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Blay JY, Penel N, Valentin T, Anract P, Duffaud F, Dufresne A, Verret B, Cordoba A, Italiano A, Brahmi M, Henon C, Amouyel T, Ray-Coquard I, Ferron G, Boudou-Rouquette P, Tlemsani C, Salas S, Rochwerger R, Faron M, Bompas E, Ducassou A, Gangloff D, Gouin F, Firmin N, Piperno-Neumann S, Rios M, Ropars M, Kurtz JE, Le Nail LR, Bertucci F, Carrere S, Llacer C, Watson S, Bonvalot S, Leroux A, Perrin C, Gantzer J, Pracht M, Narciso B, Monneur A, Lebbe C, Hervieu A, Saada-Bouzid E, Dubray-Longeras P, Fiorenza F, Chaigneau L, Nevieres ZM, Soibinet P, Bouché O, Guillemet C, Spano JP, Ruzic JC, Isambert N, Vaz G, Meeus P, Karanian M, Ngo C, Coindre JM, De Pinieux G, Le Loarer F, Ducimetiere F, Chemin C, Morelle M, Toulmonde M, Le Cesne A. Improved nationwide survival of sarcoma patients with a network of reference centers. Ann Oncol 2024; 35:351-363. [PMID: 38246351 DOI: 10.1016/j.annonc.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND We investigated the impact of the implementation of a network of reference centers for sarcomas (NETSARC) on the care and survival of sarcoma patients in France since 2010. PATIENTS AND METHODS NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized multidisciplinary tumor boards (MDTBs), funded by the French National Cancer Institute (INCa) since 2010. Its aims are to improve the quality of diagnosis and care of sarcoma patients. Patients' characteristics, treatments, and outcomes are collected in a nationwide database. The objective of this analysis was to compare the survival of patients in three periods: 2010-2012 (non-exhaustive), 2013-2015, and 2016-2020. RESULTS A total of 43 975 patients with sarcomas, gastrointestinal stromal tumors (GISTs), or connective tissue tumors of intermediate malignancy were included in the NETSARC+ database since 2010 (n = 9266 before 2013, n = 12 274 between 2013 and 2015, n = 22 435 in 2016-2020). Median age was 56 years, 50.5% were women, and 13.2% had metastasis at diagnosis. Overall survival was significantly superior in the period 2016-2020 versus 2013-2015 versus 2010-2012 for the entire population, for patients >18 years of age, and for both metastatic and non-metastatic patients in univariate and multivariate analyses (P < 0.0001). Over the three periods, we observed a significantly improved compliance to clinical practice guidelines (CPGs) nationwide: the proportion of patients biopsied before surgery increased from 62.9% to 72.6%; the percentage of patients presented to NETSARC MDTBs before first surgery increased from 31.7% to 44.4% (P < 0.0001). The proportion of patients with R0 resection on first surgery increased (from 36.1% to 46.6%), while R2 resection rate decreased (from 10.9% to 7.9%), with a better compliance and improvement in NETSARC centers. CONCLUSIONS The implementation of the national reference network for sarcoma was associated with an improvement of overall survival and compliance to guidelines nationwide in sarcoma patients. Referral to expert networks for sarcoma patients should be encouraged, though a better compliance to CPGs can still be achieved.
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Affiliation(s)
- J Y Blay
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon.
| | - N Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - T Valentin
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - P Anract
- Department of Orthopedics, Hôpital Cochin Saint Vincent de Paul, Paris
| | - F Duffaud
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - A Dufresne
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - B Verret
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - A Cordoba
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - A Italiano
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - M Brahmi
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Henon
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - T Amouyel
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - I Ray-Coquard
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - G Ferron
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | | | - C Tlemsani
- Department of Orthopedics, Hôpital Cochin Saint Vincent de Paul, Paris
| | - S Salas
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - R Rochwerger
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - M Faron
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - E Bompas
- Department of Medical Oncology, Cochin Hospital, Paris; Department of Medical Oncology, Centre René Gauducheau, Nantes St. Herblain
| | - A Ducassou
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - D Gangloff
- Department of Medical Oncology, Institut Claudius Regaud & IUCT Oncopole Toulouse, Toulouse
| | - F Gouin
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Service Orthopedie, CHU Nantes, Nantes
| | - N Firmin
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - S Piperno-Neumann
- INSERM U1194, IRCM, Univ Montpellier, Montpellier; Department of Medical Oncology, Institut Curie, Paris; Department of Surgical Oncology, Institut Curie, Paris
| | - M Rios
- Department of Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - M Ropars
- Department of Orthopedics, CHU Rennes, Rennes
| | | | | | - F Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille
| | - S Carrere
- Service Orthopedie, CHU Nantes, Nantes
| | - C Llacer
- Service Orthopedie, CHU Nantes, Nantes
| | - S Watson
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - S Bonvalot
- Department of Medical & Surgical & Radiotherapy Oncology ICM, Montpellier
| | - A Leroux
- INSERM U1194, IRCM, Univ Montpellier, Montpellier
| | - C Perrin
- Department of Medical Oncology, Eugene Marquis Comprehensive Cancer Center, Rennes
| | - J Gantzer
- Department of Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - M Pracht
- Department of Medical Oncology, Eugene Marquis Comprehensive Cancer Center, Rennes
| | - B Narciso
- Department of Orthopedic Surgery, Tours
| | - A Monneur
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille
| | - C Lebbe
- Department of Dermatology, INSERM U976 University Paris Diderot Saint Louis Hospital, Paris; Department of CIC, INSERM U976 University Paris Diderot Saint Louis Hospital, Paris
| | - A Hervieu
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon
| | - E Saada-Bouzid
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice
| | - P Dubray-Longeras
- Department of Medical Oncology, Centre Jean Perrin, Clermont-Ferrand
| | - F Fiorenza
- Department of Orthopedic Surgery, CHU Limoges, Limoges
| | - L Chaigneau
- Department of Medicine, CHU Besancon, Besancon
| | | | - P Soibinet
- Department of Medicine, Centre Francois Baclesse, Caen
| | - O Bouché
- Department of Gastroenterology, CHU Reims, Reims
| | - C Guillemet
- Department of Medical Oncology, Centre J Godinot Reims, Reims
| | - J P Spano
- Department of Oncology, Hôpital Pitié-Salpétriere, Paris
| | - J C Ruzic
- Departement d'oncologie, CHU, La Reunion
| | - N Isambert
- Service d'oncologie, CHU Poitiers, Poitiers, France
| | - G Vaz
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - P Meeus
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Karanian
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Ngo
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - J M Coindre
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | | | - F Le Loarer
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - F Ducimetiere
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - C Chemin
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Morelle
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon; Department of Surgical Oncology, Centre Léon Bérard & Université Claude Bernard, Lyon
| | - M Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux; Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - A Le Cesne
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif; Department of Surgery, Gustave Roussy Cancer Campus, Villejuif
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Blay JY, Casali P, Ray-Coquard I, Seckl MJ, Gietema J, de Herder WW, Caplin M, Klümpen HJ, Glehen O, Wyrwicz L, Peeters R, Licitra L, Girard N, Piperno-Neumann S, Kapiteijn E, Idbaih A, Franceschi E, Trama A, Frezza AM, Hohenberger P, Hindi N, Martin-Broto J, Schell J, Rogasik M, Lejeune S, Oliver K, de Lorenzo F, Weinman A. Management of patients with rare adult solid cancers: objectives and evaluation of European reference networks (ERN) EURACAN. THE LANCET REGIONAL HEALTH. EUROPE 2024; 39:100861. [PMID: 38384730 PMCID: PMC10879812 DOI: 10.1016/j.lanepe.2024.100861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/23/2024]
Abstract
About 500,000 patients with rare adult solid cancers (RASC) are diagnosed yearly in Europe. Delays and unequal quality of management impact negatively their survival. Since 2017, European reference networks (ERN) aim to improve the quality of care of patients with rare disease. The steering committee of EURACAN, including physicians, researchers and patients review here the previous actions, present objectives of the ERN EURACAN dedicated to RASC. EURACAN promoted management in reference centres, and equal implementation of excellence and innovation in Europe and developed 22 clinical practice guidelines (CPGs). Additionally, fourteen information brochures translated in 24 EU languages were developed in collaboration with patient advocacy groups (ePAGs) and seventeen training session were organized. Nevertheless, connections to national networks in the 26 participating countries (106 centres), simplification of cross-border healthcare, international multidisciplinary tumour boards, registries and monitoring of the quality of care are still required. In this Health Policy, evaluation criteria of the performances of the network and of health care providers are proposed.
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Affiliation(s)
- Jean-Yves Blay
- Department of Medical Oncology, Centre Leon Berard & Centre de Recherche en Cancérologie de Lyon (CRCL) & Université Claude Bernard Lyon 1, Lyon, France
| | - Paolo Casali
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - Isabelle Ray-Coquard
- Department of Medical Oncology, Centre Leon Berard & Centre de Recherche en Cancérologie de Lyon (CRCL) & Université Claude Bernard Lyon 1, Lyon, France
| | - Michael J. Seckl
- Department of Medical Oncology, Imperial College Hospitals National Health Service (NHS) Trust (ICHNT), London, United Kingdom
| | - Jourik Gietema
- Department of Medical Oncology, University Medical Centre Groningen, Groningen, the Netherlands
- University of Groningen Groningen, the Netherlands
| | - Wouter W. de Herder
- Department of Internal Medicine, Sector of Endocrinology, Erasmus MC and Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Martyn Caplin
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Heinz-Josef Klümpen
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Olivier Glehen
- Department of Surgical Oncology, Centre Hospitalier Lyon Sud, Equipe CICLY & Université Claude Bernard Lyon 1, Lyon, France
| | - Lucjan Wyrwicz
- M Sklodowska Curie Memorial Cancer Centre, Warsaw, Poland
| | - Robin Peeters
- Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Lisa Licitra
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - Nicolas Girard
- Department of Medical Oncology, Institut Curie, Paris, France
| | | | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Ahmed Idbaih
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - Enrico Franceschi
- Azienda USL / IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Annalisa Trama
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - Anna-Maria Frezza
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - Peter Hohenberger
- Div. of Surgical Oncology and Thoracic Surgery, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany
| | - Nadia Hindi
- Fundación Jiménez Díaz University Hospital, Madrid, Spain
- Spanish Group for Research on Sarcoma (GEIS), Spain
| | - Javier Martin-Broto
- Fundación Jiménez Díaz University Hospital, Madrid, Spain
- Spanish Group for Research on Sarcoma (GEIS), Spain
| | | | | | - Stephane Lejeune
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Kathy Oliver
- The International Brain Tumour Alliance (IBTA), Tadworth, United Kingdom
| | | | - Ariane Weinman
- European Patient Organisation for Rare Diseases (EURORDIS-Rare Diseases Europe), Brussels, Belgium
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Napolitano A, Thway K, Huang P, Jones RL. Centralisation of care improves overall survival for sarcoma patients. Ann Oncol 2024; 35:338-339. [PMID: 38342185 DOI: 10.1016/j.annonc.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/13/2024] Open
Affiliation(s)
- A Napolitano
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London
| | - K Thway
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London
| | - P Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London
| | - R L Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London; Division of Clinical Studies, The Institute of Cancer Research, London, UK.
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Brito M, Ramos M, Silva JP, Câmara G, Mayer A, Miranda A, Coelho JLP, Moreira A, Esteves S. Epidemiology, Management, and Survival Outcomes of Germ Cell Cancer in Southern Portugal: A Population-Based Study (2008-2012). Clin Genitourin Cancer 2024; 22:e170-e177.e1. [PMID: 38061978 DOI: 10.1016/j.clgc.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/03/2023] [Accepted: 11/04/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Building on previous suboptimal survival results, we aimed to perform a study of the epidemiological status, management, and outcomes of germ cell tumors (GCT) in the Portuguese population. MATERIALS AND METHODS Retrospective populational study of GCT cases diagnosed between 2008 and 2012 in southern Portugal. Joinpoint regression was used to compute average annual percentage change (AAPC) in incidence rate. ESMO/EAU guidelines served as references to evaluate compliance. Association between compliance with guidelines and hospital GCT case load was performed by generalized estimating equation. Survival was calculated by Kaplan-Meier and prognostic factors by Cox models. RESULTS The study included 401 GCT male cases. The AAPC was 5.4% (IC 95% 3.3-7.4, P < .001) from 1999 (an earlier cohort published) to 2012. The median time to diagnosis was 63 days (Q25 = 33 days; Q75 = 114 days; IQR = 81 days). For stage II/III the median time to start chemotherapy was 34 days (Q25 = 22 days; Q75 = 56 days; IQR = 22 days). In 86% cases there was noncompliance with guidelines for the orchiectomy report, 6% for staging, 38% for tumor markers evaluation, 20% for treatment and 25% for chemotherapy dose intensity. The 5-year overall survival was 93.8% (95% CI, 91.3%-96.4%). Hospitals that managed ≤ 3 GCT cases/ year had higher odds for noncompliance with guidelines of blood markers, treatment and dose intensity. None of GCT healthcare access and management factors studied were associated with prognosis. CONCLUSIONS The burden of GCT is rising in Portugal. Although survival has improved, efforts must be made to nationally enhance training and expertise in GCT and support region adapted models of centralization of care.
