Nationwide incidence of sarcomas and connective tissue tumors of intermediate malignancy over four years using an expert pathology review network

Arterial perfusion chemoembolization combined with iodine-125 seeds for stage IIB osteosarcoma: A case report

Osteosarcoma is a highly malignant bone tumor that predominantly affects adolescents. Its aggressive nature, complex treatment options and poor prognosis render it a notable concern in oncology. With advancements in therapy for osteosarcoma, neoadjuvant chemotherapy in conjunction with limb-salvage surgery has emerged as the preferred surgical strategy. However, the physical and emotional trauma associated with surgery, along with the adverse side effects of chemotherapy, can be unacceptable to some patients. In recent years, alternative local treatment modalities such as transarterial chemoembolization (TACE) and iodine-125 seed implantation have garnered considerable attention. These techniques show potential in enhancing local tumor control while minimizing systemic toxicity. TACE involves obstructing the blood supply to the tumor while administering localized chemotherapy, resulting in tumor ischemia and necrosis, which is particularly effective for hypervascular tumors. Meanwhile, iodine-125 seeds act as low-energy radiation sources that can effectively target tumor cells while sparing the surrounding healthy tissue. The present study describes a case of osteosarcoma treated with a combination of TACE and iodine-125 seed implantation. The patient, diagnosed with osteosarcoma of the left knee joint, declined surgical intervention. Consequently, a treatment plan involving TACE paired with iodine-125 seed implantation was established. Post-treatment follow-up demonstrated marked pain relief, improved limb function and a notable reduction in tumor volume with decreased bone destruction visible on imaging. Over a follow-up period of 6 years, there were no signs of disease recurrence or distant metastasis, and no notable chemotherapy-related side effects were reported. The quality of life of the patient was markedly improved. The current case illustrates the antitumor efficacy and reduced toxicity of combining TACE with iodine-125 seed implantation in the management of osteosarcoma.

Preclinical study of microphthalmia-associated transcription factor inhibitor ML329 in gastrointestinal stromal tumor growth

Gastrointestinal stromal tumors (GISTs) comprise about 80% of mesenchymal neoplasms in the gastrointestinal tract. Although imatinib mesylate is the preferred treatment, the development of drug resistance highlights the need for novel therapeutic strategies. Recently, we have identified the microphthalmia-associated transcription factor (MITF) as a critical player in pro-survival signaling and tumor growth. This study investigates the effects of MITF inhibition using ML329, an MITF pathway inhibitor, on GIST cell viability in vitro and in NMRI-nu/nu mouse xenograft models. ML329 suppresses growth in imatinib-sensitive (GIST-T1) and -resistant (GIST 430/654) cell lines, impairs MITF targets such as BCL2 and CDK2, and induces S-G2/M cell-cycle arrest. In vivo, ML329 is well tolerated and significantly reduces tumor growth in established imatinib-sensitive and -resistant GIST models. These findings underscore the importance of MITF in GIST growth and support its inhibition as a promising therapeutic approach.

[Update of the recommendations for the management and treatment of giant cell bone tumors, on behalf of GroupOS]

INTRODUCTION

Giant cell tumours (GCTs) are benign primary bone tumours that frequently present with local recurrence and occasionally malignant transformation to high-grade sarcoma. Surgery is the mainstay of treatment and generally consists of intralesional curettage. Denosumab was approved by the European Medicines Agency (EMA) in 2014 for the treatment of skeletally mature adults and adolescents with unresectable GCTs or where resection is likely to result in severe morbidity.

METHODS

On the basis of national recommendations established in 2016 and a summary of the current state of knowledge, a GroupOS working group was set up to update and develop recommendations on the management and treatment of GCTs in adults, as well as on the place of denosumab.

RESULTS

Seven recommendations are proposed here: (1) diagnostic approach and imaging work-up; (2) principles of treatment for GCTs of the limbs; (3) indications for denosumab in GCTs of the limbs; (4) specific features of GCTs of axial location and multifocal GCTs; (5) therapeutic strategy following progression after treatment with denosumab; (6) progression under treatment with denosumab and suspicion of malignant form of GCT under denosumab; (7) monitoring procedures.

CONCLUSION

There are still unresolved issues, such as the optimal duration of treatment or the precise interval between maintenance doses of denosumab. Rarely, GCTs undergo malignant transformation. No clinical, histological or radiographic criteria can accurately predict subsequent aggressive behaviour.

Solitary fibrous tumors from A to Z: a pictorial review with radiologic-pathologic correlation

Solitary fibrous tumors (SFTs) represent a rare subset of mesenchymal neoplasms, affecting 1-2 per million people, with no gender preference. They demonstrate indolent behavior, frequent asymptomatic presentation, and widespread anatomical involvement. At imaging, SFTs typically appear as well-defined, predominantly hypervascular masses with varying degrees of cystic change and necrosis, though calcification is rare. Avid heterogeneous enhancement is typical following intravenous contrast administration, with multiple blood vessels observed at the periphery. Although findings on CT and MRI alone are generally nonspecific, a frequent feature of SFTs at MRI is the presence of rounded or linear low signal intensity foci on T1- and T2-weighted images, corresponding to the fibrous and collagenous content. Nevertheless, because the imaging features of SFTs overlap with those of many benign and malignant tumors, histologic confirmation is required for the final diagnosis. A comprehensive understanding of SFTs' multifaceted clinical, pathological, and radiological presentations across various organs is crucial for accurate diagnosis and effective management. CRITICAL RELEVANCE STATEMENT: A comprehensive understanding of the classic radiological and pathological features of solitary fibrous tumors across various organs is crucial for accurate diagnosis and effective management. KEY POINTS: Solitary fibrous tumors (SFTs) are rare hypervascular fibrous tumors with indolent behavior. Imaging features of SFTs overlap with many other tumors, necessitating histologic confirmation. Understanding SFTs' radiological presentations is crucial for accurate diagnosis and effective management.

Diagnostic errors in subcutaneous myxofibrosarcoma: a retrospective case series before referral to specialist in bone and soft tissue tumors

BACKGROUND

Malignant subcutaneous soft tissue sarcomas, including myxofibrosarcoma, are often misdiagnosed as benign soft tissue tumors by non-specialists. This study investigated the clinical features of subcutaneous myxofibrosarcoma before referral to our department specializing in bone and soft tissue tumors.

METHODS

A retrospective case series analysis was conducted on 26 patients with subcutaneous myxofibrosarcoma who were referred to our department between 2013 and 2024.

RESULTS

Of the 26 cases of subcutaneous myxofibrosarcoma referred to our department, 15 cases (57.7%) had "diagnostic errors before referral," including seven cases of referral delay of ˃6 months, three cases of tumor puncture performed without suspicion of a tumor, four cases of unplanned biopsy, and seven cases of unplanned excision. The average time from the patient's first visit at a medical institution to the referral to our department was 22.7 ± 40.4 months (median 5.0 months, range 1-148 months). We performed initial wide resection in seven patients, additional wide resection in four patients, wide resection for recurrence in two patients, and amputation in two patients.

CONCLUSIONS

Subcutaneous myxofibrosarcomas are rare; however, physicians who treat subcutaneous tumors need to be knowledgeable about them. This case series suggest that poorly planned biopsies may miss malignant tumors, and that careless puncturing may lead to deep invasion of the tumor. It also suggests that if you suspect a benign tumor, you should follow up with imaging, otherwise there is a possibility that it will lead to a significant delay in diagnosis.

The use of pegylated liposomal doxorubicin in metastatic soft tissue sarcoma

BACKGROUND

Soft tissue sarcoma (STS) is a heterogeneous group of rare malignancies with limited response to conventional chemotherapy. Among these, epithelioid haemangioendothelioma (EHE) and angiosarcoma represent rare vascular sarcomas with distinct clinical behaviours, challenging treatment approaches, and poor prognoses. Doxorubicin remains the standard first-line therapy for metastatic STS, but its use is constrained by dose-dependent cardiotoxicity. Pegylated liposomal doxorubicin (PLD) has been proposed as an alternative.

MATERIAL AND METHOD

This retrospective, registry-based cohort study investigates the efficacy of PLD in patients with locally advanced or metastatic STS treated at Aarhus University Hospital, Denmark, between 2008 and 2023. Patients were identified from a regional database, and progression-free survival (PFS) and overall survival (OS) were analysed.

RESULTS

A total of 38 patients were included, with 6 diagnosed with EHE and 16 with angiosarcoma. Among EHE patients, all had metastatic disease at diagnosis, with a median PFS of 7.8 months and OS of 1.5 years from the start of PLD treatment. Two patients remained progression-free for over 5 years. In angiosarcoma patients, the median PFS was 7.4 months, and the median OS was 2.4 years. Other STS subtype including solitary fibrous tumours (SFT), showed minimal benefit from PLD, with a median PFS of 2.8 months.

INTERPRETATION

Pegylated liposomal doxorubicin demonstrated clinically relevant activity in angiosarcoma and EHE. It may be considered a therapeutic option for patients with these aggressive vascular sarcomas. Further prospective studies are warranted to confirm its efficacy and optimised treatment strategies.

Regorafenib as maintenance therapy after first-line doxorubicin-based chemotherapy in advanced non-adipocytic soft tissue sarcomas patients: a double-blind randomised trial

BACKGROUND

There is no approved maintenance therapy in advanced non-adipocytic soft tissue sarcomas (STS). We explore here the role of regorafenib as a potential maintenance therapy after first-line treatment.

