremity sarcoma but not survival. J Surg Oncol 2020; 121:1249-1258. [PMID: 32232871 DOI: 10.1002/jso.25905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/16/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Radiation improves limb salvage in extremity sarcomas. Timing of radiation therapy remains under investigation. We sought to evaluate the effects of neoadjuvant radiation (NAR) on surgery and survival of patients with extremity sarcomas. MATERIALS AND METHODS A multi-institutional database was used to identify patients with extremity sarcomas undergoing surgical resection from 2000-2016. Patients were categorized by treatment strategy: surgery alone, adjuvant radiation (AR), or NAR. Survival, recurrence, limb salvage, and surgical margin status was analyzed. RESULTS A total of 1483 patients were identified. Most patients receiving radiotherapy had high-grade tumors (82% NAR vs 81% AR vs 60% surgery; P < .001). The radiotherapy groups had more limb-sparing operations (98% AR vs 94% NAR vs 87% surgery; P < .001). NAR resulted in negative margin resections (90% NAR vs 79% surgery vs 75% AR; P < .0001). There were fewer local recurrences in the radiation groups (14% NAR vs 17% AR vs 27% surgery; P = .001). There was no difference in overall or recurrence-free survival between the three groups (OS, P = .132; RFS, P = .227). CONCLUSION In this large study, radiotherapy improved limb salvage rates and decreased local recurrences. Receipt of NAR achieves more margin-negative resections however this did not improve local recurrence or survival rates over.
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Affiliation(s)
- Rita D Shelby
- Department of Surgery, The Ohio State University, Columbus, Ohio
| | | | - Peter Y Yu
- Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Tasha M Hughes
- Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Cecilia G Ethun
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Thuy B Tran
- Department of Surgery, Stanford University, Palo Alto, California
| | | | - David M King
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Meena Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Harveshp Mogal
- Department of Surgery, Wake Forest University, Winston-Salem, North Carolina
| | - Callisia Clarke
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jennifer Tseng
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Kevin K Roggin
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | | | | | - Bradley A Krasnick
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Ryan C Fields
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Kenneth Cardona
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Valerie Grignol
- Department of Surgery, The Ohio State University, Columbus, Ohio
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Surgical Resection Margin Classifications for High-grade Pleomorphic Soft Tissue Sarcomas of the Extremity or Trunk After Neoadjuvant Cytotoxic Therapy. Am J Surg Pathol 2020; 43:844-850. [PMID: 30932925 DOI: 10.1097/pas.0000000000001246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Soft tissue sarcomas of the extremities or trunk are often resected after treatment with neoadjuvant radiotherapy. Adequate surgical resection margins for sarcomas after neoadjuvant cytotoxic therapy are not well characterized. Minimum surgical resection margins required for local control of primary, high-grade, pleomorphic soft tissue sarcomas treated with neoadjuvant therapy was assessed by competing risk regression in a series of 166 cases. Optimal tumor clearance was determined to be ≥1 mm. Predictive accuracy of three commonly used resection margin classification schemes (American Joint Committee on Cancer, Musculoskeletal Tumor Society, and the margin distance method) were comparable. However, diagnostic performance of a binary system (positive vs. negative) was more specific than margin distance classification (positive or <1 vs. ≥1 mm from tumor), but less sensitive in predicting local recurrence. The American Joint Committee on Cancer R classification (R0 vs. R1/R2) seems to adequately stratify patients by risk for local recurrence after neoadjuvant therapy and subsequent surgical resection. Furthermore, close but negative resection margins (<1 mm from tumor) appear sufficient for local control of high-grade pleomorphic soft tissue sarcomas of the extremity or trunk in this clinical setting, with minimal reduction in the risk of local recurrence with increasing margin width or surgical clearance.