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Affiliation(s)
- Margarida Brito
- Medical Oncology Department of Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisbon, Portugal
| | - Marco Ramos
- Medical Oncology Department of Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisbon, Portugal; Epidemiology Department of Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisbon, Portugal
| | - José Pais Silva
- Medical Oncology Department of Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisbon, Portugal
| | - Gabriela Câmara
- Medical Oncology Department of Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisbon, Portugal
| | - Alexandra Mayer
- Epidemiology Department of Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisbon, Portugal
| | - Ana Miranda
- Epidemiology Department of Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisbon, Portugal
| | | | - António Moreira
- Medical Oncology Department of Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisbon, Portugal; Clinical Research Unit of Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisbon, Portugal
| | - Susana Esteves
- Clinical Research Unit of Instituto Português de Oncologia Francisco Gentil de Lisboa, Lisbon, Portugal
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Belzarena AC, Binitie O, Letson GD, Joyce DM. Unplanned Sarcoma Excisions: Understanding How They Happen. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202401000-00008. [PMID: 38252542 PMCID: PMC10805420 DOI: 10.5435/jaaosglobal-d-23-00176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/03/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Soft-tissue sarcomas present as a mass with nonspecific symptoms, and unplanned excisions commonly occur. The purpose of this study was to analyze the incidence of unplanned excisions performed by orthopaedic surgeons and to conduct a root cause analysis (RCA) of the steps that led to unplanned excisions in all the cases. METHODS A retrospective case-control study was conducted. Two cohorts were identified, one including patients who underwent an unplanned excision of a soft-tissue sarcoma (n = 107) and a second cohort with patients whose entire care was performed at our sarcoma center (n = 102). A RCA was conducted with the whole sample to identify the preventable causes that led to sarcoma unplanned excisions. RESULTS Orthopedic surgeons were the second group of physicians to perform the most unplanned excisions, only behind general surgeons. Inadequate imaging was encountered in 76.6% of the patients (n = 82, 95% confidence interval, 67.8 to 83.6). Forty-five patients (42.1%) had no imaging studies before the unplanned procedure. In the RCA, the most notable obstacles found were (1) incorrect assumption of a benign diagnosis, (2) failure to obtain the appropriate imaging study, (3) incorrectly reported imaging studies, (4) failure to order a biopsy, and (5) incorrect reporting of the biopsy. CONCLUSIONS Despite educational efforts, unplanned excisions and the devastating consequences that sometimes follow continue to occur. Orthopaedic surgeons persist in playing a role in the unplanned procedure burden.
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Affiliation(s)
- Ana Cecilia Belzarena
- From the Department of Orthopedic Surgery, University of Missouri, Columbia, MO (Dr. Belzarena), and the Sarcoma Department, Moffitt Cancer Center, Tampa, FL (Dr. Binitie, Dr. Letson, and Dr. Joyce)
| | - Odion Binitie
- From the Department of Orthopedic Surgery, University of Missouri, Columbia, MO (Dr. Belzarena), and the Sarcoma Department, Moffitt Cancer Center, Tampa, FL (Dr. Binitie, Dr. Letson, and Dr. Joyce)
| | - George Douglas Letson
- From the Department of Orthopedic Surgery, University of Missouri, Columbia, MO (Dr. Belzarena), and the Sarcoma Department, Moffitt Cancer Center, Tampa, FL (Dr. Binitie, Dr. Letson, and Dr. Joyce)
| | - David Michael Joyce
- From the Department of Orthopedic Surgery, University of Missouri, Columbia, MO (Dr. Belzarena), and the Sarcoma Department, Moffitt Cancer Center, Tampa, FL (Dr. Binitie, Dr. Letson, and Dr. Joyce)
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Dudzisz-Śledź M, Kondracka M, Rudzińska M, Zając AE, Firlej W, Sulejczak D, Borkowska A, Szostakowski B, Szumera-Ciećkiewicz A, Piątkowski J, Rutkowski P, Czarnecka AM. Mesenchymal Chondrosarcoma from Diagnosis to Clinical Trials. Cancers (Basel) 2023; 15:4581. [PMID: 37760551 PMCID: PMC10527018 DOI: 10.3390/cancers15184581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Mesenchymal chondrosarcoma (MCS) is a rare subtype of chondrosarcoma with a poor prognosis. Although these tumors are sensitive to radiotherapy/chemotherapy, the standard treatment for localized MCS is only surgical resection, and there are no established treatment guidelines for patients with advanced and metastatic MCS. Due to the low incidence of MCS, the pathology of these tumors is still unknown, and other therapeutic options are lacking. Some studies show the potential role of the PDGF/PPI3K/AKT, PKC/RAF/MEK/ERK, and pRB pathways, and BCL2 overexpression in the pathogenesis of MCS. These findings provide an opportunity to use protein kinases and BCL2 inhibitors as potential therapy in MCS. In this review, we summarize the current knowledge about MCS diagnosis and treatment options. We show the immunological and molecular biomarkers used in the diagnosis of MCS. In addition, we discuss the known prognostic and predictive factors in MCS. Finally, we present the novel trends, including targeted therapies and ongoing clinical trials using protein kinase inhibitors and the death receptor 5 (DR5) agonist, which may be the focus of future MCS treatment studies.
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Affiliation(s)
- Monika Dudzisz-Śledź
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.D.-Ś.); (M.K.); (M.R.); (A.E.Z.); (W.F.); (A.B.); (B.S.); (P.R.)
| | - Monika Kondracka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.D.-Ś.); (M.K.); (M.R.); (A.E.Z.); (W.F.); (A.B.); (B.S.); (P.R.)
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Monika Rudzińska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.D.-Ś.); (M.K.); (M.R.); (A.E.Z.); (W.F.); (A.B.); (B.S.); (P.R.)
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Agnieszka E. Zając
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.D.-Ś.); (M.K.); (M.R.); (A.E.Z.); (W.F.); (A.B.); (B.S.); (P.R.)
| | - Wiktoria Firlej
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.D.-Ś.); (M.K.); (M.R.); (A.E.Z.); (W.F.); (A.B.); (B.S.); (P.R.)
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Dorota Sulejczak
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre Polish Academy of Sciences, 02-106 Warsaw, Poland;
| | - Aneta Borkowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.D.-Ś.); (M.K.); (M.R.); (A.E.Z.); (W.F.); (A.B.); (B.S.); (P.R.)
| | - Bartłomiej Szostakowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.D.-Ś.); (M.K.); (M.R.); (A.E.Z.); (W.F.); (A.B.); (B.S.); (P.R.)
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland;
- Department of Diagnostic Hematology, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland
| | - Jakub Piątkowski
- Institute of Genetics and Biotechnology, Faculty of Biology, University of Warsaw, 02-106 Warsaw, Poland;
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.D.-Ś.); (M.K.); (M.R.); (A.E.Z.); (W.F.); (A.B.); (B.S.); (P.R.)
| | - Anna M. Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.D.-Ś.); (M.K.); (M.R.); (A.E.Z.); (W.F.); (A.B.); (B.S.); (P.R.)
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre Polish Academy of Sciences, 02-106 Warsaw, Poland;
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7
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Serrano C, Martín-Broto J, Asencio-Pascual JM, López-Guerrero JA, Rubió-Casadevall J, Bagué S, García-del-Muro X, Fernández-Hernández JÁ, Herrero L, López-Pousa A, Poveda A, Martínez-Marín V. 2023 GEIS Guidelines for gastrointestinal stromal tumors. Ther Adv Med Oncol 2023; 15:17588359231192388. [PMID: 37655207 PMCID: PMC10467260 DOI: 10.1177/17588359231192388] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023] Open
Abstract
Gastrointestinal stromal tumor (GIST) is the most common malignant neoplasm of mesenchymal origin. GIST spans a wide clinical spectrum that ranges from tumors with essentially no metastatic potential to malignant and life-threatening spread diseases. Gain-of-function mutations in KIT or PDGFRA receptor tyrosine kinases are the crucial drivers of most GISTs, responsible for tumor initiation and evolution throughout the entire course of the disease. The introduction of tyrosine kinase inhibitors targeting these receptors has substantially improved the outcomes in this formerly chemoresistant cancer. As of today, five agents hold regulatory approval for the treatment of GIST: imatinib, sunitinib, regorafenib, ripretinib, and avapritinib. This, in turn, represents a success for a rare neoplasm. During the past two decades, GIST has become a paradigmatic model in cancer for multidisciplinary work, given the disease-specific particularities regarding tumor biology and tumor evolution. Herein, we review currently available evidence for the management of GIST. This clinical practice guideline has been developed by a multidisciplinary expert panel (oncologist, pathologist, surgeon, molecular biologist, radiologist, and representative of patients' advocacy groups) from the Spanish Group for Sarcoma Research, and it is conceived to provide, from a critical perspective, the standard approach for diagnosis, treatment, and follow-up.
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Affiliation(s)
- César Serrano
- Sarcoma Translational Research Group, Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Carrer de Natzaret, 115-117, Barcelona 08035, Spain
| | - Javier Martín-Broto
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, Madrid, Spain
- University Hospital General de Villalba, Madrid, Spain Instituto de investigación Sanitaria Fundación Jimenez Diaz (IIS/FJD; UAM), Madrid, Spain
| | - José Manuel Asencio-Pascual
- Department of General Surgery, Gregorio Marañón University Hospital, Madrid, Spain
- Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Jordi Rubió-Casadevall
- Department of Medical Oncology, Catalan Institute of Oncology, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Silvia Bagué
- Department of Pathology, Santa Creu i Sant Pau University Hospital, Barcelona, Spain
| | - Xavier García-del-Muro
- Department of Medical Oncology, Institut Català d’Oncologia, IDIBELL and University of Barcelona, Barcelona, Spain
| | | | - Luís Herrero
- GIST advocacy group – Colectivo GIST, Valladolid, Spain
| | - Antonio López-Pousa
- Department of Pathology, Santa Creu i Sant Pau University Hospital, Barcelona, Spain
| | - Andrés Poveda
- Initia Oncologia, Hospital Quironsalud, Valencia, Spain
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8
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Zagami P, Comandone A, Fiore M, Baldi GG, Grignani G, Vincenzi B, Gronchi A, Antonarelli G, Boglione A, Pennacchioli E, Curigliano G, Conforti F, De Pas TM. The rare entity of gastrointestinal leiomyosarcomas: An Italian multicenter retrospective study in high-volume referral centers. Cancer Med 2023; 12:17047-17055. [PMID: 37455549 PMCID: PMC10501229 DOI: 10.1002/cam4.6340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/28/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND After a huge efficacy of imatinib in treating patients with gastrointestinal stromal tumors (GISTs) was proven, a maximum effort was made to make a differential diagnosis between GISTs and gastrointestinal leiomyosarcomas (GI-LMS), showing the latter to be an extremely rare tumor entity. Limited data on GI-LMS biology, clinical behavior and drug-sensibility are available, and the clinical decision-making in this subgroup of patients is usually challenging. METHODS We conducted a multicenter, retrospective observational study on patients with diagnosed GI-LMS from 2004 to 2020 within six high-volume referral centers in Italy. RESULTS Thirty-three patients had diagnosis of KIT-negative GI-LMS confirmed by sarcoma-expert pathologist. The most common site of origin was the intestine. Twenty-two patients had localized disease and underwent surgery: with a median follow-up of 72 months, median disease-free survival was 42 months. Overall survival (OS)-rate at 5 years was 73% and median OS was 193 months. Five out of 10 patients with local relapse received a salvage surgery, and 2/5 remained with no evidence of disease. Thirteen patients received neoadjuvant (6) or adjuvant (7) chemotherapy, and 2/13 patients remained free from relapse. The median OS for patients with metastatic LMS was 16.4 months. CONCLUSION GI-LMS is very rare and extremely aggressive subgroup of sarcomas with a high tendency to systemic spread. Localized GI-LMS at diagnosis may be cured if treated with adequate surgery with or without (neo) adjuvant chemotherapy, while de-novo metastatic disease appeared to have a poor prognosis. Clinical effort to understand GI-LMS biology and clinical behavior and to develop active treatment strategy, especially for metastatic-disease, is warranted.