PATIENTS AND METHODS

EREMISS (NCT03793361) was a double-blind, placebo-controlled, comparative, 1 : 1 randomised phase II trial assessing the activity and safety of regorafenib (120 mg/day, 3 weeks on/1 week off) in patients with non-adipocytic STS, who had stable disease or partial response after six cycles of doxorubicin-based chemotherapy as first-line treatment of advanced disease. The primary endpoint was progression-free survival (PFS) according to RECIST 1.1 evaluated by blinded central review. Based on the following assumptions: PFS (placebo) = 4 months, expected PFS (regorafenib) = 7 months, hazard ratio (HR) = 0.57, one-sided α = 0.05 and β = 0.10, 110 events and 126 patients were required. This study was supported by French National Cancer Institute, a patient advocacy group and Bayer HealthCare.

RESULTS

The study population consisted of 126 patients enrolled in 17 centres from May 2019 to November 2022. Female patients accounted for 55% of total enrolment. The median age was 58 years (range 18-85 years). The most common histological subtype was leiomyosarcoma (59%). The primary objective was assessable in 122 patients (109 events). Median PFS by blinded central review was 3.5 (placebo) versus 5.6 months (regorafenib) (HR = 0.53, 95% CI 0.36-0.78; P = 0.001). Median overall survival was 20.5 versus 27.6 months (HR = 0.78, 95% CI 0.50-1.22, P = 0.28). The proportion of patients with grade ≥3 adverse events was 4.8% (placebo) versus 56.3% (regorafenib). The most common grade ≥3 clinical adverse events in the regorafenib arm were asthenia (9%), arterial hypertension (8%), and rash (8%).

CONCLUSION

This trial met its primary objective, regorafenib significantly delayed disease progression after first-line treatment in advanced non-adipocytic STS. This was associated with a non-significant trend of overall survival improvement.

Do unplanned resections in soft tissue sarcomas of the extremities have an adverse impact on the prognosis? Experience of a Latin-American sarcoma reference center

BACKGROUND

Soft tissue sarcomas (STS) are rare, heterogeneous neoplasms often not optimally managed by teams without sarcoma expertise. Between 40 % and 50 % of primary resections for extremity sarcomas occur without prior biopsy, resulting in inadequate excisions, termed "unplanned resections" or "whoops surgery."

OBJECTIVE

To determine the rate of unplanned resections in extremity STS referred to a high-volume sarcoma center and evaluate their impact on oncological outcomes.

METHODS

A retrospective study of 680 extremity STS patients referred between 2005 and 2020. Of these, 239 (35 %) had unplanned resections. We analyzed the impact of unplanned resections on recurrence, disease-free survival (DFS), and overall survival (OS) after re-excision.

RESULTS

Among the 239 patients with unplanned resections, 52 % were male, the median age was 46, and the most common histologies were liposarcoma (24 %) and synovial sarcoma (20 %). The median tumor size was 9 cm. Re-excisions achieved R0 margins of 88.6 %. Recurrence occurred in 26.3 % of cases and progression in 12.9 %, with an overall recurrence or progression rate of 39.2 %. The median DFS was 151 months for R0 resections, compared to 57.1-61.8 months for R1/R2 resections. The median OS was 140 months for R0 resections versus 50.8-52.3 months for R1/R2 resections.

CONCLUSIONS

Unplanned resections by non-specialized surgeons significantly reduce DFS and OS. Nonetheless, re-excision with negative margins (R0) provides oncological outcomes comparable to those reported in planned surgeries, emphasizing the importance of timely referral to specialized sarcoma centers.

Chondrosarcomas: Multidisciplinary review and practical recommendations, on behalf of GroupOs

Chondrosarcomas are rare tumors occurring in middle age and older adults, defined by malignant cartilaginous matrix-producing neoplasms. Chondrosarcomas represent a heterogeneous group of tumors with diverse characteristics, management strategies and prognosis. The aim is to establish recommendations to support optimal practice for the diagnosis and treatment of chondrosarcomas within the framework of an expert group at the request of GroupOs and the French Sarcoma Group. The recommendations were developed by a multidisciplinary working and underwent thorough proofreading. The level of evidence in scientific literature and the grading of recommendations by the French Haute Autorité de santé (HAS) were taken into account. Key recommendations cover: (i) diagnosis, management and follow-up enchondromatosis; (ii) initial assessment, diagnosis and staging of cartilaginous tumor; (iii) management of low-grade, clear cell and high-grade, localized resectable chondrosarcomas; (iv) indications for radiotherapy in chondrosarcomas; (v) management of locally advanced and metastatic disease; (vi) management of mesenchymal chondrosarcomas. Surgical resection at a specialized center remains the mainstay for localized chondrosarcomas management, tailored to grade and anatomical location. Limited evidence supports the use of neoadjuvant or adjuvant treatment in chondrosarcomas, except in mesenchymal chondrosarcomas. For patients with dedifferentiated chondrosarcomas, neo or adjuvant treatment with osteosarcoma-like regimens may be proposed. In cases of recurrence or metastasis, local treatment should be prioritized or participation in clinical trials including new targeted or immune therapies should be considered. This article presents consensus recommandations from adult and pediatric sarcoma experts of various disciplines on the practical management of chondrosarcomas patients.

Clinical course and prognostic factors of patients with dedifferentiated liposarcoma: a retrospective analysis

INTRODUCTION

Dedifferentiated liposarcoma (DDLPS) is a fairly common subtype of soft tissue sarcoma, but relatively little is known about the clinical course and prognostic factors of this mesenchymal malignancy.

METHODS

We performed a retrospective analysis of patients diagnosed with DDLPS at the University Hospital Leuven, Belgium between 1991 and 2022 based on an established clinical database and patient records.

RESULTS

We identified 259 patients with DDLPS, with the retroperitoneum as most common location of the primary tumor (47.5%). 204/259 patients (78.8%) patients had primary surgery. Radiotherapy was administered in the pre- (46/259, 17.8%) or postoperative setting (51/259, 19.7%). At diagnosis 28/259 (10.8%) patients presented with locally inoperable disease and 26/259 (10.0%) with synchronous metastasis. In patients who had primary surgery, local relapses were seen in 114/259 (44.0%) patients and 80/259 (30.9%) patients developed metachronous metastasis. A total of 48/259 (18.5%) patients developed both local relapse and metastasis. Patients with inoperable or metastatic disease were often treated with systemic therapy. The most common first-line systemic therapies were doxorubicin (51/98, 52.0%), doxorubicin combined with ifosfamide (12/98, 12.2%) and different types of experimental treatments (18/98, 18.4%). The median overall survival from first diagnosis of DDLPS to death of all causes was 70.5 months (95% confidence interval [CI] 56.6-98.6) for all patients, 10.9 months (95% CI 3.6-29.2) in patients with inoperable disease, 28.4 months (95% CI 1.3-199.3) for patients with local relapse and only 9.4 months (95% CI 1.2-25.9) for patients with metastatic disease. We identified lower age, primary surgery, absence of synchronous metastasis, absence of local relapse and treatment with experimental therapy as statistically significant favorable prognostic factors.

CONCLUSIONS

DDLPS is a subtype of soft tissue sarcoma with an aggressive clinical course and very poor prognosis, especially in patients with inoperable or metastatic disease. The results with classic chemotherapy are poor, and experimental treatments may be a preferred choice for individual patients. Data from this retrospective series can inform the design of future prospective and ongoing trials in this setting.

Total talectomy and reconstruction using unrestricted 3D printed prosthesis for pediatric talus hemangioendothelioma

Background

Epithelioid hemangioendothelioma (EHE) is an ultra-rare vascular sarcoma with an extremely low incidence and prevalence, particularly in children. We report the case of a 9-year-old girl diagnosed with EHE. There are limited reconstruction methods available following total talus resection for vascular endothelioma of the talus, and the use of a 3D-printed talus prosthesis in pediatric cases has not been previously documented.

Case presentation

A 9-year-old girl presented to our unit with swelling, pain, and limited mobility of the ankle for one month without an obvious cause. X-ray and CT imaging revealed osteolytic lesions in the talus, which was identified as a low-grade malignant tumor that had nearly completely invaded the talus and was surrounded by immature bone. The American Foot and Ankle Surgery Association (AOFAS) score was 75/100. We performed a total resection of the talus followed by unrestricted talus replacement. Three months post-operation, the child was able to walk unaided. Ankle function was assessed at 6 and 13 months post-surgery, with the AOFAS score improving from 75 to 91, indicating that her functional needs for daily life were largely met.

Conclusion

Following complete excision of the lesion, the immature bone surrounding the talus was successfully preserved using an unrestricted 3D-printed prosthesis during ankle reconstruction. Our patient demonstrated satisfactory ankle function during the 6-month follow-up. This method is both safe and stable, yielding promising results, particularly for juvenile patients.

Ovarian Epithelioid Hemangioendothelioma. Case Report

Epithelioid hemangioendothelioma is a rare vascular sarcoma commonly occurring in the liver, soft tissues, and organs of the chest cavity. This study provides a detailed description of the clinical presentation, diagnosis, and treatment of epithelioid hemangioendothelioma of the ovary in a 71-year-old patient. According to the pathohistological examination, a mesenchymal tumor of the ovary with epithelioid cells was diagnosed. The immunohistochemical tests confirmed the diagnosis of epithelioid hemangioendothelioma. This clinical case is of interest for clinical practitioners due to the rare location of the tumor in female reproductive organs, which has not been previously documented in the medical literature.

Diagnostic work-up of an incidental ultra-rare tumour, epithelioid haemangioendothelioma, in a Danish diagnostic centre

In this case report we present a woman in her late 40s with dual clinical presentation. First, the patient presented to general practice with muscular symptoms over months, including pain and a palpable mass in her right leg. Then acute cerebral symptoms appeared that required emergency hospitalisation. MRI scan of the head, chest X-ray, upper-body 18F-FDG-PET/CT and CT scan were indicative of both a benign meningioma and malignant lung metastases. Subsequent diagnostic work-up at our diagnostic centre led to the final diagnosis; epithelioid haemangioendothelioma, with the primary site in the right leg and lung metastases, an ultra-rare type of cancer.