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Kalbasi A, Kamrava M, Chu FI, Telesca D, Van Dams R, Yang Y, Ruan D, Nelson SD, Dry SM, Hernandez J, Chmielowski B, Singh AS, Bukata SV, Bernthal NM, Steinberg ML, Weidhaas JB, Eilber FC. A Phase II Trial of 5-Day Neoadjuvant Radiotherapy for Patients with High-Risk Primary Soft Tissue Sarcoma. Clin Cancer Res 2020; 26:1829-1836. [PMID: 32054730 DOI: 10.1158/1078-0432.ccr-19-3524] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/09/2019] [Accepted: 01/24/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE In a single-institution phase II study, we evaluated the safety of a 5-day dose-equivalent neoadjuvant radiotherapy (RT) regimen for high-risk primary soft tissue sarcoma. PATIENTS AND METHODS Patients received neoadjuvant RT alone (30 Gy in five fractions) to the primary tumor with standard margins. The primary endpoint was grade ≥2 late-radiation toxicity. Major wound complications, local recurrences, and distant metastases were also examined. In exploratory analysis, we evaluated germline biomarkers for wound toxicity and the effects of the study on treatment utilization. RESULTS Over 2 years, 52 patients were enrolled with median follow-up of 29 months. Seven of 44 evaluable patients (16%) developed grade ≥2 late toxicity. Major wound complications occurred in 16 of 50 patients (32%); a signature defined by 19 germline SNPs in miRNA-binding sites of immune and DNA damage response genes, in addition to lower extremity tumor location, demonstrated strong predictive performance for major wound complications. Compared with the preceding 2-year period, the number of patients treated with neoadjuvant RT alone at our institution increased 3-fold, with a concomitant increase in the catchment area. CONCLUSIONS A shorter 5-day neoadjuvant RT regimen results in favorable rates of wound complications and grade ≥2 toxicity after 2-year follow-up. Five-day RT significantly increased utilization of neoadjuvant RT at our high-volume sarcoma center. With further validation, a putative germline biomarker for wound complications may guide safer RT utilization.
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Affiliation(s)
- Anusha Kalbasi
- Department of Radiation Oncology, University of California Los Angeles (UCLA), Los Angeles, California. .,Division of Surgical-Oncology, Department of Surgery, University of California Los Angeles, Los Angeles, California.,University of California Los Angeles Jonsson Comprehensive Cancer Center Sarcoma Program, Los Angeles, California
| | | | - Fang-I Chu
- Department of Radiation Oncology, University of California Los Angeles (UCLA), Los Angeles, California
| | - Donatello Telesca
- Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, California
| | - Ritchell Van Dams
- Department of Radiation Oncology, University of California Los Angeles (UCLA), Los Angeles, California
| | - Yingli Yang
- Department of Radiation Oncology, University of California Los Angeles (UCLA), Los Angeles, California
| | - Dan Ruan
- Department of Radiation Oncology, University of California Los Angeles (UCLA), Los Angeles, California
| | - Scott D Nelson
- University of California Los Angeles Jonsson Comprehensive Cancer Center Sarcoma Program, Los Angeles, California.,Department of Pathology, University of California Los Angeles, Los Angeles, California
| | - Sarah M Dry
- University of California Los Angeles Jonsson Comprehensive Cancer Center Sarcoma Program, Los Angeles, California.,Department of Pathology, University of California Los Angeles, Los Angeles, California
| | - Jackie Hernandez
- Department of Radiation Oncology, University of California Los Angeles (UCLA), Los Angeles, California
| | - Bartosz Chmielowski
- University of California Los Angeles Jonsson Comprehensive Cancer Center Sarcoma Program, Los Angeles, California.,Division of Hematology-Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - Arun S Singh
- Division of Surgical-Oncology, Department of Surgery, University of California Los Angeles, Los Angeles, California.,University of California Los Angeles Jonsson Comprehensive Cancer Center Sarcoma Program, Los Angeles, California.,Division of Hematology-Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - Susan V Bukata
- University of California Los Angeles Jonsson Comprehensive Cancer Center Sarcoma Program, Los Angeles, California.,Department of Orthopedic Surgery, University of California Los Angeles, Los Angeles, California
| | - Nicholas M Bernthal
- University of California Los Angeles Jonsson Comprehensive Cancer Center Sarcoma Program, Los Angeles, California.,Department of Orthopedic Surgery, University of California Los Angeles, Los Angeles, California
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California Los Angeles (UCLA), Los Angeles, California.,University of California Los Angeles Jonsson Comprehensive Cancer Center Sarcoma Program, Los Angeles, California
| | - Joanne B Weidhaas
