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Kobayashi H, Okajima K, Zhang L, Hirai T, Ishibashi Y, Tsuda Y, Ikegami M, Kawai A, Tanaka S. Prognostic factors and treatment outcomes in patients with pleomorphic rhabdomyosarcoma: a population-based cohort study. Jpn J Clin Oncol 2024; 54:471-478. [PMID: 38183215 DOI: 10.1093/jjco/hyad188] [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: 11/14/2023] [Accepted: 12/12/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Pleomorphic rhabdomyosarcoma is a rare sarcoma in adults. The clinical characteristics, outcomes and prognostic factors associated with pleomorphic rhabdomyosarcoma remain unclear. METHODS We retrospectively analyzed data from the Bone and Soft Tissue Tumor Registry of Japan, and enrolled patients with pleomorphic rhabdomyosarcoma. Disease-specific overall survival, local recurrence-free survival and distant metastasis-free survival were estimated using the Kaplan-Meier method; Cox regression model was used to identify prognostic factors. RESULTS In total, 182 patients with pleomorphic rhabdomyosarcoma were included. Median age was 63 (range 20-95) years. The lower extremity (48%) was the most frequent tumor origin site, while head and neck were rare (4%). A total of 43 patients (24%) had distant or regional nodal metastases at first presentation. In all cases, the 2-year and 5-year survival rates were 66.3% and 54.1%, respectively. Distant metastasis was a significant poor prognostic factor (Hazard ratio 6.65; 95% confidence intervals, 3.00-14.75, P < 0.0001), with median survival of such patients being 9.4 (95% confidence intervals: 5.3-12.2) months. In 134 localized cases, the 2-year and 5-year survival rates were 91.5% and 68.3%, respectively. Large tumor size and older age were associated with poorer prognosis. Through data from localized and locally curative cases extracted and adjusted by propensity score matching, we found that perioperative chemotherapy did not improve disease-specific overall survival, distant metastasis-free survival or local recurrence-free survival. CONCLUSIONS Clinical characteristics and outcomes of pleomorphic rhabdomyosarcoma are similar to those of other high-grade soft tissue sarcomas. Pleomorphic rhabdomyosarcoma may be less chemosensitive, and a strategy other than the standard cytotoxic chemotherapy is required to improve its prognosis.
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Affiliation(s)
- Hiroshi Kobayashi
- Department of Orthopedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Koichi Okajima
- Department of Orthopedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Liuzhe Zhang
- Department of Orthopedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Toshihide Hirai
- Department of Orthopedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yuki Ishibashi
- Department of Orthopedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yusuke Tsuda
- Department of Orthopedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Masachika Ikegami
- Department of Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center Hospital, Rare Cancer Center, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Sakae Tanaka
- Department of Orthopedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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2
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Sparber-Sauer M, Ferrari A, Spunt SL, Vokuhl C, Casey D, Lautz TB, Meyer WH, Walterhouse DO, Pajtler KW, Alaggio R, Schmidt A, Safwat A, Timmermann B, Dall'Igna P, Chen S, Weiss AR, Orbach D. The significance of margins in pediatric Non-Rhabdomyosarcoma soft tissue sarcomas: Consensus on surgical margin definition harmonization from the INternational Soft Tissue SaRcoma ConsorTium (INSTRuCT). Cancer Med 2023. [PMID: 36744538 DOI: 10.1002/cam4.5671] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/05/2023] [Accepted: 01/23/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Margin status following surgery in children, adolescents, and young adults with soft tissue sarcomas is controversial and has been defined differently by various specialties, with definitions changing over time and by cooperative group. The International Soft Tissue Sarcoma Consortium (INSTRuCT) is a collaboration of the Children's Oncology Group (COG) Soft Tissue Sarcoma Committee, European pediatric Soft Tissue sarcoma Study Group (EpSSG), and the European Cooperative Weichteilsarkom Studiengruppe (CWS) devoted to improving patient outcomes by pooling and mining cooperative group clinical trial data. METHODS The INSTRuCT non-rhabdomyosarcoma soft tissue sarcoma (NRSTS) working group aimed to develop international harmonized recommendations regarding surgical margin assessment and definitions in children and adolescents with soft tissue tumors. RESULTS AND CONCLUSION This review addresses accepted principles and areas of controversy, including the perspectives of surgeons, pathologists, radiation oncologists, and pediatric oncologists, to develop a framework for building common guidelines for future research.