Patient-derived xenograft models of gastrointestinal stromal tumors provide a ready-to-use platform for translational research

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal malignancy of the gastrointestinal tract. Most GISTs harbor mutations in oncogenes, such as KIT, and are treated with tyrosine kinase inhibitors (TKIs), such as imatinib. Most tumors develop secondary mutations, inducing drug resistance against the available TKIs, requiring novel therapies. We established a GIST patient-derived xenograft (PDX) platform of GIST that can be used for preclinical drug testing. Tumor tissue from consenting GIST patients was transplanted subcutaneously to NMRI nu/nu mice. Once tumor growth was observed, the tumor was re-transplanted to a next generation of mice. Tumors were characterized histopathologically and molecularly at every re-transplantation and compared with the original patient tumor. We transplanted 112 tumor samples from 99 GIST patients, resulting in 12 established and well-characterized GIST models with different mutations and TKI sensitivity. Three models harbor secondary KIT mutations. One model is characterized by a primary, imatinib-resistant PDGFRA exon 18 p.D842V mutation. Our established platform of well-characterized GIST PDX models, covering the most relevant driver mutations, serves as an excellent tool for preclinical drug testing and tumor biology studies.

High expression level of ERBB2 and efficacy of trastuzumab deruxtecan in desmoplastic small round cell tumour: a monocentric case series report

BACKGROUND

Desmoplastic small round cell tumours (DSRCTs) represent an ultra-rare subtype of soft tissue sarcoma characterized by a recurrent EWSR1::WT1 oncogenic translocation. Considered as an extremely aggressive cancer, the prognosis remains poor with a median overall survival not exceeding 24-36 months and a 5-year survival <10%.

PATIENTS AND METHODS

We analysed ERBB2/human epidermal growth factor receptor 2 (HER2) expression levels in a series of 13 DSRCT patients, using whole-exome RNA sequencing on formalin-fixed paraffin-embedded samples from a local biopathological database. In addition, a retrospective case series describes the clinical outcome of three successive DSRCT patients treated with trastuzumab deruxtecan (T-DXd).

RESULTS

The gene expression analysis demonstrated a consistent high RNA expression level of ERBB2 in DSRCT, with elevated levels [>5 log2(transcripts per million + 1)] across all samples of the cohort and the expression level was the highest compared with all other sarcoma subtypes. In addition to these results, T-DXd showed a marked activity in all three DSRCT patients who presented with metastatic disease refractory to previous standard chemotherapy. So far, the treatment has been overall well tolerated and is currently pursued in the three patients (duration of response >3 months for all three), which warrants additional investigation.

CONCLUSIONS

This case series presents a major information, suggesting that HER2 is a therapeutic target in DSRCT and T-DXd might represent a novel therapeutic option. Those results require to be rapidly shared with the scientific community and confirmed in a prospective clinical trial in this context of very poor prognosis disease and urgent unmet need.

Challenges in Diagnosing Adolescent Goiter: A Case Report with Brief Literature Insights in Juvenile Desmoid-Type Fibromatosis of the Thyroid Gland

The prevalence of goiter, thyroid nodules, and thyroid cancers in the pediatric population has increased. In some rare cases, local conditions such as juvenile desmoid-type fibromatosis (JDTF) can mimic specific thyroid pathology, complicating the diagnostic process. A 17-year-old obese adolescent girl was admitted to the Endocrinology Department with progressive swelling on the left side of the neck, persisting for approximately one year, recently accompanied by dysphonia and inspiratory dyspnea, and ultimately diagnosed as a unilateral nodular goiter associated with compressive phenomena. Despite her euthyroid status, the thyroid ultrasound identified a suspected, large, non-homogeneous, hypoechogenic nodule with calcifications in the left thyroid lobe (TI-RADS score of 4), confirmed by a cervical-region MRI. The biopsy specimens obtained through fine-needle aspiration were classified as Bethesda III ("atypia of undetermined significance" or "follicular lesion of undetermined significance"). Left thyroid lobe removal was performed by a specialized surgeon in thyroid pathology, with histopathological analysis revealing a diagnosis of JDTF in the thyroid gland. Post-surgery, the patient showed favorable progress without any relapse. Pediatric endocrinologists face challenges in diagnosing and managing thyroid nodules in children due to their higher malignancy potential. Familiarity with similar conditions, such as JDTF, is crucial in accurate diagnosis and appropriate pediatric management.

Low-dose Imatinib Efficacy in a Gastrointestinal Stromal Tumor Patient With KIT Exon 11 W557_K558 Deletion

BACKGROUND/AIM

Gastrointestinal stromal tumors (GISTs) are rare cancers originating from Cajal's stromal cells in the gastrointestinal tract. The most common driver mutation in these cancers is the KIT mutation. This report presents a case of response to low-dose imatinib in a patient with GIST harboring KIT exon 11 W557_K558 deletion.

CASE REPORT

In June 2023, an 82-year-old male developed perineal pain. Computed tomography (CT) imaging revealed a mass measuring >9 cm, extending from the rectum to the prostate. Submucosal tumor biopsy revealed a tumor with CD117-positive and DOG1-positive spindle-shaped cells leading to a diagnosis of GIST. c-Kit gene mutation analysis detected a W557_K558 deletion in exon 11. Treatment with imatinib (400 mg/day) was initiated in late October 2023 to preserve organ function; the dose was reduced to 300 mg/day after 5 days of treatment and further reduced to 200 mg/day after 10 days, with continued treatment at this dose. The CT performed in January, April, and June 2024 showed that the rectal GIST had shrunk. The blood imatinib concentration remained at approximately 650 ng/ml from January to March 2024 and decreased to 391 ng/ml in May 2024.

CONCLUSION

The response rate of GISTs to imatinib is influenced by genetic mutations. GIST with KIT exon 11 W557_K558 deletion is associated with a high risk of recurrence. In vitro data showed that low-dose imatinib was effective in such cases. Low-dose imatinib is a treatment option for patients with GIST harboring KIT exon 11 W557_K558 deletion who are intolerant to high-dose imatinib.

Treatment of tenosynovial giant tumors with colony-stimulating factor 1 receptor kinase inhibitors: When to start? When to stop? When to restart?

Long‐term treatment of nonresectable tenosynovial giant cell tumor with pexidartinib is feasible and provides long‐term control and symptomatic improvement, with acceptable tolerance. Treatment interruption is possible, and one half of patients remain without progression after interruption. Among those who relapse, pexidartinib is again active, although not all patients need to resume treatment.

Epidemiology of Soft Tissue Sarcoma in Iran: Four-Year National Cancer Registry Data Report (2014-2017)

INTRODUCTION

An uncommon and diverse class of cancers originating from mesenchymal tissues is designated as soft tissue sarcoma (STS). To develop effective preventive and treatment strategies for STS, it is essential to gain a deeper understanding of the epidemiological trends associated with the disease. This research will analyze the 4-year age-standardized incidence rate (ASIR) and geographical distribution of STS in Iran in great detail.

METHODS

The study population comprised 4968 cases of STS recorded in the Cancer Registry System between 2014 and 2017. The demographic data examined included gender, place of residence, and year of diagnosis. The age-standardized rate (ASR) of STS incidence was calculated for each location using the World Standard Population. The data were examined using the program ArcMap10.5. The geographic distribution of STS was investigated using the Moran test.

RESULTS

The ASRs for STS in Iran from 2014 to 2017 were recorded as 1.25 (ASR in male: 1.47, ASR in female: 1.06), 1.36 (ASR in male: 1.46, ASR in female: 1.29), 1.37 (ASR in male: 1.52, ASR in female: 1.21), and 1.78 (ASR in male: 1.58, ASR in female: 1.98), respectively. In 2014 and 2015, age-standardized incidence at the national level showed a statistically significant regional dispersion that appeared as a clustering pattern, according to Moran's test. However, in 2016 and 2017, this dispersion failed to become statistically significant. Interestingly, men had a greater rate of STS incidence than females. As age grows, ASIR shows a steadily rising trend. The most important gains are shown in the 55-59 age group, which peaked at 4.535 in 2017, and the 80-84 age group, which peaked at 10.848 in the same year.

CONCLUSION

The incidence of STS in Iran is lower than the global average. The discrepancies in gender disparities, regional distribution, and incidence rates underscore the complexity of STSs. The findings of this study may assist healthcare professionals and policymakers in the development of region-specific plans for the treatment, early detection, and prevention of STSs.

Assessment of Rare Cancers and Sarcoma Policy and Sarcoma Drug Approvals in Latin America: A Report From the LACOG Sarcoma Group

PURPOSE

The availability of drugs and national public policies for patients with rare cancers, including sarcomas, varies in different parts of the world.

METHODS

In this manuscript, we have conducted a comprehensive analysis to evaluate rare cancer policies in Latin American countries' national policy documents. Additionally, we have reviewed the approvals for sarcoma drugs in selected Latin American countries and compared them with US Food and Drug Administration (FDA) and European Medicines Agency (EMA) approvals.

RESULTS

The documents reviewed showed a lack of explicit focus on rare cancers, with no mention in 70% of the countries analyzed. Drug approval data reveal that in the last 15 years, the FDA and EMA have approved 19 and 13 drugs for sarcoma, whereas their Latin American counterparts, namely ANVISA, ANMAT, and COFEPRIS, approved six, eight, and seven drugs, respectively.

CONCLUSION

Our data suggest that improving rare cancer and sarcoma care in Latin America requires enhanced collaboration for better rare cancer policies.

Timeline of surgery in localized angiosarcoma of the breast: Improving outcome following multidisciplinary treatment optimization

INTRODUCTION

Primary (PAS) and radiation-associated angiosarcomas (RAAS) of the breast are rare tumors of vascular origin with poor survival. In this retrospective cohort study, we aimed to assess the impact of multidisciplinary treatment optimization on the prognosis of patients who underwent surgery at a national referral center.