- Department of Radiation Oncology, University of California Los Angeles (UCLA), Los Angeles, California.,University of California Los Angeles Jonsson Comprehensive Cancer Center Sarcoma Program, Los Angeles, California
| | - Fritz C Eilber
- Division of Surgical-Oncology, Department of Surgery, University of California Los Angeles, Los Angeles, California. .,University of California Los Angeles Jonsson Comprehensive Cancer Center Sarcoma Program, Los Angeles, California
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Smolle MA, van de Sande M, Callegaro D, Wunder J, Hayes A, Leitner L, Bergovec M, Tunn PU, van Praag V, Fiocco M, Panotopoulos J, Willegger M, Windhager R, Dijkstra SPD, van Houdt WJ, Riedl JM, Stotz M, Gerger A, Pichler M, Stöger H, Liegl-Atzwanger B, Smolle J, Andreou D, Leithner A, Gronchi A, Haas RL, Szkandera J. Individualizing Follow-Up Strategies in High-Grade Soft Tissue Sarcoma with Flexible Parametric Competing Risk Regression Models. Cancers (Basel) 2019; 12:cancers12010047. [PMID: 31877801 PMCID: PMC7017264 DOI: 10.3390/cancers12010047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 12/15/2019] [Accepted: 12/19/2019] [Indexed: 12/13/2022] Open
Abstract
Currently, patients with extremity soft tissue sarcoma (eSTS) who have undergone curative resection are followed up by a heuristic approach, not covering individual patient risks. The aim of this study was to develop two flexible parametric competing risk regression models (FPCRRMs) for local recurrence (LR) and distant metastasis (DM), aiming at providing guidance on how to individually follow-up patients. Three thousand sixteen patients (1931 test, 1085 validation cohort) with high-grade eSTS were included in this retrospective, multicenter study. Histology (9 categories), grading (time-varying covariate), gender, age, tumor size, margins, (neo)adjuvant radiotherapy (RTX), and neoadjuvant chemotherapy (CTX) were used in the FPCRRMs and performance tested with Harrell-C-index. Median follow-up was 50 months (interquartile range: 23.3–95 months). Two hundred forty-two (12.5%) and 603 (31.2%) of test cohort patients developed LR and DM. Factors significantly associated with LR were gender, size, histology, neo- and adjuvant RTX, and margins. Parameters associated with DM were margins, grading, gender, size, histology, and neoadjuvant RTX. C-statistics was computed for internal (C-index for LR: 0.705, for DM: 0.723) and external cohort (C-index for LR: 0.683, for DM: 0.772). Depending on clinical, pathological, and patient-related parameters, LR- and DM-risks vary. With the present model, implemented in the updated Personalised Sarcoma Care (PERSARC)-app, more individualized prediction of LR/DM-risks is made possible.
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Affiliation(s)
- Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Michiel van de Sande
- Department of Orthopaedic Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Jay Wunder
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, ON M5G IX5, Canada
| | - Andrew Hayes
- Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Marko Bergovec
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Per-Ulf Tunn
- Sarcoma Centre, HELIOS-Klinikum Berlin-Buch, 13125 Berlin, Germany
| | - Veroniek van Praag
- Department of Orthopaedic Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Marta Fiocco
- Institute of Mathematics, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Medical Statistics, Department of Biomedical Data Science, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Trial and Data Center, 3584 CT Utrecht, The Netherlands
| | - Joannis Panotopoulos
- Department of Orthopaedics and Traumatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Madeleine Willegger
- Department of Orthopaedics and Traumatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedics and Traumatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Sander P. D. Dijkstra
- Department of Orthopaedic Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Winan J. van Houdt
- Department of Surgery, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Jakob M. Riedl
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Michael Stotz
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Armin Gerger
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Martin Pichler
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Herbert Stöger
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | | | - Josef Smolle
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria
| | | | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Rick L. Haas
- Department of Radiotherapy, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Department of Radiotherapy, The Netherlands Cancer Institute Amsterdam, 1066 CX Amsterdam, The Netherlands
- Correspondence: (R.L.H.); (J.S.); Tel.: +31-20-5122135 (R.L.H.); +43-316-385-13115 (J.S.)
| | - Joanna Szkandera
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
- Correspondence: (R.L.H.); (J.S.); Tel.: +31-20-5122135 (R.L.H.); +43-316-385-13115 (J.S.)
