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Zhou C, Qian G, Wang Y, Li H, Shen Z, Zheng S. Safety and efficacy of fruquintinib-based therapy in patients with advanced or metastatic sarcoma. Cancer Med 2024; 13:e7438. [PMID: 38967496 PMCID: PMC11225144 DOI: 10.1002/cam4.7438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 06/02/2024] [Accepted: 06/18/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the efficacy and safety of fruquintinib-based therapy as a salvage therapy for patients with advanced or metastatic sarcoma, including soft tissue sarcoma (STS) and bone sarcoma. METHODS Patients with advanced or metastatic sarcoma were divided into two groups. One group received fruquintinib monotherapy, while the other received fruquintinib combined therapy. Safety and efficacy of fruquintinib-based therapy were recorded and reviewed retrospectively, including progression-free survival (PFS), overall response rate (ORR), and adverse events (AEs). RESULTS Between August 2021 and December 2022, 38 sarcoma patients were retrospectively included. A total of 14 patients received fruquintinib alone (including 6 STS and 8 bone sarcoma), while 24 were treated with fruquintinib combined therapy (including 2 STS and 22 bone sarcoma). The median follow-up was 10.2 months (95% CI, 6.4-11.5). For the entire population, the median PFS was 8.0 months (95% CI, 5.5-13.0). The ORR was 13.1%, while the disease control rate (DCR) was 86.8%. The univariate analysis showed that radiotherapy history (HR, 4.56; 95% CI, 1.70-12.24; p = 0.003), bone sarcoma (HR, 0.34; 95% CI, 0.14-0.87; p = 0.024), and treatment method of fruquintinib (HR, 0.36; 95% CI, 0.15-0.85; p = 0.021) were significantly associated with PFS. The multivariate analysis showed that patients without radiotherapy history were associated with a better PFS (HR, 3.71; 95% CI: 1.31-10.55; p = 0.014) than patients with radiotherapy history. Patients in combination group reported pneumothorax (8.3%), leukopenia (33.3%), thrombocytopenia (12.5%), diarrhea (4.2%), and anemia (4.2%) as the most frequent grade 3 or higher treatment-emergent AEs (TEAEs), while there was no severe TEAEs occurred in the monotherapy group. CONCLUSIONS Fruquintinib-based therapy displayed an optimal tumor control and an acceptable safety profile in patients with advanced or metastatic sarcoma.
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Affiliation(s)
- Chenliang Zhou
- Department of OncologyShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Guowei Qian
- Department of OncologyShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yonggang Wang
- Department of OncologyShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Hongtao Li
- Department of OncologyShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zan Shen
- Department of OncologyShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Shuier Zheng
- Department of OncologyShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
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Lee MJ, Lee MW, Joo DC, Hong SM, Baek DH, Lee BE, Kim GH, Song GA. Effective Endoscopic Submucosal Dissection of a Huge Esophageal Liposarcoma: A Case Report. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2024; 83:243-246. [PMID: 38918037 DOI: 10.4166/kjg.2024.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/28/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024]
Abstract
This case report presents the successful endoscopic submucosal dissection (ESD) of a well-differentiated esophageal liposarcoma in a 51-year-old male with persistent dysphagia. The cause was initially diagnosed as a 10 cm pedunculated lesion extending from the upper esophageal sphincter to the mid-esophagus. An ESD was chosen over traditional surgery because it is less invasive. The procedure involved a precise submucosal injection and excision with special techniques to manage bleeding from a central vessel. Despite the extraction challenges owing to the size of the lesion, it was successfully removed orally. A histopathological examination of the 8.3×4.2×2.3 cm specimen revealed the characteristic features of a well-differentiated liposarcoma, including MDM2 and CDK4 positivity. The follow-up revealed no recurrence, and active surveillance has been performed since. This report highlights the versatility of ESD in treating significant esophageal tumors and provides evidence for its efficacy as a minimally invasive alternative.
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Affiliation(s)
- Myeong Jin Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Moon Won Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dong Chan Joo
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Seung Min Hong
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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3
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Mangla A. Should Neoadjuvant Treatment Be Adopted More Widely for Patients With Extremity Soft Tissue Sarcoma in Low-Income Countries? JCO Glob Oncol 2023; 9:e2300110. [PMID: 37441745 PMCID: PMC10581658 DOI: 10.1200/go.23.00110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 07/15/2023] Open
Affiliation(s)
- Ankit Mangla
- Ankit Mangla, MD, University Hospitals Seidman Cancer Center, Cleveland, OH, Case Western Reserve University School of Medicine, Cleveland, OH, Case Comprehensive Cancer Center, Cleveland, OH
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4
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Bazzocchi A, Guglielmi G, Aparisi Gómez MP. Sarcoma Imaging Surveillance. Magn Reson Imaging Clin N Am 2023; 31:193-214. [PMID: 37019546 DOI: 10.1016/j.mric.2023.01.004] [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: 03/06/2023]
Abstract
Soft tissue sarcomas (STS) are a heterogeneous group of solid tumors. There are many histologic subtypes. The prognosis after treatment may be estimated by the analysis of the type of tumor, grade, depth, size at diagnosis, and age of the patient. These type of sarcomas most commonly metastasize to the lungs and may have a relatively high rate of local recurrence, depending on the histologic type and surgical margins. Patients with recurrence have a poorer prognosis. The surveillance of patients with STS is therefore extremely important. This review analyzes the role of MR imaging and US in detecting local recurrence.
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Affiliation(s)
- Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy.
| | - Giuseppe Guglielmi
- Department of Radiology, Hospital San Giovanni Rotondo, Italy; Department of Radiology, University of Foggia, Viale Luigi Pinto 1, Foggia 71100, Italy
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand; Department of Radiology, IMSKE, Calle Suiza, 11, Valencia 46024, Spain
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5
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Traweek RS, Martin AN, Rajkot NF, Guadagnolo BA, Bishop AJ, Lazar AJ, Keung EZ, Torres KE, Hunt KK, Feig BW, Roland CL, Scally CP. Re-excision After Unplanned Excision of Soft Tissue Sarcoma is Associated with High Morbidity and Limited Pathologic Identification of Residual Disease. Ann Surg Oncol 2023; 30:480-489. [PMID: 36085392 DOI: 10.1245/s10434-022-12359-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/11/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with unplanned excision (UPE) of trunk and extremity soft tissue sarcoma (STS) present a significant management challenge for sarcoma specialists. Oncologic re-resection has been considered standard practice after UPE with positive or uncertain margins. A strategy of active surveillance or "watch and wait" has been suggested as a safe alternative to routine re-excision. In this context, the current study sought to evaluate short-term outcomes and morbidity after re-resection to better understand the risks and benefits of this treatment strategy. METHODS A retrospective, single-institution study reviewed patients undergoing oncologic re-resection after UPE of an STS during a 5-year period (2015-2020), excluding those with evidence of gross residual disease. Short-term clinical outcomes were evaluated together with final pathologic findings. RESULTS The review identified 67 patients undergoing re-resection after UPE of an STS. Of these 67 patients, 45 (67%) were treated with a combination of external beam radiation therapy (EBRT) and surgery. Plastic surgery was involved for reconstruction in 49 cases (73%). The rate of wound complications after re-resection was 45 % (n = 30), with 15 % (n = 10) of the patients experiencing a major wound complication. Radiation therapy and plastic surgery involvement were independently associated with wound complications. Notably, 45 patients (67%) had no evidence of residual disease in the re-resection specimen, whereas 13 patients (19 %) had microscopic disease, and 9 patients (13%) had indeterminate pathology. CONCLUSION Given the morbidity of re-resection and limited identification of residual disease, treatment plans and discussions with patients should outline the expected pathologic findings and morbidity of surgery.
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Affiliation(s)
- Raymond S Traweek
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Allison N Martin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nikita F Rajkot
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - B Ashleigh Guadagnolo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Andrew J Bishop
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexander J Lazar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Emily Z Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Keila E Torres
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kelly K Hunt
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Barry W Feig
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christina L Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christopher P Scally
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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Okura T, Shirakawa Y, Katsura Y, Yano T, Ishida M, Satoh D, Choda Y, Yoshimitsu M, Kanyu N, Matsukawa H, Idani H, Okajima M, Shiozaki S. Giant esophageal liposarcoma with squamous cell carcinoma resected via the cervical approach: a case report. Surg Case Rep 2022; 8:118. [PMID: 35723761 PMCID: PMC9209544 DOI: 10.1186/s40792-022-01473-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background Liposarcoma is one of the most common soft tissue sarcomas, but is extremely rarely found in the esophagus. There have been no reports of esophageal liposarcoma together with superficial carcinoma of the esophagus. Here, we report a patient who underwent complete resection of esophageal liposarcoma with carcinoma via a cervical approach. Case presentation A 66-year-old man was diagnosed with an esophageal tumor 11 years ago, but he left it untreated. He presented to our hospital with progressive dysphagia and appetite loss since the previous year. Esophagogastroduodenoscopy (EGD) showed a large pedunculated submucosal tumor (SMT) originating at the esophageal entrance, extending to the gastroesophageal junction. Additionally, there was a superficial carcinoma on the surface of the SMT, 30 cm from the incisor teeth. Three-dimensional computed tomography (3D-CT) showed a giant elongated intraluminal tumor extending downwards from the cervical esophagus. We diagnosed a giant esophageal polyp accompanied by a superficial carcinoma and performed tumor resection via a cervical approach. The excised specimen consisted of a 23.0 × 8.5 cm polypoid mass. The final diagnosis by histopathological and immunohistochemical examination was well-differentiated liposarcoma and esophageal squamous cell carcinoma. He was discharged on postoperative day 14 with drastic improvement in his swallowing ability. Conclusion We reported an extremely rare case of esophageal liposarcoma together with esophageal squamous cell carcinoma that was successfully resected through a small cervical incision.