MATERIALS AND METHODS

Cases of operable angiosarcoma of the breast evaluated by a multidisciplinary team including surgeons, medical oncologists and radiation oncologists expert in the field and treated from January 2012 to January 2023 were retrieved from a prospectively maintained database. The outcomes of three treatment groups, defined by the timing of surgery in relation to adjuvant and neoadjuvant therapies, were compared.

RESULTS

Fifty-nine patients with operable angiosarcomas of the breast (49 RAAS and 10 PAS) were retrospectively identified. The five-year overall survival was 85.2 % (95 % CI 73.9-98.2) and event-free survival was significantly better in patients with grade 1 than those with grade 2 or 3 tumors. Patients receiving neoadjuvant chemotherapy had significantly better outcomes than those treated with primary surgery. Pathological complete response was significantly higher in patients receiving neoadjuvant radiotherapy after neoadjuvant chemotherapy, and a trend towards better distant-disease-free survival was found for patients with complete response at time of surgery.

CONCLUSIONS

Optimization of angiosarcoma treatment based on specialized, multidisciplinary assessment regarding the type and timing of surgery and the use of neoadjuvant chemoradiotherapy can improve outcomes. The findings of this study support the use of neoadjuvant chemotherapy as well as adjuvant and neoadjuvant radiotherapy in clinical practice.

A randomized study of 6 versus 3 years of adjuvant imatinib in patients with localized GIST at high risk of relapse

BACKGROUND

The administration of adjuvant imatinib during 3 years is indicated after resection of primary localized GIST at high risk of recurrence, but many patients relapse afterwards.

METHODS

IMADGIST (NCT02260505) was a multicenter, open-label, randomized phase III study evaluating the maintenance of imatinib for 3 more years (6-year arm) compared with interruption (3-year arm) from the day of randomization, conducted in the French Sarcoma Group. The primary endpoint was intent-to-treat disease-free survival. Secondary endpoints included overall survival, time to imatinib resistance, response after imatinib reintroduction at relapse, and safety.

RESULTS

From 24 December 2014 to 4 April 2023, 136 patients aged ≥18 years, Eastern Cooperative Oncology Group performance status ≤2, with a localized gastrointestinal stromal tumor with an R0 or R1 surgery, and a risk of tumor recurrence ≥35% according to National Comprehensive Cancer Network (NCCN) risk classification were randomized in 14 centers. Sixty-five patients were randomized to the 3-year arm versus 71 to the 6-year arm. There were 68 males and females. Primary sites were gastric and small bowel in 60 (44%) and 64 (47%) patients, respectively. Respectively, 52 (38%) and 71 (52%) patients had a risk of relapse of 35%-70% and >70%. With a median follow-up of 55 months (interquartile range 46-59 months) after randomization, disease-free survival was significantly superior in the 6-year arm [hazard ratio: 0.40 (0.20-0.69), P = 0.0008]. Time to imatinib resistance, survival, adverse events, and quality of life were not different in the two arms.

CONCLUSIONS

Three additional years of adjuvant imatinib reduces the risk of relapse in patients who have received 3 years of adjuvant imatinib with an acceptable tolerance.

Solitary Fibrous Tumor of the Larynx: A Case Report and Brief Literature Review

Solitary fibrous tumors (SFTs) are a rare type of soft tissue tumor first identified as arising from pleura and usually arising in the thoracic cavity. The incidence of SFTs arising in the head and neck region is much lower, accounting for about 7% of SFT cases. Involvement of the larynx specifically is exceedingly rare and can have inconspicuous presentations, making them challenging to diagnose. This case report represents a patient with a history of urothelial cancer and obstructive sleep apnea who was ultimately found to have a fibrous tumor of the larynx, which was confirmed by histopathology and immunohistochemistry and treated with transoral microsurgical resection. This case report aims to shed light on an infrequently documented location of a solitary laryngeal fibrous tumor and a unique clinical presentation of this rare pathology and its successful surgical management.

Liposarcoma: A Journey into a Rare Tumor's Epidemiology, Diagnosis, Pathophysiology, and Limitations of Current Therapies

Sarcomas are a heterogeneous group of neoplasms that develop from bone and soft tissue. Approximately 80% of sarcomas affect soft tissue, with liposarcoma being one of the most common types, accounting for approximately 13-20% of all soft-tissue sarcomas. Per the World Health Organization, liposarcoma can be broadly classified into four different subtypes based on histologic examination: well-differentiated liposarcoma (WDLS)/atypical lipomatous tumors (ALT), dedifferentiated liposarcoma (DDLS), myxoid liposarcoma (MLS), and pleomorphic liposarcoma (PLS). WDLS/ALT is the most common liposarcoma subtype, accounting for approximately 31-33% of liposarcomas; DDLS accounts for 20%; MLS accounts for 19%; and PLS, the least common subtype, represents 7-8% of liposarcomas. Sarcoma diagnosis is challenging because of its rarity, intrinsic complexity, and diagnostic technological complexity. Sarcomas are misdiagnosed in approximately 30% of cases, leading to delays in diagnosis and access to appropriate therapy and clinical trials. Furthermore, treatment options are limited for those diagnosed with liposarcoma. This review discusses the epidemiology, pathology, and treatment options currently available for liposarcoma.

Overall survival of patients with KIT-mutant metastatic GIST in the era of multiple kinase inhibitor availability

PURPOSE

The prognosis of patients with metastatic GIST and imatinib-sensitive primary mutations has significantly improved. However, limited data are available to inform patients about outcomes across different lines of treatment. This retrospective analysis aims to evaluate patient outcomes at a large German GIST referral center over the past 15 years.

PATIENTS AND METHODS

Overall survival (OS) and progression-free survival (PFS) were analyzed in patients with metastatic GIST, with diagnosis of metastases between 2008 and 2021, when at least three lines of treatment were available in Germany (n = 174).

RESULTS

The median overall survival far exceeds historical data for patients with primary exon 11 and exon 9 mutations (median OS in palliative treatment with imatinib: 7.1 years; median OS in second-line palliative treatment with sunitinib: 2.9 years; median OS in third-line palliative treatment with regorafenib: 1.9 years). Among those patients who received palliative imatinib treatment, no significant difference in median OS survival was observed between those who had received perioperative imatinib for localized disease and those who did not. Furthermore, the location of metastases significantly impacted survival, whereas the time between the initial diagnosis and the diagnosis of metastases had no significant effect on survival.

CONCLUSION

In conclusion, this study provides a novel, real-world reference for survival outcomes in patients with metastatic GIST.

Connecting the changing trace elements spectrum and survival in sarcoma: a pilot study

OBJECTIVES

While some metals have been reported as carcinogens or potential carcinogens, only few modern-standard datasets including a large number of elements are available. The present analysis established a first trace elements spectrum by relating the concentration of metals and trace elements in the serum of sarcoma patients with survival data.

METHODS

Patients with sarcoma and controls were retrospectively selected from the International Sarcoma Kindred Study database (ISKS). As part of the ISKS study, blood samples were prospectively collected at the Leon Bérard Cancer Center from February 2012 to July 2019. Stable specimens and copper isotopes (65Cu/63Cu) were analyzed using Triple Quadrupole Inductively Coupled Plasma Mass Spectrometer (ICP-MS) and the Multicollector MC-ICP-MS Nu Plasma HR 500. Wilcoxon rank sum test, log-rank test, and multivariate Cox regression models were used for statistics.

RESULTS

In total, 151 patients and 59 healthy controls were included. At the time of blood sample collection, 62% of patients had locally advanced or metastatic disease. Copper (Cu), copper/zinc (Cu/Zn) and potassium/rubidium (K/Rb) ratio were significantly higher in patients compared to controls and were also significantly higher in patients with advanced compared to early-stage sarcoma. Whereas S and Se were significantly correlated in patients, no correlation was observed in controls. Importantly, levels of K, Rb, Se, Fe, P, Si, S, δ65Cu, Cu, S/Se and Cu/Zn ratio were independently associated with overall survival.

CONCLUSIONS

These results depict the metallomic spectrum in sarcoma and highlight substantial variation associated with survival, enhancing our understanding of sarcoma's biology.

True Mitotic Count Prediction in Gastrointestinal Stromal Tumors: Bayesian Network Model and PROMETheus (Preoperative Mitosis Estimator Tool) Application Development

BACKGROUND

Gastrointestinal stromal tumors (GISTs) present a complex clinical landscape, where precise preoperative risk assessment plays a pivotal role in guiding therapeutic decisions. Conventional methods for evaluating mitotic count, such as biopsy-based assessments, encounter challenges stemming from tumor heterogeneity and sampling biases, thereby underscoring the urgent need for innovative approaches to enhance prognostic accuracy.

OBJECTIVE

The primary objective of this study was to develop a robust and reliable computational tool, PROMETheus (Preoperative Mitosis Estimator Tool), aimed at refining patient stratification through the precise estimation of mitotic count in GISTs.

METHODS

Using advanced Bayesian network methodologies, we constructed a directed acyclic graph (DAG) integrating pertinent clinicopathological variables essential for accurate mitotic count prediction on the surgical specimen. Key parameters identified and incorporated into the model encompassed tumor size, location, mitotic count from biopsy specimens, surface area evaluated during biopsy, and tumor response to therapy, when applicable. Rigorous testing procedures, including prior predictive simulations, validation utilizing synthetic data sets were employed. Finally, the model was trained on a comprehensive cohort of real-world GIST cases (n=80), drawn from the repository of the Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, with a total of 160 cases analyzed.