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Role of Radiation Therapy in Adult Extraskeletal Ewing's Sarcoma Patients Treated with Chemotherapy and Surgery. Sarcoma 2019; 2019:5413527. [PMID: 31178655 PMCID: PMC6507246 DOI: 10.1155/2019/5413527] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/13/2019] [Indexed: 12/23/2022] Open
Abstract
Radiation therapy (RT) is advocated in the multimodal treatment of high-grade soft tissue sarcoma (STS), but its role may be less clear in chemotherapy-sensitive STS such as extraskeletal Ewing sarcoma (EES). The purpose of this study was to determine the role of RT on overall survival (OS) in localized EES adult patients treated with chemotherapy and surgery. Adult patients diagnosed with EES and reported to the National Cancer Database from 2004 to 2014 were evaluated. All patients were treated with surgical resection. Patient demographics, tumor characteristics, treatments received, resection margins, and survival were examined for the 232 patients identified. Using multivariate analysis and Cox proportional hazard analysis, predictors of OS were determined. In the overall cohort, 40 percent of patients received RT and 78 percent received chemotherapy, with 31 percent receiving both. The addition of RT to the patients receiving surgery + chemotherapy did not improve OS (p < 0.05). Twenty-four percent of patients who achieved R0 resection after surgery still received RT without any improvement in OS. Patients treated at community cancer centers were more likely to receive additional RT compared with Comprehensive Cancer Centers (p < 0.05). In adult EES patients with localized disease treated with chemotherapy and surgery, the addition of RT does not improve overall survival.
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Extremity soft tissue sarcoma in the elderly: Are we overtreating or undertreating this potentially vulnerable patient population? J Surg Oncol 2019; 119:1087-1098. [DOI: 10.1002/jso.25470] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/03/2019] [Accepted: 03/27/2019] [Indexed: 01/14/2023]
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Are Limb-sparing Surgical Resections Comparable to Amputation for Patients With Pelvic Chondrosarcoma? A Case-control, Propensity Score-matched Analysis of the National Cancer Database. Clin Orthop Relat Res 2019; 477:596-605. [PMID: 30762693 PMCID: PMC6382183 DOI: 10.1097/corr.0000000000000622] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Chondrosarcoma is the second most frequent primary sarcoma of bone and frequently occurs in the pelvis. Surgical resection is the primary treatment with the two main operative modalities being limb-sparing resection and amputation. Contemporary management has trended toward limb-sparing procedures; however, whether this approach has an adverse effect on long-term survival is unclear. QUESTIONS/PURPOSES (1) What are the 5- and 10-year survival rates after limb-sparing surgery and amputation? (2) What factors are associated with survival after contemporary surgical management of pelvic chondrosarcoma? METHODS The 2004-2014 National Cancer Database, a nationwide registry that includes approximately 70% of all new cancers in the United States with requirement for 90% followup, was reviewed for patients diagnosed with pelvic chondrosarcoma who had undergone limb-sparing surgery or amputation. To compare survival, patient demographics, tumor attributes, and treatment characteristics were used to generate one-to-one propensity score-matched cohorts. Other factors associated with survival were determined through multivariable Cox regression. Three hundred eighty-five patients (75%) underwent limb-sparing surgery and 131 (25%) underwent amputation. Propensity score matching resulted in two balanced cohorts of 131 patients. RESULTS With the numbers available, we could not demonstrate a difference in overall survival between limb-sparing procedures and amputation. The 5-year survivorship was 70% (95% confidence interval [CI], 62%-79%) for limb-sparing surgery versus 70% (95% CI, 62%-79%) for amputation. The 10-year survivorship was 60% (95% CI, 48%-75%) for limb-sparing surgery versus 59% (95% CI, 48%-72%) for amputation. Kaplan-Meier survival analysis did not demonstrate a difference in survival (p = 0.9). Older age (hazard ratio [HR] = 1.029, p < 0.001), higher Charlson/Deyo comorbidity score (HR = 3.039, p = 0.004), higher grade (HR = 2.547, p = 0.005 for Grade 2; HR = 7.269, p < 0.001 for Grade 3; HR = 10.36, p < 0.001 for Grade 4), and positive surgical margins (HR = 1.61, p = 0.039) were associated with decreased survival. CONCLUSIONS Our findings support the trend toward increased use of limb-sparing surgery for patients with pelvic chondrosarcoma. Orthopaedic oncologists may use our results when counseling their patients regarding treatment options. However, the choice of limb-sparing surgery versus amputation for these challenging patients should still be a highly individualized decision with careful discussion between the patient and the surgeon. LEVEL OF EVIDENCE Level III, therapeutic study.