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Affiliation(s)
- Monika Sparber-Sauer
- Klinikum der Landeshauptstadt Stuttgart gKAöR, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pädiatrie 5 (Pädiatrische Onkologie, Hämatologie, Immunologie), Stuttgart, Germany.,Medizinische Fakultät der Universität Tübingen, Tübingen, Germany
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Sheri L Spunt
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - Christian Vokuhl
- Section of Pediatric Pathology, University of Bonn, Bonn, Germany
| | - Dana Casey
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
| | - Timothy B Lautz
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - William H Meyer
- Jimmy Everest Section of Pediatric Hematology Oncology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - David O Walterhouse
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Kristian W Pajtler
- Hopp-Children's Cancer Center, NCT Heidelberg (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Rita Alaggio
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andreas Schmidt
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Akmal Safwat
- Oncology Department and Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), Germany
| | - Patrizia Dall'Igna
- Pediatric Surgery, Department of Emergencies and Organ Transplantation, University of Bari, Bari, Italy
| | - Sonja Chen
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Aaron R Weiss
- Department of Pediatrics, Maine Medical Center, Portland, Maine, United States
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), PSL University, Institut Curie, Paris, France
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3
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Kobayashi H, Zhang L, Okajima K, Hirai T, Tsuda Y, Ikegami M, Kawai A, Tanaka S. Role of perioperative chemotherapy and radiotherapy for localized high-grade malignant peripheral nerve sheath tumor at the extremities and trunk wall: a population-based cohort study. Jpn J Clin Oncol 2023; 53:138-145. [PMID: 36461784 DOI: 10.1093/jjco/hyac178] [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: 07/09/2022] [Accepted: 10/27/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Primary tumor resection is the mainstay of treatment for malignant peripheral nerve sheath tumors. However, the efficacy of perioperative chemotherapy and radiotherapy for malignant peripheral nerve sheath tumors has not been elucidated. METHODS This retrospective analysis based on a Japanese registry included patients with localized malignant peripheral nerve sheath tumors arising at the extremities and trunk wall. Disease-specific overall survival and local recurrence-free survival were estimated using the Kaplan-Meier method. A Cox regression model was used to identify prognostic factors. Characteristics of groups with or without chemotherapy were adjusted using propensity score matching. RESULTS In total, 291 patients were included. The 5-year disease-specific overall survival rate was 70.6%. Multivariate analysis of disease-specific overall survival revealed that deep-seated tumors were a poor prognostic factor, but perioperative chemotherapy was not associated with disease-specific overall survival (hazard ratio, 0.81; 95% confidence interval, 0.45-1.43, P = 0.46). Local recurrence was observed in 55 patients (19.0%), and surgical margins (R1 and R2) were significant risk factors. Overall, perioperative chemotherapy did not prolong disease-specific overall survival (5-year disease-specific overall survival: 74.1% vs. 69.3%, P = 0.75) and had limited efficacy in the group with tumor size ≥ 5 cm, although the difference was not statistically significant (5-year disease-specific overall survival: 77.2% vs. 68.6%, respectively, P = 0.13). After adjustment by propensity score matching, perioperative chemotherapy significantly prolonged disease-specific overall survival (5-year disease-specific overall survival: 74.9% vs. 57.1%, P = 0.03), but this effect was not observed in local recurrence-free survival. In all patients, perioperative radiotherapy did not correlate with local recurrence-free survival (hazard ratio, 1.43; 95% confidence interval 0.78-2.62, P = 0.25). CONCLUSIONS Perioperative chemotherapy had limited efficacy for disease-specific overall survival in patients with localized malignant peripheral nerve sheath tumors.
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Affiliation(s)
- Hiroshi Kobayashi
- The University of Tokyo, Department of Orthopedic Surgery, Tokyo, Japan
| | - Liuzhe Zhang
- The University of Tokyo, Department of Orthopedic Surgery, Tokyo, Japan
| | - Koichi Okajima
- The University of Tokyo, Department of Orthopedic Surgery, Tokyo, Japan
| | - Toshihide Hirai
- The University of Tokyo, Department of Orthopedic Surgery, Tokyo, Japan
| | - Yusuke Tsuda
- The University of Tokyo, Department of Orthopedic Surgery, Tokyo, Japan
| | - Masachika Ikegami
- Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Department of Musculoskeletal Oncology, Bunkyo-ku, Tokyo, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center Hospital, Rare Cancer Center, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Sakae Tanaka
- The University of Tokyo, Department of Orthopedic Surgery, Tokyo, Japan
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4
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Acem I, van de Sande MAJ. Prediction tools for the personalized management of soft-tissue sarcomas of the extremity. Bone Joint J 2022; 104-B:1011-1016. [PMID: 36047022 PMCID: PMC9987162 DOI: 10.1302/0301-620x.104b9.bjj-2022-0647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Prediction tools are instruments which are commonly used to estimate the prognosis in oncology and facilitate clinical decision-making in a more personalized manner. Their popularity is shown by the increasing numbers of prediction tools, which have been described in the medical literature. Many of these tools have been shown to be useful in the field of soft-tissue sarcoma of the extremities (eSTS). In this annotation, we aim to provide an overview of the available prediction tools for eSTS, provide an approach for clinicians to evaluate the performance and usefulness of the available tools for their own patients, and discuss their possible applications in the management of patients with an eSTS.Cite this article: Bone Joint J 2022;104-B(9):1011-1016.