RESULTS

Our computational model exhibited excellent diagnostic performance on synthetic data. Different model architecture were selected based on lower deviance and robust out-of-sample predictive capabilities. Posterior predictive checks (retrodiction) further corroborated the model's accuracy. Subsequently, PROMETheus was developed. This is an intuitive tool that dynamically computes predicted mitotic count and risk assessment on surgical specimens based on tumor-specific attributes, including size, location, surface area, and biopsy-derived mitotic count, using posterior probabilities derived from the model.

CONCLUSIONS

The deployment of PROMETheus represents a potential advancement in preoperative risk stratification for GISTs, offering clinicians a precise and reliable means to anticipate mitotic counts on surgical specimens and a solid base to stratify patients for clinical studies. By facilitating tailored therapeutic strategies, this innovative tool is poised to revolutionize clinical decision-making paradigms, ultimately translating into improved patient outcomes and enhanced prognostic precision in the management of GISTs.

A Single-Arm Phase 2 Trial of Trametinib in Patients with Locally Advanced or Metastatic Epithelioid Hemangioendothelioma

PURPOSE

Epithelioid hemangioendothelioma (EHE) is a rare vascular cancer with pathogenic TAZ-CAMTA1 (calmodulinbinding transcription activator 1) operating as an oncogenic driver through activation of the MAPK pathway. Trametinib is an inhibitor of MEK, a critical kinase in the MAPK pathway. We sought to evaluate the effect of trametinib in patients with EHE.

PATIENTS AND METHODS

A phase 2 trial of trametinib was conducted in patients with locally advanced or metastatic EHE. Eligibility requirements included evidence of tumor progression or presence of EHE-related pain requiring opiates for management before enrollment. The primary endpoint was objective response rate (ORR) as per RECIST1.1 in cases with TAZ- CAMTA1 confirmed by fusion-FISH. Secondary objectives were to estimate ORR for all patients, median progression-free survival (PFS), 2-year overall survival (OS) rate, patient safety, and change in patient-reported global health and pain scores per PROMIS questionnaires.

RESULTS

44 patients enrolled and 42 started trametinib. TAZ- CAMTA1 was detected in 27 tumor samples. TheORRwas 3.7%[95% confidence interval (CI), 0.094-19.0], median PFS was 10.4 months (95%CI, 7.1-NA), and 2-year OS rate was 33.3%(95%CI, 19.1-58.2) in the target population. Median pain intensity and interference scores improved significantly after 4 weeks of trametinib in patients using opiates. Common adverse events related to trametinib were rash, fatigue, nausea/vomiting, diarrhea/constipation, alopecia, and edema; one grade 5 ARDS/pneumonitis was related to trametinib.

CONCLUSIONS

Trametinib was associated with reduction in EHE-related pain and median PFS of more than 6 months, providing palliative benefit in patients with advanced EHE, but the trial did not meet the ORR goal. See related commentary by Van Tine and Haarberg, p. 4552.

The landscape of drug sensitivity and resistance in sarcoma

Sarcomas are rare malignancies with over 100 distinct histological subtypes. Their rarity and heterogeneity pose significant challenges to identifying effective therapies, and approved regimens show varied responses. Novel, personalized approaches to therapy are needed to improve patient outcomes. Patient-derived tumor organoids (PDTOs) model tumor behavior across an array of malignancies. We leverage PDTOs to characterize the landscape of drug resistance and sensitivity in sarcoma, collecting 194 specimens from 126 patients spanning 24 distinct sarcoma subtypes. Our high-throughput organoid screening pipeline tested single agents and combinations, with results available within a week from surgery. Drug sensitivity correlated with clinical features such as tumor subtype, treatment history, and disease trajectory. PDTO screening can facilitate optimal drug selection and mirror patient outcomes in sarcoma. We could identify at least one FDA-approved or NCCN-recommended effective regimen for 59% of the specimens, demonstrating the potential of our pipeline to provide actionable treatment information.

Solitary fibrous tumor of the orbit in a 1-year-old patient: a case report

Solitary fibrous tumors (SFTs) are rare neoplasms of mesenchymal origin. While the mean age of presentation is 58 years old, we report the case of the youngest documented patient with an SFT of the orbit. A 13-month-old child was evaluated for eyelid asymmetry and then referred to the oculoplastic service. On examination, a soft tissue mass of the right inferomedial orbit was observed. MRI demonstrated a well-circumscribed, extraocular lesion in the inferomedial right orbit, potentially fibrous in nature. Excision was performed without complications. Pathologic examination demonstrated fibrous tissue proliferation with a staghorn vascular pattern, as well as benign fibrous cells with tapering nuclei and abundant pericellular reticulin. Immunohistochemistry (IHC) demonstrated that the cells stain diffusely positive for CD34 and vimentin. With the MRI findings, pathology, and IHC, the diagnosis was confirmed to be SFT. SFTs of the orbit, although rare, may occur in the pediatric population.

Immunological Tumor Microenvironment of Solitary Fibrous Tumors-Associating Immune Infiltrate with Variables of Prognostic Significance

BACKGROUND AND OBJECTIVES

Solitary fibrous tumors (SFTs) are morphologically heterogeneous tumors characterized by the NAB2::STAT6 gene fusion. Clinical outcomes may vary widely, and while most cases have favorable outcomes, some can progress to aggressive disease, manifesting as recurrence and metastasis, and ultimately resulting in patient death. Herein, we analyze the immunological tumor microenvironment (ITME) of SFTs, aiming to determine its prognostic value and correlation with established risk stratification systems (RSSs).

METHODS

A retrospective observational multicenter study of 52 fusion-confirmed SFTs with clinical follow-up data. Immunohistochemical analysis including CD163, CD68, CD3, CD8, CD20, PDL-1, PD-1, and LAG1 were evaluated in tissue microarrays, using an analog scale with scores ranging from 0 to 3 (0 = ≤9, 1 = 10-49, 2 = 50-99, and 3 = >100 positive cells per 10 high-power fields). The expression of these markers was correlated with clinical outcomes, morphological characteristics previously evaluated in whole slide tissue sections (hypercellularity/hypocellularity, round-oval or spindle dominant constituent cell (DCC) morphology, and necrosis), Ki67, overall survival, and RSS.

RESULTS

Only one of the fifty-two cases studied showed progression. In the multivariate analysis, neither the presence nor absence of immune cells (B-lymphocytes, T-lymphocytes, and macrophages) showed any association with the assessed RSSs (Demicco, Sugita, G-score, and Huang). Interestingly, the case that showed progression had high immune infiltrate with expression of CD68, CD163, CD8, and CD20 markers (score of 3). Round-oval cell morphology was associated with the presence of higher levels of CD163 macrophages. Lastly, the scant presence of CD20+ lymphocytes correlated with less necrosis, and cases with higher PDL-1 expression correlated with increased Ki67 values. All cases were negative for LAG-1 and PD-1.

CONCLUSIONS

SFT ITME components correlated with independent variables with prognostic significance. Nevertheless, ITME did not correlate with RSS scores.

Cellular origin and clonal evolution of human dedifferentiated liposarcoma

Dedifferentiated liposarcoma (DDLPS) is the most frequent high-grade soft tissue sarcoma subtype. It is characterized by a component of undifferentiated tumor cells coexisting with a component of well-differentiated adipocytic tumor cells. Both dedifferentiated (DD) and well-differentiated (WD) components exhibit MDM2 amplification, however their cellular origin remains elusive. Using single-cell RNA sequencing, DNA sequencing, in situ multiplex immunofluorescence and functional assays in paired WD and DD components from primary DDLPS tumors, we characterize the cellular heterogeneity of DDLPS tumor and micro-environment. We identify a population of tumor adipocyte stem cells (ASC) showing striking similarities with adipocyte stromal progenitors found in white adipose tissue. We show that tumor ASC harbor the ancestral genomic alterations of WD and DD components, suggesting that both derive from these progenitors following clonal evolution. Last, we show that DD tumor cells keep important biological properties of ASC including pluripotency and that their adipogenic properties are inhibited by a TGF-β-high immunosuppressive tumor micro-environment.

Disruptions in antigen processing and presentation machinery on sarcoma

BACKGROUND

The antigen processing machinery (APM) plays a critical role in generating tumor-specific antigens that can be recognized and targeted by the immune system. Proper functioning of APM components is essential for presenting these antigens on the surface of tumor cells, enabling immune detection and destruction. In many cancers, defects in APM can lead to immune evasion, contributing to tumor progression and poor clinical outcomes. However, the status of the APM in sarcomas is not well characterized, limiting the development of effective immunotherapeutic strategies for these patients.

METHODS

We investigated 126 patients with 8 types of bone and soft tissue sarcoma operated between 2001-2021. Tissue microarrays mapped 11 specific areas in each case. The presence/absence of APM protein was determined through immunohistochemistry. Bayesian networks were used.

RESULTS

All investigated sarcomas had some defects in APM. The least damaged component was HLA Class I subunit β2-microglobulin and HLA Class II. The proteasome LMP10 subunit was defective in leiomyosarcoma (LMS), myxoid liposarcoma (MLPS), and dedifferentiated liposarcoma (DDLPS), while MHC I transporting unit TAP2 was altered in undifferentiated pleomorphic sarcoma (UPS), gastrointestinal stromal tumor (GIST), and chordoma (CH). Among different neoplastic areas, high-grade areas showed different patterns of expression compared to high lymphocytic infiltrate areas. Heterogeneity at the patient level was also observed. Loss of any APM component was prognostic of distant metastasis (DM) for LMS and DDLPS and of overall survival (OS) for LMS.

CONCLUSION

Sarcomas exhibit a high degree of defects in APM components, with differences among histotypes and tumoral areas. The most commonly altered APM components were HLA Class I subunit β2-microglobulin, HLA Class I subunit α (HC10), and MHC I transporting unit TAP2. The loss of APM components was prognostic of DM and OS and clinically relevant for LMS and DDLPS. This study explores sarcoma molecular mechanisms, enriching personalized therapeutic approaches.