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37
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Cannon RB, Kull AJ, Carpenter PS, Francis S, Buchmann LO, Monroe MM, Lloyd S, Hitchcock YJ, Cannon D, Weis JR, Houlton JJ, Hunt JP. Adjuvant radiation for positive margins in adult head and neck sarcomas is associated with improved survival: Analysis of the National Cancer Database. Head Neck 2019; 41:1873-1879. [PMID: 30652375 DOI: 10.1002/hed.25619] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/20/2018] [Accepted: 12/12/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Adult head and neck (H&N) sarcomas are a rare malignancy with limited data delineating the role of postoperative radiotherapy (PORT), particularly for a positive surgical margin. There are no randomized trials supporting the use of PORT, therefore treatment trends vary between institutions. A positive margin predicts recurrence and poor survival outcomes. This study uses the National Cancer Database (NCDB) to investigate whether PORT improves overall survival (OS) in adult H&N sarcomas with a positive margin and how utilization has changed. METHODS Patients (n = 1142) in the NCDB from 2004-2013 with adult H&N sarcomas who underwent resection and had a positive margin. RESULTS Factors significantly associated with increased utilization of PORT were: having insurance, salivary gland primary site, high-risk histology, poor differentiation, and a macroscopic positive margin. Treatment with PORT was associated with improved 5-year OS for all patients with a positive margin (57% vs 48%; P = .002), both microscopic (57% vs 49%; P = .010) and macroscopic (57% vs 41%; P = .036). Improved OS was significant after controlling for other known covariates on multivariate analysis (HR: 0.76; [0.64-0.90]; P = .002). Treatment at a community-based facility was an independent predictor for reduced OS (HR: 1.37; [1.15-1.64]; P < .001). The percentage utilization (53%) of PORT for these patients did not change significantly over time. CONCLUSION PORT provides a significant survival benefit for adult H&N sarcoma patients with either a microscopic or macroscopic positive margin; however, PORT is underutilized. Treatment at academic/research cancer programs was associated with increased utilization of PORT and improved survival outcomes.
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Affiliation(s)
- Richard B Cannon
- Otolaryngology Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Amanda J Kull
- Otolaryngology Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Patrick S Carpenter
- Otolaryngology Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Sam Francis
- Department of Radiation Oncology, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Luke O Buchmann
- Otolaryngology Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Marcus M Monroe
- Otolaryngology Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Shane Lloyd
- Department of Radiation Oncology, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Ying J Hitchcock
- Department of Radiation Oncology, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Donald Cannon
- Department of Radiation Oncology, The University of Utah School of Medicine, Salt Lake City, Utah
| | - John R Weis
- Division of Oncology, The University of Utah School of Medicine, Salt Lake City, Utah
| | - Jeffrey J Houlton
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Washington
| | - Jason P Hunt
- Otolaryngology Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah
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Zschaeck S, Wust P, Melcher I, Nadobny J, Rau D, Striefler J, Pahl S, Flörcken A, Kunitz A, Ghadjar P. Neoadjuvant chemotherapy plus radiation versus chemotherapy plus regional hyperthermia in high-grade soft tissue sarcomas: a retrospective comparison. Int J Hyperthermia 2018; 35:1-9. [PMID: 30300018 DOI: 10.1080/02656736.2018.1498137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Localized adult high-grade soft tissue sarcomas (STS) usually require multimodality treatment including surgery, radiotherapy, chemotherapy and hyperthermia. If maximal preoperative tumor-shrinkage is envisaged, neoadjuvant chemotherapy + radiation (CRT) is often applied, however at the expense of relatively high toxicities and increased postoperative complication rates. This study aims to compare preoperative CRT with neoadjuvant chemotherapy + regional hyperthermia (HCT) regarding histopathological response, toxicity and outcome. METHODS In this retrospective analysis, 61 consecutive high-grade STS patients treated between 2009 and 2016 were included. All patients were treated within a prospective treatment protocol. 28 patients received neoadjuvant CRT 33 patients HCT. CRT consisted of four cycles doxorubicin/ifosfamide and two cycles ifosfamide concomitant to 50.4 Gray external beam radiotherapy. HCT consisted of 4-6 cycles doxorubicin/ifosfamide with deep regional hyperthermia administered bi-weekly during each cycle. Association of treatment modality with overall survival (OS), local control (LC) and freedom from distant metastases (FFDM) was evaluated by Kaplan-Meier and log-rank analyses. RESULTS The overall patient characteristics were well balanced. Histopathological tumor response did not differ significantly between both groups (p = .67), neither did higher-grade toxicities during neoadjuvant treatment. Wound dehiscence (p = .018) and surgical hospital re-admissions (p < .001) were both significantly more frequent in the CRT group. Two-year OS, LC and FFDM rates of all patients were 93, 85 and 71% with no significant differences between CRT and HCT. CONCLUSION Compared to CRT, HCT seems equally efficient and appears to bear less surgical complications. Interpretation should be cautious due to the low number of patients and the retrospective nature of this study.