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Stanborough R, Demertzis JL, Wessell DE, Lenchik L, Ahlawat S, Baker JC, Banks J, Caracciolo JT, Garner HW, Hentz C, Lewis VO, Lu Y, Maynard JR, Pierce JL, Scott JA, Sharma A, Beaman FD. ACR Appropriateness Criteria® Malignant or Aggressive Primary Musculoskeletal Tumor-Staging and Surveillance: 2022 Update. J Am Coll Radiol 2022; 19:S374-S389. [PMID: 36436964 DOI: 10.1016/j.jacr.2022.09.015] [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: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Malignant or aggressive primary musculoskeletal tumors are rare and encompass a wide variety of bone and soft tissue tumors. Given the most common site for metastasis from these primary musculoskeletal tumors is to the lung, chest imaging is integral in both staging and surveillance. Extrapulmonary metastases are rarely encountered with only a few exceptions. Following primary tumor resection, surveillance of the primary tumor site is generally recommended. Local surveillance imaging recommendations differ between primary tumors of bone origin versus soft tissue origin. This document consolidates the current evidence and expert opinion for the imaging staging and surveillance of these tumors into five clinical scenarios. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Jennifer L Demertzis
- Diagnostic Imaging Associates, Chesterfield, Missouri; Partner, ProSight Radiology.
| | | | - Leon Lenchik
- Panel Vice-Chair, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Shivani Ahlawat
- The Johns Hopkins University School of Medicine, Baltimore, Maryland; member
| | - Jonathan C Baker
- MSK Imaging and Interventions Fellowship Director, Mallinckrodt Institute of Radiology Washington University School of Medicine, Saint Louis, Missouri
| | - James Banks
- Nova Southeastern University, Fort Lauderdale, Florida; FRS 2023 Program Chair; ACR alternate counselor from Florida; MSK Section Chair for group; Medical student radiology rotation clerkship director for HCA Florida Aventura and Kendall Hospitals
| | - Jamie T Caracciolo
- Section Head, MSK Imaging, Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, Florida; MSK-RADS (Bone) Committee; Chairman
| | - Hillary W Garner
- Mayo Clinic Florida, Jacksonville, Florida; Committee Chair, Society of Skeletal Radiology and International Skeletal Society
| | - Courtney Hentz
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois; Commission on Radiation Oncology
| | - Valerae O Lewis
- University of Texas Health Science Center, Houston, Texas; American Academy of Orthopaedic Surgeons; Chair, Department of Orthopaedic Surgery
| | - Yi Lu
- Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts; American Association of Neurological Surgeons/Congress of Neurological Surgeons; Director, Neurosurgical Trauma; Codirector, Spinal Deformity and Scoliosis Surgery Brigham and Women's Hospital; Cochair, Spinal Cord Injury Section, North American Spine Society; Chair, Payor Response
| | - Jennifer R Maynard
- Mayo Clinic Florida, Jacksonville, Florida; Primary care physician; Jacksonville Sports Medicine Program, Chair of the Governing Board; Program Director Sports Medicine Fellowship, Mayo Clinic Florida
| | - Jennifer L Pierce
- University of Virginia, Charlottesville, Virginia; Associate Division Chair, Musculoskeletal Radiology, University of Virginia; Radiology Residency Global Health Leadership Track Program Director, University of Virginia
| | - Jinel A Scott
- Chief Quality Officer, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Akash Sharma
- Mayo Clinic, Jacksonville, Florida; Commission on Nuclear Medicine and Molecular Imaging; Chair, Research Committee, Radiology, Mayo Clinic Florida; Chair, PET-MRI Workgroup, Mayo Clinic Florida
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Yanar F, Öner G, Yüksel S, Salduz A, Azamat İF, Özçınar B, Bilgic B, Günöz Cömert R, Kozanoğlu E, Kurtoğlu M. Femoral artery aneurysm developed on intimal sarcoma: Case report. Turk J Surg 2022; 38:306-311. [PMID: 36846070 PMCID: PMC9948668 DOI: 10.47717/turkjsurg.2022.4381] [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: 10/11/2020] [Accepted: 05/05/2020] [Indexed: 12/24/2022]
Abstract
Intimal angiosarcoma is a rare vascular malignancy, and diagnosis is very difficult due to nonspecific symptoms. There are controversial points regarding the diagnosis, treatment and follow-up of intimal angiosarcomas. The purpose of this case report was to evaluate the diagnosis and treatment process of a patient diagnosed with femoral artery intimal angiosarcoma. Furthermore, in line with previous studies, it was aimed to illuminate controversial points. A 33-year-old male patient, who had been operated on due to ruptured femoral artery aneurysm, was diagnosed with intimal angiosarcoma with the pathology result. Recurrence was observed during clinical follow-up, and the patient was treated with chemotherapy and radiotherapy. Since there was no response to treatment, the patient underwent aggressive surgery including the surrounding tissues. No recurrence or metastasis was observed in the patient's 10th month follow-up. Although intimal angiosarcoma is rare, it should be considered in differential diagnosis when femoral artery aneurysm is detected. The most important step in treatment is aggressive surgery, but adding chemo-radiotherapy to the treatment should be considered.
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Affiliation(s)
- Fatih Yanar
- Department of General Surgery, İstanbul University Faculty of Medicine, İstanbul, Türkiye
| | - Gizem Öner
- Multidisciplinary Oncologic Centre (MOCA), Antwerpen University Hospital, Antwerpen, Belgium
| | - Sercan Yüksel
- Department of General Surgery, İstanbul University Faculty of Medicine, İstanbul, Türkiye
| | - Ahmet Salduz
- Department of Orthopaedic Surgery and Traumatology, İstanbul University Faculty of Medicine, İstanbul, Türkiye
| | - İbrahim Fethi Azamat
- Department of General Surgery, İstanbul University Faculty of Medicine, İstanbul, Türkiye
| | - Beyza Özçınar
- Department of General Surgery, İstanbul University Faculty of Medicine, İstanbul, Türkiye
| | - Bilge Bilgic
- Department of Pathology, İstanbul University Faculty of Medicine, İstanbul, Türkiye
| | - Rana Günöz Cömert
- Department of Radiology, İstanbul University Faculty of Medicine, İstanbul, Türkiye
| | - Erol Kozanoğlu
- Department of Plastic and Reconstructive Surgery, İstanbul University Faculty of Medicine, İstanbul, Türkiye
| | - Mehmet Kurtoğlu
- Department of General Surgery, İstanbul University Faculty of Medicine, İstanbul, Türkiye
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9
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Brügemann D, Lehner B, Kieser M, Krisam J, Hommertgen A, Jaekel C, Harrabi SB, Herfarth K, Mechtesheimer G, Sedlaczek O, Egerer G, Geisbüsch A, Uhl M, Debus J, Seidensaal K. Neoadjuvant irradiation of extremity soft tissue sarcoma with ions (Extrem-ion): study protocol for a randomized phase II pilot trial. BMC Cancer 2022; 22:538. [PMID: 35550036 PMCID: PMC9097299 DOI: 10.1186/s12885-022-09560-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The standard of care treatment for soft tissue sarcoma of the extremities is a wide resection in combination with pre- or postoperative radiotherapy with high local control rates, sparing patients the necessity of amputation without compromising on overall survival rates. The currently preferred timing of radiotherapy is under debate. Albeit having higher rates of acute wound complications, late side effects like fibrosis, joint stiffness or edema are less frequent in preoperative compared to postoperative radiotherapy. This can be explained in smaller treatment volumes and a lower dose in the preoperative setting. Particles allow better sparing of surrounding tissues at risk, and carbon ions additionally offer biologic advantages and are preferred in less radiosensitive tumors. Hypofractionation allows for a significantly shorter treatment duration. METHODS Extrem-ion is a prospective, randomized, monocentric phase II trial. Patients with resectable or marginally resectable, histologically confirmed soft tissue sarcoma of the extremities will be randomized between neoadjuvant proton or neoadjuvant carbon ion radiotherapy in active scanning beam application technique (39 Gy [relative biological effectiveness, RBE] in 13 fractions [5-6 fractions per week] in each arm). The primary objective is the proportion of therapies without wound healing disorder the first 120 days after surgery or discontinuation of treatment for any reason related to the treatment. The secondary endpoints of the study consist of local control, local progression-free survival, disease-free survival, overall survival, and quality of life. DISCUSSION The aim of this study is to confirm that hypofractionated, preoperative radiotherapy is safe and feasible. The potential for reduced toxicity by the utilization of particle therapy is the rational of this trial. A subsequent randomized phase III trial will compare the hypofractionated proton and carbon ion irradiation in regards to local control. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04946357 ; Retrospectively registered June 30, 2021.