Discontinuation versus continuation of imatinib in patients with advanced gastrointestinal stromal tumours (BFR14): exploratory long-term follow-up of an open-label, multicentre, randomised, phase 3 trial

BACKGROUND

The long-term impact of tyrosine kinase inhibitor (TKI) discontinuation on resistance and survival in patients with advanced gastrointestinal stromal tumours (GIST) is unclear. We report the exploratory long-term outcomes of patients with advanced GIST stopping imatinib in the BFR14 trial.

METHODS

BFR14, an open-label, randomised, phase 3 trial, was done in 17 comprehensive cancer centres or hospitals across France. Patients with advanced GIST aged 18 years or older with an Eastern Cooperative Oncology Group performance status of 0-3, no previous treatment with imatinib, and no previous malignancy were eligible. Patients were treated with oral imatinib 400 mg daily. Patients with a complete or partial response, or stable disease, according to Response Evaluation Criteria in Solid Tumours (1.0) at 1 year, 3 years, and 5 years from the start of treatment were randomly assigned (1:1) to treatment discontinuation until progression (interruption group) or treatment continuation until progression (continuation group). Randomisation was done centrally with computer-generated permuted blocks of two and six patients stratified by participating centre and presence or absence of residual disease on CT scan. The primary endpoint was progression-free survival. Secondary endpoints included time to imatinib resistance and overall survival. Analyses were conducted on an intention-to-treat basis in all randomly assigned patients who were not lost to follow-up. This trial is registered with ClinicalTrial.gov, NCT00367861.

FINDINGS

Between May 12, 2003, and March 16, 2004, after 1 year of imatinib, 32 patients were randomly assigned to the interruption group and 26 to the continuation group. Between June 13, 2005, and May 30, 2007, after 3 years of imatinib, 25 patients were randomly assigned to the interruption group and 25 to the continuation group. Between Nov 9, 2007, and July 12, 2010, after 5 years of imatinib, 14 patients were randomly assigned to the interruption group and 13 to the continuation group. Median follow-up was 235·2 months (IQR 128·8-236·6) after the 1-year randomisation, 200·9 months (190·2-208·4) after the 3-year randomisation, and 164·5 months (134·4-176·4) after the 5-year randomisation. Median progression-free survival in the interruption group versus the continuation group after 1 year of imatinib was 6·1 months (95% CI 2·5-10·1) versus 27·8 months (19·5-37·9; hazard ratio [HR] 0·36 [95% CI 0·20-0·64], log-rank p=0·0003), after 3 years of imatinib was 7·0 months (3·5-11·7) versus 67·0 months (48·8-85·6; 0·15 [0·07-0·32], log-rank p<0·0001), and after 5 years of imatinib was 12·0 months (9·0-16·6) versus not reached (NR; NR-NR; 0·13 [0·03-0·58], log-rank p=0·0016). The median time to imatinib resistance after 1 year of imatinib was 28·7 months (95% CI 18·1-39·1) versus 90·6 months (25·3-156·1; HR 0·93 [95% CI 0·51-1·71], log-rank p=0·82), after 3 years was 66·2 months (43·0-89·6) versus 127·3 months (15·0-239·7; 0·35 [0·17-0·72, log-rank p=0·0028), and after 5 years was 58·6 months (0·0-167·4) versus NR (NR-NR; 0·24 [0·05-1·12], log-rank p=0·049). Median overall survival after 1 year of imatinib was 56·0 months (95% CI 30·3-82·9) versus 105·0 months (20·6-189·6; HR 0·84 [95% CI 0·46-1·54], log-rank p=0·57), after 3 years was 104·0 months (90·7-118·7) versus 134·0 months (89·7-178·3; 0·40 [0·20-0·82], log-rank p=0·0096), and after 5 years was NR (NR-NR) versus 110·4 months (82·7-154·1; 1·28 [0·41-3·99]; log-rank p=0·67), INTERPRETATION: Imatinib interruption in patients with GIST without progressive disease is not recommended. Imatinib interruption in non-progressing patients with GIST was associated with rapid progression, faster resistance to imatinib, and shorter overall survival in the long-term follow-up when compared with imatinib continuation in patients after 3 years and 5 years of imatinib.

FUNDING

Centre Léon Bérard, INCa, CONTICANET, Ligue Contre le Cancer, and Novartis.

Long term survival in adult osteosarcoma patients treated with a two-drug regimen: Final results of the OSAD93 phase II study of the FSG-GETO

RATIONALE

We report a phase II trial (OSAD93) testing CDDP with ifosfamide (IFO), without doxorubicin in neoadjuvant phase, in adult osteosarcoma with a 25 years follow-up.

PATIENTS AND METHODS

This is a multicentric phase II study of neoadjuvant chemotherapy with IFO and CDDP in localized high-grade osteosarcoma of patients. Patients received 4 pre-operative courses of IFO 9 g/m2 and CDDP 100 mg/m2 on day 4 (SHOC regimen), followed by local treatment. Doxorubicin was added post-operatively (HOCA regimen) in patients with > 10 % residual tumor cells. A Good Histological Response (GHR), ie ≤ 10 % residual tumor cells in > 30 % of patients, was the primary objective. Disease-free survival (DFS), overall survival (OS) and toxicity were secondary objectives.

RESULTS

From Jan 1994 to Jun 1998, 60 patients were included. Median age was 27 (range: 16-63). Primary tumor sites were limbs (76 %), trunk, head or neck (24 %). After neoadjuvant SHOC, grade 3-4 and febrile neutropenia, thrombopenia, and re-hospitalization occurred in 58 %, 17 %, 17 % and 22 % of SHOC courses and in 76 %, 28 %, 47 %, 47 % of HOCA courses, respectively. GHR was obtained in 16/60 (27.5 %) patients. With a median follow-up of 322 months, the DFS and OS were 51.8 % and 64.4 % at 5 years. At 10 years, DFS and OS were 49.9 % and 64.4 %. At 25 years, DFS and OS were 47.8 % and 55.9 %. No long-term cardiac toxicity was observed. Three patients developed a second malignancy (one fatal) after 300 months.

CONCLUSION

Though the primary endpoint of OSAD93 was not met, this pre-operative doxorubicin-free regimen led to excellent long-term survival with limited toxicity in localized osteosarcoma.

Craniofacial primary well-differentiated low-grade central osteosarcoma in a paediatric patient: a case report

Osteosarcoma is a primary malignant tumour that accounts for less than 1% of cancers diagnosed annually in the United States and 3% of all cancers in paediatric patients. Surgical treatment and adjuvant chemotherapy are essential to improve short- and long-term survival. In this report, we present the case of an 11-month-old female patient referred to the first level of care for a suspected tumour in the left orbit, who underwent biopsy and tumour resection surgery by the maxillofacial surgery service and underwent adjuvant chemotherapy in a specialised centre. Timely detection of cancer in the paediatric population, as well as multidisciplinary management and close surveillance, improves the survival and quality of life of patients.

A case of lumbar spinal solitary fibrous tumor or hemangiopericytomas

Background

Solitary fibrous tumors (SFTs) account for 3.7% of all soft-tissue sarcomas, with an annual incidence of 0.35/100,000 individuals. Notably, although 20% involve the central nervous system, only one in 10 occurs in the spine versus the brain.

Case Description

A 46-year-old female presented with 18 months of left lower extremity sciatica. On examination, she had a 60° limitation of straight leg raising but was otherwise neurologically intact. The lumbar magnetic resonance revealed a dumbbell tumor at the L4-L5 level filing the canal, causing cauda equina compression and extending into the left L45 foramen. The patient successfully underwent a L4 left hemi-laminectomy for tumor resection. The postoperative World Health Organization (WHO) histopathology was consistent with a SFT/WHO Grade I hemangiopericytoma (HPC).

Conclusion

A 46-year-old female with a lumbar L4 SFT with the left L45 foraminal extension successfully underwent a left hemilaminectomy for GTR of an SFT/WHO Grade I HPC.

TRAbectedin in adVanced rEtroperitoneal well differentiated/dedifferentiated Liposarcoma and Leiomyosarcoma (TRAVELL): results of a phase II study from the Italian Sarcoma Group

BACKGROUND

This is a multicentre, single-arm, phase II study aimed at further exploring the activity of trabectedin as second-/further-line treatment in retroperitoneal leiomyosarcoma (LMS) and well-differentiated/dedifferentiated liposarcoma (LPS).

MATERIALS AND METHODS

The primary endpoint was the growth modulation index (GMI) defined as the ratio between PFS under trabectedin (PFS) and during previous chemotherapy treatment: time to progression (TTP-1). Secondary endpoints were objective response rate (ORR) and PFS. As per protocol, patients were considered responders if the GMI was >1.33, non-responders if <0.75 and neither if 0.76-1.32.

RESULTS

Overall 91 patients were assessable for the primary endpoint (32 patients with LMS and 59 patients with LPS): the median number of cycles received was 6.0 (Q1-Q3 3.0-12.0), and the main reason for treatment discontinuation was disease progression in 72% of patients. The median PFS was 6.0 months, while the median TTP1 was 7.5 months (8.1 and 6.4 months for LMS and LPS, respectively). Thirty-three patients [52%, 95% confidence interval (CI) 36% to 58%, P = 0.674, odds of response 1.1] had a GMI >1.33 (LMS 46%, 95% CI 26% to 67%, odds of response 0.85; LPS 56%, 95% CI 40% to 72%, odds of response 1.3). Overall, in LPS we observed 15/47 patients with a GMI <0.5 and 15/47 patients with a GMI >2. Among LMS patients, 9/26 had a GMI <0.5 and 10/26 had a GMI >2. Overall, ORR (complete response + partial response) was 16% (24% for LMS and 12% for LPS).

