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Chmiel P, Rutkowski P, Spałek M, Szumera-Ciećkiewicz A, Czarnecka AM. What is the Optimal Treatment Strategy after Sarcoma R2 Surgery? Curr Treat Options Oncol 2024; 25:798-812. [PMID: 38809411 DOI: 10.1007/s11864-024-01218-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 05/30/2024]
Abstract
OPINION STATEMENT Soft tissue sarcomas (STS) are rare tumours of mesenchymal origin, most commonly occurring in the extremity but also in the retroperitoneum. The curative treatment for STS is radical surgery with wide margins, in some cases in combination with perioperative radiotherapy and chemotherapy. Nonradical resection (R2) of STS has been an emerging issue in recent decades, as optimal subsequent management remains debatable. Similarly, there is still no consensus on optimal surgical margins. Combining multiple treatment modalities in adjuvant therapy can achieve local and distant control in patients following surgery with positive margins. Patients who have undergone nonradical resection therefore require additional surgical interventions, and adjuvant radiotherapy resulting in a better prognosis but a higher number of complications. Following non-radical treatment, patients with limb and trunk wall sarcomas and retroperitoneal sarcomas should also undergo increased oncological surveillance. Given the potential issues that may emerge in such clinical situations, it is crucial to up-date the current guidelines to enhance the long-term prognosis of these patients.
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Affiliation(s)
- Paulina Chmiel
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland
- Faculty of Medicine, Medical University of Warsaw, 02-091, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland
| | - Mateusz Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland
- Department of Radiotherapy I, Maria Sklodowska-Curie National Research Institute of Oncology, 02-718, Warsaw, Poland
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland
- Biobank Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland
| | - Anna M Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781, Warsaw, Poland.
- Department of Experimental Pharmacology, Mossakowski Medical Research Institute Polish Academy of Sciences, 02-106, Warsaw, Poland.
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Blay JY, Penel N, Valentin T, Anract P, Duffaud F, Dufresne A, Verret B, Cordoba A, Italiano A, Brahmi M, Henon C, Amouyel T, Ray-Coquard I, Ferron G, Boudou-Rouquette P, Tlemsani C, Salas S, Rochwerger R, Faron M, Bompas E, Ducassou A, Gangloff D, Gouin F, Firmin N, Piperno-Neumann S, Rios M, Ropars M, Kurtz JE, Le Nail LR, Bertucci F, Carrere S, Llacer C, Watson S, Bonvalot S, Leroux A, Perrin C, Gantzer J, Pracht M, Narciso B, Monneur A, Lebbe C, Hervieu A, Saada-Bouzid E, Dubray-Longeras P, Fiorenza F, Chaigneau L, Nevieres ZM, Soibinet P, Bouché O, Guillemet C, Spano JP, Ruzic JC, Isambert N, Vaz G, Meeus P, Karanian M, Ngo C, Coindre JM, De Pinieux G, Le Loarer F, Ducimetiere F, Chemin C, Morelle M, Toulmonde M, Le Cesne A. Improved nationwide survival of sarcoma patients with a network of reference centers. Ann Oncol 2024; 35:351-363. [PMID: 38246351 DOI: 10.1016/j.annonc.2024.01.001] [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: 11/01/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND We investigated the impact of the implementation of a network of reference centers for sarcomas (NETSARC) on the care and survival of sarcoma patients in France since 2010. PATIENTS AND METHODS NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDTBs), funded by the French National Cancer Institute (INCa) since 2010. Its aims are to improve the quality of diagnosis and care of sarcoma patients. Patients' characteristics, treatments, and outcomes are collected in a nationwide database. The objective of this analysis was to compare the survival of patients in three periods: 2010-2012 (non-exhaustive), 2013-2015, and 2016-2020. RESULTS A total of 43 975 patients with sarcomas, gastrointestinal stromal tumors (GISTs), or connective tissue tumors of intermediate malignancy were included in the NETSARC+ database since 2010 (n = 9266 before 2013, n = 12 274 between 2013 and 2015, n = 22 435 in 2016-2020). Median age was 56 years, 50.5% were women, and 13.2% had metastasis at diagnosis. Overall survival was significantly superior in the period 2016-2020 versus 2013-2015 versus 2010-2012 for the entire population, for patients >18 years of age, and for both metastatic and non-metastatic patients in univariate and multivariate analyses (P < 0.0001). Over the three periods, we observed a significantly improved compliance to clinical practice guidelines (CPGs) nationwide: the proportion of patients biopsied before surgery increased from 62.9% to 72.6%; the percentage of patients presented to NETSARC MDTBs before first surgery increased from 31.7% to 44.4% (P < 0.0001). The proportion of patients with R0 resection on first surgery increased (from 36.1% to 46.6%), while R2 resection rate decreased (from 10.9% to 7.9%), with a better compliance and improvement in NETSARC centers. CONCLUSIONS The implementation of the national reference network for sarcoma was associated with an improvement of overall survival and compliance to guidelines nationwide in sarcoma patients. Referral to expert networks for sarcoma patients should be encouraged, though a better compliance to CPGs can still be achieved.
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Affiliation(s)
- J Y Blay
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon.
| | - N Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - T Valentin
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - P Anract
- Department of Orthopedics, Hôpital Cochin Saint Vincent de Paul, Paris
| | - F Duffaud
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - A Dufresne
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - B Verret
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - A Cordoba
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - A Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - M Brahmi
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Henon
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - T Amouyel
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - I Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - G Ferron
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | | | - C Tlemsani
- Department of Orthopedics, Hôpital Cochin Saint Vincent de Paul, Paris
| | - S Salas
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - R Rochwerger
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - M Faron
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - E Bompas
- Department of Medical Oncology, Cochin Hospital, Paris; Department of Medical Oncology, Centre René Gauducheau, Nantes St. Herblain
| | - A Ducassou
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - D Gangloff
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - F Gouin
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Service Orthopedie, CHU Nantes, Nantes
| | - N Firmin
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - S Piperno-Neumann
- INSERM U1194, IRCM, Univ Montpellier, Montpellier; Department of Medical Oncology, Institut Curie, Paris; Department of Surgical Oncology, Institut Curie, Paris
| | - M Rios
- Department of Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - M Ropars
- Department of Orthopedics, CHU Rennes, Rennes
| | | | | | - F Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille
| | - S Carrere
- Service Orthopedie, CHU Nantes, Nantes
| | - C Llacer
- Service Orthopedie, CHU Nantes, Nantes
| | - S Watson
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - S Bonvalot
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - A Leroux
- INSERM U1194, IRCM, Univ Montpellier, Montpellier
| | - C Perrin
- Department of Medical Oncology, Eugene Marquis Comprehensive Cancer Center, Rennes
| | - J Gantzer
- Department of Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - M Pracht
- Department of Medical Oncology, Eugene Marquis Comprehensive Cancer Center, Rennes
| | - B Narciso
- Department of Orthopedic Surgery, Tours
| | - A Monneur
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille
| | - C Lebbe
- Department of Dermatology, INSERM U976 University Paris Diderot Saint Louis Hospital, Paris; Department of CIC, INSERM U976 University Paris Diderot Saint Louis Hospital, Paris
| | - A Hervieu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon
| | - E Saada-Bouzid
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice
| | - P Dubray-Longeras
- Department of Medical Oncology, Centre Jean Perrin, Clermont-Ferrand
| | - F Fiorenza
- Department of Orthopedic Surgery, CHU Limoges, Limoges
| | - L Chaigneau
- Department of Medicine, CHU Besancon, Besancon
| | | | - P Soibinet
- Department of Medicine, Centre Francois Baclesse, Caen
| | - O Bouché
- Department of Gastroenterology, CHU Reims, Reims
| | - C Guillemet
- Department of Medical Oncology, Centre J Godinot Reims, Reims