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Affiliation(s)
- D Brügemann
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany
| | - B Lehner
- Center for Orthopedics, Trauma Surgery and Paraplegiology, University of Heidelberg, Heidelberg, Germany
| | - M Kieser
- Institute for Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - J Krisam
- Institute for Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - A Hommertgen
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - C Jaekel
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - S B Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - K Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - G Mechtesheimer
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - O Sedlaczek
- Department of Radiology, University of Heidelberg, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - G Egerer
- Department of Hematology, Oncology and Rheumatology, Heidelberg University, Heidelberg, Germany
| | - A Geisbüsch
- Center for Orthopedics, Trauma Surgery and Paraplegiology, University of Heidelberg, Heidelberg, Germany
| | - M Uhl
- Department of Radiation Oncology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - J Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - K Seidensaal
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.
- National Center for Tumor diseases (NCT), Heidelberg, Germany.
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany.
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10
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Hartley LJ, AlAqeel M, Kurisunkal VJ, Evans S. Outcomes of soft-tissue sarcoma in nonagenarians. Bone Joint J 2022; 104-B:177-182. [PMID: 34969278 DOI: 10.1302/0301-620x.104b1.bjj-2021-0761.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Current literature suggests that survival outcomes and local recurrence rates of primary soft-tissue sarcoma diagnosed in the very elderly age range, (over 90 years), are comparable with those in patients diagnosed under the age of 75 years. Our aim is to quantify these outcomes with a view to rationalizing management and follow-up for very elderly patients. METHODS Retrospective access to our prospectively maintained oncology database yielded a cohort of 48 patients across 23 years with a median follow-up of 12 months (0 to 78) and mean age at diagnosis of 92 years (90 to 99). Overall, 42 of 48 of 48 patients (87.5%) were managed surgically with either limb salvage or amputation. RESULTS A lower overall local recurrence rate (LRR) was seen with primary amputations compared with limb salvage (p > 0.050). The LRR was comparable between free (R0), microscopically (R1), and macroscopically positive (R2) resection margins in the limb salvage group. Amputation was also associated with longer survival times (p < 0.050). Overall median survival time was limited to 20 months (0 to 80). CONCLUSION Early and aggressive treatment with appropriate oncological surgery confers the lowest LRR and a survival advantage versus conservative treatment in this cohort of patients. With limited survival, follow-up can be rationalized on a patient-by-patient basis using alternative means, such as GP, local oncology, and/or patient-led follow-up. Cite this article: Bone Joint J 2022;104-B(1):177-182.
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Affiliation(s)
- Laura J Hartley
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Motaz AlAqeel
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Scott Evans
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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11
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Novikov SN, Gafton GI, Ebert MA, Fedosova EA, Melnik JS, Zinovev GV, Gafton IG, Sinyachkin MS, Kanaev SV. Preoperative stereotactic ablative body radiotherapy with postoperative conventional irradiation of soft tissue sarcomas: Protocol overview with a preliminary safety report. Radiother Oncol 2021; 161:126-131. [PMID: 34089751 DOI: 10.1016/j.radonc.2021.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/14/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022]
Abstract
Preoperative radiotherapy in patients with soft tissue sarcomas is characterized by important advantages: high precision of dose delivery, reduction of tumor volume and implantation potential, induction of immunologic response. Postoperative irradiation is associated with a reduced risk of complication, and a comprehensive radiotherapy planning in accordance with the pathologic report. Combination of pre- and postoperative irradiation gives the opportunity to use the best of both methods. OBJECTIVE To analyze feasibility and safety of radiotherapy protocol that combined pre- and postoperative radiotherapy in patients with soft tissues sarcomas of extremities. MATERIALS AND METHODS From 06.2018 to 01.2021, 23 patients with soft tissue sarcomas of extremities were included in the protocol (NCT04330456) and 14 cases with at least 12 months follow-up were eligible for analysis. Preoperative stereotactic ablative body radiotherapy (SBRT) was performed as 5 fraction of 7 Gy with dose reduction (5 fractions of 5 Gy) on the margins of the tumor. Postoperative radiotherapy started 5-8 weeks after the surgery and was performed as standard compartmental irradiation in 25 fractions of 2 Gy. Complications were determined according to CTCAE and wound complication scales. RESULTS Preoperative SBRT and subsequent radical resection with tumor free surgical margins were performed in all 14 cases. Primary wound closure was mentioned in all patients. Postoperative radiotherapy started 51.8 days (range 33-99 days) days after the surgery. With a relatively short follow-up of 21.5 (13-30) months, we recorded 2 cases (14%) of severe complications (Canadian sarcoma group criteria), and there were no local recurrences. CONCLUSION Our preliminary results demonstrate that the combination of preoperative SBRT and postoperative conventional radiotherapy is feasible and does not increase the risk of postoperative complications.
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Affiliation(s)
- S N Novikov
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology named after N.N. Petrov of the Ministry of Healthcare of the Russian Federation, St. Petersburg, Russia.
| | - G I Gafton
- Department of Surgery №3, N.N. Petrov National Medical Research Center of Oncology named after N.N. Petrov of the Ministry of Healthcare of the Russian Federation, St. Petersburg, Russia.
| | - M A Ebert
- Department of Surgery №3, N.N. Petrov National Medical Research Center of Oncology named after N.N. Petrov of the Ministry of Healthcare of the Russian Federation, St. Petersburg, Russia
| | - E A Fedosova
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology named after N.N. Petrov of the Ministry of Healthcare of the Russian Federation, St. Petersburg, Russia.
| | - J S Melnik
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology named after N.N. Petrov of the Ministry of Healthcare of the Russian Federation, St. Petersburg, Russia
| | - G V Zinovev
- Department of Surgery №3, N.N. Petrov National Medical Research Center of Oncology named after N.N. Petrov of the Ministry of Healthcare of the Russian Federation, St. Petersburg, Russia
| | - I G Gafton
- Department of Surgery №3, N.N. Petrov National Medical Research Center of Oncology named after N.N. Petrov of the Ministry of Healthcare of the Russian Federation, St. Petersburg, Russia.
| | - M S Sinyachkin
- Department of Surgery №3, N.N. Petrov National Medical Research Center of Oncology named after N.N. Petrov of the Ministry of Healthcare of the Russian Federation, St. Petersburg, Russia.
| | - S V Kanaev
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology named after N.N. Petrov of the Ministry of Healthcare of the Russian Federation, St. Petersburg, Russia.
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12
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Noebauer-Huhmann IM, Chaudhary SR, Papakonstantinou O, Panotopoulos J, Weber MA, Lalam RK, Albtoush OM, Fueger BJ, Szomolanyi P, Grieser T, Bloem JL. Soft Tissue Sarcoma Follow-up Imaging: Strategies to Distinguish Post-treatment Changes from Recurrence. Semin Musculoskelet Radiol 2020; 24:627-644. [PMID: 33307581 DOI: 10.1055/s-0040-1721464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Soft tissue sarcomas encompass multiple entities with differing recurrence rates and follow-up intervals. The detection of recurrences and their differentiation from post-therapeutic changes is therefore complex, with a central role for the clinical radiologist. This article describes approved recommendations. Prerequisite is a precise knowledge of the current clinical management and surgical techniques. We review recurrence rates and treatment modalities. An adequate imaging technique is paramount, and comparison with previous imaging is highly recommended. We describe time-dependent therapy-related complications on magnetic resonance imaging compared with the spectrum of regular post-therapeutic changes. Early complications such as seromas, hematomas, and infections, late complications such as edema and fibrosis, and inflammatory pseudotumors are elucidated. The appearance of recurrences and radiation-associated sarcomas is contrasted with these changes. This systematic approach in follow-up imaging of soft tissue sarcoma patients will facilitate the differentiation of post-therapeutic changes from recurrences.