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Affiliation(s)
- Ibtissam Acem
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.,Department of Orthopaedic Oncology, Leiden University Medical Centre, Leiden, the Netherlands
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5
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Acem I, van Houdt WJ, Grünhagen DJ, van der Graaf WTA, Rueten-Budde AJ, Gelderblom H, Verhoef C, van de Sande MAJ. The role of perioperative chemotherapy in primary high-grade extremity soft tissue sarcoma: a risk-stratified analysis using PERSARC. Eur J Cancer 2022; 165:71-80. [PMID: 35219025 DOI: 10.1016/j.ejca.2022.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of the study is to assess the effect of perioperative chemotherapy (CTX) in patients with grade II-III extremity soft tissue sarcoma (eSTS) on overall survival (OS) and evaluate whether the PERSARC prediction tool could identify patients with eSTS more likely to benefit from CTX. METHODS Patients (18-70 years) with primary high-grade eSTS surgically treated with curative intent were included in the retrospective cohort study. The effect of any perioperative CTX and anthracycline + ifosfamide (AI)-based CTX on OS was investigated in three PERSARC-risk groups (high/intermediate/low). The PERSARC-risk groups were defined by the 33% and 66% quantile of the predicted 5-year OS of the study population equal to a 5-year OS of 65.8% and 79.8%, respectively. The effect of CTX on OS was investigated with weighted Kaplan-Meier curves and multivariable Cox models with an interaction between risk group and CTX. RESULTS This study included 5683 patients. The weighted Kaplan-Meier curves did not demonstrate a beneficial effect of any CTX and AI-based CTX on OS in the overall population. However, in the high PERSARC-risk group the 5-year OS of AI-based CTX was significantly better than no CTX (69.8% vs 59.0%, respectively, p = 0.004) (HR 0.66, 95%CI 0.53-0.83). CONCLUSIONS This study demonstrated a beneficial effect of AI-based CTX on OS in a selected group of high-risk patients with an absolute survival benefit of 11% as stratified by the PERSARC prediction tool. However, no beneficial effect of CTX on OS was found in the overall population of patients with primary high-grade eSTS younger than 70 years.
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Affiliation(s)
- Ibtissam Acem
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands; Department of Orthopaedic Oncology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.
| | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Anja J Rueten-Budde
- Mathematical Institute, Leiden University, Niels Bohrweg 1, 2333 CA, Leiden, the Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, 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
| | | | - Michiel A J van de Sande
- Department of Orthopaedic Oncology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
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6
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Kobayashi H, Zhang L, Hirai T, Tsuda Y, Ikegami M, Tanaka S. Role of adjuvant chemotherapy in patients with localized, undifferentiated pleomorphic sarcoma of soft tissue: a population-based cohort study. Int J Clin Oncol 2022; 27:802-810. [DOI: 10.1007/s10147-021-02102-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022]
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Pasquali S, Palmerini E, Quagliuolo V, Martin-Broto J, Lopez-Pousa A, Grignani G, Brunello A, Blay JY, Tendero O, Diaz-Beveridge R, Ferraresi V, Lugowska I, Infante G, Braglia L, Merlo DF, Fontana V, Marchesi E, Donati DM, Palassini E, Bianchi G, Marrari A, Morosi C, Stacchiotti S, Bagué S, Coindre JM, Dei Tos AP, Picci P, Bruzzi P, Miceli R, Casali PG, Gronchi A. Neoadjuvant chemotherapy in high-risk soft tissue sarcomas: A Sarculator-based risk stratification analysis of the ISG-STS 1001 randomized trial. Cancer 2021; 128:85-93. [PMID: 34643947 DOI: 10.1002/cncr.33895] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/25/2021] [Accepted: 06/07/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND The value of neoadjuvant chemotherapy in soft tissue sarcoma (STS) is not completely understood. This study investigated the benefit of neoadjuvant chemotherapy according to prognostic stratification based on the Sarculator nomogram for STS. METHODS This study analyzed data from ISG-STS 1001, a randomized study that tested 3 cycles of neoadjuvant anthracycline plus ifosfamide (AI) or histology-tailored (HT) chemotherapy in adult patients with STS. The 10-year predicted overall survival (pr-OS) was estimated with the Sarculator and was stratified into higher (10-year pr-OS < 60%) and lower risk subgroups (10-year pr-OS ≥ 60%). RESULTS The median pr-OS was 0.63 (interquartile range [IQR], 0.51-0.72) for the entire study population, 0.62 (IQR, 0.51-0.70) for the AI arm, and 0.64 (IQR, 0.51-0.73) for the HT arm. Three- and 5-year overall survival (OS) were 0.86 (95% confidence interval [CI], 0.82-0.93) and 0.81 (95% CI, 0.71-0.86) in lower risk patients and 0.69 (95% CI, 0.70-0.85) and 0.59 (95% CI, 0.51-0.72) in the higher risk patients (log-rank test, P = .004). In higher risk patients, the 3- and 5-year Sarculator-predicted and study-observed OS rates were 0.68 and 0.58, respectively, and 0.85 and 0.66, respectively, in the AI arm (P = .04); the corresponding figures in the HT arm were 0.69 and 0.60, respectively, and 0.69 and 0.55, respectively (P > .99). In lower risk patients, the 3- and 5-year