| | - J P Spano
- Department of Oncology, Hôpital Pitié-Salpétriere, Paris
| | - J C Ruzic
- Departement d'oncologie, CHU, La Reunion
| | - N Isambert
- Service d'oncologie, CHU Poitiers, Poitiers, France
| | - G Vaz
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - P Meeus
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Karanian
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Ngo
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - J M Coindre
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | | | - F Le Loarer
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - F Ducimetiere
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Chemin
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Morelle
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - A Le Cesne
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
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Gouin F, Michot A, Jafari M, Honoré C, Mattei JC, Rochwerger A, Ropars M, Tzanis D, Anract P, Carrere S, Gangloff D, Ducoulombier A, Lebbe C, Guiramand J, Waast D, Marchal F, Sirveaux F, Causeret S, Gimbergues P, Fiorenza F, Paquette B, Soibinet P, Guilloit JM, Le Nail LR, Dujardin F, Brinkert D, Chemin-Airiau C, Morelle M, Meeus P, Karanian M, Le Loarer F, Vaz G, Blay JY. Improved Metastatic-Free Survival after Systematic Re-Excision Following Complete Macroscopic Unplanned Excision of Limb or Trunk Soft Tissue Sarcoma. Cancers (Basel) 2024; 16:1365. [PMID: 38611043 PMCID: PMC11010862 DOI: 10.3390/cancers16071365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Whether re-excision (RE) of a soft tissue sarcoma (STS) of limb or trunk should be systematized as adjuvant care and if it would improve metastatic free survival (MFS) are still debated. The impact of resection margins after unplanned macroscopically complete excision (UE) performed out of a NETSARC reference center or after second resection was further investigated. METHODS This large nationwide series used data from patients having experienced UE outside of a reference center from 2010 to 2019, collected in a French nationwide exhaustive prospective cohort NETSARC. Patient characteristics and survival distributions in patients reexcised (RE) or not (No-RE) are reported. Multivariate Cox proportional hazard model was conducted to adjust for classical prognosis factors. Subgroup analysis were performed to identify which patients may benefit from RE. RESULTS Out of 2371 patients with UE for STS performed outside NETSARC reference centers, 1692 patients were not reviewed by multidisciplinary board before treatment decision and had a second operation documented. Among them, 913 patients experienced re-excision, and 779 were not re-excised. Characteristics were significantly different regarding patient age, tumor site, size, depth, grade and histotype in patients re-excised (RE) or not (No-RE). In univariate analysis, final R0 margins are associated with a better MFS, patients with R1 margins documented at first surgery had a better MFS as compared to patients with first R0 resection. The study identified RE as an independent favorable factor for MFS (HR 0.7, 95% CI 0.53-0.93; p = 0.013). All subgroups except older patients (>70 years) and patients with large tumors (>10 cm) had superior MFS with RE. CONCLUSIONS RE might be considered in patients with STS of limb or trunk, with UE with macroscopic complete resection performed out of a reference center, and also in originally defined R0 margin resections, to improve LRFS and MFS. Systematic RE should not be advocated for patients older than 70 years, or with tumors greater than 10 cm.
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Affiliation(s)
- Francois Gouin
- Surgery Department, Centre Léon Bérard, 69008 Lyon, France (G.V.)
| | - Audrey Michot
- Surgery Department, Institut Bergonié, 33076 Bordeaux, France
| | - Mehrdad Jafari
- General and Digestive Oncologic Surgery, Centre Oscar Lambret, 59000 Lille, France
| | - Charles Honoré
- Surgery Department, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Jean Camille Mattei
- Orthopedic and Traumatologic Surgery Department, Hôpital Nord, Hopital de la Conception, APHM, 13005 Marseille, France
| | - Alexandre Rochwerger
- Orthopedic and Traumatologic Surgery Department, Hôpital Nord, Hopital de la Conception, APHM, 13005 Marseille, France
| | - Mickael Ropars
- Orthopedic Surgery Department, CHU de Rennes, 35033 Rennes, France;
| | - Dimitri Tzanis
- Surgery Department, Institut Curie, PSL University, 75248 Paris, France;
| | - Philippe Anract
- Orthopedic Surgery Department, Hôpital Cochin, AP-HP, Université de Paris, Faculté de Santé, Unités de Formation et de Recherche de Médecine, 75015 Paris, France
| | - Sébastien Carrere
- Surgery Department, Institut de Recherche en Cancérologie, 34298 Montpellier, France
| | | | - Agnès Ducoulombier
- Senology Surgery Department, Onco-Gynécologique et Reconstructrice, Centre Antoine Lacassagne, 06100 Nice, France
| | - Céleste Lebbe
- Reconstructive et Esthetic Plastic Surgery, Hôpital Saint Louis, 75010 Paris, France
| | - Jérôme Guiramand
- Surgery Department, Institut Paoli Calmette, 13009 Marseille, France
| | - Denis Waast
- Orthopedic and Traumatologic Surgery Clinic, CHU Nantes, 44093 Nantes, France
| | - Frédéric Marchal
- Surgery Department, Institut de Cancérologie de Lorraine, Université de Lorraine, CNRS, CRAN, UMR 7039, 54000 Nancy, France
| | | | - Sylvain Causeret
- Surgery Department, Centre George-François Leclerc, 21079 Dijon, France;
| | - Pierre Gimbergues
- Surgery Department, Centre Jean Perrin, 63011 Clermont Ferrand, France
| | - Fabrice Fiorenza
- Orthopedic and Traumatology Surgery Department, CHU Limoges, 87000 Limoges, France
| | - Brice Paquette
- Department of Digestive Surgery, Jean Minjoz University Hospital, 25000 Besançon, France;
| | - Pauline Soibinet
- Medical Oncology Department, Institut Godinot, 51100 Reims, France
| | - Jean-Marc Guilloit
- Visceral et Digestive Surgery Department, Centre François Baclesse, 14076 Caen, France
| | - Louis R. Le Nail
- Onco-Orthopedic Surgery Department, Hôpital Trousseau, CHRU de Tours, 37000 Tours, France
| | - Franck Dujardin
- Medical Oncology and Surgical Oncology Department, Centre Henri Becquerel, 76038 Rouen, France
| | - David Brinkert
- Orthopedic Surgery Department, CHU de Strasbourg, 67200 Strasbourg, France;
| | - Claire Chemin-Airiau
- Clinical Research and Innovation Department, Centre Léon Bérard, 69008 Lyon, France
| | - Magali Morelle
- Clinical Research and Innovation Department, Centre Léon Bérard, 69008 Lyon, France
| | - Pierre Meeus
- Surgery Department, Centre Léon Bérard, 69008 Lyon, France (G.V.)
| | - Marie Karanian
- Department of Biopathology, Centre Léon Bérard, 69008 Lyon, France
| | - François Le Loarer
- Anatomo-Pathology Surgery Department, Institut Bergonié, 33076 Bordeaux, France
| | - Gualter Vaz
- Surgery Department, Centre Léon Bérard, 69008 Lyon, France (G.V.)
| | - Jean-Yves Blay
- Department of Medical Oncology, University Claude Bernard Lyon I, 69008 Lyon, France
- Department of Medicine, Léon Bérard Center, Unicancer, 69008 Lyon, France
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4
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Belzarena AC, Binitie O, Letson GD, Joyce DM. Unplanned Sarcoma Excisions: Understanding How They Happen. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202401000-00008. [PMID: 38252542 PMCID: PMC10805420 DOI: 10.5435/jaaosglobal-d-23-00176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/03/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Soft-tissue sarcomas present as a mass with nonspecific symptoms, and unplanned excisions commonly occur. The purpose of this study was to analyze the incidence of unplanned excisions performed by orthopaedic surgeons and to conduct a root cause analysis (RCA) of the steps that led to unplanned excisions in all the cases. METHODS A retrospective case-control study was conducted. Two cohorts were identified, one including patients who underwent an unplanned excision of a soft-tissue sarcoma (n = 107) and a second cohort with patients whose entire care was performed at our sarcoma center (n = 102). A RCA was conducted with the whole sample to identify the preventable causes that led to sarcoma unplanned excisions. RESULTS Orthopedic surgeons were the second group of physicians to perform the most unplanned excisions, only behind general surgeons. Inadequate imaging was encountered in 76.6% of the patients (n = 82, 95% confidence interval, 67.8 to 83.6). Forty-five patients (42.1%) had no imaging studies before the unplanned procedure. In the RCA, the most notable obstacles found were (1) incorrect assumption of a benign diagnosis, (2) failure to obtain the appropriate imaging study, (3) incorrectly reported imaging studies, (4) failure to order a biopsy, and (5) incorrect reporting of the biopsy. CONCLUSIONS Despite educational efforts, unplanned excisions and the devastating consequences that sometimes follow continue to occur. Orthopaedic surgeons persist in playing a role in the unplanned procedure burden.