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Affiliation(s)
- Paola Zagami
- Department of Oncology and HematologyUniversity of MilanMilanItaly
| | | | - Marco Fiore
- Fondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | | | - Giovanni Grignani
- Medical OncologyCandiolo Cancer Institute‐FPO, IRCCSCandioloItaly
- Department of Oncology AOU Citta della Salute e della Scienza di TorinoTorinoItaly
| | - Bruno Vincenzi
- Department of Medical OncologyUniversità Campus Bio‐Medico di RomaRomeItaly
| | | | | | | | | | - Giuseppe Curigliano
- Department of Oncology and HematologyUniversity of MilanMilanItaly
- Division of New Drugs and Early Drug Development for Innovative TherapiesEuropean Institute of Oncology, IRCCSMilanItaly
| | - Fabio Conforti
- Division of Medical Oncology of MelanomaSarcoma and Rare tumors, European Institute of Oncology, IRCCSMilanItaly
- Oncology DepartmentHumanitas GavazzeniBergamoItaly
| | - Tommaso Martino De Pas
- Division of Medical Oncology of MelanomaSarcoma and Rare tumors, European Institute of Oncology, IRCCSMilanItaly
- Oncology DepartmentHumanitas GavazzeniBergamoItaly
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9
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Yeo S, Lee U, Xu YH, Simmons C, Smrke A, Wang Y. Survival Outcomes of Ewing Sarcoma and Rhabdomyosarcoma by High- versus Low-Volume Cancer Centres in British Columbia, Canada. Diagnostics (Basel) 2023; 13:diagnostics13111973. [PMID: 37296824 DOI: 10.3390/diagnostics13111973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/19/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Due to the rarity and complexity of treatment for Ewing sarcoma and rhabdomyosarcoma, studies demonstrate improved patient outcomes when managed by a multidisciplinary team at high-volume centres (HVCs). Our study explores the difference in outcomes of Ewing sarcoma and rhabdomyosarcoma patients based on the centre of initial consultation in British Columbia, Canada. This retrospective study assessed adults diagnosed with Ewing sarcoma and rhabdomyosarcoma between 1 January 2000 and 31 December 2020 undergoing curative intent therapy in one of five cancer centres across the province. Seventy-seven patients were included, 46 seen at HVCs and 31 at low-volume centres (LVCs). Patients at HVCs were younger (32.1 vs. 40.8 years, p = 0.020) and more likely to receive curative intent radiation (88% vs. 67%, p = 0.047). The time from diagnosis to first chemotherapy was 24 days shorter at HVCs (26 vs. 50 days, p = 0.120). There was no significant difference in overall survival by treatment centre (HR 0.850, 95% CI 0.448-1.614). Variations in care exist amongst patients treated at HVCs vs. LVCs, which may reflect differences in access to resources, clinical specialists, and varying practice patterns across centres. This study can be used to inform decisions regarding triaging and centralization of Ewing sarcoma and rhabdomyosarcoma patient treatment.
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Affiliation(s)
- Sarah Yeo
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Ursula Lee
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Cancer Surrey, Surrey, BC V3V 1Z2, Canada
| | - Ying Hui Xu
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Christine Simmons
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
| | - Alannah Smrke
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
| | - Ying Wang
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Cancer Vancouver, Vancouver, BC V5Z 4E6, Canada
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10
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Strönisch A, Märdian S, Flörcken A. Centralized and Interdisciplinary Therapy Management in the Treatment of Sarcomas. Life (Basel) 2023; 13:life13040979. [PMID: 37109507 PMCID: PMC10144040 DOI: 10.3390/life13040979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
Sarcoma treatment requires a high level of expertise due to its rarity and heterogeneity. Sarcoma patients should, therefore, be referred to an expert centre as early as possible to ensure optimal treatment. Numerous studies have been carried out to provide evidence for this strategy. In compliance with the 2020 PRISMA guidelines, a systematic search was conducted in PubMed, EMBASE, Ovid Medline, ClinicalTrials.gov and Cochrane Library databases. The subject of these studies was the centralised treatment of adult sarcoma patients at expert centres and the use of interdisciplinary tumour boards. Uncertainty in therapy, delays in referral to expert centres, and limited access to therapeutic modalities continue to be a challenge in sarcoma therapy. At expert centres, diagnostic procedures were more frequently and adequately performed, and treatment was associated with an improvement in outcomes in the majority of studies: patients benefited from longer survival, lower local recurrence rates and a better postoperative outcome. The implementation of an interdisciplinary tumour board was associated with discrepant results. In a greater number of studies, it was associated with a lower local relapse rate, better overall survival and surgical outcome. In two studies, however, a shorter overall survival was observed. The establishment of expert centres and the consistent use of interdisciplinary tumour boards are important structures for ensuring multidisciplinary therapy approaches. There is growing evidence that this holds great potential for optimising sarcoma therapy.
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Affiliation(s)
- Annika Strönisch
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Sven Märdian
- Centre for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Anne Flörcken
- Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, German Cancer Consortium (DKTK), Partner Site Berlin, and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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11
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Melo Mateus M, Catalão-Lopes M, Portugal R. Survival analysis of cancer patients in Portugal following the reference centre model implementation. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:157-168. [PMID: 35507197 DOI: 10.1007/s10198-022-01461-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
Cancer has affected around eighteen million people all over the world in 2018. In Portugal, cancer was diagnosed in sixty thousand individuals during 2018, being the second leading cause of death (one in every four deaths). Following the European Directive 2011/24/EU, the Portuguese Health System has been recognizing oncology Reference Centres (RCs), which are focused on delivering best-in-class treatment for cancer patients. This paper performs a survival analysis of cancer patients in Portugal, having hospital episodes with discharge date after the official recognition, in 2016, of the first RCs for hepatobiliary, pancreatic, sarcomas and oesophageal cancer. The aim is to assess the impact of RCs on the survival probability of these patients. For each cancer type, survival curves are estimated using the Kaplan-Meier methodology, and hazard ratios are estimated for different covariates, using multivariate Extended Cox models. The results obtained support the implementation and encourage the further extension of the RC model for oncology in Portugal, as cancer patients treated in an oncology RC, overall, have a better survival probability when compared to patients who had no episode in an RC. These results are clearer for hepatobiliary and pancreatic cancer, but also visible for sarcomas and oesophageal cancer.
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Affiliation(s)
| | - Margarida Catalão-Lopes
- Centre for Management Studies of Instituto Superior Técnico (CEG-IST), Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001, Lisbon, Portugal.
| | - Rui Portugal
- Faculdade de Medicina da Universidade de Lisboa, Universidade de Lisboa, Lisbon, Portugal
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12
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Vincenzi B, Napolitano A, Comandone A, Sanfilippo R, Celant S, Olimpieri PP, Di Segni S, Russo P, Casali PG. Trabectedin use in soft-tissue sarcoma patients in a real-world setting: Data from an Italian national drug-access registry. Int J Cancer 2023; 152:761-768. [PMID: 36196483 PMCID: PMC10092104 DOI: 10.1002/ijc.34309] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/24/2022] [Accepted: 09/15/2022] [Indexed: 02/01/2023]
Abstract
Trabectedin is a marine-derived anticancer drug approved for the treatment of patients with advanced soft-tissue sarcomas (STS). Here, we aimed to analyze its use in a large cohort of STS patients treated in Italy in a real-world setting. Data on STS patients treated with trabectedin in Italy were prospectively collected from January 2013 to December 2019 by the national drug regulator, the Italian Medicines Agency (AIFA). Time-to-off-treatment (TToT) was defined as the time between the initial prescription of trabectedin and the date of treatment discontinuation for any cause. The impact of the different baseline covariates, including the initial prescribed dose of trabectedin, on TToT was evaluated using an accelerated failure time (AFT) models with log-logistic distribution. In total, we analyzed data from 2633 sarcoma patients and 14 950 individual cycles of trabectedin. The median number of cycles of trabectedin received per patient was 3 (interquartile range 2-7). The labeled 1.5 mg/sqm dose was used in 27.3% of all first prescriptions. Overall, the median TToT was 93 days. In the final AFT model, the variables significantly associated to longer TToT were female gender (+13% increase in TToT); ECOG performance status 0 (+50%); histological diagnosis of leiomyosarcoma (+22%), well-differentiated/dedifferentiated liposarcoma (+72%) or myxoid liposarcoma (+61%); receiving treatment in a high-volume center (+23%). In this large real-world cohort of STS patients treated with trabectedin, our findings support the use of trabectedin in STS patients, in particular in leiomyosarcoma and liposarcoma patients, and highlight the role of treatment center volume in their management.
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Affiliation(s)
| | - Andrea Napolitano
- University Campus Bio-Medico, Rome, Italy.,Royal Marsden NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | - Paolo G Casali
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,University of Milan, Milan, Italy
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13
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Blay JY, Italiano A, Penel N, Le Loarer F, Karanian M, De Pinieux G, Coindre JM, Ducimetiere F, Chemin C, Morelle M, Gouin F, Toulmonde M, Le Cesne A. Impact d’un réseau de centre de référence pour le diagnostic et la prise en charge des patients atteints de sarcomes en France depuis 2010. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2023. [DOI: 10.1016/j.banm.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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14
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The benefit for radiotherapy at specialised sarcoma centres: A systematic review and clinical practice guidelines from the Australia and New Zealand Sarcoma Association. Radiother Oncol 2022; 177:158-162. [PMID: 36336110 DOI: 10.1016/j.radonc.2022.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
Patients with sarcoma are best managed at specialised sarcoma centres as supported by published literature. Optimal management requires multidisciplinary team input to formulate the diagnosis and treatment sequencing taking into consideration multiple clinical and pathologic factors. This systematic review aimed to evaluate the impact on outcomes of radiotherapy at specialised sarcoma centres. A systematic review was conducted using the population, intervention, comparison and outcome model. A literature search was performed using Medline, Embase, Cochrane Central databases for publications from 1990 to February 2022 that evaluated the local control, survival and toxicity of radiotherapy at specialised sarcoma centres. A total of 21 studies were included (17 cancer registry studies, four retrospective comparative studies). Four studies reported the local recurrence endpoint when radiotherapy was part of limb conservation treatment and showed better conformity to clinical practice guidelines and an improved local recurrence free rate when radiotherapy treatment is supported through, but may not be necessarily delivered at a specialised sarcoma centres. Only one retrospective study analysed toxicity specifically and demonstrated that patients who received preoperative radiotherapy at community centres compared to radiotherapy at a specialised sarcoma centre were more likely to develop a major wound complication. Fourteen studies reported overall survival, and 12 of these showed significantly better 5-year overall survival for patients managed at specialised sarcoma centres, however the specific impact of radiotherapy delivered at sarcoma centres could not be determined. In conclusion, patients with sarcoma should be managed through specialised sarcoma centres for better oncological outcomes. Radiotherapy in specialised sarcoma centre is associated with a lower rate of wound complications and may contribute to improved oncological outcomes as part of the limb conservation treatment at a specialised sarcoma centre.
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15
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Salerno KE, Baldini EH. Role of Radiation Therapy in Retroperitoneal Sarcoma. J Natl Compr Canc Netw 2022; 20:845-849. [PMID: 35830885 DOI: 10.6004/jnccn.2022.7035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022]
Abstract
Retroperitoneal sarcoma comprises a small subset of all soft tissue sarcoma and includes various histopathologic subtypes, each with unique patterns of behavior and differential risks for local recurrence and hematogenous metastatic spread. The primary treatment modality is surgery, although even with complete macroscopic resection, recurrence is common. The rationale for the addition of radiotherapy to resection is to improve local control; however, the use of radiation therapy for retroperitoneal sarcoma is controversial, and existing data are suboptimal to guide management. Treatment decisions should be determined with multidisciplinary input and shared decision-making. When used in selected patients, radiation therapy should be delivered preoperatively; postoperative treatment is not recommended.