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Affiliation(s)
- Iris-M Noebauer-Huhmann
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Snehansh R Chaudhary
- Department of Clinical Radiology, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Joannis Panotopoulos
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Radhesh K Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - Omar M Albtoush
- Department of Radiology, University of Jordan, and Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Barbara J Fueger
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pavol Szomolanyi
- High Field MR Center, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Grieser
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Johan L Bloem
- Department of radiology, Leiden University Medical Center, Leiden, The Netherlands
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13
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Graham DS, Onyshchenko M, Eckardt MA, DiPardo BJ, Venigalla S, Nelson SD, Chmielowski B, Singh AS, Shabason JE, Eilber FC, Kalbasi A. Low Rates of Chemotherapy Use for Primary, High-Grade Soft Tissue Sarcoma: A National Cancer Database Analysis. J Natl Compr Canc Netw 2020; 18:1055-1065. [PMID: 32755981 DOI: 10.6004/jnccn.2020.7553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 02/19/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is conflicting evidence regarding the role of chemotherapy for high-grade soft tissue sarcoma (STS) in adults. We sought to characterize patterns of chemotherapy use, including multiagent and neoadjuvant chemotherapy, in the United States. PATIENTS AND METHODS Using the National Cancer Database, we identified 19,969 adult patients who underwent surgical resection for primary high-grade STS from 2004 to 2016. Using logistic regression, we examined factors associated with overall, multiagent, and neoadjuvant chemotherapy use. RESULTS Chemotherapy was administered to 22% (n=4,377) of the study population. Among patients treated using chemotherapy, 85% received multiagent treatment and 47% received neoadjuvant treatment. On multivariate analysis, factors associated with chemotherapy use included tumor size, depth, histology, and primary site; receipt of radiation treatment; younger age; higher patient income; and academic treatment facility. Factors associated with multiagent chemotherapy use included tumor histology, tumor primary site, and younger age. Factors associated with neoadjuvant chemotherapy use included tumor size, depth, margin status, and primary site; receipt of radiation treatment; higher patient income; academic treatment facility type; and distance to treatment facility. Treatment at a high-volume facility was the only factor associated with overall, multiagent, and neoadjuvant chemotherapy use. No significant temporal trend was seen in overall, multiagent, or neoadjuvant chemotherapy use. CONCLUSIONS Overall chemotherapy use was low (22%). The variability in chemotherapy use was driven by clinical, patient, demographic, and facility factors. Among patients treated with chemotherapy, the use of multiagent chemotherapy was high (85%), and nearly half received neoadjuvant therapy. There was a discrepancy in the use of chemotherapy-including neoadjuvant and multiagent chemotherapy-between high- and low-volume treatment centers.
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Affiliation(s)
- Danielle S Graham
- Division of Surgical Oncology, Department of Surgery, University of California, Los Angeles, Los Angeles, California
| | - Mykola Onyshchenko
- Division of Hematology-Oncology, Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Mark A Eckardt
- Division of Surgical Oncology, Department of Surgery, University of California, Los Angeles, Los Angeles, California.,Department of Surgery, Yale School of Medicine, New Haven, Connecticut.,Department of Surgery, Greater Los Angeles Veterans Health Administration, Los Angeles, California
| | - Benjamin J DiPardo
- Division of Surgical Oncology, Department of Surgery, University of California, Los Angeles, Los Angeles, California.,Department of Surgery, Greater Los Angeles Veterans Health Administration, Los Angeles, California
| | - Sriram Venigalla
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Bartosz Chmielowski
- Division of Hematology-Oncology, Department of Internal Medicine, and.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
| | - Arun S Singh
- Division of Hematology-Oncology, Department of Internal Medicine, and.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
| | - Jacob E Shabason
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Family Cancer Research Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Fritz C Eilber
- Division of Surgical Oncology, Department of Surgery, University of California, Los Angeles, Los Angeles, California.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
| | - Anusha Kalbasi
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California.,Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
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14
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Brown A, Spazzoli B, Mah E, May D, Chu J, Spelman T, Choong P, Di Bella C. Planned combined onco-plastic (COP) surgical approach improves oncologic outcomes in soft tissue sarcomas. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 47:443-449. [PMID: 32660707 DOI: 10.1016/j.ejso.2020.06.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/22/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Combined modality of radiotherapy and surgery is the standard of treatment of soft tissue sarcomas (STS). The goal of this study was to assess whether a Combined Onco-Plastic (COP) surgical approach in the setting of neo-adjuvant radiotherapy can improve the oncologic outcomes of STS and reduce the rate of wound complications. METHODS We performed a retrospective review of all patients with STS treated at a single sarcoma centre (St Vincent's Hospital, Melbourne) between 2007 and 2018. Patients were stratified into two groups based on whether they have received the COP approach or were closed primarily by the orthopaedic surgeon. We analysed oncological outcomes and rate of wound complications. RESULTS A total of 546 patients with comparable demographics and tumor characteristics were included. The COP approach was performed in 75.6% of the patients. Wide margins were obtained in 97.4% of the cases, and this was significantly higher in the COP group (p < 0.001). The cumulative rate of local recurrence was 4.9%, with a 52% risk reduction in the COP approach, although this reduction was not significant (HR = 0.48; 95% CI 0.21-1.06; p = 0.070). The COP approach had better disease free survival (DFS) (aHR 1.86, 95% CI 1.45-2.37; p < 0.001) and Overall survival (risk of death aHR 0.49; 95% CI 0.30-0.79; p = 0.004). The overall wound complication rate was 18.6% with no difference between the two groups. CONCLUSION A planned collaboration between the orthopaedic oncologist and the plastic surgeon is beneficial in the treatment of STS after neo-adjuvant radiotherapy, allowing remarkably good oncological outcomes and a low rate of wound complications.
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Affiliation(s)
- A Brown
- Department of Orthopaedics, Sarcoma Unit, St Vincent's Hospital, Melbourne, Australia
| | - B Spazzoli
- Department of Orthopaedics, Sarcoma Unit, St Vincent's Hospital, Melbourne, Australia; Rizzoli Orthopaedic Institute, Bologna, Italy
| | - E Mah
- Department of Plastic and Reconstructive Surgery, St Vincent's Hospital, Melbourne, Australia
| | - D May
- Department of Orthopaedics, Sarcoma Unit, St Vincent's Hospital, Melbourne, Australia
| | - J Chu
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Australia
| | - T Spelman
- Department of Surgery, The University of Melbourne, Australia
| | - P Choong
- Department of Orthopaedics, Sarcoma Unit, St Vincent's Hospital, Melbourne, Australia; Department of Surgery, The University of Melbourne, Australia
| | - C Di Bella
- Department of Orthopaedics, Sarcoma Unit, St Vincent's Hospital, Melbourne, Australia; Department of Surgery, The University of Melbourne, Australia.
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15
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Gómez J, Tsagozis P. Multidisciplinary treatment of soft tissue sarcomas: An update. World J Clin Oncol 2020; 11:180-189. [PMID: 32355640 PMCID: PMC7186235 DOI: 10.5306/wjco.v11.i4.180] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/13/2020] [Accepted: 03/22/2020] [Indexed: 02/06/2023] Open
Abstract
Standard treatment for soft tissue sarcoma, based on complete surgical resection with or without adjuvant radiotherapy and chemotherapy, has not substantially changed during the last several decades. Nevertheless, recent advances have contributed to considerable improvement in the management of these patients; for example, new magnetic resonance imaging sequences such as diffusion-weighted imaging and magnetic resonance imaging radiomics can better assess tumor extension and even estimate its grade. Detection of circulating genetic material (liquid biopsy) and next-generation sequencing are powerful techniques for genetic analysis, which will increase our understanding of the underlying molecular mechanisms and may reveal potential therapeutic targets. The role of chemotherapy in non-metastatic disease is still controversial, and there is a need to identify patients who really benefit from this treatment. Novel chemotherapeutic regimens have entered clinical praxis and can change the outcome of patients with metastatic disease. Advances in radiotherapy have helped decrease local adverse effects and sustain good local control of the disease. The following report provides an updated view of the diagnosis, treatment, and future perspectives on the management of patients with soft tissue sarcomas.
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Affiliation(s)
- Jorge Gómez
- Department of Orthopedic Surgery, Clínica Universidad de Navarra, University of Navarra, Pamplona 31008, Spain
| | - Panagiotis Tsagozis
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm 17176, Sweden
- Muskuloskeletal Tumour Service, Karolinska University Hospital, Stockholm 17176, Sweden
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16
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Abstract
After initial treatment of sarcoma, disease progression may occur in the form of local recurrence, pulmonary metastases, or extrapulmonary metastases. As such, surveillance is an important aspect of management, but no universally accepted practice standards are found. In the absence of strong evidence, and to allow for individualized care, existing guidelines contain flexibility in terms of both the frequency and modality of surveillance. In general, they agree that follow-up should be more intense in the early years after treatment, especially for high-grade sarcomas, and continue for at least 10 years. For local recurrence, data suggest that physical examination is usually sufficient for monitoring; in addition, some guidelines endorse imaging routinely, whereas others only as clinically indicated. For pulmonary metastasis, either radiograph or CT is recommended, with the latter having theoretical advantages but no proven survival benefit to date. Extrapulmonary metastases are rare in most sarcoma types, so the literature only supports extrapulmonary surveillance for certain diagnoses. This topic is complicated by the diversity of sarcomas, the limited evidence, and the indefinite, often conflicting recommendations; therefore, it is critical for providers to understand the existing research and guidelines to determine optimal surveillance strategies for their patients.