Sarculator-predicted and study-observed OS rates were 0.85 and 0.80, respectively, and 0.89 and 0.82, respectively, in the AI arm (P = .507); the corresponding figures in the HT arm were 0.87 and 0.81, respectively, and 0.86 and 0.74, respectively (P = .105). CONCLUSIONS High-risk patients treated with AI performed better than predicted, and this adds to the evidence for the efficacy of neoadjuvant AI in STS. LAY SUMMARY People affected by soft tissue sarcomas of the extremities and trunk wall are at some risk of developing metastasis after surgery. Preoperative or postoperative chemotherapy has been tested in clinical trials to reduce the chances of distant metastasis. However, study findings have not been conclusive. This study stratified the risk of metastasis for people affected by sarcomas who were included in a clinical trial testing neoadjuvant chemotherapy. Exploiting the prognostic nomogram Sarculator, it found a benefit for chemotherapy when the predicted risk, based on patient and tumor characteristics, was high.
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Affiliation(s)
- Sandro Pasquali
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Emanuela Palmerini
- Osteoncology, Bone and Soft Tissue Sarcomas, and Innovative Therapies Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Javier Martin-Broto
- Medical Oncology Department, University Hospital Virgen del Rocio, Seville, Spain.,Institute of Biomedicine of Seville, University of Seville, Seville, Spain
| | - Antonio Lopez-Pousa
- Department of Cancer Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Giovanni Grignani
- Department of Cancer Medicine, Fondazione del Piemonte per l'Oncologia IRCCS Candiolo, Turin, Italy
| | - Antonella Brunello
- Department of Oncology, Medical Oncology 1 Unit, Istituto Oncologico Veneto, IRCCS, Padua, Italy
| | - Jean-Yves Blay
- Department of Cancer Medicine, Léon Bérard Cancer Center, Lyon, France.,Université Claude Bernard Lyon I, Lyon, France
| | - Oscar Tendero
- Department of Surgery, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Robert Diaz-Beveridge
- Department of Cancer Medicine, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Iwona Lugowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Centrum Onkologii Instytut im Marii Skłodowskiej Curie, Warsaw, Poland
| | - Gabriele Infante
- Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Braglia
- Research and Statistics Infrastructure, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | - Domenico Franco Merlo
- Research and Statistics Infrastructure, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | - Valeria Fontana
- Clinical Trial Center and Department of Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | | | - Davide Maria Donati
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elena Palassini
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Bianchi
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Marrari
- Department of Cancer Medicine, Istituto Clinico Humanitas, Rozzano, Italy
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Bagué
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Angelo Paolo Dei Tos
- Department of Pathology, Treviso General Hospital, Padua, Italy.,University of Padua, Padua, Italy
| | - Piero Picci
- Laboratory of Oncologic Research, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Bruzzi
- Clinical Trial Center and Department of Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Rosalba Miceli
- Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Giovanni Casali
- Department of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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8
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Acem I, Smit MM, Verhoef C, van Houdt WJ, Haas RL, van der Hage JA, Grünhagen DJ, van de Sande MAJ. Management of Soft Tissue Sarcomas in Extremities: Variation in Treatment Recommendations and Surveillance According to Specialty and Continent. Ann Surg Oncol 2021; 28:7923-7936. [PMID: 33970372 PMCID: PMC8519885 DOI: 10.1245/s10434-021-09946-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/17/2021] [Indexed: 12/22/2022]
Abstract
Background This study aimed to provide an insight into clinical decision-making and surveillance strategy of sarcoma specialists for patients with primary soft tissue sarcoma of the extremities (eSTS). The secondary aim was to quantify the role of patient- and tumor-specific factors in the perioperative management. Methods Members of sarcoma societies were sent a Web-based 21-item survey about eSTS management. The survey concerned only primary resectable high-grade eSTS in adults. Results The study enrolled 396 respondents. The majority of the surgical specialists thought the evidence for perioperative chemotherapy (CTX) for high-grade eSTS was insufficient. Radiotherapy (RTX) was less frequently offered in Asia than in North America and Europe. The specialties and continents also differed regarding the importance of patient and tumor characteristics influencing RTX and CTX recommendation. For surveillance after initial treatment outpatient visits, chest computed tomography (CT) scans, and magnetic resonance images of the extremity were the methods primarily used. The specialists in North America preferred chest CT scan over chest x-ray, whereas those in Asia and Europe had no clear preference. Discussion Specialty and continent are important factors contributing to the variation in clinical practice, treatment recommendations, and surveillance of patients with primary resectable high-grade eSTS.