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Affiliation(s)
- Ana Cecilia Belzarena
- From the Department of Orthopedic Surgery, University of Missouri, Columbia, MO (Dr. Belzarena), and the Sarcoma Department, Moffitt Cancer Center, Tampa, FL (Dr. Binitie, Dr. Letson, and Dr. Joyce)
| | - Odion Binitie
- From the Department of Orthopedic Surgery, University of Missouri, Columbia, MO (Dr. Belzarena), and the Sarcoma Department, Moffitt Cancer Center, Tampa, FL (Dr. Binitie, Dr. Letson, and Dr. Joyce)
| | - George Douglas Letson
- From the Department of Orthopedic Surgery, University of Missouri, Columbia, MO (Dr. Belzarena), and the Sarcoma Department, Moffitt Cancer Center, Tampa, FL (Dr. Binitie, Dr. Letson, and Dr. Joyce)
| | - David Michael Joyce
- From the Department of Orthopedic Surgery, University of Missouri, Columbia, MO (Dr. Belzarena), and the Sarcoma Department, Moffitt Cancer Center, Tampa, FL (Dr. Binitie, Dr. Letson, and Dr. Joyce)
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Lese I, Baesu C, Hoyos IA, Pais MA, Klenke F, Kollar A, Ionescu C, Constantinescu M, Olariu R. Flap Reconstruction Outcome Following Surgical Resection of Soft Tissue and Bone Sarcoma in the Setting of (Neo)adjuvant Therapy: A Sarcoma Center Experience. Cancers (Basel) 2023; 15:cancers15092423. [PMID: 37173890 PMCID: PMC10177579 DOI: 10.3390/cancers15092423] [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: 03/27/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Soft tissue and bone sarcomas are heterogeneous groups of malignant tumors. The shift in their management, with an emphasis on limb salvage, has deemed the involvement of reconstructive surgeons an integral part of their multidisciplinary treatment. We present our experience with free and pedicled flaps in the reconstruction of sarcomas at a tertiary referral university hospital and major sarcoma center. MATERIALS AND METHODS All patients undergoing flap reconstruction after sarcoma resection over a 5-year period have been included in the study. Patient-related data and postoperative complications were collected retrospectively, ensuring a minimum follow-up of 3 years. RESULTS A total of 90 patients underwent treatment with 26 free flaps and 64 pedicled flaps. Postoperative complications occurred in 37.7% of patients, and the flap failure rate was 4.4%. Diabetes, alcohol consumption and male gender were associated with increased early necrosis of the flap. Preoperative chemotherapy significantly increased the occurrence of early infection and late dehiscence, while preoperative radiotherapy was associated with a higher incidence of lymphedema. Intraoperative radiotherapy was associated with late seromas and lymphedema. CONCLUSIONS Reconstructive surgery with either pedicled or free flaps is reliable, but it can be demanding in the setting of sarcoma surgery. A higher complication rate is to be expected with neoadjuvant therapy and with certain comorbidities.
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Affiliation(s)
- Ioana Lese
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
| | - Crinu Baesu
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
| | - Isabel Arenas Hoyos
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
| | - Michael-Alexander Pais
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
| | - Frank Klenke
- Department of Orthopedic Surgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
| | - Attila Kollar
- Department of Medical Oncology, Inselspital, Bern University Hospital, 3012 Bern, Switzerland
| | - Codruta Ionescu
- Department of Radiation Oncology, Inselspital, Bern University Hospital, 3012 Bern, Switzerland
| | - Mihai Constantinescu
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
| | - Radu Olariu
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
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Wang EHM, Araneta KTS, Gaston CLL, Rubio DAT, de Dios AMV, Cañal JPA, Goleta-Dy AN, Alcasabas APA, Odoño EG, Atun JML, Fernando GY, Dimayuga CCD, Quintos AJD. Unplanned Excision of Soft Tissue Sarcomas of the Extremities in a Low-to-Middle-Income Country. Ann Surg Oncol 2023; 30:3681-3689. [PMID: 36800129 PMCID: PMC9936942 DOI: 10.1245/s10434-023-13188-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/14/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Outcomes of unplanned excisions of extremity soft tissue sarcomas (STSE) range from poor to even superior compared with planned excisions in developed countries. However, little is known regarding outcomes in low-to-middle-income countries. This study aimed to determine whether definitively treated STSE patients with a previous unplanned excision have poorer oncologic outcomes compared with those with planned excisions. PATIENTS AND METHODS Using the database of a single sarcoma practice, we reviewed 148 patients with STSE managed with definitive surgery-78 with previous unplanned excisions (UE) and 70 with planned excisions (PE). RESULTS Median follow-up was 4.4 years. UE patients had more surgeries overall and plastic reconstructions (P < 0.001). On multivariate analysis, overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were not worse among UE patients compared with PE patients. Negative predictors for LRFS were high tumor grade (P = 0.031) and an R1 surgical margin (P < 0.001). High grade (P <0.001), local recurrence (P = 0.001), and planned excisions (P = 0.009) predicted poorer DMFS, while age over 65 years (P = 0.011) and distant metastasis predicted poorer OS (P < 0.001). CONCLUSIONS We recommend systematic re-excision for patients with unplanned excisions. Our study shows that STSE patients with UE, when subjected to re-excision with appropriate surgical margins, can achieve oncologic results similar to those for PE patients. However, there is an associated increased number of surgeries and plastic reconstruction for UE patients. This underscores the need, especially in a resource-limited setting, for education and collaborative policies to raise awareness about STSE among patients and physicians.
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Affiliation(s)
- Edward H. M. Wang
- Department of Orthopedics, Section of Tumor Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | | | - Czar Louie L. Gaston
- Department of Orthopedics, Section of Tumor Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Donnel Alexis T. Rubio
- Department of Orthopedics, Section of Tumor Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Ariel M. Vergel de Dios
- Department of Pathology, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Johanna Patricia A. Cañal
- Department of Radiology, Section of Radiation Oncology, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Amy N. Goleta-Dy
- Department of Pediatrics, Section of Hematologic Oncology, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Ana Patricia A. Alcasabas
- Department of Pediatrics, Section of Hematologic Oncology, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Eugene G. Odoño
- Department of Pathology, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Jenny Maureen L. Atun
- Department of Pathology, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Gracieux Y. Fernando
- Department of Internal Medicine, Section of Medical Oncology, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Cesar Cipriano D. Dimayuga
- Department of Orthopedics, Section of Tumor Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Albert Jerome D. Quintos
- Department of Orthopedics, Section of Tumor Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines, Manila, Philippines
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7
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Maes DJ, Alaqeel M, Parry M, Botchu R, Sumathi V, Jeys LM, Stevenson JD. Haemorrhagic soft-tissue sarcoma: Oncological outcomes and prognostic factors for survival. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:345-352. [PMID: 36031468 DOI: 10.1016/j.ejso.2022.08.017] [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: 06/10/2022] [Revised: 08/04/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Haemorrhagic soft-tissue sarcomas (HSTS) are characterised by aggressive local growth and highly metastatic behaviour. We aimed to describe oncological outcomes and prognostic factors. MATERIALS AND METHODS Retrospective review including 64 patients treated with palliation (n = 7), with limb salvage surgery (LSS) (n = 9), with neoadjuvant radiotherapy (RT) + LSS (n = 12), with LSS + adjuvant RT (n = 30) or amputation (n = 6). Kaplan-Meier survival analysis estimated overall survival (OS), metastasis-free survival (MFS) and local recurrence-free survival (LRFS). After uni- and multivariate analysis, prognostic factors affecting OS, MFS and LRFS were identified. RESULTS Median age was 67 years (IQR 23 years) with median follow-up of 11 months (IQR 28 months). All cases were high grade. Eight (13%) had pulmonary metastases at presentation and another 40 (63%) developed metastases after median 9 months (IQR 19 months). Median OS was 12 months (IQR 38 months), and estimated OS after two-years was 15.9% and 52.9% for patients with and without metastatic disease at presentation, respectively. Improved OS was associated with negative resection margins (p = 0.031), RT (p = 0.045), neoadjuvant RT (versus adjuvant RT, p = 0.044) and amputation (versus LSS, p < 0.001). MFS was 35.1% after two-years. LR occurred in 18 of 51 (35.3%) patients with surgically treated localised disease. LRFS was 63.4% after two-years and significantly affected by a negative margin (p = 0.042) and RT (p = 0.001). CONCLUSION Haemorrhagic soft-tissue sarcomas should be excised, either with amputation or LSS with a clear resection margin. If LSS is attempted, neoadjuvant RT reduces the risk of tumour spillage and early LR, enhances the feasibility of achieving clear resection margins, and offers superior overall survival compared to adjuvant RT.