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17
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De Angelis F, Guy F, Bertaut A, Méjean N, Varbedian O, Hervieu A, Truc G, Thibouw D, Barra CC, Fraisse J, Burnier P, Isambert N, Causeret S. Limbs and trunk soft tissue sarcoma systematic local and remote monitoring by MRI and thoraco-abdomino-pelvic scanner: A single-centre retrospective study. Eur J Surg Oncol 2019; 45:1274-1280. [PMID: 30765271 DOI: 10.1016/j.ejso.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/25/2019] [Accepted: 02/02/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Soft tissue sarcomas (STS) are rare malignant tumors that require management by an expert center. Monitoring modalities are not consensual. The objective of our study is to report systematic radiological monitoring data obtained by local MRI and by thoracic-abdominal-pelvic computed tomography (TAP CT). MATERIAL AND METHODS 113 consecutive patients managed at "Centre Georges François Leclerc, Dijon", between 2008 and 2016, for an initially localized STS were included. Patient follow-up consisted of a local MRI and a TAP CT. Follow-up exams schedule was initially every 4 months during 2 years, followed by every 6 months during 3 years and finally every year during 5 years. RESULTS Median follow-up time was 37.2 months [min = 2.4 - max = 111.6]. After 5 years of surveillance, local recurrence (LR) rate was 8.8% and diagnosed by imaging in 60% of cases. No deep LR was clinically found. Median LR diagnosis time was 23.9 months [min = 2.0 - max = 52.4]. 50% of patients locally treated for their LR were alive without recurrence. Metastatic recurrence (MR) rate was 31%. 42.8% had extra-pulmonary involvement and 17.1% had exclusive extrathoracic metastases. The median time to diagnosis of MR was 17.4 months [min = 2.7- max = 77.2]. High-grade tumors relapsed more (20.4%) and earlier (all before the 5th year) than low grade. CONCLUSION Local MRI seems particularly suitable for monitoring deep tumors. In addition, the systematic monitoring by TAP CT highlighted a limited number of cases of exclusive extrathoracic metastases. The schedule of local and remote monitoring should primarily be adjusted to tumor grade.
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Affiliation(s)
- Floriane De Angelis
- Department of Radiology, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France; Department of Radiology, Centre Hospitalier Universitaire, 14 rue Paul Gaffarel, 21000, Dijon, France.
| | - France Guy
- Department of Radiology, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Aurélie Bertaut
- Department of Statistic, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Nathalie Méjean
- Department of Radiology, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Olivier Varbedian
- Department of Radiology, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Alice Hervieu
- Department of Oncology, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Gilles Truc
- Department of Radiotherapy, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - David Thibouw
- Department of Radiotherapy, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Céline Charon Barra
- Department of Anatomopathology, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Jean Fraisse
- Department of Surgery, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Pierre Burnier
- Department of Surgery, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Nicolas Isambert
- Department of Oncology, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
| | - Sylvain Causeret
- Department of Surgery, Centre Georges François Leclerc, 1 rue du Professeur Marion, 21000, Dijon, France
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18
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Ezuddin NS, Pretell-Mazzini J, Yechieli RL, Kerr DA, Wilky BA, Subhawong TK. Local recurrence of soft-tissue sarcoma: issues in imaging surveillance strategy. Skeletal Radiol 2018; 47:1595-1606. [PMID: 29785452 DOI: 10.1007/s00256-018-2965-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/16/2018] [Accepted: 04/30/2018] [Indexed: 02/02/2023]
Abstract
Soft-tissue sarcomas pose diagnostic and therapeutic challenges to physicians, owing to the large number of subtypes, aggressive tumor biology, lack of consensus on management, and controversy surrounding interval and duration of surveillance scans. Advances in multidisciplinary management have improved the care of sarcoma patients, but controversy remains regarding strategies for surveillance following definitive local control. This review provides an updated, comprehensive overview of the current understanding of the risk of local recurrence of soft-tissue sarcoma, by examining the literature based on features such as histological type and grade, tumor size, and resection margin status, with the aim of helping clinicians, surgeons, and radiologists to develop a tailored approach to local imaging surveillance.
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Affiliation(s)
- Nisreen S Ezuddin
- Department of Radiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Avenue, JMH WW 279, Miami, FL, 33136, USA
| | - Juan Pretell-Mazzini
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Raphael L Yechieli
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Darcy A Kerr
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Breelyn A Wilky
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Ty K Subhawong
- Department of Radiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Avenue, JMH WW 279, Miami, FL, 33136, USA.
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19
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Roeder F, de Paoli A, Saleh-Ebrahimi L, Alldinger I, Bertola G, Boz G, Navarria F, Cuervo M, Uhl M, Alvarez A, Buechler M, Lehner B, Debus J, Calvo FA, Krempien R. Intraoperative Electron Radiation Therapy Combined with External Beam Radiation Therapy after Gross Total Resection in Extremity Soft Tissue Sarcoma: A European Pooled Analysis. Ann Surg Oncol 2018; 25:3833-3842. [PMID: 30276647 DOI: 10.1245/s10434-018-6787-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION We report a pooled analysis evaluating the combination of gross complete limb-sparing surgery, intraoperative electron radiation therapy (IOERT), and external beam radiation therapy (EBRT) in patients with extremity soft tissue sarcoma (STS). METHODS Individual data of 259 patients (median follow-up 63 months) with extremity STS from three European expert centers were pooled. Median age was 55 years and median tumor size was 8 cm. Eighty percent of patients presented with primary disease, mainly located in the lower limb (81%). Union for International Cancer Control 7th edition stage at presentation was as follows: stage I: 9%; stage II: 47%; stage III: 39%; stage IV: 5%. Most patients showed high-grade lesions (91%), predominantly liposarcoma (31%). Median IOERT dose was 12 Gy, preceeded (17%) or followed (83%) by EBRT, with a median dose of 45 Gy. RESULTS Surgery resulted in R0 resections in 71% of patients and R1 resections in 29% of patients. The 5-year local control (LC) rate was 86%, and significant factors in univariate analysis were disease status and resection margin. Only margin remained significant in multivariate analysis. The 5-year distant control rate was 69%, and significant factors in univariate analysis were histology, grading, resection margin, and metastases prior to/at IOERT. Only grading and metastases remained significant in multivariate analysis. Actuarial 5-year rates of freedom from treatment failure and OS were 61% and 78%, respectively. Significant factors for OS were grading and metastases prior to/at IOERT (univariate, multivariate). Limb preservation and good functional outcome were achieved in 95% and 81% of patients. CONCLUSIONS Our pooled analysis confirmed prior reports of encouraging LC and survival, with excellent rates of preserved limb function with this treatment approach. Resection margin remained the most important factor for LC, while grading and metastases prior to/at IOERT mainly predicted survival.
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Affiliation(s)
- Falk Roeder
- Department of Radiation Oncology, University Hospital LMU Munich, Munich, Germany. .,CCU Molecular and Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.
| | - Antonino de Paoli
- Department of Radiation Oncology, National Cancer Institute, CRO, Aviano, Italy
| | | | | | - Giulio Bertola
- Department of Surgical Oncology, National Cancer Institute, CRO, Aviano, Italy
| | - Giovanni Boz
- Department of Radiation Oncology, National Cancer Institute, CRO, Aviano, Italy
| | - Federico Navarria
- Department of Radiation Oncology, National Cancer Institute, CRO, Aviano, Italy
| | - Miguel Cuervo
- Musculoskeletal Tumor Unit, University Hospital Gregorio Maranon, Complutense University, Madrid, Spain
| | - Matthias Uhl
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - Ana Alvarez
- Department of Radiation Oncology, University Hospital Gregorio Maranon, Complutense University, Madrid, Spain
| | - Markus Buechler
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - Burkhard Lehner
- Department of Orthopedics and Traumatology, University of Heidelberg, Heidelberg, Germany
| | - Juergen Debus
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.,CCU Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Felipe A Calvo
- Department of Radiation Oncology, University Hospital Gregorio Maranon, Complutense University, Madrid, Spain
| | - Robert Krempien
- Department of Radiotherapy, Helios Hospital Berlin-Buch, Berlin, Germany
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20
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Song B, Lee K, Lee C, Moon KC. Prognostic significance of microscopic tumor extension in local recurrence of myxofibrosarcoma and undifferentiated pleomorphic sarcoma. Pathol Int 2018; 68:509-516. [PMID: 30094896 DOI: 10.1111/pin.12709] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 07/11/2018] [Indexed: 01/06/2023]
Abstract
Myxofibrosarcoma (MFS) and undifferentiated pleomorphic sarcoma (UPS) frequently display infiltrative growth into the adjacent normal soft tissue. In this study, we aimed to determine whether the microscopic extension into surrounding normal tissue can influence the local recurrence of MFS and UPS. A total of 42 cases (22 MFS and 20 UPS) were examined. The length of the microscopic extension was measured from the edge of the main tumor mass to the end of infiltration. The length of 5.5 mm was selected as the optimal cut-off value that could predict local recurrence using the receiver operating characteristic (ROC) curve and Youden index. Longer length of microscopic extension was significantly correlated with the status of resection margin (P = 0.032). The group with longer length of microscopic extension (>5.5 mm) had significantly worse recurrence-free survival than the group with shorter length of microscopic extension (≤5.5 mm) (P = 0.000). Multivariate analysis revealed that the length of microscopic extension was independent predictors of recurrence-free survival (P = 0.018). In conclusion, microscopic extensions at the edge of the main mass into the surrounding normal tissue were observed in most MFS and UPS patients, and the length of microscopic extension was associated with local recurrence.