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Affiliation(s)
- Ibtissam Acem
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Erasmus Medical Centre, Rotterdam, The Netherlands. .,Department of Orthopedic Oncology, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Merel M Smit
- Department of Orthopedic Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rick L Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jos A van der Hage
- Department of Surgical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Erasmus Medical Centre, Rotterdam, The Netherlands
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Wan L, Tu C, Qi L, Li Z. Survivorship and prognostic factors for pleomorphic liposarcoma: a population-based study. J Orthop Surg Res 2021; 16:175. [PMID: 33663547 PMCID: PMC7931523 DOI: 10.1186/s13018-021-02327-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/24/2021] [Indexed: 02/03/2023] Open
Abstract
Background Pleomorphic liposarcoma is the least common but most aggressive subtype of liposarcoma. Very few studies have presented data on pleomorphic liposarcoma specifically, often including a limited number of cases and short-term follow-up. As a result, the survivorship and prognostic characteristics of this tumor remain incompletely identified. Study design and setting Cross-sectional analysis of the Surveillance Epidemiology and End Results database (1996–2015). Results Overall survival for the entire series was 54% (95% confidence interval [CI], 49–58%) and 40% (95% CI, 35–45%) at 5 and 10 years, respectively. Disease-specific survival for the entire series was 60% (95% CI, 56–65%) and 53% (95% CI, 48–58%) at 5 and 10 years, respectively. Patients who survived 10 years or more were more likely to die of events unrelated to pleomorphic liposarcoma. Univariate and multivariate analysis demonstrated that not receiving cancer-directed surgery was an independent poor prognostic factor. Older age (≥ 65 years old) was associated with worse overall survival but not disease-specific survival. Tumor stage and radiotherapy showed different impact on survival depending on tumor size. In comparison to localized staged tumors, regional stage only predicts poor survival in patients with tumor size less than 5 cm, while distant stage is an independent worse prognosis factor. Radiotherapy only benefits patients with tumor size larger than 10 cm. These results were confirmed in competing risk analysis. Conclusion Survival rates of patients with pleomorphic liposarcoma has not changed over the past 20 years. Patients with distant stage have poor prognosis; regional stage indicates worse survival in patients with tumor size less than 5 cm. Receiving surgery could prolong the survival, while radiotherapy only benefits patients with large tumor size (> 10 cm). Older age is associated with poor overall survival but not disease-specific survival. Routine patient surveillance following initial diagnosis should at least be 10 years for pleomorphic liposarcoma. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02327-3.
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Affiliation(s)
- Lu Wan
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, 139 Renming Road, Changsha, 410011, Hunan, People's Republic of China.,Vaccine and Immunotherapy Center, Infectious Diseases Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA.,Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, 139 Renming Road, Changsha, 410011, Hunan, People's Republic of China
| | - Chao Tu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, 139 Renming Road, Changsha, 410011, Hunan, People's Republic of China.,Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, 139 Renming Road, Changsha, 410011, Hunan, People's Republic of China
| | - Lin Qi
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, 139 Renming Road, Changsha, 410011, Hunan, People's Republic of China.,Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, 139 Renming Road, Changsha, 410011, Hunan, People's Republic of China
| | - Zhihong Li
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, 139 Renming Road, Changsha, 410011, Hunan, People's Republic of China. .,Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, 139 Renming Road, Changsha, 410011, Hunan, People's Republic of China.