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Affiliation(s)
- Kilian E Salerno
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; and
| | - Elizabeth H Baldini
- Harvard Medical School, and.,Sarcoma Center, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts
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16
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Treatment Outcomes for Primary Hepatic Angiosarcoma: National Cancer Database Analysis 2004-2014. Curr Oncol 2022; 29:3637-3646. [PMID: 35621682 PMCID: PMC9139369 DOI: 10.3390/curroncol29050292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: To determine the risk of mortality and factors associated with survival amongst patients diagnosed with primary hepatic angiosarcoma (PHA). Methods: All patients diagnosed with hepatocellular carcinoma (HCC) or PHA from 2004 to 2014 were identified from the National Cancer Database (NCDB). Further analysis was performed within the cohort of patients with PHA to assess the impact of surgery, chemotherapy, radiation, and facility type on overall survival (OS). A multivariable analysis using the Cox proportional methods and a survival analysis using the Kaplan−Meier method were used. Results: A total of 117,633 patients with HCC were identified, out of whom 346 patients had PHA. Patients with PHA had a mean age of 62.9 years (SD 13.7), the majority were men (64.7%), white (85.8%), and had a Charlson comorbidity index (CCI) of zero (66.2%). A third of the patients with PHA (35.7%) received chemotherapy, and 14.6% underwent a surgical resection. The median survival was 1.9 months (1.8−2.4 months) compared to patients with HCC (10.4 months, 10.2−10.5) (aHR-2.41, 95% CI: 2.10−2.77, p < 0.0001). Surgical resection was associated with a higher median survival (7.7 versus 1.8 months, aHR-0.23, 95% CI: 0.15−0.37, p < 0.0001). A receipt of chemotherapy was associated with a higher median survival than no chemotherapy (5.1 versus 1.2 months, aHR-0.44, 95% CI: 0.32−0.60, p < 0.0001), although the survival benefit did not persist long term. Conclusion: PHA is associated with poor outcomes. A surgical resection and chemotherapy are associated with improved survival outcomes; however, the long-term benefits of chemotherapy are limited.
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Fernández JÁ, Pérez BG, Cantín S, Asencio JM, Artigas V. National survey on the treatment of sarcomas in Spain. Cir Esp 2022; 100:193-201. [PMID: 35491323 DOI: 10.1016/j.cireng.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/19/2021] [Indexed: 06/14/2023]
Abstract
Surgical units attending sarcomas in Spain are poor studied. The aim is to know the management of this pathology to identify areas of improvement through multicenter study based on a voluntary survey. The survey was completed by 74 surgeons of different hospitals, which 32,4% is exclusively dedicated to sarcomas. Only 24.3% declared to receive specific training in sarcomas. The most frequent type of hospital was the third level (56.8%), where 38,1% of the surgeons belong to societies or working-groups in sarcoma fields vs. 9,4% in first-second levels. The number of surgeons with specific theoretical training and papers published in this field are higher in third level hospitals. 55,4% belonged to a multidisciplinary unit. A multidisciplinary team was available in 57% of third level hospital vs 28% in others. Most services in charge of this patients are characterized by deficient specialization, low workload and the absence of a multidisciplinary team.
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Affiliation(s)
- Juan Ángel Fernández
- Unidad de Sarcomas y Tumores Mesenquimales, Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
| | - Beatriz Gómez Pérez
- Unidad de Sarcomas y Tumores Mesenquimales, Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Sonia Cantín
- Unidad de Cirugía Esofagogástrica y Sarcomas, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - José Manuel Asencio
- Sección Cirugía HPB y Unidad de Trasplante Hepático, CSUR de Sarcomas y Tumores Musculoesqueléticos, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Vicente Artigas
- Coordinador Grupo de Trabajo de Sarcomas y Tumores Mesenquimales de la Asociación Española de Cirujanos (AEC), Spain
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18
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David BBL, Abdon Mello C, Santos Thuler LC, de Melo AC. Overview of Adult Sarcoma Burden and Clinical Pathways in Brazil. JCO Glob Oncol 2022; 8:e2100387. [PMID: 35230876 PMCID: PMC8887943 DOI: 10.1200/go.21.00387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Sarcomas are a heterogeneous group of cancers classified as rare cancers and are often poorly characterized. In Brazil, little is known about the adult sarcoma burden and patients' clinical pathways.
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Affiliation(s)
- Bruna Bianca Lopes David
- Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Celso Abdon Mello
- Department of Medical Oncology, A.C Camargo Cancer Center, São Paulo, Brazil
| | - Luiz Claudio Santos Thuler
- Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Andreia Cristina de Melo
- Division of Clinical Research and Technological Development, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
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19
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Blay JY, Penel N, Gouin F, Le Cesne A, Toulmonde M. Improving at a nationwide level the management of patients with sarcomas with an expert network. Ann Oncol 2022; 33:659-661. [DOI: 10.1016/j.annonc.2022.02.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/30/2022] Open
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Blay JY, Hindi N, Bollard J, Aguiar S, Angel M, Araya B, Badilla R, Bernabeu D, Campos F, Caro-Sánchez CHS, Carvajal B, Carvajal Montoya A, Casavilca-Zambrano S, Castro-Oliden V, Chacón M, Clara M, Collini P, Correa Genoroso R, Costa FD, Cuellar M, Dei Tos AP, Dominguez Malagon HR, Donati D, Dufresne A, Eriksson M, Farias-Loza M, Fernandez P, Frezza AM, Frisoni T, Garcia-Ortega DY, Gelderblom H, Gouin F, Gómez-Mateo MC, Gronchi A, Haro J, Huanca L, Jimenez N, Karanian M, Kasper B, Lopes David BB, Lopez-Pousa A, Lutter G, Martinez-Said H, Martinez-Tlahuel J, Mello CA, Morales Pérez JM, Moura David S, Nascimento AG, Ortiz-Cruz EJ, Palmerini E, Patel S, Pfluger Y, Provenzano S, Righi A, Rodriguez A, Salas R, Santos TTG, Scotlandi K, Soule T, Stacchiotti S, Valverde C, Waisberg F, Zamora Estrada E, Martin-Broto J. SELNET clinical practice guidelines for soft tissue sarcoma and GIST. Cancer Treat Rev 2022; 102:102312. [PMID: 34798363 DOI: 10.1016/j.ctrv.2021.102312] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/30/2021] [Indexed: 12/12/2022]
Affiliation(s)
- J Y Blay
- Léon Bérard Center, 28 rue Laennec 69373 Lyon Cedex 08, France.
| | - N Hindi
- Research Health Institute Fundacion Jimenez Diaz (IIS/FJD), 28015 Madrid, Spain; Hospital Fundación Jimenez Diaz University Hospital, 28040 Madrid, Spain; General de Villalba University Hospital, 28400 Madrid, Spain
| | - J Bollard
- Léon Bérard Center, 28 rue Laennec 69373 Lyon Cedex 08, France
| | - S Aguiar
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo - SP 01509-010, Brazil
| | - M Angel
- Instituto Alexander Fleming. Av. Cramer 1180. CP C1426ANZ, Buenos Aires, Argentina
| | - B Araya
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - R Badilla
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - D Bernabeu
- Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - F Campos
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo - SP 01509-010, Brazil
| | - C H S Caro-Sánchez
- Instituto Nacional de Cancerologia. Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP 14080, Tlalpan Mexico
| | - B Carvajal
- Fundación GIST México, Altadena 59, Nápoles, Benito Juárez, 03810 Ciudad de Mexico, CDMX, Mexico
| | - A Carvajal Montoya
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - S Casavilca-Zambrano
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 34, Peru
| | - V Castro-Oliden
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 34, Peru
| | - M Chacón
- Instituto Alexander Fleming. Av. Cramer 1180. CP C1426ANZ, Buenos Aires, Argentina
| | - M Clara
- Instituto Nacional de Cancerologia. Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP 14080, Tlalpan Mexico
| | - P Collini
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - R Correa Genoroso
- Hospital Clínico Universitario Virgen de la Victoria, Campus Universitario de Teatinos s/n, 29010 Malaga, Spain
| | - F D Costa
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo - SP 01509-010, Brazil
| | - M Cuellar
- Fundación GIST México, Altadena 59, Nápoles, Benito Juárez, 03810 Ciudad de Mexico, CDMX, Mexico
| | - A P Dei Tos
- Treviso General Hospital Treviso, University of Padua, Padova, Italy
| | - H R Dominguez Malagon
- Instituto Nacional de Cancerologia. Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP 14080, Tlalpan Mexico
| | - D Donati
- IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli, 1, 40136 Bologna, Italy
| | - A Dufresne
- Léon Bérard Center, 28 rue Laennec 69373 Lyon Cedex 08, France
| | - M Eriksson
- Skane University Hospital and Lund University, Lund, Sweden
| | - M Farias-Loza
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 34, Peru
| | | | - A M Frezza
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - T Frisoni
- IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli, 1, 40136 Bologna, Italy
| | - D Y Garcia-Ortega
- Instituto Nacional de Cancerologia. Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP 14080, Tlalpan Mexico
| | - H Gelderblom
- Leiden University Medical Center, Leiden, the Netherlands
| | - F Gouin
- Léon Bérard Center, 28 rue Laennec 69373 Lyon Cedex 08, France
| | - M C Gómez-Mateo
- Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - J Haro
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 34, Peru
| | - L Huanca
- Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos Este 2520, Lima 34, Peru
| | - N Jimenez
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - M Karanian
- Léon Bérard Center, 28 rue Laennec 69373 Lyon Cedex 08, France
| | - B Kasper
- University of Heidelberg, Mannheim Cancer Center, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - B B Lopes David
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - A Lopez-Pousa
- Hospital de la Santa Creu i Sant Pau, Carrer de Sant Quintí, 89, 08041 Barcelona, Espagne
| | - G Lutter
- Instituto Alexander Fleming. Av. Cramer 1180. CP C1426ANZ, Buenos Aires, Argentina
| | - H Martinez-Said
- Centro Oncologico Integral, Hospital Medica Sur, Planta Baja Torre III - Cons. 305, Col. Toriello Guerra, Deleg. Tlalpan. C.P. 14050, Mexico, D.F
| | - J Martinez-Tlahuel
- Instituto Nacional de Cancerologia. Torre Nueva de Hospitalización, primer piso. Av. San Fernando 86, Colonia Niño Jesus. CP 14080, Tlalpan Mexico
| | - C A Mello
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo - SP 01509-010, Brazil
| | - J M Morales Pérez
- Hospital Universitario Virgen del Rocio, Av Manuel Siurot s/n, 41013 Sevilla, Spain
| | - S Moura David
- Hospital Universitario Virgen del Rocio, Av Manuel Siurot s/n, 41013 Sevilla, Spain
| | - A G Nascimento
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo - SP 01509-010, Brazil
| | - E J Ortiz-Cruz
- Hospital Universitario La Paz, MD Anderson Cancer Center, Calle de Arturo Soria, 270 28033 Madrid, Spain
| | - E Palmerini
- IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli, 1, 40136 Bologna, Italy
| | - S Patel
- UT MD Anderson Cancer Center, Houston, TX, USA
| | - Y Pfluger
- Instituto Alexander Fleming. Av. Cramer 1180. CP C1426ANZ, Buenos Aires, Argentina
| | - S Provenzano
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - A Righi
- IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli, 1, 40136 Bologna, Italy
| | - A Rodriguez
- Instituto Alexander Fleming. Av. Cramer 1180. CP C1426ANZ, Buenos Aires, Argentina
| | - R Salas
- Fundación GIST México, Altadena 59, Nápoles, Benito Juárez, 03810 Ciudad de Mexico, CDMX, Mexico
| | - T T G Santos
- A.C.Camargo Cancer Center, Rua prof Antonio Prudente, 211 - Liberdade, São Paulo - SP 01509-010, Brazil