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Affiliation(s)
- Boram Song
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoungbun Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
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Weichteilsarkome: Wie lassen sich posttherapeutische Veränderungen von Rezidiven unterscheiden? Radiologe 2017; 57:923-937. [DOI: 10.1007/s00117-017-0310-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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22
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Gingrich AA, Bateni SB, Monjazeb AM, Darrow MA, Thorpe SW, Kirane AR, Bold RJ, Canter RJ. Neoadjuvant Radiotherapy is Associated with R0 Resection and Improved Survival for Patients with Extremity Soft Tissue Sarcoma Undergoing Surgery: A National Cancer Database Analysis. Ann Surg Oncol 2017; 24:3252-3263. [PMID: 28741123 DOI: 10.1245/s10434-017-6019-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Neoadjuvant radiotherapy (RT) is increasingly advocated for the management of soft tissue sarcoma (STS). Therefore, this study sought to characterize the impact of neoadjuvant RT on rates of R0 resection and overall survival (OS) in extremity STS patients undergoing surgery. METHODS From January 2003 to December 2012, the study identified patients with a diagnosis of extremity STS from the National Cancer Database. After exclusion of patients younger than 18 years, not treated by surgery, who had metastases at diagnosis, intraoperative RT, and missing or unknown data, 27,969 patients were identified. Logistic regression and Cox-proportional hazard analysis were used to compare rates of R0 resection among preoperative, postoperative, and no-RT cohorts and to determine predictors of R0 resection and OS. RESULTS The mean age of the patients was 59.5 ± 17.1 years, and 45.9% were female. The median tumor size was 10.5 cm. The data showed that 51% of the patients did not receive RT, 11.8% received preoperative RT, and 37.2% received postoperative RT. The rates of R0 resection were 90.1% for the preoperative RT cohort, 74.9% for the postoperative RT cohort, and 79.9% for the no-RT cohort (P < 0.001). The independent predictors for achievement of R0 resection included academic facility type (odds ratio [OR] 1.36; 95% confidence interval [CI] 1.20-1.55), histologic subtype, tumor size (OR 0.99; 95% CI 0.99-0.99), Charlson score (OR 0.92; 95% CI 0.84-0.99), and preoperative RT (OR 1.83; 95% CI 1.61-2.07). Both R0 resection and RT (pre- or post-operative) were associated with increased OS. CONCLUSIONS Preoperative RT independently predicts higher rates of R0 resection for patients with extremity STS undergoing surgical resection. Negative surgical margins and pre- or postoperative RT are associated with improved OS.
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Affiliation(s)
- Alicia A Gingrich
- Division of Surgical Oncology, Department of Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Sarah B Bateni
- Division of Surgical Oncology, Department of Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Arta M Monjazeb
- Department of Radiation Oncology, UC Davis Medical Center, Sacramento, CA, USA
| | - Morgan A Darrow
- Department of Pathology, UC Davis Medical Center, Sacramento, CA, USA
| | - Steven W Thorpe
- Department of Orthopedic Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Amanda R Kirane
- Division of Surgical Oncology, Department of Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Richard J Bold
- Division of Surgical Oncology, Department of Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Robert J Canter
- Division of Surgical Oncology, Department of Surgery, UC Davis Medical Center, Sacramento, CA, USA.
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Palumbo BT, Henderson E, Rizer J, Letson DG, Cheong D. Computer navigation and distal femoral reconstruction in the oncologic patient. J Orthop 2017; 14:257-263. [PMID: 28377642 DOI: 10.1016/j.jor.2017.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/13/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES As adjuvant treatments for musculoskeletal malignancies improve expectations of preserved function increase. We questioned whether computer navigation for distal femoral reconstruction would improve outcomes. METHODS Twenty oncology patients were reviewed after distal femoral reconstruction using navigation. Outcomes included local recurrence, implant revision, patient function, patellofemoral complications and leg-length inequality. RESULTS Implant survivorship was 85% at 26 months. There were no local recurrences and 3 failures for aseptic loosening. Good functional outcomes were observed in remaining cases. CONCLUSION Computer navigation for distal femoral reconstruction resulted in acceptable functional outcomes and implant survivorship. Reduced local recurrence were observed at intermediate follow-up. Level of Evidence: Level IV.
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Affiliation(s)
- Brian T Palumbo
- Florida Orthopaedic Institute, 13020 Telecom Parkway N, Tampa, FL, United States
| | - Eric Henderson
- Orthopaedic Oncology, Dartmouth-Hitchcock Medical Center, The Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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Wortmann M, Alldinger I, Böckler D, Ulrich A, Hyhlik-Dürr A. Vascular reconstruction after retroperitoneal and lower extremity sarcoma resection. Eur J Surg Oncol 2017; 43:407-415. [DOI: 10.1016/j.ejso.2016.10.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/16/2016] [Accepted: 10/31/2016] [Indexed: 12/17/2022] Open
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López-Gómez J, Flores-Vázquez ER, Salazar-Álvarez MA, Adame RY, Garcia-Ortega DY, Cuellar-Hübbe M. Treatment of intimal sarcoma of peripheral veins. Int J Surg Case Rep 2017; 31:93-98. [PMID: 28129609 PMCID: PMC5266490 DOI: 10.1016/j.ijscr.2017.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/09/2017] [Accepted: 01/09/2017] [Indexed: 11/30/2022] Open
Abstract
Intimal sarcoma is an extremely rare group. Intimal sarcoma of large veins even rarer information and case reports are limited. Unique case in the medical literature and the best current evidence in the biological behavior and the response of the multiple options of treatment in this type of tumors.
Introduction Intimal sarcoma is an extremely rare group of undifferentiated pleomorphic sarcoma arising from the intimal layer of vessels accounting for only 1% of all sarcomas, intimal sarcoma of large veins are even less common. Cases presentation We present two cases of intima sarcoma, one originated form the basilar vein and the other from the cephalic vein, the first one was treated with surgery and postoperative chemotherapy followed by Radiotherapy (RT), the second case was treated with isolated limb perfusion followed by marginal resection and RT. Both patients progressed to the lungs in a short time, the first case was treated with metastasectomy of the lung and is without evidence of disease 7 months after surgery; the second case treated with isolated limb perfusion has stable disease. Discussion Intimal sarcoma are very aggressive tumors, with a high metastatic potential, the two patients progressed to lung in a short time (2 months) after local treatment. Both cases exhibit good response to chemotherapy and metastasectomy with a disease – free period of 7 months. Conclusion We propose that given the aggressive behavior of these tumors, they should be treated with chemoradiotherapy postoperative, either by systemic chemotherapy or isolated limb perfusion for the limp sparing surgery in this histology.
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Affiliation(s)
- Javier López-Gómez
- Department of Oncologic Surgery, National Cancer Institute, Mexico City, Av. San Fernando No. 22, Col. Sección XVI, C.P. 14080, Mexico.
| | - Erwin R Flores-Vázquez
- Department of Oncologic Surgery, National Cancer Institute, Mexico City, Av. San Fernando No. 22, Col. Sección XVI, C.P. 14080, Mexico
| | - Ma Alejandra Salazar-Álvarez
- Department of Oncologic Surgery, National Cancer Institute, Mexico City, Av. San Fernando No. 22, Col. Sección XVI, C.P. 14080, Mexico
| | - Rodrigo Y Adame
- Department of Oncologic Surgery, National Cancer Institute, Mexico City, Av. San Fernando No. 22, Col. Sección XVI, C.P. 14080, Mexico
| | - Dorian Y Garcia-Ortega
- Department of Skin and Soft Tissue Tumors, National Cancer Institute, Mexico City, Av. San Fernando No. 22, Col. Sección XVI, C.P. 14080, Mexico
| | - Mario Cuellar-Hübbe
- Department of Skin and Soft Tissue Tumors, National Cancer Institute, Mexico City, Av. San Fernando No. 22, Col. Sección XVI, C.P. 14080, Mexico
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Tiwari A, Shah S, Sharma AK, Mehta S, Batra U, Sharma SK, Dewan AK. Prognostic Factors in Indian Patients Operated for Soft Tissue Sarcomas-a Retrospective Cross-sectional Analysis. Indian J Surg Oncol 2016; 8:128-135. [PMID: 28546706 DOI: 10.1007/s13193-016-0569-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/18/2016] [Indexed: 01/25/2023] Open
Abstract
Soft tissue sarcomas are a rare entity. While surgery is established as the mainstay of treatment, the exact role and sequencing of adjuvant therapy is not well defined. Literature on Indian patients with soft tissue sarcoma with respect to clinical profile and prognostic factors is scarce. We retrospectively analysed the data of 112 patients operated for soft tissue sarcoma of extremity or trunk (excluding retroperitoneal and mediastinal sarcomas, round cell histology) at our institute from 1 January 2009 to 31 December 2013. Around half the patients were less than 50 years of age and around a third had size more than 10 cm. Oncological outcome was correlated with various demographic, tumour-related and treatment-related factors using SPSS 22. Overall survival at 5 years was 73.2 % and event-free survival at 5 years was 42.2 %. At final follow-up (mean of 44.85 ± 4.64 months), local recurrence was seen in 31.9 % and distant metastasis was seen in 30.1 % of the patients. Using both univariate and multivariate analysis, younger age (<50 years), larger size (>10 cm, but not >5 cm) and pathologically positive lymph nodes were the only factors found significantly affecting overall survival. The clinical profile and prognosis of Indian patients with soft tissue sarcoma were found to be different from that reported in Western literature. The impact of established prognostic indicators for soft tissue sarcoma also differed in Indian patients, which may have both prognostic and therapeutic implications.