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10
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Chemotherapy and Survival in Patients with Primary High-Grade Extremity and Trunk Soft Tissue Sarcoma. Cancers (Basel) 2020; 12:cancers12092389. [PMID: 32846908 PMCID: PMC7564235 DOI: 10.3390/cancers12092389] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/18/2020] [Accepted: 08/22/2020] [Indexed: 11/17/2022] Open
Abstract
The use of upfront chemotherapy for primary localized soft tissue sarcoma (STS) of the extremity and trunk is debated. It remains unclear if chemotherapy adds clinical benefit, which patients are likely to benefit, and whether the timing of therapy affects outcomes. We used the National Cancer Database (NCDB) to examine the association between overall survival (OS) and chemotherapy in 5436 patients with the five most common subtypes of STS with primary disease localized to the extremity or trunk, mirroring the patient population of a modern phase 3 clinical trial of neoadjuvant chemotherapy. We then examined associations between timing of multi-agent chemotherapy (neoadjuvant or adjuvant) and OS. We used a Cox proportional hazards model and propensity score matching (PSM) to account for covariates including demographic, patient, clinical, treatment, and facility factors. In the overall cohort, we observed no association between multi-agent chemotherapy or its timing and improved OS. Multi-agent chemotherapy was associated with improved OS in several subgroups, including patients with larger tumors (>5 cm), those treated at high-volume centers, or those who received radiation. We also identified an OS benefit to multi-agent chemotherapy among the elderly (>70 years) and African American patients. Multi-agent chemotherapy was associated with improved survival for patients with tumors >5 cm, who receive radiation, or who receive care at high-volume centers. Neither younger age nor chemotherapy timing was associated with better outcomes. These 'real-world' findings align with recent randomized trial data supporting the use of multi-agent chemotherapy in high-risk patients with localized STS.
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11
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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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12
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Graham DS, Onyshchenko M, Eckardt MA, DiPardo BJ, Venigalla S, Nelson SD, Chmielowski B, Singh AS, Shabason JE, Eilber FC, Kalbasi A. Low Rates of Chemotherapy Use for Primary, High-Grade Soft Tissue Sarcoma: A National Cancer Database Analysis. J Natl Compr Canc Netw 2020; 18:1055-1065. [PMID: 32755981 DOI: 10.6004/jnccn.2020.7553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 02/19/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is conflicting evidence regarding the role of chemotherapy for high-grade soft tissue sarcoma (STS) in adults. We sought to characterize patterns of chemotherapy use, including multiagent and neoadjuvant chemotherapy, in the United States. PATIENTS AND METHODS Using the National Cancer Database, we identified 19,969 adult patients who underwent surgical resection for primary high-grade STS from 2004 to 2016. Using logistic regression, we examined factors associated with overall, multiagent, and neoadjuvant chemotherapy use. RESULTS Chemotherapy was administered to 22% (n=4,377) of the study population. Among patients treated using chemotherapy, 85% received multiagent treatment and 47% received neoadjuvant treatment. On multivariate analysis, factors associated with chemotherapy use included tumor size, depth, histology, and primary site; receipt of radiation treatment; younger age; higher patient income; and academic treatment facility. Factors associated with multiagent chemotherapy use included tumor histology, tumor primary site, and younger age. Factors associated with neoadjuvant chemotherapy use included tumor size, depth, margin status, and primary site; receipt of radiation treatment; higher patient income; academic treatment facility type; and distance to treatment facility. Treatment at a high-volume facility was the only factor associated with overall, multiagent, and neoadjuvant chemotherapy use. No significant temporal trend was seen in overall, multiagent, or neoadjuvant chemotherapy use. CONCLUSIONS Overall chemotherapy use was low (22%). The variability in chemotherapy use was driven by clinical, patient, demographic, and facility factors. Among patients treated with chemotherapy, the use of multiagent chemotherapy was high (85%), and nearly half received neoadjuvant therapy. There was a discrepancy in the use of chemotherapy-including neoadjuvant and multiagent chemotherapy-between high- and low-volume treatment centers.