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Affiliation(s)
- Danielle J Maes
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
| | - Motaz Alaqeel
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK; Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Michael Parry
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
| | - Rajesh Botchu
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
| | - Vaiyapuri Sumathi
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
| | - Lee M Jeys
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK; College of Health and Life Sciences, Aston University, Birmingham, B4 7ET, UK.
| | - Jonathan D Stevenson
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK; Aston Medical School, Aston University, Birmingham, B4 7ET, UK.
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8
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Blay JY, Italiano A, Penel N, Le Loarer F, Karanian M, De Pinieux G, Coindre JM, Ducimetiere F, Chemin C, Morelle M, Gouin F, Toulmonde M, Le Cesne A. Impact d’un réseau de centre de référence pour le diagnostic et la prise en charge des patients atteints de sarcomes en France depuis 2010. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2023. [DOI: 10.1016/j.banm.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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9
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Gouin F, Stoeckle E, Honoré C, Ropars M, Jafari M, Mattei JC, Rochwerger A, Carrere S, Waast D, Ferron G, Machiavello JC, Anract P, Marchal F, Sirveaux F, Marco O, Guiramand J, Paquette B, Di Marco A, Causeret S, Guilloit JM, Soibinet P, Tzanis D, Gimbergues P, Fiorenza F, Dujardin F, Le Nail LR, Ruzic JC, Chemin-Airiau C, Morelle M, Meeus P, Karanian M, Le Loarer F, Vaz G, Blay JY. Overall survival in patients with re-excision of positive microscopic margins of limb and trunk wall soft tissue sarcoma operated outside of a reference center: a nationwide cohort analysis. BMC Cancer 2022; 22:1034. [PMID: 36192725 PMCID: PMC9531489 DOI: 10.1186/s12885-022-10121-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 09/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background This French nationwide NETSARC exhaustive prospective cohort aims to explore the impact of systematic re-excision (RE) as adjuvant care on overall survival (OS), local recurrence free survival (LRFS), and local and distant control (RFS) in patients with soft tissue sarcoma (STS) with positive microscopic margins (R1) after initial resection performed outside of a reference center. Methods Eligible patients had experienced STS surgery outside a reference center from 2010 to 2017, and had R1 margins after initial surgery. Characteristics and treatment comparisons used chi-square for categorical variables and Kruskall-Wallis test for continuous data. Survival distributions were compared in patients reexcised (RE) or not (No-RE) using a log-rank test. A Cox proportional hazard model was used for subgroup analysis. Results A total of 1,284 patients had experienced initial STS surgery outside NETSARC with R1 margins, including 1,029 patients with second operation documented. Among the latter, 698 patients experienced re-excision, and 331 were not re-excised. Characteristics were significantly different regarding patient age, tumor site, tumor size, tumor depth, and histotype in the population of patients re-excised (RE) or not (No-RE). The study identified RE as an independent favorable factor for OS (HR 0.36, 95%CI 0.23–0.56, p<0.0001), for LRFS (HR 0.45, 95%CI 0.36–0.56, p<0.0001), and for RFS (HR 0.35, 95%CI 0.26–0.46, p<0.0001). Conclusion This large nationwide series shows that RE improved overall survival in patients with STS of extremities and trunk wall, with prior R1 resection performed outside of a reference center. RE as part of adjuvant care should be systematically considered. Level of evidence II Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-10121-5.
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Affiliation(s)
| | | | - Charles Honoré
- Surgery department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Mickael Ropars
- Orthopedic surgery department, CHU de Rennes, Rennes, France
| | - Mehrdad Jafari
- General and digestive oncologic surgery, Centre Oscar Lambret, Lille, France
| | - Jean Camille Mattei
- Ramsay Santé, Hôpital Privé Clairval, Marseille, France.,Aix Marseille University, Marseille, France.,INSERM, MMG, Marseille, France.,Orthopedic and traumatologic surgery department, Hôpital Nord, Marseille, France.,Hopital de la Conception, APHM, Marseille, France
| | - Alexandre Rochwerger
- INSERM, MMG, Marseille, France.,Hopital de la Conception, APHM, Marseille, France
| | - Sébastien Carrere
- Surgery department, Institut de recherche en cancérologie, Montpellier, France
| | - Denis Waast
- Orthopedic and traumatologic surgery clinic, CHU, Nantes, France
| | | | | | - Philippe Anract
- Orthopedic surgery department, Hôpital Cochin, AP-HP, Paris, France
| | - Frédéric Marchal
- Surgery department, Institut de Cancérologie de Lorraine, Université de Lorraine, CNRS, CRAN, UMR 7039, Vandoeuvre-les-Nancy, France
| | | | - Oren Marco
- Reconstructive et esthetic plastic surgery, Hôpital Saint Louis, Paris, France
| | | | - Brice Paquette
- Department of Digestive Surgery, Jean Minjoz University Hospital, Besançon, France
| | - Antonio Di Marco
- Orthopedic surgery department, CHU de Strasbourg, Strasbourg, France
| | - Sylvain Causeret
- Surgery department, Centre George-François Leclerc, Dijon, France
| | - Jean-Marc Guilloit
- Visceral et digestive surgery department, Centre François Baclesse, Caen, France
| | | | - Dimitri Tzanis
- Surgery department, Institut Curie, PSL university, Paris, France
| | | | - Fabrice Fiorenza
- Orthopedic and traumatology surgery department, CHU Limoges, Limoges, France
| | - Franck Dujardin
- Medical Oncology and Surgical Oncology department, Centre Henri Becquerel, Rouen, France
| | - Louis R Le Nail
- Onco-orthopedic surgery department, Hôpital Trousseau, CHRU de Tours, Tours, France
| | | | | | - Magali Morelle
- Clinical research and innovation department, Centre Léon Bérard, Lyon, France
| | - Pierre Meeus
- Surgery department, Centre Léon Bérard, Lyon, France
| | - Marie Karanian
- Department of Biopathology, Centre Léon Bérard, Lyon, France
| | - François Le Loarer
- Anatomo-pathology surgery department, Institut Bergonié, Bordeaux, France
| | - Gualter Vaz
- Surgery department, Centre Léon Bérard, Lyon, France
| | - Jean-Yves Blay
- Medical oncology Centre Léon Bérard, Lyon, France.,University Claude Bernard Lyon I, Lyon, France.,Headquarters, Unicancer, Paris, France
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10
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Takemori T, Kawamoto T, Hara H, Fukase N, Fujiwara S, Kitayama K, Yahiro S, Miyamoto T, Mifune Y, Hoshino Y, Kakutani K, Matsumoto T, Matsushita T, Niikura T, Kuroda R, Akisue T. Clinical Outcomes and Prognostic Factors in Soft Tissue Sarcoma Patients After Unplanned Excision. Cancer Manag Res 2022; 14:1815-1824. [PMID: 35642242 PMCID: PMC9148585 DOI: 10.2147/cmar.s364912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/09/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Soft tissue sarcomas (STSs) constitute a group of rare, heterogeneous tumors representing approximately 1% of all cancers. Owing to the rarity and pathological diversity of the disease, unplanned excision (UE) has often been performed for STS, resulting in an unfavorable prognosis. This study aimed to clarify clinical outcomes and prognostic factors in STS patients who underwent UE. Patients and Methods In a retrospective review of the medical records of patients with STS who underwent surgery at our institution between 1999 and 2015, patients were enrolled to either a UE group or a planned excision (PE) group. An analysis was then conducted to identify factors associated with prognosis after UE. Results Of 134 patients undergoing surgery for STS, 110 were enrolled to the PE group and 24 to the UE group. The median size of the primary tumor was significantly smaller, and more lesions were located in the superficial layer in the UE group than in the PE group. In addition, plastic reconstruction after additional radical resection was required significantly more often in the UE group than in the PE group. No significant difference in overall survival, local recurrence-free survival, or disease-free survival (DFS) between the UE and PE groups was observed; however, metastasis-free survival was significantly better in the UE group. In the UE group, poorer DFS was associated with older age (≥61 years) and a larger primary tumor (≥2.9 cm). Conclusion A prognosis similar to that in patients undergoing PE could be achieved by appropriate additional surgeries in patients initially undergoing UE. However, UE for STS should be avoided, especially in older patients and those with a larger primary tumor.