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Affiliation(s)
- Akshay Tiwari
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute, Sector 5, Rohini, Delhi 110085 India
| | - Swati Shah
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute, Sector 5, Rohini, Delhi 110085 India
| | - Ashwani Kumar Sharma
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute, Sector 5, Rohini, Delhi 110085 India
| | - Sandeep Mehta
- Department of Reconstructive Surgery, BLK Cancer Center, Delhi, India
| | - Ullas Batra
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute, Rohini, Delhi India
| | - S K Sharma
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute, Rohini, Delhi India
| | - A K Dewan
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute, Sector 5, Rohini, Delhi 110085 India
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Takiguchi G, Nakamura T, Otowa Y, Tomono A, Kanaji S, Oshikiri T, Suzuki S, Ishida T, Kakeji Y. Successful resection of giant esophageal liposarcoma by endoscopic submucosal dissection combined with surgical retrieval: a case report and literature review. Surg Case Rep 2016; 2:90. [PMID: 27589985 PMCID: PMC5010540 DOI: 10.1186/s40792-016-0219-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/16/2016] [Indexed: 12/21/2022] Open
Abstract
Liposarcoma of the esophagus is very rare. We experienced a huge (27.5 × 11.6 cm) liposarcoma of the esophagus. A 73-year-old man presented with severe dyspnea requiring emergency tracheal intubation. Computed tomography and esophagogastroduodenoscopy showed a large submucosal tumor arising from the esophageal entrance and extending intraluminally to the lower esophagus. We successfully performed endoscopic submucosal dissection (ESD) and esophagotomy to remove the tumor, which preserved swallowing and phonation. The final diagnosis by histopathologic and immunohistologic examination was well-differentiated liposarcoma of the esophagus. Treatment by the combination of ESD and esophagotomy can be performed even for a very large tumor. This method preserves deglutition with a lower risk of recurrent laryngeal nerve paralysis than that with esophagectomy.
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Affiliation(s)
- Gosuke Takiguchi
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Tetsu Nakamura
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yasunori Otowa
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Ayako Tomono
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Shingo Kanaji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Taro Oshikiri
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Satoshi Suzuki
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Tsukasa Ishida
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.,Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, 650-0017, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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Bonvalot S, Levy A, Terrier P, Tzanis D, Bellefqih S, Le Cesne A, Le Péchoux C. Primary Extremity Soft Tissue Sarcomas: Does Local Control Impact Survival? Ann Surg Oncol 2016; 24:194-201. [DOI: 10.1245/s10434-016-5462-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Indexed: 11/18/2022]
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29
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Nguyen JQ, Gowani ZS, O'Connor M, Pence IJ, Nguyen TQ, Holt GE, Schwartz HS, Halpern JL, Mahadevan-Jansen A. Intraoperative Raman spectroscopy of soft tissue sarcomas. Lasers Surg Med 2016; 48:774-781. [PMID: 27454580 DOI: 10.1002/lsm.22564] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND OBJECTIVE Soft tissue sarcomas (STS) are a rare and heterogeneous group of malignant tumors that are often treated through surgical resection. Current intraoperative margin assessment methods are limited and highlight the need for an improved approach with respect to time and specificity. Here we investigate the potential of near-infrared Raman spectroscopy for the intraoperative differentiation of STS from surrounding normal tissue. MATERIALS AND METHODS In vivo Raman measurements at 785 nm excitation were intraoperatively acquired from subjects undergoing STS resection using a probe based spectroscopy system. A multivariate classification algorithm was developed in order to automatically identify spectral features that can be used to differentiate STS from the surrounding normal muscle and fat. The classification algorithm was subsequently tested using leave-one-subject-out cross-validation. RESULTS With the exclusion of well-differentiated liposarcomas, the algorithm was able to classify STS from the surrounding normal muscle and fat with a sensitivity and specificity of 89.5% and 96.4%, respectively. CONCLUSION These results suggest that single point near-infrared Raman spectroscopy could be utilized as a rapid and non-destructive surgical guidance tool for identifying abnormal tissue margins in need of further excision. Lasers Surg. Med. 48:774-781, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- John Q Nguyen
- Biophotonics Center, Vanderbilt University, 410 24th Ave. South (Keck FEL Center), Nashville, Tennessee 37232
| | - Zain S Gowani
- School of Medicine, Vanderbilt University, 2215 Garland Ave (Light Hall), Nashville, Tennessee 37232
| | - Maggie O'Connor
- Biophotonics Center, Vanderbilt University, 410 24th Ave. South (Keck FEL Center), Nashville, Tennessee 37232
| | - Isaac J Pence
- Biophotonics Center, Vanderbilt University, 410 24th Ave. South (Keck FEL Center), Nashville, Tennessee 37232
| | - The-Quyen Nguyen
- Department of Biomedical Engineering, Northwestern University, Silverman Hall, Evanston, Illinois 60208
| | - Ginger E Holt
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 691 Preston Building, Nashville, Tennessee 37232-6838
| | - Herbert S Schwartz
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 691 Preston Building, Nashville, Tennessee 37232-6838
| | - Jennifer L Halpern
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 691 Preston Building, Nashville, Tennessee 37232-6838
| | - Anita Mahadevan-Jansen
- Biophotonics Center, Vanderbilt University, 410 24th Ave. South (Keck FEL Center), Nashville, Tennessee 37232.
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Roberts CC, Kransdorf MJ, Beaman FD, Adler RS, Amini B, Appel M, Bernard SA, Fries IB, Germano IM, Greenspan BS, Holly LT, Kubicky CD, Lo SSM, Mosher TJ, Sloan AE, Tuite MJ, Walker EA, Ward RJ, Wessell DE, Weissman BN. ACR Appropriateness Criteria Follow-Up of Malignant or Aggressive Musculoskeletal Tumors. J Am Coll Radiol 2016; 13:389-400. [PMID: 26922595 DOI: 10.1016/j.jacr.2015.12.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 12/16/2015] [Indexed: 02/07/2023]
Abstract
Appropriate imaging modalities for the follow-up of malignant or aggressive musculoskeletal tumors include radiography, MRI, CT, (18)F-2-fluoro-2-deoxy-D-glucose PET/CT, (99m)Tc bone scan, and ultrasound. Clinical scenarios reviewed include evaluation for metastatic disease to the lung in low- and high-risk patients, for osseous metastatic disease in asymptomatic and symptomatic patients, for local recurrence of osseous tumors with and without significant hardware present, and for local recurrence of soft tissue tumors. The timing for follow-up of pulmonary metastasis surveillance is also reviewed. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Affiliation(s)
| | | | | | - Ronald S Adler
- New York University Center for Musculoskeletal Care, New York, New York
| | - Behrang Amini
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marc Appel
- Warwick Valley Orthopedic Surgery, Warwick, New York, American Academy of Orthopaedic Surgeons
| | - Stephanie A Bernard
- Penn State University Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Ian Blair Fries
- Bone, Spine and Hand Surgery, Chartered, Brick, New Jersey, American Academy of Orthopaedic Surgeons
| | | | | | - Langston T Holly
- University of California Los Angeles Medical Center, Los Angeles, California
| | | | - Simon Shek-Man Lo
- University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Timothy J Mosher
- Penn State University Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Andrew E Sloan
- University Hospital Case Medical Center, Cleveland, Ohio
| | | | - Eric A Walker
- Penn State University Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Fidel J, Kennedy KC, Dernell WS, Hansen S, Wiss V, Stroud MR, Molho JI, Knoblaugh SE, Meganck J, Olson JM, Rice B, Parrish-Novak J. Preclinical Validation of the Utility of BLZ-100 in Providing Fluorescence Contrast for Imaging Spontaneous Solid Tumors. Cancer Res 2016; 75:4283-91. [PMID: 26471914 DOI: 10.1158/0008-5472.can-15-0471] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
There is a need in surgical oncology for contrast agents that can enable real-time intraoperative visualization of solid tumors that can enable complete resections while sparing normal surrounding tissues. The Tumor Paint agent BLZ-100 is a peptide-fluorophore conjugate that can specifically bind solid tumors and fluoresce in the near-infrared range, minimizing light scatter and signal attenuation. In this study, we provide a preclinical proof of concept for use of this imaging contrast agent as administered before surgery to dogs with a variety of naturally occurring spontaneous tumors. Imaging was performed on excised tissues as well as intraoperatively in a subset of cases. Actionable contrast was achieved between tumor tissue and surrounding normal tissues in adenocarcinomas, squamous cell carcinomas, mast cell tumors, and soft tissue sarcomas. Subcutaneous soft tissue sarcomas were labeled with the highest fluorescence intensity and greatest tumor-to-background signal ratio. Our results establish a foundation that rationalizes clinical studies in humans with soft tissue sarcoma, an indication with a notably high unmet need.