CONCLUSIONS

While the primary endpoint of the study was not met, we noticed a subgroup of patients with a markedly discrepant TTP with trabectedin in comparison to previous therapy (GMI <0.5 or >2, the latter including some patients with a long TTP with trabectedin). A mismatch between PFS and overall survival was observed, possibly due to the natural history of the two different histologies and the availability of further lines in LMS.

Histological diagnostic discrepancy and its clinical impact in bone and soft tissue tumors referred to a sarcoma center

Histological diagnosis of sarcomas (malignant bone and soft tissue tumors) is challenging due to their rarity, morphological diversity, and constantly evolving diagnostic criteria. In this study, we aimed to assess the concordance in histological diagnosis of bone and soft tissue tumors between referring hospitals and a tertiary sarcoma center and analyzed the clinical impact of the diagnostic alteration. We analyzed 628 consecutively accessioned specimens from 624 patients who visited a specialized sarcoma center for treatment. The diagnoses at referring hospitals and those at the sarcoma center were compared and classified into four categories: agreed, disagreed, specified, and de-specified. Of the 628 specimens, the diagnoses agreed in 403 (64.2%) specimens, whereas some changes were made in 225 (35.8%) specimens: disagreed in 153 (24.3%), specified in 52 (8.3%), and de-specified in 20 (3.2%) cases. The benign/intermediate/malignant judgment changed for 92 cases (14.6%). The diagnostic change resulted in patient management modification in 91 cases (14.5%), including surgical and medical treatment changes. The main inferred reason for the diagnostic discrepancies was a different interpretation of morphological findings of the tumor, which accounted for 48.9% of the cases. This was followed by the unavailability of specialized immunohistochemical antibodies and the unavailability of genetic analysis. In summary, our study clarified the actual clinical impact of diagnostic discrepancy in bone and soft tissue tumors. This may underscore the value of pathology consultation, facilitating access to specialized diagnostic tools, and continued education. These measures are expected to improve diagnostic precision and ultimately benefit patients.

The challenge of running trials in advanced angiosarcoma: A systematic review of the literature from EORTC/STBSG to guide the development of angiosarcoma-specific trials

INTRODUCTION

While available systemic treatments have modest long term efficacy in advanced angiosarcoma, immunotherapy represents an interesting new therapeutic opportunity. To establish its benefit, it is required to conduct a clinical trial assessing its efficacy and toxicity compared to standard treatments.

MATERIAL AND METHODS

This is a literature review from PubMed search.

RESULTS

Several systemic treatments (chemotherapy and TKI) are currently used in advanced angiosarcoma with ORR ranging from 12.5 to 68 % and PFS from 2 to 7 months. However, few randomized trials, mainly phase II, has been conducted to compare these treatments. While most centers propose doxorubicin containing regimens or paclitaxel in 1st or 2nd line, a high heterogeneity of regimens administered in this setting is observed even across sarcoma specialized centers with no consensual standard treatment. Encouraging signals of immunotherapy activity have been reported in angiosarcoma from several retrospective and phase II studies assessing anti-PD1 either alone or in combination with anti CTLA4 or TKI. Although cutaneous and head and neck location seems to benefit more from immunotherapy, response may be observed in any angiosarcoma subtype. In sarcoma in general and AS in particular, no biomarker has been clearly established to predict the efficacy of immunotherapy: high tumor mutational burden and presence of tertiary lymphoid structures are under assessment.

DISCUSSION

Even essential, developing a randomized clinical trial in AS struggles with the heterogeneity of the disease, the lack of consensual standard regimen, the uncertainty on optimal immunotherapy administration and the absence of established predictive biomarkers.

CONCLUSION

International collaboration is essential to run randomized trial in advanced AS and asses the efficacy of immune therapy in this rare and heterogeneous disease.

Potentially actionable targets in synovial sarcoma: A tissue microarray study

BACKGROUND

Synovial sarcoma (SynSa) is one of the most common translocation-related soft tissue sarcomas. Patients with metastatic SynSa have limited treatment options and a very poor prognosis. Several novel experimental therapies are currently being explored in clinical trials, including T cell-based therapies targeting cancer testis antigens such as New York esophageal squamous cell carcinoma 1 (NY-ESO-1) or melanoma-associated antigen A4 (MAGE-A4), and degraders targeting bromodomain-containing protein 9 (BRD9). Preclinical studies investigate inhibitors of Yes associated protein 1 (YAP1), transcriptional co-activator with PDZ-binding motif (TAZ) and inhibitors of chemokine receptor 4 (CXCR4).

METHODS

We explored the immunohistochemical expression of these targets using a tissue microarray (TMA) constructed from 91 clinical SynSa samples and correlated these findings with corresponding clinicopathological data.

RESULTS

Expression of MAGE-A4 and NY-ESO-1 was found in 69 % and 56 % of the samples, respectively. NY-ESO-1 was statistically higher expressed in samples from metastatic lesions as compared to samples from primary tumors. Nuclear expression of YAP1 and TAZ was observed in 92 % and 51 % of the samples, respectively. CXCR4 was expressed in the majority of the samples (82 %). BRD9 was highly expressed in all specimens. No prognostic role could be identified for any of the investigated proteins.

CONCLUSION

This study is a comprehensive study providing real-world data on the expression of several actionable proteins in a large proportion of SynSa samples. All evaluated markers were expressed in a clinically meaningful proportion of cases represented in our TMA, supporting the relevance of ongoing preclinical and clinical research with novel agents directed against these targets.

ASPSCR1::TFE3 Drives Alveolar Soft Part Sarcoma by Inducing Targetable Transcriptional Programs

Alveolar soft part sarcoma (ASPS) is a rare mesenchymal malignancy driven by the ASPSCR1::TFE3 fusion. A better understanding of the mechanisms by which this oncogenic transcriptional regulator drives cancer growth is needed to help identify potential therapeutic targets. In this study, we characterized the transcriptional and chromatin landscapes of ASPS tumors and preclinical models, identifying the essential role of ASPSCR1::TFE3 in tumor cell viability by regulating core transcriptional programs involved in cell proliferation, angiogenesis, and mitochondrial biology. ASPSCR1::TFE3 directly interacted with key epigenetic regulators at enhancers and promoters to support ASPS-associated transcription. Among the effector programs driven by ASPSCR1::TFE3, cell proliferation was driven by high levels of cyclin D1 expression. Disruption of cyclin D1/CDK4 signaling led to a loss of ASPS proliferative capacity, and combined inhibition of CDK4/6 and angiogenesis halted tumor growth in xenografts. These results define the ASPS oncogenic program, reveal mechanisms by which ASPSCR1::TFE3 controls tumor biology, and identify a strategy for therapeutically targeting tumor cell-intrinsic vulnerabilities. Significance: The ASPSCR1::TFE3 fusion propels the growth of alveolar soft part sarcoma  by activating transcriptional programs that regulate proliferation, angiogenesis, mitochondrial biogenesis, and differentiation and can be therapeutically targeted to improve treatment.

What is a useful marker for predicting survival in patients with high-grade soft tissue sarcoma who have non-inflammatory conditions?

BACKGROUND

The modified Glasgow prognostic score (mGPS) is a reliable system for identifying patients at high risk of death among patients with soft tissue sarcoma (STS). The scoring systems use a combination of C-reactive protein (CRP) and albumin levels. Although patients with high-grade STS are at risk of metastasis and death, even if their mGPS is 0, the prognostic indicators in these patients are unknown. Therefore, we investigated useful prognostic indicators for survival and the development of metastasis in patients with high-grade STS and an mGPS of 0.

METHODS

One hundred and four patients with CRP and albumin levels of <1.0 mg/dl and >3.5 g/dl, respectively, indicating an mGPS of 0, were included. The mean follow-up period was 79 months.

RESULTS

The 5-year disease-specific survival (DSS) rate was 79.2%. Cox proportional analysis showed that tumor size and absolute neutrophil count (ANC) were prognostic variables in multivariate analyses. Patients with higher ANC (ANC>3370/μl) had a worse DSS than those with lower ANC. The 5-year DSS was 74.7% vs. 91.7%, respectively (p = 0.0207). The 5-year metastasis-free survival was 67.2%. Tumor size and ANC remained significant variables for predicting the development of metastasis in the multivariate analysis. Patients with higher ANC had a worse metastasis-free survival than those with lower ANC. The 5-year metastasis-free survival was 59.5% vs. 87.3%, respectively (p = 0.00269).

CONCLUSIONS

When patients with high-grade STS have an mGPS of 0, the ANC and tumor size should be carefully evaluated. A higher neutrophil count and larger tumor size may increase the risk of metastasis development.

Survival of patients with ruptured gastrointestinal stromal tumour treated with adjuvant imatinib in a randomised trial

BACKGROUND

Patients with ruptured gastrointestinal stromal tumour (GIST) have poor prognosis. Little information is available about how adjuvant imatinib influences survival.

METHODS

We explored recurrence-free survival (RFS) and overall survival (OS) of patients with ruptured GIST who participated in a randomised trial (SSG XVIII/AIO), where 400 patients with high-risk GIST were allocated to adjuvant imatinib for either 1 year or 3 years after surgery. Of the 358 patients with confirmed localised GIST, 73 (20%) had rupture reported. The ruptures were classified retrospectively using the Oslo criteria.

RESULTS

Most ruptures were major, four reported ruptures were reclassified unruptured. The 69 patients with rupture had inferior RFS and OS compared with 289 patients with unruptured GIST (10-year RFS 21% vs. 55%, OS 59% vs. 78%, respectively). Three-year adjuvant imatinib did not significantly improve RFS or OS of the patients with rupture compared with 1-year treatment, but in the largest mutational subset with KIT exon 11 deletion/indel mutation OS was higher in the 3-year group than in the 1-year group (10-year OS 94% vs. 54%).