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Affiliation(s)
- Sebastian Zschaeck
- a Department of Radiation Oncology , Charité Universitätsmedizin Berlin , Berlin , Germany.,b Berlin Insitute of Health (BIH), Berlin , Germany
| | - Peter Wust
- a Department of Radiation Oncology , Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Ingo Melcher
- c Department of Surgery , Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Jacek Nadobny
- a Department of Radiation Oncology , Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Daniel Rau
- c Department of Surgery , Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Jana Striefler
- d Department of Hematology, Oncology, and Tumorimmunology , Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Stefan Pahl
- e Charité Universitätsmedizin Berlin, Institute of Pathology , Berlin , Germany
| | - Anne Flörcken
- d Department of Hematology, Oncology, and Tumorimmunology , Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Annegret Kunitz
- d Department of Hematology, Oncology, and Tumorimmunology , Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Pirus Ghadjar
- a Department of Radiation Oncology , Charité Universitätsmedizin Berlin , Berlin , Germany
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Tsagozis P, Brosjö O, Skorpil M. Preoperative radiotherapy of soft-tissue sarcomas: surgical and radiologic parameters associated with local control and survival. Clin Sarcoma Res 2018; 8:19. [PMID: 30323920 PMCID: PMC6172791 DOI: 10.1186/s13569-018-0106-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/10/2018] [Indexed: 12/18/2022] Open
Abstract
Background Preoperative radiotherapy is often used to facilitate excision of soft-tissue sarcomas. We aimed define factors that affect local tumour control and patient survival. Methods A single institution registry study of 89 patients with non-metastatic soft-tissue sarcomas having preoperative radiotherapy between 1994 and 2014. Radiologic (presence of peritumoural oedema and volume change following radiotherapy) and histopathologic (tumour volume, grade and surgical margin) parameters were recorded. Outcomes were the events of local recurrence, amputation, metastasis and death. Results Local recurrence rate was low (12%) and marginal excision gave equal local control to wide excision. Pelvic localization was associated with a higher risk for amputation. The absence of peritumoural oedema on MRI defined a subgroup of tumours with more favourable oncologic outcome. Reduction of tumour volume following radiotherapy was also associated with better patient survival. Both these radiologic parameters were associated with lower tumour grade. Tumour necrosis was not significant for patient survival. The local complication rate, mainly wound healing problems and infection, was high (40%), but did not lead to any amputation. Conclusion Preoperative radiotherapy of high-risk soft-tissue sarcomas allows for good local control rate at the expense of local wound complications, which are however manageable. Marginal excision is sufficient for local control. Absence of peritumoural oedema on MRI, as well as tumour size reduction following radiotherapy are associated to superior patient survival and can be used ass early prognostic factors. Electronic supplementary material The online version of this article (10.1186/s13569-018-0106-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Panagiotis Tsagozis
- 1Department of Orthopaedic Surgery, Karolinska University Hospital, Solna, Sweden.,2Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Otte Brosjö
- 1Department of Orthopaedic Surgery, Karolinska University Hospital, Solna, Sweden.,2Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Skorpil
- 2Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,3Department of Neuroradiology, Karolinska University Hospital, Solna, Sweden
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Ramey SJ, Yechieli R, Zhao W, Kodiyan J, Asher D, Chinea FM, Patel V, Reis IM, Wang L, Wilky BA, Subhawong T, Trent JC. Limb-sparing surgery plus radiotherapy results in superior survival: an analysis of patients with high-grade, extremity soft-tissue sarcoma from the NCDB and SEER. Cancer Med 2018; 7:4228-4239. [PMID: 30030882 PMCID: PMC6144142 DOI: 10.1002/cam4.1625] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 12/11/2022] Open
Abstract