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Affiliation(s)
- Danielle S Graham
- Division of Surgical Oncology, Department of Surgery, University of California, Los Angeles, Los Angeles, California
| | - Mykola Onyshchenko
- Division of Hematology-Oncology, Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Mark A Eckardt
- Division of Surgical Oncology, Department of Surgery, University of California, Los Angeles, Los Angeles, California.,Department of Surgery, Yale School of Medicine, New Haven, Connecticut.,Department of Surgery, Greater Los Angeles Veterans Health Administration, Los Angeles, California
| | - Benjamin J DiPardo
- Division of Surgical Oncology, Department of Surgery, University of California, Los Angeles, Los Angeles, California.,Department of Surgery, Greater Los Angeles Veterans Health Administration, Los Angeles, California
| | - Sriram Venigalla
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Bartosz Chmielowski
- Division of Hematology-Oncology, Department of Internal Medicine, and.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
| | - Arun S Singh
- Division of Hematology-Oncology, Department of Internal Medicine, and.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
| | - Jacob E Shabason
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Family Cancer Research Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Fritz C Eilber
- Division of Surgical Oncology, Department of Surgery, University of California, Los Angeles, Los Angeles, California.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
| | - Anusha Kalbasi
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California.,Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
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13
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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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14
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Gómez J, Tsagozis P. Multidisciplinary treatment of soft tissue sarcomas: An update. World J Clin Oncol 2020; 11:180-189. [PMID: 32355640 PMCID: PMC7186235 DOI: 10.5306/wjco.v11.i4.180] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/13/2020] [Accepted: 03/22/2020] [Indexed: 02/06/2023] Open
Abstract
Standard treatment for soft tissue sarcoma, based on complete surgical resection with or without adjuvant radiotherapy and chemotherapy, has not substantially changed during the last several decades. Nevertheless, recent advances have contributed to considerable improvement in the management of these patients; for example, new magnetic resonance imaging sequences such as diffusion-weighted imaging and magnetic resonance imaging radiomics can better assess tumor extension and even estimate its grade. Detection of circulating genetic material (liquid biopsy) and next-generation sequencing are powerful techniques for genetic analysis, which will increase our understanding of the underlying molecular mechanisms and may reveal potential therapeutic targets. The role of chemotherapy in non-metastatic disease is still controversial, and there is a need to identify patients who really benefit from this treatment. Novel chemotherapeutic regimens have entered clinical praxis and can change the outcome of patients with metastatic disease. Advances in radiotherapy have helped decrease local adverse effects and sustain good local control of the disease. The following report provides an updated view of the diagnosis, treatment, and future perspectives on the management of patients with soft tissue sarcomas.
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Affiliation(s)
- Jorge Gómez
- Department of Orthopedic Surgery, Clínica Universidad de Navarra, University of Navarra, Pamplona 31008, Spain
| | - Panagiotis Tsagozis
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm 17176, Sweden
- Muskuloskeletal Tumour Service, Karolinska University Hospital, Stockholm 17176, Sweden
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15
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Dadras M, Koepp P, Wallner C, Wagner JM, Sogorski A, Lehnhardt M, Harati K, Behr B. Predictors of oncologic outcome in patients with and without flap reconstruction after extremity and truncal soft tissue sarcomas. J Plast Reconstr Aesthet Surg 2020; 73:1239-1252. [PMID: 32245732 DOI: 10.1016/j.bjps.2020.03.008] [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: 11/01/2019] [Revised: 01/25/2020] [Accepted: 03/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Soft tissue sarcomas (STS) of the extremities or trunk often require plastic reconstructive transfer of vital tissue for wound closure after resection. Literature on the oncologic outcome of patients receiving flap closure in comparison with patients receiving primary wound closure is very limited. METHODS Patients who underwent resection of a primary extremity or truncal STS without dissemination at our institution between January 2000 until December 2015 were eligible for the study. Patients were divided into two groups based on type of soft tissue closure (primary or flap) while patients receiving skin grafting were excluded. Characteristics, oncologic outcome and prognostic factors of both groups were compared. RESULTS 781 patients could be included, of these 200 had received flap closure and 581 primary wound closure. Tumors receiving flap closure were significantly smaller but were located in distal extremities and showed a trend towards prior neoadjuvant radiotherapy. Incidence of wound and general complications was similar in both groups. 5-year local recurrence free survival (LRFS, 71% vs. 69%) and 5-year disease specific survival (DSS, 84% vs. 88%) did not differ significantly between patients with primary closure and flap closure. Most important predictors in both groups were tumor size and grading with no major differences in analysis of predictors for both endpoints. CONCLUSION Plastic reconstructive surgery plays an important role in limb-conserving STS treatment. Complication rates of patients with flap coverage are not higher than of patients with primary wound closure and oncologic outcome is similar with no major differences in predictors of LRFS and DSS.
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Affiliation(s)
- Mehran Dadras
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Bochum, Germany.