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Affiliation(s)
- Toshiyuki Takemori
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Teruya Kawamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Division of Orthopaedic Surgery, Kobe University Hospital International Clinical Cancer Research Center, Kobe, Japan
- Correspondence: Teruya Kawamoto, Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan, Tel +81-783825985, Fax +81-783516944, Email
| | - Hitomi Hara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naomasa Fukase
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shuichi Fujiwara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumichi Kitayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shunsuke Yahiro
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomohiro Miyamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshihiro Akisue
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
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11
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Nakamura T, Kawai A, Asanuma K, Hagi T, Sudo A. Is no additional excision after unplanned excision with positive margins justified in patients with small (≤5 cm) high-grade soft-tissue sarcoma?: Analysis from the Bone and Soft Tissue Tumor registry in Japan. J Orthop Sci 2022; 27:463-467. [PMID: 33549400 DOI: 10.1016/j.jos.2020.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/01/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study aimed to elucidate the clinical outcomes of patients with small (≤5 cm) high-grade soft tissue sarcoma, who underwent unplanned excision with positive surgical margin, using data from the Bone and Soft Tissue Tumor registry in Japan. METHODS We examined 174 patients (101 males and 73 females; mean age, 59 years) with primary non-metastatic soft tissue sarcoma. The tumor size was ≤5 cm, and tumor histological grade was high in all patients. The mean follow-up duration was 50 months. RESULTS Unplanned excision with R1 and R2 margins was reported in 115 (66%) and 59 patients (34%), respectively. After unplanned excision, immediate additional excision was performed in 154 patients, whereas no additional excision was performed in the remaining 20. Of the 154 patients who underwent additional excision, wide surgical margin resection was achieved in 140 patients, while marginal and intralesional resections were achieved in 10 and 3 patients, respectively. Additionally, 93 patients (60%) underwent reconstruction after additional excision. During the last follow-up, 8 patients died of the disease, 22 developed distant metastasis, and 14 reported local recurrence. The 5-year disease-specific survival rate and 5-year metastasis-free survival rate was 93.5% and 85%, respectively. Tumor depth and additional excision after unplanned excision showed statistical significance in the multivariate analysis. The 5-year metastasis-free survival rate was 89.1% in patients with additional excision and 39.2% in those without. Univariate analysis showed an association between additional excision and local control. The 5-year local recurrence-free survival was significantly worse in patients without additional excision after unplanned excision (52.6%) than in those with additional excision (92.8%). CONCLUSION If unplanned excision is performed in patients with small high-grade soft tissue sarcoma, additional excision is recommended for preventing metastasis, along with necessary preparations for reconstruction.
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Affiliation(s)
- Tomoki Nakamura
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-city, Mie, 514-8507, Japan.
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kunihiro Asanuma
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-city, Mie, 514-8507, Japan
| | - Tomohito Hagi
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-city, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-city, Mie, 514-8507, Japan
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12
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Nakamura T, Kawai A, Sudo A. The incidence of unplanned excision in patients with soft tissue sarcoma: Reports from the Bone and Soft Tissue Tumor registry in Japan. J Orthop Sci 2022; 27:468-472. [PMID: 33558102 DOI: 10.1016/j.jos.2020.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Due to their rarity, soft tissue sarcomas (STS)s are often treated surgically as unplanned excisions (UE)s before referral to specialists. The Bone and Soft Tissue Tumor (BSTT) registry is a nationwide, organ-specific cancer registry for bone and soft-tissue tumors in Japan. The aim of this study was to elucidate the incidence and risk factors for UEs using data from the BSTT registry. METHODS Our study comprised 8761 patients with STS including 4826 males and 3935 females, with a mean age of 59 years (range, 0-105 years). Patients were classified into primary STS and UE groups. RESULTS Superficial and deep tumors were found in 2533 and 6120 patients, respectively. The mean STS size was 8.6 cm (range, 0.2-49 cm). We identified 6610 patients with high-grade, and 1758 patients with low-grade STS. Of the total 8761 patients, 7770 patients had primary STSs, whereas 991 patients were referred after undergoing UE. The UE mean incidence rate over 11 years was 11.3%. The UE incidence rates for leiomyosarcoma (LMS) (odds ratio [OR] = 1.75, p < 0.0001), fibrosarcoma (FS) (OR = 2.28, p < 0.0001), and epithelioid sarcoma (OR = 1.82, p = 0.01) were higher than the mean UE incidence rate (11.3%). Of 757 patients who underwent UE, 354 (47%) patients had superficial (≤5 cm) STSs, whereas 156 (20.6%) of patients had deep STSs (>5 cm) (p < 0.0001). Logistic regression analysis revealed that UE was frequently associated with males and small, superficial, and trunk STSs. CONCLUSIONS In the present study, the mean UE incidence rate (11.3%) was significantly different from the individual UE incidence rates of histological diagnoses suggesting that surgeons should consider STS, even with small tumors. Continuous education during training for medical students and surgeons is essential to ensure awareness and correct diagnostic procedures for STS.
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Affiliation(s)
- Tomoki Nakamura
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-city, Mie, 514-8507, Japan.
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, 104-0045, Japan
| | - Akihiro Sudo
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-city, Mie, 514-8507, Japan
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13
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Tirotta F, Sayyed R, Jones RL, Hayes AJ. Risk factors for the development of local recurrence in extremity soft-tissue sarcoma. Expert Rev Anticancer Ther 2021; 22:83-95. [PMID: 34822313 DOI: 10.1080/14737140.2022.2011723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Local recurrence (LR) is one of the main pitfalls in surgery for extremities soft tissue sarcoma (eSTS). Achieving clear histopathological margins is the most important factor to reduce the risk of LR, but the ability to do so depends on not only surgical technique but also the interplay between tumor biology, anatomical location and surgical approach. The balance between postoperative morbidity and oncological benefits in reducing the risk of LR needs to be considered. AREAS COVERED This review will cover which etiological factors for the development of eSTS lead to an increased risk of LR and discuss histological subtypes that have a high risk of LR and which surgical and neoadjuvant therapeutic strategies can minimize the risk of LR. EXPERT OPINION The traditional view that surgical radicality always results in low rates of LR, while marginality alone always leads to high rates of relapse, is outdated. In the modern era of surgical oncology, limb salvage and high-level function after resectional surgery are the key surgical goals. The best results are achieved by combining effective neoadjuvant treatments with planned bespoke oncological operations that consider the biological and anatomical factors of each individual sarcoma.