Small randomized trials have not shown an overall survival (OS) difference among local treatment modalities for patients with extremity soft‐tissue sarcomas (E‐STS) but were underpowered for OS. We examine the impact of local treatment modalities on OS and sarcoma mortality (SM) using two national registries. The National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) Program were analyzed separately to identify patients with stage II‐III, high‐grade E‐STS diagnosed between 2004 and 2013 and treated with (1) amputation alone, (2) limb‐sparing surgery (LSS) alone, (3) preoperative radiation therapy (RT) and LSS, or (4) LSS and postoperative RT. Multivariable analyses (MVAs) and 1:1 matched pair analyses (MPAs) examined treatment impacts on OS (both databases) and SM (SEER only). From the NCDB and SEER, 7828 and 2937 patients were included. On MVAs, amputation was associated with inferior OS and SM. Relative to LSS alone, both preoperative RT and LSS (HR, 0.70; 95% CI: 0.62‐0.78) and LSS and postoperative RT (HR, 0.69; 95% CI: 0.63‐0.75) improved OS in NCDB analyses with confirmation by SEER. Estimated median survivals from MPA utilizing NCDB data were 7.2 years with LSS alone (95% CI: 6.5‐8.9 years) vs 9.8 years (95% CI: 9.0‐11.2 years) with LSS and postoperative RT. A MPA comparing preoperative RT and LSS to LSS alone found median survivals of 8.9 years (95% CI: 7.9‐not estimable) and 6.6 years (95% CI: 5.4‐7.8 years). Optimal high‐grade E‐STS management includes LSS with preoperative or postoperative RT as evidenced by superior OS and SM.
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Affiliation(s)
- Stephen J Ramey
- Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Raphael Yechieli
- Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Wei Zhao
- Biostatistics and Bioinformatics Shared Resources (BBSR), University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Joyson Kodiyan
- Department of Internal Medicine, Jackson Health System, Miami, FL, USA
| | - David Asher
- Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Felix M Chinea
- Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Vivek Patel
- Department of Radiation Oncology, Holy Cross Hospital, Fort Lauderdale FL, USA
| | - Isildinha M Reis
- Biostatistics and Bioinformatics Shared Resources (BBSR), University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA.,Division of Biostatistics, Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
| | - Lily Wang
- Division of Biostatistics, Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA
| | - Breelyn A Wilky
- Division of Medical Oncology, Department of Medicine, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Ty Subhawong
- Department of Radiology, University of Miami School of Medicine, Miami, FL, USA
| | - Jonathan C Trent
- Division of Medical Oncology, Department of Medicine, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
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Johnson AC, Ethun CG, Liu Y, Lopez-Aguiar AG, Tran TB, Poultsides G, Grignol V, Howard JH, Bedi M, Gamblin TC, Tseng J, Roggin KK, Chouliaras K, Votanopoulos K, Cullinan D, Fields RC, Delman KA, Wood WC, Cardona K, Maithel SK. Studying a Rare Disease Using Multi-Institutional Research Collaborations vs Big Data: Where Lies the Truth? J Am Coll Surg 2018; 227:357-366.e3. [PMID: 29906615 DOI: 10.1016/j.jamcollsurg.2018.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/31/2018] [Accepted: 05/31/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Multi-institutional collaborations provide granularity lacking in epidemiologic data sets to enable in-depth study of rare diseases. For patients with superficial, high-grade soft tissue sarcomas of the trunk and extremity, the value of radiation therapy (RT) is not clear. We aimed to use the 7-institution US Sarcoma Collaborative (USSC) and the National Cancer Database (NCDB) to investigate this issue. STUDY DESIGN All adult patients with superficial truncal and extremity high-grade soft tissue sarcomas who underwent primary curative-intent resection from 2000 to 2016 at USSC institutions or were included in the NCDB from 2004 to 2013 were analyzed. Propensity score matching was performed. End points were locoregional recurrence-free survival (LRFS), overall survival (OS), and disease-specific survival (DSS). RESULTS Of 4,153 patients in the USSC, 169 patients with superficial high-grade tumors underwent primary curative-intent resection, 38% of which received RT. On multivariable Cox-regression analysis, RT was not associated with improved LRFS (p = 0.56), OS (p = 0.31), or DSS (p = 0.20). On analysis of 51 propensity score-matched pairs, RT was still not associated with increased LRFS, OS, or DSS. Analysis of 631 propensity score-matched pairs in the NCDB demonstrated improved 5-year OS rate associated with RT (80% vs 70%; p = 0.02). The LRFS and DSS rates were not evaluable. CONCLUSIONS Granular data afforded by collaborative research enables in-depth analysis of patient outcomes. The NCDB, although powered with large numbers, cannot assess many relevant outcomes (eg recurrence, DSS, or complications). In this study, the approaches yielded conflicting results. The USSC data suggested no value of radiation and the NCDB demonstrated improved OS, contradicting all randomized controlled trials in sarcoma. The pros and cons of either approach must be considered when applying results to clinical practice, and underscore the importance of randomized controlled trials.