| | - K Scotlandi
- IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli, 1, 40136 Bologna, Italy
| | - T Soule
- Instituto Alexander Fleming. Av. Cramer 1180. CP C1426ANZ, Buenos Aires, Argentina
| | - S Stacchiotti
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy
| | - C Valverde
- Vall d́Hebrón University Hospital, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - F Waisberg
- Instituto Alexander Fleming. Av. Cramer 1180. CP C1426ANZ, Buenos Aires, Argentina
| | - E Zamora Estrada
- Hospital Dr. R. A. Calderón Guardia, 7-9 Av, 15-17 St, Aranjuez, San José, Costa Rica
| | - J Martin-Broto
- Research Health Institute Fundacion Jimenez Diaz (IIS/FJD), 28015 Madrid, Spain; Hospital Fundación Jimenez Diaz University Hospital, 28040 Madrid, Spain; General de Villalba University Hospital, 28400 Madrid, Spain
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21
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Testa S, Hu BD, Saadeh NL, Pribnow A, Spunt SL, Charville GW, Bui NQ, Ganjoo KN. A Retrospective Comparative Analysis of Outcomes and Prognostic Factors in Adult and Pediatric Patients with Osteosarcoma. Curr Oncol 2021; 28:5304-5317. [PMID: 34940082 PMCID: PMC8700626 DOI: 10.3390/curroncol28060443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/22/2021] [Accepted: 12/09/2021] [Indexed: 11/21/2022] Open
Abstract
Osteosarcoma is the most common primary bone malignancy in both children and adults. Despite introduction of intensive multimodal treatment with chemotherapy and surgery, outcomes are still poor, especially for patients with metastatic disease and adults. Hence, there is an ongoing need for better prognostic markers and outcome data to inform management decisions in both the adult and pediatric setting. Here, we retrospectively analyzed 112 patients with bone osteosarcoma treated at two large adult and pediatric tertiary academic centers between 1989 and 2019. Patients were divided into an adult (≥18 years) and pediatric (<18 years) cohort for comparison. Our aim was to evaluate predictors of outcomes in pediatric and adult patients, with a specific focus on the role of methotrexate when added to a combination of doxorubicin-cisplatin; the prognostic value of tumor necrosis after neoadjuvant chemotherapy; and outlining any differences in outcomes between adults and pediatric patients that could inform clinical management. Adult patients treated with methotrexate-doxorubicin-cisplatin and those treated with doxorubicin-cisplatin had similar 5-year PFS (26%, 95%CI: 45.5%–10% vs. 50%, 95%CI: 69.6%–26.2%, p = 0.1) and 5-year OS (63%, 95%CI: 82%–34%, vs. 78%, 95%CI: 90.6%–52.6%, p = 0.5). In the adult cohort, there was no difference between patients with ≥90% necrosis and <90% necrosis in either 5-year PFS (42%, 95%CI: 71.1%–11.3% vs. 38%, 95%CI: 57.7%–18.2%, p = 0.4) or 5-year OS (85%, 95%CI: 97.8%–33.4% vs. 56%, 95%CI: 76.8%–27.6%, p = 0.4). In the pediatric cohort, compared to patients with <90% necrosis, those with ≥90% necrosis had significantly better 5-year PFS (30%, 95%CI: 49.3%–14.1% vs. 55%, 95%CI: 73.9%–38.5%, p = 0.003) and 5-year OS (64%, 95%CI: 80.8%–41.1% vs. 78%, 95%CI: 92%–60.9%, p = 0.04). Adult and pediatric patients had similar 5-year OS (69%, 95%CI: 83.2%–49.8% vs. 73%, 95%CI: 83.2%–59.3%, p = 0.8) and 5-year PFS (37%, 95%CI: 52.4%–22.9% vs. 43%, 95%CI: 56.2%–30.4% p = 0.3) even though the proportion of patients with ≥90% necrosis after neoadjuvant chemotherapy was higher for children compared to adults (60.3% vs. 30%, OR: 3.54, 95%CI: 1.38–8.46, p = 0.006). In conclusion, in adult patients, the addition of methotrexate to doxorubicin and cisplatin did not correlate with a significant survival benefit, questioning the therapeutic value of methotrexate overall. Our study confirms the prognostic utility of percent tumor necrosis after neoadjuvant chemotherapy in pediatric patients but not in adult patients. Lastly, this is one of the few reported studies where patients with osteosarcoma younger and older than 18 years had similar PFS and OS.
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Affiliation(s)
- Stefano Testa
- Department of Medicine, Stanford University, Stanford, CA 94304, USA
- Correspondence: (S.T.); (K.N.G.)
| | - Benjamin D. Hu
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA 94304, USA; (B.D.H.); (A.P.); (S.L.S.)
| | - Natalie L. Saadeh
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94304, USA; (N.L.S.); (N.Q.B.)
| | - Allison Pribnow
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA 94304, USA; (B.D.H.); (A.P.); (S.L.S.)
| | - Sheri L. Spunt
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA 94304, USA; (B.D.H.); (A.P.); (S.L.S.)
| | | | - Nam Q. Bui
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94304, USA; (N.L.S.); (N.Q.B.)
| | - Kristen N. Ganjoo
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA 94304, USA; (N.L.S.); (N.Q.B.)
- Correspondence: (S.T.); (K.N.G.)
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22
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Bisogno G, Congiu G, Affinita MC, Milano GM, Zanetti I, Coppadoro B, Manzitti C, Basso E, Tamburini A, Melchionda F, Cellini M, Pericoli R, D'Angelo P, Cataldo AD, De Leonardis F, Rabusin M, De Corti F, Zin A, Alaggio R, Scarzello G, Ferrari A. Role of centers with different patient volumes in the management of rhabdomyosarcoma. An analysis by the Italian Pediatric Soft Tissue Sarcoma Committee. Pediatr Blood Cancer 2021; 68:e29234. [PMID: 34260145 DOI: 10.1002/pbc.29234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 12/14/2022]
Abstract
PROCEDURE The survival of children with rhabdomyosarcoma (RMS) has gradually improved as a result of the adoption of multidisciplinary treatments. Dedicated skills and facilities are indispensable and more readily available at reference centers. In this study, we examined the role of centers' experience (based on the number of patients treated) in their management of patients with RMS. METHODS We analyzed 342 patients with localized RMS enrolled in the European RMS 2005 protocol from October 2005 to December 2016 at 31 Italian centers that are part of the Soft Tissue Sarcoma Committee (STSC). We grouped the centers by the number of patients each one enrolled (Group 1: >40; Group 2: <40 and >10; and Group 3: <10), and compared a number of indicators to assess the appropriateness of patients' diagnostic workup and treatment and their survival. RESULTS Overall, 74.6% of patients were treated at 10 centers, and only three of them classifiable as high-volume centers. Only minor differences emerged between the three patient groups in terms of diagnostic investigations and treatment modalities. Survival was similar in the three groups. Approximately, one in four children treated at the centers in Groups 2 and 3 traveled to another center for surgery or radiotherapy. CONCLUSION Patients treated at STSC centers with different amounts of experience had similar results in terms of survival. This is attributable to all centers in the network adhering to protocol recommendations and receiving the STSC's support on diagnostics and multidisciplinary treatments for RMS.
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Affiliation(s)
- Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Giovanna Congiu
- Pediatric Hematology Oncology, Ospedale Microcitemico "A. Cao," A.O. Brotzu, Cagliari, Italy
| | - Maria Carmen Affinita
- Hematology Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | | | - Ilaria Zanetti
- Hematology Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Beatrice Coppadoro
- Hematology Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Carla Manzitti
- Department of Pediatric Hematology/Oncology, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Eleonora Basso
- Pediatric Oncology-Hematology Unit, Hospital Maggiore della Carità, Novara, Italy
| | - Angela Tamburini
- Hematology Oncology Unit, A. Meyer Children's Hospital, Firenze, Italy
| | - Fraia Melchionda
- Pediatric Hematology and Oncology Unit, S. Orsola-University Hospital, IRCCS, Bologna, Italy
| | - Monica Cellini
- Pediatric Oncology-Hematology Unit, Modena University Hospital, Modena, Italy
| | - Roberta Pericoli
- Pediatric Onco-Hematology Unit, Ospedale Infermi, Azienda della Romagna, Rimini, Italy
| | - Paolo D'Angelo
- Pediatric Hematology and Oncology Unit, Ospedali Civico, Di Cristina and Benfratelli, Palermo, Italy
| | - Andrea Di Cataldo
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, Catania University Hospital, Catania, Italy
| | - Francesco De Leonardis
- Pediatric Hematology-Oncology Division, Department of Pediatrics, Bari University Hospital, Bari, Italy
| | - Marco Rabusin
- Hemato-Oncology Unit, Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Federica De Corti
- Pediatric Surgery Unit, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Angelica Zin
- Hematology Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Rita Alaggio
- Hematology/Oncology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | | | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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23
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Logan IT, Vroobel KM, le Grange F, Perrett CM. Pleomorphic dermal sarcoma: Clinicopathological features and outcomes from a 5-year tertiary referral centre experience. Cancer Rep (Hoboken) 2021; 5:e1583. [PMID: 34766474 PMCID: PMC9675369 DOI: 10.1002/cnr2.1583] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/27/2021] [Accepted: 10/12/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Pleomorphic dermal sarcoma (PDS) describes rare dermal-based malignant tumours that are morphologically similar to atypical fibroxanthoma (AFX). PDS may be differentiated from AFX by the presence of one or more of the following histologic features: subcutaneous invasion, tumour necrosis, lymphovascular invasion (LVI), and/or perineural infiltration (PNI). AIMS To further define the clinicopathological features, surgical management, and outcomes of PDS primary tumours. METHODS AND RESULTS This study was a retrospective observational case series using a database search from 2012 to 2017. Inclusion criteria required all cases to meet the histopathologic criteria for PDS as confirmed by a specialist soft-tissue histopathologist. A total of n = 17 cases were included with a median age of 78 years (range 66-85). All tumours were located on the head and neck, with 13/17 located on the scalp. Primary treatment was with wide local excision (WLE) in all cases. Median follow-up was 48 months. Local recurrence occurred in 4/17 cases (24%) and distant metastasis in 2/17 cases (12%). CONCLUSION PDS behaves more aggressively than atypical fibroxanthoma with which it shares a biologic continuum. The optimal surgical management approach is yet to be determined.
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Affiliation(s)
- Ian T. Logan
- Department of DermatologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Katherine M. Vroobel
- Department of HistopathologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Franel le Grange
- Department of OncologyUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Conal M. Perrett
- Department of DermatologyUniversity College London Hospitals NHS Foundation TrustLondonUK
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24
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Blay JY, Casali P, Bouvier C, Dehais C, Galloway I, Gietema J, Halámková J, Hindi N, Idbaih A, Kinloch E, Klümpen HJ, Kolarova T, Kopeckova K, Lovey J, Magalhaes M, Oselin K, Piperno-Neumann S, Ravnsbaek A, Rogasik M, Safwat A, Scheipl S, Seckl M, Taylor J, Temnyk M, Trama A, Urbonas M, Wartenberg M, Weinman A. European Reference Network for rare adult solid cancers, statement and integration to health care systems of member states: a position paper of the ERN EURACAN. ESMO Open 2021; 6:100174. [PMID: 34139485 PMCID: PMC8219752 DOI: 10.1016/j.esmoop.2021.100174] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- J-Y Blay
- Department of Medical Oncology, Centre Leon Berard & Centre de Recherche en Cancérologie de Lyon (CRCL) & Université Claude Bernard Lyon 1, Lyon, France.