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Affiliation(s)
- Fabio Tirotta
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Raza Sayyed
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Andrew J Hayes
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
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14
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Nakamura T, Kawai A, Hagi T, Asanuma K, Sudo A. A comparison of clinical outcomes between additional excision after unplanned and planned excisions in patients with soft-tissue sarcoma of the limb : a propensity matching cohort study. Bone Joint J 2021; 103-B:1809-1814. [PMID: 34847719 DOI: 10.1302/0301-620x.103b12.bjj-2021-0037.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIMS Patients with soft-tissue sarcoma (STS) who undergo unplanned excision (UE) are reported to have worse outcomes than those who undergo planned excision (PE). However, others have reported that patients who undergo UE may have similar or improved outcomes. These discrepancies are likely to be due to differences in characteristics between the two groups of patients. The aim of the study is to compare patients who underwent UE and PE using propensity score matching, by analyzing data from the Japanese Bone and Soft Tissue Tumor (BSTT) registry. METHODS Data from 2006 to 2016 was obtained from the BSTT registry. Only patients with STS of the limb were included in the study. Patients with distant metastasis at the initial presentation and patients with dermatofibrosarcoma protuberans and well-differentiated liposarcoma were excluded from the study. RESULTS A total of 4,483 patients with STS of the limb were identified before propensity score matching. There were 355 patients who underwent UE and 4,128 patients who underwent PE. The five-year disease-specific survival (DSS) rate was significantly better in the patients who received additional excision after UE than in those who underwent PE. There was no significant difference in local recurrence-free survival (LRFS) between the two groups. After propensity score matching, a new cohort of 355 patients was created for both PE and UE groups, in which baseline covariates were appropriately balanced. Reconstruction after tumour excision was frequently performed in patients who underwent additional excision after UE. There were no significant differences in DSS and LRFS between the patients who underwent PE and those who had an additional excision after UE. CONCLUSION Using propensity score matching, patients with STS of the limb who underwent additional excision after UE did not experience higher mortality and local failure than those who underwent PE. Reconstruction may be necessary when additional excision is performed. Cite this article: Bone Joint J 2021;103-B(12):1809-1814.
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Affiliation(s)
- Tomoki Nakamura
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine Faculty of Medicine, Tsu, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomohito Hagi
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine Faculty of Medicine, Tsu, Japan
| | - Kunihiro Asanuma
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine Faculty of Medicine, Tsu, Japan
| | - Akihiro Sudo
- Department of Orthopedic Surgery, Mie University Graduate School of Medicine Faculty of Medicine, Tsu, Japan
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Lee Y, Guertin MP, Summers S, Conway SA, Al Maaieh M, Yechieli R, Trent J, Rosenberg AE, Pretell-Mazzini J. Oncological Outcomes in Patients with Appendicular Myxofibrosarcomas: A Retrospective Study. JOURNAL OF ONCOLOGY 2021; 2021:1844816. [PMID: 34876901 PMCID: PMC8645367 DOI: 10.1155/2021/1844816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/28/2021] [Accepted: 11/09/2021] [Indexed: 12/05/2022]
Abstract
BACKGROUND Myxofibrosarcoma (MFS) is notorious for its infiltrative growth pattern, making wide excisions difficult to achieve. Our objective was to assess the impact of surgical margins and other factors that affected rates of local recurrence (LR), distant metastasis (DM), and overall survival (OS) of individuals undergoing resection for MFS. METHODS We retrospectively reviewed the medical records of 209 patients with appendicular soft tissue sarcomas between January 2012 and June 2018. Of these, 29 patients (14%) were diagnosed with myxofibrosarcoma. These patients underwent a total of 33 resections. The pathological analyses were conducted by an experienced musculoskeletal (MSK) pathologist. Demographics data, operative details, adjuvant therapy, and oncological outcomes were assessed. RESULTS Of the 29 patients (33 resections), the overall LR rate was 24% (7/29) and the 2-year LR rate was 17% (5/29). Factors associated with negative oncological outcomes were as follows: tumor size ≤10 cm (2-year local recurrence-free rates (LRFRs), 65%; 95% CI, 44-86%; p=0.02) and positive surgical margins grouped with surgical margins ≤0.1 cm (hazard ratio (HR), 11.74; 95% CI, 1.41-97.74; p=0.02). Chemotherapy and radiotherapy together increased the 2-year LRFR (LRFR, 100%; 95% CI, 100%, p=0.001). Two-year DM and OS rates were 15% and 79%, respectively. Female gender was a predictor of distant metastasis. Local recurrence had a negative impact on overall survival. Intraoperative analysis of resection margin accuracy was 75% (12/16) when non-MSK pathologists were involved but 100% accurate (12/12) when analyzed by an MSK pathologist. CONCLUSION Myxofibrosarcomas showed high LR rates after treatment. Close margins (≤0.1 cm) should be considered as a risk factor for LR, and LR is associated with negative overall survival. Neoadjuvant therapy in terms of combined chemotherapy and radiation therapy associates with decreased LR rates. If intraoperative assessment of margins is to be done, it should be performed by an experienced MSK pathologist.
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Affiliation(s)
- Yonghoon Lee
- Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | | | - Spencer Summers
- Orthopedic Surgery Resident, Department of Orthopedic Surgery, Jackson Memorial Hospital, Miami, FL, USA
| | - Sheila A. Conway
- Musculoskeletal Oncology Division, Department of Orthopedics, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | | | | | - Jonathan Trent
- University of Miami, Jackson Memorial Hospital, Miami, FL, USA
| | - Andrew E. Rosenberg
- Director of Anatomic Pathology, Director of Bone & Soft Tissue Pathology, Department of Pathology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Juan Pretell-Mazzini
- Director of Clinical Research Musculoskeletal Oncology Division, Musculoskeletal Oncology Division, Department of Orthopedics, Miller School of Medicine, University of Miami, Miami, FL, USA
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Fujiwara T, Evans S, Stevenson J, Tsuda Y, Gregory J, Grimer R, Abudu A. Impact of the national sarcoma guidelines on the prevalence and outcome of inadvertent excisions of soft tissue sarcomas: An observational study from a UK tertiary referral centre. Eur J Surg Oncol 2021; 48:533-540. [PMID: 34838395 DOI: 10.1016/j.ejso.2021.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/29/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES This study aims to investigate the impact of the national guideline on the prevalence and outcome in patients with soft-tissue sarcoma (STS) who had undergone inadvertent excisions. METHODS A total of 2336 patients were referred to a tertiary sarcoma centre from six regions (North East, North West, East Midlands, West Midlands, Wales, and South West) in the United Kingdom with a diagnosis of STS between 1996 and 2016, of whom 561 patients (24.0%) had undergone inadvertent excisions. Patients were categorised into two groups of 10-year periods pre and post the National Institute for Health and Clinical Excellence (NICE) guideline implementation in 2006. RESULTS The proportion of inadvertent excisions decreased after the NICE guideline implementation: 27.2% (pre-NICE) versus 19.8% (post-NICE) (p = 0.001). A substantial regional variation (17.4%-34.5%) in the proportion of inadvertent excisions in the pre-NICE era was reduced in the post-NICE era (14.3%-22.4%). The 5-year disease-specific survival was 77.7% (pre-NICE) versus 75.6% (post-NICE) (p = 0.961) and there was a trend toward lower incidence of local recurrence in the post-NICE era; 13.5% (pre-NICE) versus 10.5% (post-NICE) (p = 0.522). Multivariate analyses revealed that residual tumours in re-resection specimens were independently associated with an increased risk of disease-specific mortality (HR, 3.35; p < 0.001) and local recurrence (HR, 1.99; p = 0.017), which was significantly reduced after the NICE guideline implementation (53.2% versus 42.0%; p = 0.022). CONCLUSIONS The NICE guideline implementation reduced the proportion of patients with STS who had undergone inadvertent excisions and residual tumour in re-resection specimens, indicating an improved pre-referral management of STSs.