| | - Pascal Koepp
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Christoph Wallner
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Johannes M Wagner
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Alexander Sogorski
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Kamran Harati
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Björn Behr
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
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16
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D'Ambrosio L, Touati N, Blay JY, Grignani G, Flippot R, Czarnecka AM, Piperno-Neumann S, Martin-Broto J, Sanfilippo R, Katz D, Duffaud F, Vincenzi B, Stark DP, Mazzeo F, Tuchscherer A, Chevreau C, Sherriff J, Estival A, Litière S, Sents W, Ray-Coquard I, Tolomeo F, Le Cesne A, Rutkowski P, Stacchiotti S, Kasper B, Gelderblom H, Gronchi A. Doxorubicin plus dacarbazine, doxorubicin plus ifosfamide, or doxorubicin alone as a first-line treatment for advanced leiomyosarcoma: A propensity score matching analysis from the European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group. Cancer 2020; 126:2637-2647. [PMID: 32129883 DOI: 10.1002/cncr.32795] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/05/2020] [Accepted: 01/24/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The optimal treatment for advanced leiomyosarcoma is still debated. Given histotype-specific prospective controlled data lacking, this study retrospectively evaluated doxorubicin plus dacarbazine, doxorubicin plus ifosfamide, and doxorubicin alone as first-line treatments for advanced/metastatic leiomyosarcoma treated at European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group (EORTC-STBSG) sites. METHODS The inclusion criteria were a confirmed histological diagnosis, treatment between January 2010 and December 2015, measurable disease (Response Evaluation Criteria in Solid Tumors 1.1), an Eastern Cooperative Oncology Group performance status ≤2, and an age ≥ 18 years. The endpoints were progression-free survival (PFS), overall survival (OS), and overall response rate (ORR). PFS was analyzed with methods for interval-censored data. Patients were matched according to their propensity scores, which were estimated with a logistic regression model accounting for histology, grade, age, sex, performance status, tumor site, and tumor extent. RESULTS Three hundred three patients from 18 EORTC-STBSG sites were identified. One hundred seventeen (39%) received doxorubicin plus dacarbazine, 71 (23%) received doxorubicin plus ifosfamide, and 115 (38%) received doxorubicin. In the 2:1:2 propensity score-matched population (205 patients), the estimated median PFS was 9.2 months (95% confidence interval [CI], 5.2-9.7 months), 8.2 months (95% CI, 5.2-10.1 months), and 4.8 months (95% CI, 2.3-6.0 months) with ORRs of 30.9%, 19.5%, and 25.6% for doxorubicin plus dacarbazine, doxorubicin plus ifosfamide, and doxorubicin alone, respectively. PFS was significantly longer with doxorubicin plus dacarbazine versus doxorubicin (hazard ratio [HR], 0.72; 95% CI, 0.52-0.99). Doxorubicin plus dacarbazine was associated with longer OS (median, 36.8 months; 95% CI, 27.9-47.2 months) in comparison with both doxorubicin plus ifosfamide (median, 21.9 months; 95% CI, 16.7-33.4 months; HR, 0.65; 95% CI, 0.40-1.06) and doxorubicin (median, 30.3 months; 95% CI, 21.0-36.3 months; HR, 0.66; 95% CI, 0.43-0.99). Adjusted analyses retained an effect for PFS but not for OS. None of the factors selected for multivariate analysis had a significant interaction with the received treatment for both PFS and OS. CONCLUSIONS This is the largest retrospective study of first-line treatment for advanced leiomyosarcoma. In the propensity score-matched population, doxorubicin and dacarbazine showed favorable activity in terms of both ORR and PFS and warrants further evaluation in prospective trials.
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Affiliation(s)
- Lorenzo D'Ambrosio
- Department of Oncology, University of Turin, Turin, Italy.,Sarcoma Unit, Division of Medical Oncology, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | - Nathan Touati
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Jean-Yves Blay
- Leon Berard Center and Claude Bernard Lyon I University, EURACAN, LYRICAN, Lyon, France
| | - Giovanni Grignani
- Sarcoma Unit, Division of Medical Oncology, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | - Ronan Flippot
- Department of Medicine, Gustave Roussy, Villejuif Cedex, France
| | - Anna M Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute-Oncology Center, Gliwice, Poland.,Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | | | - Javier Martin-Broto
- Virgen del Rocio University Hospital, Institute of Biomedicine Research/CSIC/University of Seville, Seville, Spain
| | - Roberta Sanfilippo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniela Katz
- Oncology Department, Sharett Institute of Oncology, Hadassah-Hebrew University, Jerusalem, Israel
| | - Florence Duffaud
- Medical Oncology - University Hospital Timone, Aix-Marseille University, Marseille, France
| | - Bruno Vincenzi
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Daniel P Stark
- St James's Institute of Oncology, Leeds Institute of Cancer and Pathology, University of Leeds and Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
| | - Filomena Mazzeo
- Medical Oncology, Clinique Universitaire Saint-Luc, Woluwe-Saint-Lambert, Belgium
| | - Armin Tuchscherer
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - Christine Chevreau
- Claudius Regaud Institute, University Cancer Institute of Toulouse, Toulouse, France
| | - Jenny Sherriff
- Cancer Centre, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | | | - Saskia Litière
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Ward Sents
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - Isabelle Ray-Coquard
- Leon Berard Center and Claude Bernard Lyon I University, EURACAN, LYRICAN, Lyon, France
| | - Francesco Tolomeo
- Sarcoma Unit, Division of Medical Oncology, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | - Axel Le Cesne
- Department of Medicine, Gustave Roussy, Villejuif Cedex, France
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute-Oncology Center, Gliwice, Poland.,Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Silvia Stacchiotti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Bernd Kasper
- Sarcoma Unit, Interdisciplinary Tumor Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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