CONCLUSIONS

About one-fifth of ruptured GISTs treated with adjuvant imatinib did not recur during the first decade of follow-up. Relatively high OS rates were achieved despite rupture.

CLINICAL TRIAL REGISTRATION

NCT00116935.

Neoadjuvant Imatinib in Gastrointestinal Stromal Tumors (GIST): The First Analysis of a Mexican Population

Introduction Gastrointestinal stromal tumors (GISTs) are neoplasms originating from the interstitial cells of Cajal, pacemaker cells responsible for intestinal motility. Patients with locally advanced GISTs and those with borderline resections due to the proximity of vital anatomical structures, which could result in unacceptable post-surgical morbidity, require special therapeutic consideration. Imatinib, a tyrosine kinase inhibitor, has demonstrated significant success in the non-surgical management of metastatic GIST, and its favorable impact on overall survival in the adjuvant setting makes it logical to speculate on the benefit it could provide as a neoadjuvant medication in patients with locally advanced disease. Methods Patients aged 18-90 years with a diagnosis of GIST confirmed by immunohistochemistry (CD117 positivity) who were treated at the Oncology Hospital of Centro Médico Nacional Siglo XXI in Mexico City from January 2012 to December 2016 were included in the study. It is a retrospective study with a duration of four years. Clinical data were collected from the medical records, which included sex, age, tumor location, initial resectability, reason for unresectability, initial tumor size, and mitotic rate. In the case of unresectable disease, patients who were evaluated by medical oncology and who had received treatment with 400 mg of imatinib daily were evaluated. Results A total of 312 patients diagnosed with GIST were analyzed. One hundred thirty-one were men (42%) with a mean age of 57 years, and 181 were women (58%) with a mean age of 59 years. The most frequent anatomical location was the stomach (n=185, 59.2%). At the time of diagnosis, 210 patients (67.3%) presented with resectable disease, while n=102 patients (32.7%) had unresectable disease. A total of 102 patients with unresectable disease received therapy with 400 mg of imatinib per day. Sixteen patients (15.7%) presented a reduction in tumor dimensions and underwent surgery. Conclusion The study highlights the importance of complete surgical resection and the potential benefit of neoadjuvant imatinib therapy in converting unresectable to resectable disease. The results suggest that imatinib can be effective in converting unresectable GISTs to resectable ones, allowing for a complete resection to be performed and obtaining an R0 resection in 93.7% of these cases.

A Prospective Observational Cohort Study for Newly Diagnosed Osteosarcoma Patients in the UK: ICONIC Study Initial Results

There has been little change to the standard treatment for osteosarcoma (OS) over the last 25 years and there is an unmet need to identify new biomarkers and novel therapeutic approaches if outcomes are to improve. Furthermore, there is limited evidence on the impact of OS treatment on patient-reported outcomes (PROs). ICONIC (Improving Outcomes through Collaboration in Osteosarcoma; NCT04132895) is a prospective observational cohort study recruiting newly diagnosed OS patients across the United Kingdom (UK) with matched longitudinal collection of clinical, biological, and PRO data. During Stage 1, which assessed the feasibility of recruitment and data collection, 102 patients were recruited at 22 sites with representation from patient groups frequently excluded in OS studies, including patients over 50 years and those with less common primary sites. The feasibility of collecting clinical and biological samples, in addition to PRO data, has been established and there is ongoing analysis of these data as part of Stage 2. ICONIC will provide a unique, prospective cohort of newly diagnosed OS patients representative of the UK patient population, with fully annotated clinical outcomes linked to molecularly characterised biospecimens, allowing for comprehensive analyses to better understand biology and develop new biomarkers and novel therapeutic approaches.

Resection of pleural solitary fibrous tumors with distinct feeding vessels arising from the descending aorta: a case report

BACKGROUND

Pleural solitary fibrous tumors (pSFTs) are rare mesenchymal pleural tumors with rich vascularity. Surgical resection is the cornerstone of pSFTs treatment, requiring careful preoperative imaging to delineate lesion extent and vascular supply including contrast-enhanced computed tomography and other examinations depending on its size and characteristics.

CASE PRESENTATION

The patient was a 34-year-old female with a mass measuring approximately 67 × 42 × 65 mm in the left posterior mediastinum. Intraoperatively, the mass demonstrated rich vascularity. Two veins originating from the abdominal cavity entered the lower pole, one converged from the superior pole, draining into the brachiocephalic vein. Additionally, two arteries arose directly from the descending aorta, while several veins drained into the intercostal veins. In response to unexpected intraoperative vascular findings, vascular clips and silk threads were used to ligate them. Subsequently, the tumor was successfully dissected, with approximately 600 ml of blood loss recorded during the 4-hour surgery. The patient exhibited a satisfactory postoperative recovery, and follow-up spanning over six months revealed no indications of recurrence or metastasis.

CONCLUSIONS

We firstly present a case of successful resection of a pSFT in a 34-year-old woman with a distinct feeding vessel arising from the descending aorta and describe the related surgical procedures. This case highlights preoperative evaluation of mass vascularity based on contrast-enhanced computed tomography. When blood supply is challenging to clarify, angiography can offer additional details, especially for giant pSFTs. Despite this, thorough intraoperative exploration remains essential to detect unexpected vessels. Appropriate interventions should be customized based on the vascular origins and the surrounding anatomical structures.

Clinicopathological analysis of EWSR1/FUS::NFATC2 rearranged sarcoma in the left forearm: A case report

BACKGROUND

We present a case of an EWSR1/FUS::NFATC2 rearranged sarcoma in the left forearm and analyze its clinicopathological and molecular features.

CASE SUMMARY

The patient is a 23-year-old woman. Microscopically, the tumor cells were medium-sized round cells arranged in small nests. The cytoplasm was clear, nuclei were relatively uniform, chromatin was dense, nucleoli were visible, and mitotic figures were rare. Immunohistochemically, the tumor cells were positive for Vimentin, INI-1, CD99, NKX2.2, CyclinD1, friend leukaemia virus integration 1, and NKX3.1. Next-generation sequencing revealed the presence of the EWSR1-NFATC2 fusion gene. EWSR1/FUS::NFATC2 rearranged sarcomas are rare and can easily be misdiagnosed.

CONCLUSION

Clinical imaging, immunohistochemistry, and molecular pathology should be considered to confirm the diagnosis.

Improving Diagnosis and Care for Patients With Sarcoma: Do Real-World General Practitioners Data and Prospective Data Collections Have a Place Next to Clinical Trials?

There has been growing interest in the use of real-world data (RWD) to address clinically and policy-relevant (research) questions that cannot be answered with data from randomized controlled trials (RCTs) alone. This is, for example, the case in rare malignancies such as sarcomas as limited patient numbers pose challenges in conducting RCTs within feasible timeliness, a manageable number of collaborators, and statistical power. This narrative review explores the potential of RWD to generate real-world evidence (RWE) in sarcoma research, elucidating its application across different phases of the patient journey, from prediagnosis to the follow-up/survivorship phase. For instance, examining electronic health records (EHRs) from general practitioners (GPs) enables the exploration of consultation frequency and presenting symptoms in primary care before a sarcoma diagnosis. In addition, alternative study designs that integrate RWD with well-designed observational RCTs may offer relevant information on the effectiveness of clinical treatments. As, especially in cases of ultrarare sarcomas, it can be an extreme challenge to perform well-powered randomized prospective studies. Therefore, it is crucial to support the adaptation of novel study designs. Regarding the follow-up/survivorship phase, examining EHR from primary and secondary care can provide valuable insights into identifying the short- and long-term effects of treatment over an extended follow-up period. The utilization of RWD also comes with several challenges, including issues related to data quality and privacy, as described in this study. Notwithstanding these challenges, this study underscores the potential of RWD to bridge, at least partially, gaps between evidence and practice and holds promise in contributing to the improvement of sarcoma care.

Demographic and clinical profile of 1106 adult soft tissue sarcoma patients: A single institutional prospective database experience from India

BACKGROUND

Adult soft tissue sarcomas (STS) are rare and diverse. Current management is based on limited literature from the West. Therefore, data from different geographical regions is required, including the low-middle-income countries. This is our experience managing adult sarcomas in the tertiary cancer center of North India.

MATERIALS AND METHODS

This is a retrospective analysis of the structured sarcoma database of patients treated in the surgical oncology department between 1992 and 2020. The descriptive analysis includes demography, site distribution, diagnosis, histopathology variations, prior surgical interventions, and stage.

RESULTS

A total of 1106 soft tissue sarcoma patients were treated in three decades. Age distribution was 13%, 43%, 31%, and 11% in <20, 21-40, and 41-60 and >60 years, respectively. The male-to-female ratio was 1.73. The anatomical distribution was 17%, 42%, 23%, 7%, 7%, and 3% in upper extremity, lower extremity, trunk, retroperitoneum, head and neck, and viscera, respectively. Overall, 49% of patients had undergone prior suboptimal surgeries at community hospitals. Common histology subtypes were synovial sarcoma (18%), undifferentiated pleomorphic sarcoma (UPS) (13%), dermatofibrosarcoma protuberans (12%), and liposarcoma (9%). A pathological discordance of 13% was identified between the initial and the final histologies. Overall, 61% of tumors were high-grade. Memorial Sloan Kettering Stages II and III were present in 33% and 35% of patients, respectively.

CONCLUSIONS

This is one of the largest single institutional experiences of STS from the Asian population. Mostly young adults were affected with male preponderance. The lower extremity and trunk were common subsites. Frequent histologies were synovial sarcoma and UPS. A high rate of suboptimal surgical intervention at the community level and pathological discordance was noted. This study highlights the need to establish prospective structured databases for capturing quality information related to rare malignancies and providing insights for future research.