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Affiliation(s)
- Tomohiro Fujiwara
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK; Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Scott Evans
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan Stevenson
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Yusuke Tsuda
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jonathan Gregory
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Robert Grimer
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Adesegun Abudu
- Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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Wang XW, Sun Q, Xu SB, Xu C, Xia CJ, Zhao QM, Zhang HH, Tan WQ, Zhang L, Yao SD. A 3-DNA methylation signature as a novel prognostic biomarker in patients with sarcoma by bioinformatics analysis. Medicine (Baltimore) 2021; 100:e26040. [PMID: 34011115 PMCID: PMC8137010 DOI: 10.1097/md.0000000000026040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/04/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Tumor-specific DNA methylation can potentially be a useful indicator in cancer diagnostics and monitoring. Sarcomas comprise a heterogeneous group of mesenchymal neoplasms which cause life-threatening tumors occurring throughout the body. Therefore, potential molecular detection and prognostic evaluation is very important for early diagnosis and treatment. METHODS We performed a retrospective study analyzing DNA methylation of 261 patients with sarcoma from The Cancer Genome Atlas (TCGA) database. Cox regression analyses were conducted to identify a signature associated with the overall survival (OS) of patients with sarcoma, which was validated in a validation dataset. RESULTS Three DNA methylation signatures were identified to be significantly associated with OS. Kaplan-Meier analysis showed that the 3-DNA methylation signature could significantly distinguish the high- and low-risk patients in both training (first two-thirds) and validation datasets (remaining one-third). Receiver operating characteristic (ROC) analysis confirmed that the 3-DNA methylation signature exhibited high sensitivity and specificity in predicting OS of patients. Also, the Kaplan-Meier analysis and the area under curve (AUC) values indicated that the 3-DNA methylation signature was independent of clinical characteristics, including age at diagnosis, sex, anatomic location, tumor residual classification, and histological subtypes. CONCLUSIONS The current study showed that the 3-DNA methylation model could efficiently function as a novel and independent prognostic biomarker and therapeutic target for patients with sarcoma.
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Affiliation(s)
| | - Qi Sun
- Department of Orthopedic Surgery, Fuyang Orthopedics and Traumatology Hospital, Zhejiang Chinese Medical University
| | - Shi-Bin Xu
- Department of Orthopedic Surgery, The First People's Hospital of Xiaoshan District
| | - Chao Xu
- Department of Oncology, Zhejiang Cancer Hospital
| | - Chen-Jie Xia
- Department of Orthopedic Surgery, Li Hui-Li Hospital, Ningbo
| | - Qi-Ming Zhao
- Department of Plastic Surgery, Zhejiang Hospital
| | | | - Wei-Qiang Tan
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine
| | - Lei Zhang
- Department of Orthopedic Surgery, Xiaoshan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou
| | - Shu-Dong Yao
- Department of Nephrology, Huzhou Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Huzhou, Zhejiang, China
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Abstract
PURPOSE Intramuscular myxoma (IM) is a rare benign myxoid tumor that may be challenging to differentiate from sarcoma in small amounts of biopsied material. Although IM appears to be well-circumscribed macroscopically, it infiltrates the adjacent edematous muscle microscopically. The recommended treatment is resection, but there is controversy with regard to the appropriate surgical margin. This study aimed to clarify which surgical procedure that should be applied when the preoperative diagnosis is IM and how to manage treatment if the postoperative diagnosis turns out to be a sarcoma. METHODS We retrospectively examined 55 IM patients treated from January 1982 to December 2014. Patient characteristics, tumor location, tumor size, radiograph, preoperative and postoperative pathological reports, surgical techniques, treatment outcome, and complications were reviewed. The patients were followed up on for at least 5 years. All patients were confirmed not to have Mazabraud syndrome. RESULTS In the 55 IM patients examined, the mean patient age was 48 years and most were female. The most common tumor locations were in the muscles of the thighs (47%) and buttocks (20%). The mean tumor diameter was 5 cm. Wide resection and marginal resection were performed in 24 and 31 patients, respectively. The mean follow-up duration was 19 years. No local recurrence, malignant transformation, or complications were observed. CONCLUSIONS Marginal resection is suitable in patients whose preoperative diagnosis is IM, as it is able to prevent local recurrence and allows for the preservation of muscle and muscle fascia. If the postoperative diagnosis turns out to be myxoid sarcoma, minimum surgical contamination makes additional wide resection less invasive.
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Calleja M, Afzaal Q, Saifuddin A. The safety of primary surgical excision of small deep indeterminate musculoskeletal soft tissue masses. Br J Radiol 2021; 94:20200713. [PMID: 33095649 DOI: 10.1259/bjr.20200713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the suitability of primary excision of small indeterminate deep soft tissue masses presenting to a tertiary musculoskeletal oncology service. METHODS AND MATERIALS Review of all patients referred to a specialist musculoskeletal oncology service over a 20-month period with a deep indeterminate soft tissue mass by non-contrast MRI criteria that was recommended for primary surgical excision due to relatively small size (<30 mm). Data collected included age, gender, site and maximal size of the lesion, and final histological diagnosis for excised lesions. RESULTS 85 patients were included, mean lesion size being 12 mm (range 5-29 mm). Primary surgical resection had been undertaken in 69 cases (81.2%) by the conclusion of data collection, 36 males and 33 females with mean age of 45.6 years (range 11-80 years). Of these, 11 cases (15.9%) were non-neoplastic, 53 (76.8%) were benign, 1 (1.4%) was intermediate grade, while 4 (5.8%) were malignant including 3 synovial sarcomas. Two of these were treated with re-excision of the tumour bed showing no residual disease, with no evidence of local recurrence at a mean of 10.7 months post-excision. CONCLUSION Primary surgical excision of small deep soft tissue masses that are indeterminate by non-contrast MRI criteria is considered a safe procedure when undertaken in a specialist musculoskeletal oncology service, with only 4 of 69 cases (5.8%) being malignant. ADVANCES IN KNOWLEDGE Small indeterminate deep soft tissue masses can safely be treated with primary excision in the setting of a specialist musculoskeletal oncology service.
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Affiliation(s)
- Michèle Calleja
- Department of Radiology, Royal National orthopaedic Hospital, Brockley Hill, Stanmore, London, UK
| | - Qasim Afzaal
- Department of Urology, Northampton General Hospital, Cliftonville, Northampton, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National orthopaedic Hospital, Brockley Hill, Stanmore, London, UK
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Collignon C, Brisse HJ, Lemelle L, Cardoen L, Gauthier A, Pierron G, Roussel A, Dumont B, Alimi A, Cordero C, Rouffiange L, Orbach D. [Diagnostic strategy in pediatrics soft tissue sarcomas]. Bull Cancer 2020; 107:963-971. [PMID: 32950242 DOI: 10.1016/j.bulcan.2020.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 06/09/2020] [Accepted: 06/18/2020] [Indexed: 02/08/2023]
Abstract
Soft tissue sarcomas in children are rare tumor, representing around 6 to 7% of children cancer. They spread mostly sporadically (90%) and therefore are rarely associated to an underlying constitutional genetic disease (10%). About half of those sarcomas are rhabdomyosarcomas and the others are a very heterogenous histologic group with various bio-pathologies and prognosis. Clinical presentation is mainly a soft tissue lump often difficult to distinguish from more frequent benign causes (malformative, infectious, benign, or pseudotumor). Inappropriate initial diagnosis work-up has a strong impact on soft tissue sarcomas' prognosis. Adapted complementary investigations (first ultrasound and MRI) are important to compile arguments for a malign origin and to indicate a biopsy. However, predictive value of imaging exams still remains imperfect, and histological analysis by percutaneous image-guided biopsy and sometimes by surgical biopsy is often necessary. Authors realize an update on optimal diagnostic pathway including molecular tests in presence of a soft tissue mass in a child.