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Affiliation(s)
- Aileen C Johnson
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Cecilia G Ethun
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Yuan Liu
- Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Alexandra G Lopez-Aguiar
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Thuy B Tran
- Department of Surgery, Stanford University Medical Center, Palo Alto, CA
| | - George Poultsides
- Department of Surgery, Stanford University Medical Center, Palo Alto, CA
| | - Valerie Grignol
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH
| | - J Harrison Howard
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH
| | - Meena Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - T Clark Gamblin
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Jennifer Tseng
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Kevin K Roggin
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | | | | | - Darren Cullinan
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Ryan C Fields
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Keith A Delman
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - William C Wood
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Kenneth Cardona
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA.
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Stevenson MG, Ubbels JF, Slump J, Huijing MA, Bastiaannet E, Pras E, Hoekstra HJ, Been LB. Identification of predictors for wound complications following preoperative or postoperative radiotherapy in extremity soft tissue sarcoma. Eur J Surg Oncol 2018; 44:816-822. [PMID: 29472042 DOI: 10.1016/j.ejso.2018.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/24/2018] [Accepted: 02/02/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION In extremity soft tissue sarcoma (ESTS), external beam radiotherapy (EBRT) has been used in addition to limb-sparing surgery (LSS). This study aims to identify predictors for major wound complication (MWC) development following EBRT and LSS in ESTS. METHODS This retrospective study includes ESTS patients treated with EBRT and LSS between 2005 and 2017. Two groups were formed; Group I included preoperatively irradiated patients, whereas Group II included patients who underwent postoperative EBRT. Multivariate logistic regression analyses were performed to create a prediction model for MWC development. RESULTS One hundred twenty-seven patients were included, 58 patients (45.7%) in Group I and 69 patients (54.3%) in Group II. Some differences in baseline characteristics were found between the groups, e.g. in tumor size and grade, histological subtype and total RT dose. Twenty-three patients (39.7%) in Group I and 14 patients (20.3%) in Group II developed a MWC (p = 0.02). Preoperative EBRT was identified as independent predictor for MWC development, OR 2.75 (95%CI 1.21-6.26), p = 0.02. Furthermore, a trend towards an increased MWC risk was shown for patients' age (OR 1.02 (0.99-1.04)), delayed wound closure (OR 3.20 (0.64-16.02)) and negative surgical margins (OR 2.26 (0.72-7.11)). The area under the curve (AUC) of the model was 0.68 (0.57-0.79). CONCLUSIONS This study corroborates the increased MWC risk following preoperative EBRT in ESTS. It remains important to carefully weigh the MWC risk against the expected long-term functional outcome, and to consider the liberal use of primary plastic surgical reconstructions in an individualized multidisciplinary tumor board prior to treatment.
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Affiliation(s)
- Marc G Stevenson
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan F Ubbels
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jelena Slump
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marijn A Huijing
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Esther Bastiaannet
- Department of Surgical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Elisabeth Pras
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harald J Hoekstra
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lukas B Been
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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