| | - P Casali
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - C Bouvier
- Neuroendocrine Cancer Unit, Royal Free Hospital, London, UK
| | - C Dehais
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - I Galloway
- Melanoma Patient Network Europe, OcuMel, Birmingham, UK
| | - J Gietema
- Department of Medical Oncology, University Medical Centre Groningen, Groningen, The Netherlands
| | - J Halámková
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - N Hindi
- Institute of Biomedicine of Sevilla (IBIS, HUVR, CSIC, Universidad de Sevilla), Virgen, Virgen del Rocío University Hospital, Seville, Spain
| | - A Idbaih
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | | | - H-J Klümpen
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - T Kolarova
- International Neuroendocrine Cancer Alliance, Boston, USA
| | - K Kopeckova
- Department of Oncology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - J Lovey
- National Institute of Oncology, Budapest, Hungary
| | - M Magalhaes
- Oncology Department, Centro Hospitalar e Universitário Universitário do Porto, Porto, Portugal
| | - K Oselin
- Department of Chemotherapy, Clinic of Haematology and Oncology, North Estonia Medical Centre Foundation, Tallinn, Estonia
| | | | - A Ravnsbaek
- Oncology Department, and Danish Centre for Particle Therapy, University Hospital, Aarhus, Denmark
| | - M Rogasik
- Research and Innovation Department, Centre Léon Bérard, Lyon, France
| | - A Safwat
- Oncology Department, and Danish Centre for Particle Therapy, University Hospital, Aarhus, Denmark
| | - S Scheipl
- Medical University of Graz, Graz, Austria
| | - M Seckl
- Department of Medical Oncology, Charing Cross Hospital Campus of Imperial College London, London, UK
| | - J Taylor
- Thyroid Cancer Alliance, Rotterdam, The Netherlands
| | - M Temnyk
- Maria Skłodowska Curie Institute, Warsaw, Poland
| | - A Trama
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - M Urbonas
- Lithuanian University of Health Sciences, Department of Neurosurgery, Kaunas, Lithuania
| | | | - A Weinman
- EURORDIS-Rare Diseases Europe (European Patient Organisation for Rare Diseases)
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25
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Hindi N, Martin-Broto J. What is the standard indication of adjuvant or neoadjuvant chemotherapy in localized soft-tissue sarcoma? Curr Opin Oncol 2021; 33:329-335. [PMID: 33973551 DOI: 10.1097/cco.0000000000000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim is to bring latest evidence of the role of perioperative chemotherapy in localized soft-tissue sarcomas (STS) of limbs and to review the risk classification systems of retroperitoneal and extremity STS. RECENT FINDINGS High-risk subset of localized STS of limbs and trunk-wall, defined with classic prognostic factors, consistently obtained 5-year overall survival ranging from 69 to 76% in randomized patients treated with full-dose of anthracycline and ifosfamide. Validated nomograms accurately predict, on individual basis, the risk of death and recurrence in localized STS of retroperitoneum and limbs, enabling a better selection of high-risk patients (usually those with death risk of ≥40%) that potentially could benefit with perioperative systemic treatment. Nomograms have virtually converted a negative large perioperative trial into a positive, favouring chemotherapy arm in the high-risk selection. SUMMARY Perioperative three cycles of full-dose of anthracycline and ifosfamide should be proposed on an individual basis, in reference sarcoma centres, to high-risk localized STS of limbs or trunk-wall in certain histologies.
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Affiliation(s)
- Nadia Hindi
- Oncology Department, Fundacion Jimenez Diaz University Hospital, Av Reyes Catolicos 2, 28040 Madrid (Spain)/Villalba University Hospital/Rey Juan Carlos I University Hospital/Infanta Elena University Hospital and Research Institute FJD-UAM, Madrid (Spain) and ATBsarc, CITIUS III, Seville, Spain
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26
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Fernández JÁ, Gómez Pérez B, Cantín S, Asencio JM, Artigas V. National survey on the treatment of sarcomas in Spain. Cir Esp 2021; 100:S0009-739X(21)00204-9. [PMID: 34183153 DOI: 10.1016/j.ciresp.2021.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/09/2021] [Accepted: 05/19/2021] [Indexed: 02/07/2023]
Abstract
Surgical units attending sarcomas in Spain are poor studied. The aim is to know the management of this pathology to identify areas of improvement through multicenter study based on a voluntary survey. The survey was completed by 74 surgeons of different hospitals, which 32.4% is exclusively dedicated to sarcomas. Only 24.3% declared to receive specific training in sarcomas. The most frequent type of hospital was the third level (56.8%), where 38.1% of the surgeons belong to societies or working-groups in sarcoma fields vs. 9.4% in first-second levels. The number of surgeons with specific theoretical training and papers published in this field are higher in third level hospitals. 55.4% belonged to a multidisciplinary unit. A multidisciplinary team was available in 57% of third level hospital vs. 28% in others. Most services in charge of these patients are characterized by deficient specialization, low workload and the absence of a multidisciplinary team.
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Affiliation(s)
- Juan Ángel Fernández
- Unidad de Sarcomas y Tumores Mesenquimales, Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
| | - Beatriz Gómez Pérez
- Unidad de Sarcomas y Tumores Mesenquimales, Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Sonia Cantín
- Unidad de Cirugía Esofagogástrica y Sarcomas, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
| | - José Manuel Asencio
- Sección Cirugía HPB y Unidad de Trasplante Hepático, CSUR de Sarcomas y Tumores Musculoesqueléticos, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Vicente Artigas
- Coordinación Grupo de Trabajo de Sarcomas y Tumores Mesenquimales de la Asociación Española de Cirujanos (AEC), España
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Abstract
Achieving a balance between long-term efficacy and good quality of life (QoL) is the main goal of treatment for patients with advanced soft tissue sarcoma, some of whom experience prolonged survival without progression. An awareness of the challenges particular to this complex set of diseases can help preserve patient QoL during treatment. Histology is among the main factors to consider when selecting treatment in advanced disease. Close attention to the toxicity profiles of available regimens is of particular importance, especially in more advanced lines where the population is usually more vulnerable. Surgical outcomes are significantly better in patients managed with expert care, and early referral to sarcoma reference centers is key to improving survival and QoL.
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Affiliation(s)
- Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Université Claude Bernard, 69300, Lyon, France
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28
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Broto JM, Jones RL. Current Reality of Treating Advanced Soft Tissue Sarcoma as Illustrated by Case Studies. Oncology 2021; 99 Suppl 1:8-16. [PMID: 33849013 DOI: 10.1159/000515366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/12/2021] [Indexed: 11/19/2022]
Abstract
In the first-line setting of advanced soft tissue sarcomas (STS), the treatment aim generally drives decision-making. Anthracycline combinations with ifosfamide or dacarbazine are more appropriate when the aim is tumour shrinkage, and doxorubicin monotherapy is suitable for tumour control. In patients who progress on anthracycline-based regimens, scope exists for tumour shrinkage with trabectedin and concurrent low-dose radiotherapy. Selecting systemic treatment for patients with advanced STS unsuited to receive standard anthracycline-based therapy often involves complex decision-making as clinical trial evidence comparing alternative options is lacking. Key factors to consider are patient characteristics (e.g., age, medical history, performance status), disease characteristics (e.g., stage, histology), and treatment requirements such as the drug's safety profile, evidence of efficacy by subtype, and approved indication as an alternative first-line treatment option. Real-world data for elderly STS patients derived from retrospective studies and post hoc analyses of clinical trials have particular value in guiding treatment selection and improving the management of this populous but undertreated segment of the STS population.
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Affiliation(s)
- Javier Martín Broto
- Biomedicine Institute of Seville (IBIS), Medical Oncology Department, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Robin L Jones
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
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de Pinieux G, Karanian M, Le Loarer F, Le Guellec S, Chabaud S, Terrier P, Bouvier C, Batistella M, Neuville A, Robin YM, Emile JF, Moreau A, Larousserie F, Leroux A, Stock N, Lae M, Collin F, Weinbreck N, Aubert S, Mishellany F, Charon-Barra C, Croce S, Doucet L, Quintin-Rouet I, Chateau MC, Bazille C, Valo I, Chetaille B, Ortonne N, Brouchet A, Rochaix P, Demuret A, Ghnassia JP, Mescam L, Macagno N, Birtwisle-Peyrottes I, Delfour C, Angot E, Pommepuy I, Ranchere D, Chemin-Airiau C, Jean-Denis M, Fayet Y, Courrèges JB, Mesli N, Berchoud J, Toulmonde M, Italiano A, Le Cesne A, Penel N, Ducimetiere F, Gouin F, Coindre JM, Blay JY. Nationwide incidence of sarcomas and connective tissue tumors of intermediate malignancy over four years using an expert pathology review network. PLoS One 2021; 16:e0246958. [PMID: 33630918 PMCID: PMC7906477 DOI: 10.1371/journal.pone.0246958] [Citation(s) in RCA: 126] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 01/28/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Since 2010, nationwide networks of reference centers for sarcomas (RREPS/NETSARC/RESOS) collected and prospectively reviewed all cases of sarcomas and connective tumors of intermediate malignancy (TIM) in France. METHODS The nationwide incidence of sarcoma or TIM (2013-2016) was measured using the 2013 WHO classification and confirmed by a second independent review by expert pathologists. Simple clinical characteristics, yearly variations and correlation of incidence with published clinical trials are presented and analyzed. RESULTS Over 150 different histological subtypes are reported from the 25172 patients with sarcomas (n = 18712, 74,3%) or TIM (n = 6460, 25.7%), with n = 5838, n = 6153, n = 6654, and n = 6527 yearly cases from 2013 to 2016. Over these 4 years, the yearly incidence of sarcomas and TIM was therefore 70.7 and 24.4 respectively, with a combined incidence of 95.1/106/year, higher than previously reported. GIST, liposarcoma, leiomyosarcomas, undifferentiated sarcomas represented 13%, 13%, 11% and 11% of tumors. Only GIST, as a single entity had a yearly incidence above 10/106/year. There were respectively 30, 64 and 66 different histological subtypes of sarcomas or TIM with an incidence ranging from 10 to 1/106, 1-0.1/106, or < 0.1/106/year respectively. The 2 latter incidence groups represented 21% of the patients with 130 histotypes. Published phase III and phase II clinical trials (p<10-6) are significantly higher with sarcomas subtypes with an incidence above 1/106 per. CONCLUSIONS This nationwide registry of sarcoma patients, with exhaustive histology review by sarcoma experts, shows that the incidence of sarcoma and TIM is higher than reported, and that tumors with a very low incidence (1<106/year) are less likely to be included in clinical trials.