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Affiliation(s)
- Charlotte Collignon
- Institut Curie, centre intégré de soins et de recherche en oncologie de l'enfant, adolescent et jeune adulte (SIREDO), 26, rue d'Ulm, 75005 Paris, France.
| | - Hervé J Brisse
- Institut Curie, département d'imagerie, 26, rue d'Ulm, 75005 Paris, France
| | - Lauriane Lemelle
- Institut Curie, centre intégré de soins et de recherche en oncologie de l'enfant, adolescent et jeune adulte (SIREDO), 26, rue d'Ulm, 75005 Paris, France
| | - Liesbeth Cardoen
- Institut Curie, département d'imagerie, 26, rue d'Ulm, 75005 Paris, France
| | - Arnaud Gauthier
- Institut Curie, département de médecine diagnostique et théranaustique, 26, rue d'Ulm, 75005 Paris, France
| | - Gaëlle Pierron
- Institut Curie, unité de génétique somatique, 26, rue d'Ulm, 75005 Paris, France
| | - Aphaia Roussel
- Hôpital Robert-Debré, service d'immuno-hématologie, 48, boulevard Sérurier, 75019 Paris, France
| | - Benoit Dumont
- Institut Curie, centre intégré de soins et de recherche en oncologie de l'enfant, adolescent et jeune adulte (SIREDO), 26, rue d'Ulm, 75005 Paris, France
| | - Aurélia Alimi
- Institut Curie, centre intégré de soins et de recherche en oncologie de l'enfant, adolescent et jeune adulte (SIREDO), 26, rue d'Ulm, 75005 Paris, France
| | - Camille Cordero
- Institut Curie, centre intégré de soins et de recherche en oncologie de l'enfant, adolescent et jeune adulte (SIREDO), 26, rue d'Ulm, 75005 Paris, France
| | - Lucie Rouffiange
- Institut Curie, centre intégré de soins et de recherche en oncologie de l'enfant, adolescent et jeune adulte (SIREDO), 26, rue d'Ulm, 75005 Paris, France
| | - Daniel Orbach
- Institut Curie, centre intégré de soins et de recherche en oncologie de l'enfant, adolescent et jeune adulte (SIREDO), 26, rue d'Ulm, 75005 Paris, France
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Erol B, Baysal Ö. Does Unplanned Soft Tissue Sarcoma Surgery Have a Negative Effect on Prognosis? J INVEST SURG 2020; 35:38-43. [PMID: 32862737 DOI: 10.1080/08941939.2020.1813852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND We aimed to compare the oncological outcomes of patients who underwent re-excision following unplanned surgery and those who underwent planned surgery. METHODS Patients who were referred to our hospital after a mass was inappropriately resected and reported to have a malignant pathology with a positive surgical margin, as well as patients diagnosed with malignant soft tissue tumors, and operated on following a multidisciplinary assessment and staging between 2012 and 2018. All patients were followed up at least 6 months. RESULTS Our study included a total of 125 patients. Forty percent (n = 50) underwent unplanned excision and sixty percent (n = 75) underwent planned excision.There was no statistically significant difference in the survival curves between the two groups (p = 0.248). Tumor size was larger, and the rate of deep-localized tumors was higher in patients undergoing planned surgery than in the unplanned surgery group (p = 0.001). The rate of tumors localized in the upper extremities was significantly higher in the unplanned surgery group than in the planned surgery (p = 0.033). MRI examinations could detect residual tumors with an accuracy of 80%. Age (>48 years), tumor size (>8 cm), tumor grade (grade 3), and distant organ metastasis at follow-up, which were among risk factors found to have a significant effect on mortality. CONCLUSION Patients undergoing re-excision after an inappropriate resection and undergoing planned resection had a similar prognosis. Superficial, upper extremity-localized, and relatively small-size tumors are more prone to inadequate surgical resection. MRI can be used to detect residual tumors at a high rate in patients who have undergone unplanned surgery. Distant organ metastasis is the most important factor affecting survival.
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Affiliation(s)
- Bülent Erol
- Department of Orthopaedic and Traumatology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Özgür Baysal
- Department of Orthopaedic and Traumatology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
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Oncological outcome, functional results and costs after unplanned excision of musculoskeletal soft tissue sarcoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:898-904. [PMID: 32037016 DOI: 10.1016/j.ejso.2020.01.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/05/2020] [Accepted: 01/17/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Treatment of soft tissue sarcomas (STS) should only be initiated once the diagnosis is fully established. Resection of tumors of unknown nature should be avoided. Nevertheless, specialized centers continue to face numbers of unplanned excisions (UPE) in STS. AIM To compare oncologic and functional outcomes, number of surgeries, length of hospital stay and treatment costs of UPE versus planned excision (PE) in STS. METHOD A retrospective single tertiary center study was performed on 201 patients. Survival, local and distant recurrence rates were compared between PE (n = 137) and UPE (n = 64). In a subgroup analysis of 60 patients, functional outcome (MSTS and TESS scores), and socio-economic impact (number of surgeries, length of hospital stay and treatment costs) in "functional planned excision" (fPE) group (n = 30) and "functional unplanned excision" (fUPE) group (n = 29) were compared. RESULTS There was no significant difference in oncological outcome between PE and UPE. In the subgroup analysis, we found a non-significant difference in functional outcome. Patients in the fUPE had significantly more surgeries (3.5 vs. 1.4; p < 0.00001) and costs of their management was 64% higher than fPE (p = 0.048). Hospital stay was longer after fUPE but not statistically significant (18.3 days vs. 11.8 days; p = 0.13). CONCLUSION Even though oncological and functional outcomes are comparable after PE and UPE of STS, the number of surgeries, length of hospital stay and treatment costs were higher in patients with UPE. Our data underscore the importance of specialized STS treatment centers including multidisciplinary management.
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Saifuddin A, Siddiqui S, Pressney I, Khoo M. The incidence and diagnostic relevance of chemical shift artefact in the magnetic resonance imaging characterisation of superficial soft tissue masses. Br J Radiol 2019; 93:20190828. [PMID: 31834812 DOI: 10.1259/bjr.20190828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Chemical shift artefact (CSA) is often encountered during MRI evaluation of superficial soft tissue masses. The study aim was to determine the incidence and diagnostic relevance of CSA in a consecutive series of superficial soft tissue masses referred to a specialist musculoskeletal sarcoma service. METHODS All patients referred over a 6 month period with a non-lipomatous superficial soft tissue mass were prospectively analysed. Patients characteristics (age, gender), lesion features (anatomical location, size, relationship to the skin and deep fascia), presence of CSA and final histopathological diagnosis were collected. The presence of CSA was statistically analysed against these clinical, imaging and histopathological variables. RESULTS 128 patients fulfilled the inclusion criteria [63 males, 65 females; mean age = 50.6 years (7-96 years)]. CSA was present in 50 cases (39.1%) overall, but in 39 (41.5%) of 94 cases with histological diagnosis. There was no statistically significant relationship to any assessed variable apart from relationship to the deep fascia, CSA being more frequent in lesions contacting the fascia compared to lesions contacting both skin and fascia (p-value 0.02). In particular, the presence of CSA did not allow differentiation between non-malignant and malignant lesions. CONCLUSION The presence of CSA is a not infrequent finding in the MRI assessment of superficial soft tissue masses but does not appear to be of any significance in differentiating between non-malignant and malignant lesions. ADVANCES IN KNOWLEDGE CSA is a relatively common finding in association with superficial soft tissue masses, but does not indicate a particular histological diagnosis or help in the differentiation of non-malignant from malignant lesions.
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Affiliation(s)
- Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Shuaib Siddiqui
- Department of Accident & Emergency, East Surrey Hospital, Redhill, UK
| | - Ian Pressney
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Michael Khoo
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
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Tiwari A. Management of bone and soft-tissue sarcomas: From state of practice to state of art. CANCER RESEARCH, STATISTICS, AND TREATMENT 2019. [DOI: 10.4103/crst.crst_107_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Kattepur A, Pareekutty N, Alapatt J, Satheesan B. Unplanned excision in soft-tissue sarcomas – Is it the unkindest cut of all? CANCER RESEARCH, STATISTICS, AND TREATMENT 2019. [DOI: 10.4103/crst.crst_72_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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