QUALITY OF LIFE OF PATIENTS WITH SARCOMA AFTER CONSERVATIVE SURGERY OR AMPUTATION OF LIMBS

Quality of Life and Limb Functionality in Adolescents and Young Adults Surviving Bone Tumors in the Lower Extremity in a Developing Country: A Cross-Sectional Study

Introduction Due to higher survival rates among patients with bone tumors, there is a growing interest in determining these individuals' limb functionality and psychosocial prognosis.

Objectives This study aimed to analyze the differences in functionality and quality of life (QoL) related to health in patients diagnosed with a malignant bone tumor during childhood, according to the type of surgery performed.

Materials and Methods A cross-sectional study was performed for patients older than 14 years who treated for osteosarcoma or Ewing's sarcoma of the lower limb by who receiving surgery. To assess lower limb functionality and QoL among patients surviving malignant bone tumors, 19 patients surviving osteosarcoma or Ewing's sarcoma of the lower extremity were studied. An evaluation of functionality and QoL was done using the “Enneking and Medical Outcomes Study Short-Form 36 scales.” We compared the functional results according to the surgical technique used. Categorical variables were compared according to the Mann–Whitney and Kruskal–Wallis tests, with an established 95% level of significance.

Results QoL among patients who had conservative surgery was not significantly better than amputee patients in the physical or mental aspects, nor in any of their components. Limb functionality, according to Enneking's staging, was significantly higher in non-amputee patients (p = 0.035).

Conclusion According to the data analysis done in this study, the QoL was found to be not significantly different, based on the type of surgery performed; however, there were differences in limb functionality.

A Residual Fusion Network for Osteosarcoma MRI Image Segmentation in Developing Countries

Among primary bone cancers, osteosarcoma is the most common, peaking between the ages of a child's rapid bone growth and adolescence. The diagnosis of osteosarcoma requires observing the radiological appearance of the infected bones. A common approach is MRI, but the manual diagnosis of MRI images is prone to observer bias and inaccuracy and is rather time consuming. The MRI images of osteosarcoma contain semantic messages in several different resolutions, which are often ignored by current segmentation techniques, leading to low generalizability and accuracy. In the meantime, the boundaries between osteosarcoma and bones or other tissues are sometimes too ambiguous to separate, making it a challenging job for inexperienced doctors to draw a line between them. In this paper, we propose using a multiscale residual fusion network to handle the MRI images. We placed a novel subnetwork after the encoders to exchange information between the feature maps of different resolutions, to fuse the information they contain. The outputs are then directed to both the decoders and a shape flow block, used for improving the spatial accuracy of the segmentation map. We tested over 80,000 osteosarcoma MRI images from the PET-CT center of a well-known hospital in China. Our approach can significantly improve the effectiveness of the semantic segmentation of osteosarcoma images. Our method has higher F1, DSC, and IOU compared with other models while maintaining the number of parameters and FLOPS.

Combined Preoperative Hypofractionated Radiotherapy With Doxorubicin-Ifosfamide Chemotherapy in Marginally Resectable Soft Tissue Sarcomas: Results of a Phase 2 Clinical Trial

PURPOSE

There is no standard treatment for marginally resectable soft tissue sarcomas (STSs) of the extremities and trunk wall, and current approaches produce unsatisfactory results. We hypothesized that the combination of doxorubicin-ifosfamide (AI) chemotherapy and 5 × 5 Gy hypofractionated radiotherapy can generate a higher ratio of limb-sparing or conservative surgeries with negative microscopic margins (R0) and acceptable treatment toxicity.

METHODS AND MATERIALS

We conducted a single-arm prospective clinical trial. Treatment combined 1 cycle of AI with subsequent 5 × 5 Gy radiotherapy within 1 week, followed by 2 cycles of AI and surgery. The primary endpoint was to assess the number of patients in whom en bloc R0 resection was achieved.

RESULTS

Forty-six patients met the eligibility criteria. Three patients had resectable lung metastases at baseline. Forty-two received the planned protocol treatment. In 2 patients, the treatment was prematurely stopped because of the toxicity of chemotherapy. One patient died of septic shock because of severe bone marrow suppression after the second AI cycle; a second death was not related to treatment for STS. Three patients underwent amputation. In 72% of patients in the intention-to-treat analysis, we achieved en bloc R0 resections. Grade 3+ Common Terminology Criteria for Adverse Events 4.03 chemotherapy toxicity requiring dose reduction or treatment interruption occurred in 15 patients. Wound complications occurred in 18 patients, but they were severe in only 6 patients.

CONCLUSIONS

Preoperative AI combined with 5 × 5 Gy radiotherapy is a promising method for the management of marginally resectable STS. This protocol enables a high ratio of R0 limb-sparing or conservative surgeries. Further evaluation of this strategy is warranted.

Symptoms and their implications on quality of life and psychological distress in sarcoma patients

The aim of this study was to investigate symptoms, their variation over time and their relationship with quality of life (QoL)/psychological distress in sarcoma patients, as few data regarding QoL and psychological distress in this set of patients are currently available. A total of 188 sarcoma patients from an Italian referral center were involved. Symptoms and financial difficulties were evaluated with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire from the first treatment and over the follow-up period, up to 6 years. The authors found that patients with sarcoma experience several symptoms, especially fatigue and pain, which may dramatically worsen QoL and psychological distress. In conclusion, patients with sarcoma often experience fatigue, pain and financial difficulties, which negatively impacts QoL and psychological distress. To ameliorate overall QoL, proper control of symptoms is necessary.

QUALITY OF LIFE IN ADULTS WITH SARCOMAS UNDER CONSERVATIVE SURGERY OR AMPUTATION

OBJECTIVE

To understand the perception of quality of life, functionality, and psychological aspects of adults with lower limb sarcoma who underwent conservative surgery or amputation.

METHODS

Sociodemographic data were collected, and the following questionnaires were used: EORTC QLQ - C30 for quality of life, the Functional Assessment System (MSTS) for functionality and the Beck Depression Inventory (BDI) for depression symptoms.

RESULTS

The sample consisted of 45 young adults with sarcoma, divided into two groups: amputation (29) and conservative surgery (16). Most were male, single and students. Average family income before and after the disease did not differ, but those that were employed had a better perception of general quality of life, as well as those with higher family income after the disease. Regarding the type of surgery, there was a predominance of amputation; osteosarcoma was the most common histological type and the most affected region was the femur. All participants participated in social, cultural, sporting or religious activities. MSTS and Beck scale values did not differ between procedures.

CONCLUSION

Given the scarcity of studies on the subject at the national level, further investigations are suggested to explore aspects related to quality of life for patients with sarcomas. Level of Evidence III, Retrospective comparative study.