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Affiliation(s)
| | - Marie Karanian
- Department of Biopathology, Centre Léon Bérard, Lyon, France
| | | | - Sophie Le Guellec
- Department of Biopathology, Institut Claudius Regaud et Institut Universitaire du Cancer de Toulouse—Oncopôle, Toulouse, France
| | - Sylvie Chabaud
- Department of Biopathology, Centre Léon Bérard, Lyon, France
| | | | - Corinne Bouvier
- Department of pathology, La Timone University Hospital, Marseille, France
| | - Maxime Batistella
- Pathology Department, Saint-Louis Hospital, AP-HP, Université de Paris, Paris, France
| | - Agnès Neuville
- Department of Biopathology, Institut Bergonié, Bordeaux, France
| | - Yves-Marie Robin
- Pôle de Biologie-Pathologie-Génétique Centre Oscar Lambret, & Institut de Pathologie entre Oscar Lambret & CHU Lille, Lille, France
| | | | - Anne Moreau
- Department of Pathology, Department of Orthopedy CHU Nantes, Nantes, France
| | | | - Agnes Leroux
- Department of Biopathology, Institut de Cancérologie de Lorraine—Alexis Vautrin, Vandoeuvre-lès-Nancy, France
| | - Nathalie Stock
- Department of Biopathology, Eugene Marquis Comprehensive Cancer Center & CHU Rennes, Rennes, France
| | - Marick Lae
- Department of Biopathology, Eugene Marquis Comprehensive Cancer Center & CHU Rennes, Rennes, France
- Department of Biopathology, Institut Curie, Paris, France
| | - Francoise Collin
- Department of Biopathology, Centre Georges François Leclerc, Dijon, France
| | | | - Sebastien Aubert
- Pôle de Biologie-Pathologie-Génétique Centre Oscar Lambret, & Institut de Pathologie entre Oscar Lambret & CHU Lille, Lille, France
| | | | | | - Sabrina Croce
- Department of Biopathology, Institut Bergonié, Bordeaux, France
| | | | | | - Marie-Christine Chateau
- Department of Biopathology, Institut de Cancérologie de Montpellier & CHU Montpellier, Montpellier, France
| | - Celine Bazille
- Department of Biopathology, Centre Francois Baclesse, Caen, France
| | - Isabelle Valo
- Department of Pathology, Institut de Cancerologie de l’Ouest, Angers, France
| | | | - Nicolas Ortonne
- Department of Biopathology, Hopital Henri Mondor, Creteil, France
| | - Anne Brouchet
- Department of Biopathology, Institut Claudius Regaud et Institut Universitaire du Cancer de Toulouse—Oncopôle, Toulouse, France
| | - Philippe Rochaix
- Department of Biopathology, Institut Claudius Regaud et Institut Universitaire du Cancer de Toulouse—Oncopôle, Toulouse, France
| | - Anne Demuret
- Department of pathology, CHU de Tours, Tours, France
| | | | - Lenaig Mescam
- Department of Biopathology, Institut Paoli Calmettes, Marseille, France
| | - Nicolas Macagno
- Department of pathology, La Timone University Hospital, Marseille, France
| | | | - Christophe Delfour
- Department of Biopathology, Institut de Cancérologie de Montpellier & CHU Montpellier, Montpellier, France
| | - Emilie Angot
- Department of Biopathology, Eugene Marquis Comprehensive Cancer Center & CHU Rennes, Rennes, France
| | | | | | | | | | - Yohan Fayet
- Department of Biopathology, Centre Léon Bérard, Lyon, France
| | | | - Nouria Mesli
- Department of Biopathology, Institut Bergonié, Bordeaux, France
| | - Juliane Berchoud
- Department of Pathology, Department of Orthopedy CHU Nantes, Nantes, France
| | - Maud Toulmonde
- Department of Biopathology, Institut Bergonié, Bordeaux, France
| | | | - Axel Le Cesne
- Department of Biopathology, Centre Léon Bérard, Lyon, France
| | - Nicolas Penel
- Pôle de Biologie-Pathologie-Génétique Centre Oscar Lambret, & Institut de Pathologie entre Oscar Lambret & CHU Lille, Lille, France
| | | | - Francois Gouin
- Department of Biopathology, Centre Léon Bérard, Lyon, France
| | | | - Jean-Yves Blay
- Department of Biopathology, Centre Léon Bérard, Lyon, France
- Department of Medicine of Centre Leon Berard, University Claude Bernard Lyon I, Lyon, France
- Headquarters, Unicancer, Paris, France
- * E-mail:
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30
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Callegaro D, Raut CP, Keung EZ, Kim T, Le Pechoux C, Martin-Broto J, Gronchi A, Swallow C, Gladdy R. Strategies for care of patients with gastrointestinal stromal tumor or soft tissue sarcoma during COVID-19 pandemic: A guide for surgical oncologists. J Surg Oncol 2020; 123:12-23. [PMID: 33022754 PMCID: PMC7675701 DOI: 10.1002/jso.26246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 12/15/2022]
Abstract
The coronavirus disease-2019 (COVID-19) pandemic is deeply impacting the accessibility of cancer patients to surgery. In resource-limited conditions, the standard of care might not be deliverable, but evidence to support alternative management strategies often exists. By revisiting available treatment options, this review provides surgical oncologists with an evidence-based framework for treating patients with gastrointestinal stromal tumor, extremity/truncal soft tissue sarcoma, and retroperitoneal sarcoma to rapidly adapt their decision-making to the constant evolution of the COVID-19 pandemic.
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Affiliation(s)
- Dario Callegaro
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Emily Z Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Teresa Kim
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | | | - Javier Martin-Broto
- Medical Oncology Department in University Hospital Virgen del Rocio and Institute of Biomedicine of Sevilla (IBIS) (HUVR, CSIC), University of Sevilla, Sevilla, Spain
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Carol Swallow
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Rebecca Gladdy
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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31
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de Sande González LM, Martin-Broto J, Kasper B, Blay JY, Le Cesne A. Real-world evidence of the efficacy and tolerability of trabectedin in patients with advanced soft-tissue sarcoma. Expert Rev Anticancer Ther 2020; 20:957-963. [PMID: 32930637 DOI: 10.1080/14737140.2020.1822744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The efficacy and tolerability of trabectedin in patients with soft tissue sarcoma (STS) have been confirmed by various clinical studies involving lipo- and leiomyosarcomas as well as many other subtypes including translocation-related sarcomas. These data have been obtained from randomized phase II and III clinical trials. Studies in real-world clinical practice are necessary to bridge the efficacy-effectiveness gap and complete the body of evidence. Furthermore, reinforcing clinical experience with data from routine clinical practice allows drug management to be optimized and clinical benefits to be maximized. AREAS COVERED The present review provides the most significant data on the efficacy of trabectedin in real-world studies, and the interpretation of real-world experience with trabectedin, in patients with advanced STS. EXPERT OPINION Trabectedin has demonstrated durable disease control and an adequate safety profile, indicating it to be a suitable long-term treatment drug associated with a good quality of life. Personalized strategies and individualized objectives are the way forward in the management of STS.
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Affiliation(s)
| | - Javier Martin-Broto
- MUsculoSkeletal Tumor Board of Excellence Sevilla (MUSTBE SEVILLA), Virgen del Rocío University Hospital , Sevilla, Spain
| | - Bernd Kasper
- Sarcoma Unit, Interdisciplinary Tumor Center Mannheim, University Medical Center, University of Heidelberg, Theodor‑Kutzer‑Ufer , Mannheim, Germany
| | - Jean-Yves Blay
- Medical Oncology Department, Centre Léon Bérard , Lyon, France.,Medical Oncology Department, Université Claude Bernard Lyon I , Lyon, France
| | - Axel Le Cesne
- Medical Oncology Department, Gustave Roussy , Villejuif, France
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32
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Martin‐Broto J, Hindi N, Aguiar S, Badilla‐González R, Castro‐Oliden V, Chacón M, Correa‐Generoso R, de Álava E, Donati DM, Eriksson M, Falla‐Jimenez M, German G, Gobo Silva ML, Gouin F, Gronchi A, Haro‐Varas JC, Jiménez‐Brenes N, Kasper B, Lopes de Mello CA, Maki R, Martínez‐Delgado P, Martínez‐Said H, Martinez‐Tlahuel JL, Morales‐Pérez JM, Muñoz‐Casares FC, Nakagawa SA, Ortiz‐Cruz EJ, Palmerini E, Patel S, Moura DS, Stacchiotti S, Sunyach MP, Valverde CM, Waisberg F, Blay J. Sarcoma European and Latin American Network (SELNET) Recommendations on Prioritization in Sarcoma Care During the COVID-19 Pandemic. Oncologist 2020; 25:e1562-e1573. [PMID: 32888360 PMCID: PMC7543334 DOI: 10.1634/theoncologist.2020-0516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/14/2020] [Indexed: 01/12/2023] Open
Abstract
Background The COVID‐19 outbreak has resulted in collision between patients infected with SARS‐CoV‐2 and those with cancer on different fronts. Patients with cancer have been impacted by deferral, modification, and even cessation of therapy. Adaptive measures to minimize hospital exposure, following the precautionary principle, have been proposed for cancer care during COVID‐19 era. We present here a consensus on prioritizing recommendations across the continuum of sarcoma patient care. Material and Methods A total of 125 recommendations were proposed in soft‐tissue, bone, and visceral sarcoma care. Recommendations were assigned as higher or lower priority if they cannot or can be postponed at least 2–3 months, respectively. The consensus level for each recommendation was classified as “strongly recommended” (SR) if more than 90% of experts agreed, “recommended” (R) if 75%–90% of experts agreed and “no consensus” (NC) if fewer than 75% agreed. Sarcoma experts from 11 countries within the Sarcoma European‐Latin American Network (SELNET) consortium participated, including countries in the Americas and Europe. The European Society for Medical Oncology‐Magnitude of clinical benefit scale was applied to systemic‐treatment recommendations to support prioritization. Results There were 80 SRs, 35 Rs, and 10 NCs among the 125 recommendations issued and completed by 31 multidisciplinary sarcoma experts. The consensus was higher among the 75 higher‐priority recommendations (85%, 12%, and 3% for SR, R, and NC, respectively) than in the 50 lower‐priority recommendations (32%, 52%, and 16% for SR, R, and NC, respectively). Conclusion The consensus on 115 of 125 recommendations indicates a high‐level of convergence among experts. The SELNET consensus provides a tool for sarcoma multidisciplinary treatment committees during the COVID‐19 outbreak. Implications for Practice The Sarcoma European‐Latin American Network (SELNET) consensus on sarcoma prioritization care during the COVID‐19 era issued 125 pragmatical recommendations distributed as higher or lower priority to protect critical decisions on sarcoma care during the COVID‐19 pandemic. A multidisciplinary team from 11 countries reached consensus on 115 recommendations. The consensus was lower among lower‐priority recommendations, which shows reticence to postpone actions even in indolent tumors. The European Society for Medical Oncology‐Magnitude of Clinical Benefit scale was applied as support for prioritizing systemic treatment. Consensus on 115 of 125 recommendations indicates a high level of convergence among experts. The SELNET consensus provides a practice tool for guidance in the decisions of sarcoma multidisciplinary treatment committees during the COVID‐19 outbreak. The COVID‐19 pandemic has caused deferral, modification, or cessation of treatment for patients with cancer. This article presents a consensus on prioritizing recommendations across the continuum of sarcoma patient care.
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Affiliation(s)
- Javier Martin‐Broto
- Group of Advanced Therapies and Biomarkers in Sarcoma, Institute of Biomedicine of Seville (IBIS, HUVR, CSIC, Universidad de Sevilla)SevillaSpain
- Department of Medical Oncology, University Hospital Virgen del RocioSevilleSpain
| | - Nadia Hindi
- Group of Advanced Therapies and Biomarkers in Sarcoma, Institute of Biomedicine of Seville (IBIS, HUVR, CSIC, Universidad de Sevilla)SevillaSpain
- Department of Medical Oncology, University Hospital Virgen del RocioSevilleSpain
| | - Samuel Aguiar
- Department of Pelvic Surgery, A.C. Camargo Cancer CenterSão PauloBrazil
| | | | - Victor Castro‐Oliden
- Department of Medical Oncology, Instituto Nacional de Enfermedades NeoplásicasLimaPeru
| | - Matias Chacón
- Department of Medical Oncology, Alexander Fleming Cancer InstituteBuenos AiresArgentina
| | | | - Enrique de Álava
- Pathology Department, University Hospital Virgen del RocíoSevilleSpain
- CIBERONCMadridSpain
- Department of Normal and Pathological Cytology and Histology, School of Medicine, University of SevilleSevilleSpain
| | - Davide María Donati
- Unit of Orthopedic Pathology and Osteoarticular Tissue Regeneration, Rizzoli Orthopedic InstituteBolognaItaly
| | - Mikael Eriksson
- Department of Medical Oncology, Skane University Hospital‐LundLundSweden
| | - Martin Falla‐Jimenez
- Department of Breast and Soft Tissues Surgery, Instituto Nacional de Enfermedades NeoplásicasLimaPeru
| | - Gisela German
- Department of Medical Oncology, Hospital Oncológico ProvincialCórdobaArgentina
| | | | - Francois Gouin
- Department of Orthopedic Surgery, Centre León BérardLyonFrance
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori and University of MilanMilanItaly
| | | | | | - Bernd Kasper
- Department of Medical Oncology, Mannheim University Medical CenterMannheimGermany
| | | | - Robert Maki
- Department of Medical Oncology, Abramson Cancer Center, University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Paula Martínez‐Delgado
- Group of Advanced Therapies and Biomarkers in Sarcoma, Institute of Biomedicine of Seville (IBIS, HUVR, CSIC, Universidad de Sevilla)SevillaSpain
| | - Hector Martínez‐Said
- Department of Medical Oncology, Instituto Nacional de CancerologíaMexico CityMexico
| | | | | | | | - Suely A. Nakagawa
- Department of Orthopedics, A.C. Camargo Cancer CenterSão PauloBrazil
| | | | - Emanuela Palmerini
- Department of Medical Oncology, Rizzoli Orthopedic InstituteBolognaItaly
| | - Shreyaskumar Patel
- Department of Melanoma Medical Oncology, University of Texas M. D. Anderson Cancer CenterHoustonTexasUSA
| | - David S. Moura
- Group of Advanced Therapies and Biomarkers in Sarcoma, Institute of Biomedicine of Seville (IBIS, HUVR, CSIC, Universidad de Sevilla)SevillaSpain
| | - Silvia Stacchiotti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori and University of MilanMilanItaly
| | | | | | - Federico Waisberg
- Department of Medical Oncology, Alexander Fleming Cancer InstituteBuenos AiresArgentina
| | - Jean‐Yves Blay
- Department of Medical Oncology, Centre León BérardLyonFrance
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33
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Blay JY, Bonvalot S, Gouin F, Le Cesne A, Penel N. Criteria for reference centers for sarcomas: volume but also long-term multidisciplinary organisation. Ann Oncol 2019; 30:2008-2009. [PMID: 31584607 DOI: 10.1093/annonc/mdz408] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Affiliation(s)
- J-Y Blay
- Department of Medicine, Centre Leon Berard, Lyon.
| | - S Bonvalot
- Department of Surgery, Institut Curie, Paris
| | - F Gouin
- Department of Surgery, Centre Leon Berard, Lyon
| | - A Le Cesne
- Department of Medicine, Institut Gustave Roussy, Villejuif
| | - N Penel
- Department of Medicine, Centre Oscar Lambret, Lille, France
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34
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Martin-Broto J, Hindi N, Moura DS. Which goals should we pursue in each line of treatment for advanced soft tissue sarcoma? Future Oncol 2019; 15:17-23. [DOI: 10.2217/fon-2019-0490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Treatment goals for advanced soft tissue sarcoma (STS) vary according to disease stage and treatment line. In potentially resectable advanced disease, the goal of treatment is tumor shrinkage to facilitate surgical resection with better margins. Doxorubicin in combination with ifosfamide (or dacarbazine) is first-line therapy of choice in this setting. Tumor shrinkage is relevant not only for surgical rescue but also to obtain rapid symptomatic relief related to tumor volume. Doxorubicin monotherapy can be selected as first-line therapy in cases where disease control with less morbidity is the objective. Second-line therapy for metastatic disease generally aims for disease stabilization with good quality of life although, in some palliative or potentially resectable cases, tumor shrinkage may be relevant. To date, treatment aim has not been a critical factor in the design of clinical trials in advanced STS. In clinical practice, however, treatment is selected according to aim. Future clinical trials in patients with advanced STS should take treatment goals into account. Using illustrative case studies, evidence is examined which supports the current approach to treatment of advanced STS.
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Affiliation(s)
- Javier Martin-Broto
- Department of Medical Oncology, Virgen del Rocio University Hospital, Sevilla, Spain
- Institute of Biomedicine of Sevilla (IBIS, HUVR, CSIC, Universidad de Sevilla), Sevilla, Spain
| | - Nadia Hindi
- Department of Medical Oncology, Virgen del Rocio University Hospital, Sevilla, Spain
- Institute of Biomedicine of Sevilla (IBIS, HUVR, CSIC, Universidad de Sevilla), Sevilla, Spain
| | - David S Moura
- Institute of Biomedicine of Sevilla (IBIS, HUVR, CSIC, Universidad de Sevilla), Sevilla, Spain
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35
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Blay JY, Honoré C, Stoeckle E, Meeus P, Jafari M, Gouin F, Anract P, Ferron G, Rochwerger A, Ropars M, Carrere S, Marchal F, Sirveaux F, Di Marco A, Le Nail LR, Guiramand J, Vaz G, Machiavello JC, Marco O, Causeret S, Gimbergues P, Fiorenza F, Chaigneau L, Guillemin F, Guilloit JM, Dujardin F, Spano JP, Ruzic JC, Michot A, Soibinet P, Bompas E, Chevreau C, Duffaud F, Rios M, Perrin C, Firmin N, Bertucci F, Le Pechoux C, Le Loarer F, Collard O, Karanian-Philippe M, Brahmi M, Dufresne A, Dupré A, Ducimetière F, Giraud A, Pérol D, Toulmonde M, Ray-Coquard I, Italiano A, Le Cesne A, Penel N, Bonvalot S. Surgery in reference centers improves survival of sarcoma patients: a nationwide study. Ann Oncol 2019; 30:1143-1153. [PMID: 31081028 PMCID: PMC6637376 DOI: 10.1093/annonc/mdz124] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND NETSARC (netsarc.org) is a network of 26 sarcoma reference centers with specialized multidisciplinary tumor boards (MDTB) aiming to improve the outcome of sarcoma patients. Since 2010, presentation to an MDTB and expert pathological review are mandatory for sarcoma patients nationwide. In the present work, the impact of surgery in a reference center on the survival of sarcoma patients investigated using this national NETSARC registry. PATIENTS AND METHODS Patients' characteristics and follow-up are prospectively collected and data monitored. Descriptive, uni- and multivariate analysis of prognostic factors were conducted in the entire series (N = 35 784) and in the subgroup of incident patient population (N = 29 497). RESULTS Among the 35 784 patients, 155 different histological subtypes were reported. 4310 (11.6%) patients were metastatic at diagnosis. Previous cancer, previous radiotherapy, neurofibromatosis type 1 (NF1), and Li-Fraumeni syndrome were reported in 12.5%, 3.6%, 0.7%, and 0.1% of patients respectively. Among the 29 497 incident patients, 25 851 (87.6%) patients had surgical removal of the sarcoma, including 9949 (33.7%) operated in a NETSARC center. Location, grade, age, size, depth, histotypes, gender, NF1, and surgery outside a NETSARC center all correlated to overall survival (OS), local relapse free survival (LRFS), and event-free survival (EFS) in the incident patient population. NF1 history was one of the strongest adverse prognostic factors for LRFS, EFS, and OS. Presentation to an MDTB was associated with an improved LRFS and EFS, but was an adverse prognostic factor for OS if surgery was not carried out in a reference center. In multivariate analysis, surgery in a NETSARC center was positively correlated with LRFS, EFS, and OS [P < 0.001 for all, with a hazard ratio of 0.681 (95% CI 0.618-0.749) for OS]. CONCLUSION This nationwide registry of sarcoma patients shows that surgical treatment in a reference center reduces the risk of relapse and death.
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Affiliation(s)
- J-Y Blay
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth.
| | - C Honoré
- Department of Medical Oncology and Department of Surgical Oncology, Gustave Roussy Cancer Campus-Surgery, Villejuif
| | - E Stoeckle
- Department of Medical Oncology and Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - P Meeus
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - M Jafari
- Department of Medical Oncology and Department of Surgical Oncology, Centre Oscar Lambret, Lille; Department of Surgical Oncology, CHU, Lille
| | - F Gouin
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth; Department of Medical Oncology and Department of Surgical Oncology, Institut de Cancerologie Nantes, Nantes; Department of Orthopedics, CHU Nantes, Nantes
| | - P Anract
- Department of Orthopedics, Hôpital Cochin-Saint-Vincent de Paul, Paris
| | - G Ferron
- Department of Medical Oncology and Department of Surgical Oncology, Institut Universitaire de Cancerologie de Toulouse, Claudius Regaud, Toulouse
| | - A Rochwerger
- Department of Medical Oncology and Department of Orthopedics, La Timone University Hospital, Marseille
| | - M Ropars
- Medical Oncology Department, Eugene Marquis Comprehensive Cancer Center, Rennes; Department of Orthopedics, CHU, Rennes
| | - S Carrere
- Medical Oncology Department, Institut de Cancérologie de Montpellier, Montpellier
| | - F Marchal
- Department of Medical Oncology and Department of Surgical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - F Sirveaux
- Department of Medical Oncology and Department of Surgical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - A Di Marco
- Department of Surgical Oncology and Department of Medical Oncology, Centre Paul Strauss & CHU Strasbourg, Hôpitaux Universitaires de Strasbourg, Strasbourg
| | - L R Le Nail
- Department of Orthopedics, CHU de Tours, Tours
| | - J Guiramand
- Department of Medical Oncology and Department of Surgical Oncology, Institut Paoli Calmettes, Marseille
| | - G Vaz
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - J-C Machiavello
- Department of Medical Oncology and Department of Surgical Oncology, Centre Antoine-Lacassagne, Nice
| | - O Marco
- Oncology Unit, Saint Louis Hospital, Paris
| | - S Causeret
- Department of Surgery, Centre Georges François Leclerc, Dijon
| | - P Gimbergues
- Department of Surgery, Centre Jean Perrin/ERTICa EA, Clermont-Ferrand
| | - F Fiorenza
- Department of Medical Oncology and Department of Surgical Oncology, CHU Limoges, Limoges
| | - L Chaigneau
- Medical Oncology Department, CHU Besancon, Besançon
| | - F Guillemin
- Department of Medical Oncology and Department of Surgical Oncology, Institut J Godinot Reims
| | - J-M Guilloit
- Department of Surgical Oncology, Centre Francois Baclesse, Caen
| | - F Dujardin
- Department of Surgery, Centre Henri Becquerel, Rouen
| | - J-P Spano
- Medical Oncology Department, APHP La Pitié Salpetriere/Tenon/Bicetre, Paris
| | - J-C Ruzic
- Medical Oncology Department, CHU La Réunion, Saint-Pierre, La Réunion
| | - A Michot
- Department of Medical Oncology and Department of Surgical Oncology, Gustave Roussy Cancer Campus-Surgery, Villejuif
| | - P Soibinet
- Department of Medical Oncology and Department of Surgical Oncology, Institut J Godinot Reims
| | - E Bompas
- Department of Medical Oncology and Department of Surgical Oncology, Institut de Cancerologie Nantes, Nantes; Department of Orthopedics, CHU Nantes, Nantes
| | - C Chevreau
- Department of Medical Oncology and Department of Surgical Oncology, Institut Universitaire de Cancerologie de Toulouse, Claudius Regaud, Toulouse
| | - F Duffaud
- Department of Medical Oncology and Department of Orthopedics, La Timone University Hospital, Marseille
| | - M Rios
- Medical Oncology Department, Eugene Marquis Comprehensive Cancer Center, Rennes; Department of Orthopedics, CHU, Rennes
| | - C Perrin
- Medical Oncology Department, Eugene Marquis Comprehensive Cancer Center, Rennes; Department of Orthopedics, CHU, Rennes
| | - N Firmin
- Medical Oncology Department, Institut de Cancérologie de Montpellier, Montpellier
| | - F Bertucci
- Department of Medical Oncology and Department of Surgical Oncology, Institut Paoli Calmettes, Marseille
| | - C Le Pechoux
- Department of Medical Oncology and Department of Surgical Oncology, Gustave Roussy Cancer Campus-Surgery, Villejuif
| | - F Le Loarer
- Department of Medical Oncology and Department of Surgical Oncology, Gustave Roussy Cancer Campus-Surgery, Villejuif
| | - O Collard
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - M Karanian-Philippe
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - M Brahmi
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - A Dufresne
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - A Dupré
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - F Ducimetière
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - A Giraud
- Department of Orthopedics, Hôpital Cochin-Saint-Vincent de Paul, Paris
| | - D Pérol
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - M Toulmonde
- Department of Medical Oncology and Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - I Ray-Coquard
- Department of Medical Oncology and Department of Surgical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon; Institut de Cancerologie L. Neuwirth
| | - A Italiano
- Department of Medical Oncology and Department of Surgical Oncology, Institut Bergonié, Bordeaux
| | - A Le Cesne
- Department of Medical Oncology and Department of Surgical Oncology, Gustave Roussy Cancer Campus-Surgery, Villejuif
| | - N Penel
- Department of Medical Oncology and Department of Surgical Oncology, Centre Oscar Lambret, Lille; Department of Surgical Oncology, CHU, Lille
| | - S Bonvalot
- Surgery Department, Institut Curie, Paris, France
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36
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Martin-Broto J, Hindi N. In Reply. Oncologist 2019; 24:e401-e402. [PMID: 30846512 DOI: 10.1634/theoncologist.2019-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 01/28/2019] [Indexed: 11/17/2022] Open
Abstract
Authors of the recently published article from the Spanish Group for Research in Sarcoma respond to comments on the results of their study.
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Affiliation(s)
- Javier Martin-Broto
- Biomedicine Institute of Seville (IBIS), Medical Oncology Department, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Nadia Hindi
- Biomedicine Institute of Seville (IBIS), Medical Oncology Department, Virgen del Rocio University Hospital, Sevilla, Spain
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37
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Valenti V. Hospital Volume Versus Good Clinical Practice. Oncologist 2019; 24:e400. [PMID: 30819786 DOI: 10.1634/theoncologist.2019-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/29/2019] [Indexed: 11/17/2022] Open
Abstract
This letter to the editor comments on a recently published article that assessed the treatment of patients with soft tissue sarcoma in high‐volume versus low‐volume centers.
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