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Affiliation(s)
- Janean Fidel
- College of Veterinary Medicine, Washington State University, Pullman, Washington
| | - Katie C Kennedy
- College of Veterinary Medicine, Washington State University, Pullman, Washington
| | - William S Dernell
- College of Veterinary Medicine, Washington State University, Pullman, Washington
| | | | | | | | | | | | | | - James M Olson
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Brad Rice
- PerkinElmer, Inc., Waltham, Massachusetts
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Nguyen JQ, Gowani Z, O'Connor M, Pence I, Nguyen TQ, Holt G, Mahadevan-Jansen A. Near-infrared autofluorescence spectroscopy of in vivo soft tissue sarcomas. OPTICS LETTERS 2015; 40:5498-5501. [PMID: 26625035 PMCID: PMC4933651 DOI: 10.1364/ol.40.005498] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Soft tissue sarcomas (STS) are a rare and heterogeneous group of malignant tumors that are often treated via surgical resection. Inadequate resection can lead to local recurrence and decreased survival rates. In this study, we investigate the hypothesis that near-infrared (NIR) autofluorescence can be utilized for tumor margin analysis by differentiating STS from the surrounding normal tissue. Intraoperative in vivo measurements were acquired from 30 patients undergoing STS resection and were characterized to differentiate between normal tissue and STS. Overall, normal muscle and fat were observed to have the highest and lowest autofluorescence intensities, respectively, with STS falling in between. With the exclusion of well-differentiated liposarcomas, the algorithm's accuracy for classifying muscle, fat, and STS was 93%, 92%, and 88%, respectively. These findings suggest that NIR autofluorescence spectroscopy has potential as a rapid and nondestructive surgical guidance tool that can inform surgeons of suspicious margins in need of immediate re-excision.
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Affiliation(s)
- John Quan Nguyen
- Biophotonics Center, Vanderbilt University, 410 24th Ave. South (Keck FEL Center), Nashville, Tennessee 37232, USA
| | - Zain Gowani
- School of Medicine, Vanderbilt University, 2215 Garland Ave (Light Hall), Nashville, Tennessee 37232, USA
| | - Maggie O'Connor
- Biophotonics Center, Vanderbilt University, 410 24th Ave. South (Keck FEL Center), Nashville, Tennessee 37232, USA
| | - Isaac Pence
- Biophotonics Center, Vanderbilt University, 410 24th Ave. South (Keck FEL Center), Nashville, Tennessee 37232, USA
| | - The-Quyen Nguyen
- Biomedical Engineering Department, Northwestern University, Silverman Hall, Evanston, Illinois 60208, USA
| | - Ginger Holt
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 691 Preston Building, Nashville, Tennessee 37232-6838, USA
| | - Anita Mahadevan-Jansen
- Biophotonics Center, Vanderbilt University, 410 24th Ave. South (Keck FEL Center), Nashville, Tennessee 37232, USA
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The role of 18F-FDG PET/CT in diagnosis and staging of musculoskeletal soft tissue sarcomas. Clin Transl Imaging 2015. [DOI: 10.1007/s40336-015-0108-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Alamanda VK, Song Y, Shinohara E, Schwartz HS, Holt GE. Postoperative radiation boost does not improve local recurrence rates in extremity soft tissue sarcomas. J Med Imaging Radiat Oncol 2014; 58:633-40. [PMID: 24821569 DOI: 10.1111/1754-9485.12184] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 03/29/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The standard of care for extremity soft tissue sarcomas continues to be negative-margin limb salvage surgery. Radiotherapy is frequently used as an adjunct to decrease local recurrence. No differences in survival have been found between preoperative and postoperative radiotherapy regimens. However, it is uncertain if the use of a postoperative boost in addition to preoperative radiotherapy reduces local recurrence rates. METHODS This retrospective review evaluated patients who received preoperative radiotherapy (n = 49) and patients who received preoperative radiotherapy with a postoperative boost (n = 45). The primary endpoint analysed was local recurrence, with distant metastasis and death due to sarcoma analysed as secondary endpoints. Wilcoxon rank-sum test and either χ(2) or Fisher's exact test were used to compare variables. Multivariable regression analyses were used to take into account potential confounders and identify variables that affected outcomes. RESULTS No differences in the proportion or rate of local recurrence, distant metastasis or death due to sarcoma were observed between the two groups (P > 0.05). The two groups were similarly matched with respect to demographics such as age, race and sex and tumour characteristics including excision status, tumour site, size, depth, grade, American Joint Committee on Cancer stage, chemotherapy receipt and histological subtype (P > 0.05). The postoperative boost group had a larger proportion of patients with positive microscopic margins (62% vs 10%; P < 0.001). CONCLUSION No differences in rates of local recurrence, distant metastasis or death due to sarcoma were found in patients who received both pre- and postoperative radiotherapy when compared with those who received only preoperative radiotherapy.
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Affiliation(s)
- Vignesh K Alamanda
- Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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[Radiotherapy as conservative therapy for sarcomas within the irradiated field]. Cancer Radiother 2014; 18:171-6. [PMID: 24746453 DOI: 10.1016/j.canrad.2014.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/18/2014] [Accepted: 02/27/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE To describe long-term outcome after combined-modality treatment including radiation therapy in patients with localized sarcoma within irradiated field. PATIENTS AND METHODS Individual clinical data from all consecutive patients diagnosed and treated for a localized sarcoma within irradiated field between January 2000 and October 2011 at the Institut Claudius-Regaud, Toulouse, France, were retrospectively reviewed. RESULTS Twenty-seven patients were eligible for this study. Ten patients were re-irradiated with a rate of unresectable, gross or microscopically positive margins disease significantly higher than the rest of the cohort (90% vs. 12%; P<0.001). After a median follow-up of 3.8 years, there is a non-significant trend toward longer 4-year relapse free survival in the subgroup of patients who received adjuvant or definitive radiation therapy compared to the rest of the cohort (53% vs. 27%; P=0.09) with an acceptable toxicity profile allowing conservative management. CONCLUSION The complete surgical resection sarcoma within irradiated field is often difficult to achieve enhancing the risk of relapse. Radiation therapy should be discussed when faced with an unresectable tumour or after suboptimal surgery as part of intensified local management with a curative intent.
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Prognostic analysis for survival after resections of localized primary cardiac sarcomas: a single-institution experience. Ann Thorac Surg 2014; 97:1379-85. [PMID: 24565404 DOI: 10.1016/j.athoracsur.2013.12.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/22/2013] [Accepted: 12/09/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Primary cardiac sarcomas are rare diseases with a poor prognosis. This study aims to provide a prognostic analysis after different levels of resections of cardiac sarcomas. METHODS Twenty-nine patients undergoing resections of primary cardiac sarcomas at the Zhongshan Hospital from September 1995 to July 2012 were retrospectively reviewed. RESULTS There were 15 women and 14 men. The mean age was 41.0 years. The most common histologic type was angiosarcoma (28%). The median survival for the entire cohort was 17 months (range, 5 to 216 months). Patients with microscopically negative margin (R0) resections had a better median survival than those with microscopically positive margin (R1) resections (58 months versus 11 months; p<0.001). The median survival after an R1 resection was not different from that after a partial resection (12 months; p=0.81). The median local recurrence-free survival after an R0 resection was longer than that after an R1 resection (36 months versus 6 months; p<0.001). Five patients who underwent R0 resections and repeated resections of local recurrences or metastases had the longest median survival of 72 months. None of the patients with R0 resections received adjuvant therapy. Multimodality treatment after R1 and partial resections slightly increased the survival. CONCLUSIONS For nonmetastatic and localized primary cardiac sarcoma, an R0 surgical resection of cardiac sarcomas should be performed. Aggressive surgical treatment or radiation therapy for local recurrence or metastasis prolongs the survival. Multimodality treatment is recommended after incomplete resections of cardiac sarcomas. The role of adjuvant chemotherapy after R0 resections is unclear.
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Tumour volume changes following pre-operative radiotherapy in borderline resectable limb and trunk soft tissue sarcoma. Eur J Surg Oncol 2014; 40:394-401. [PMID: 24534361 DOI: 10.1016/j.ejso.2014.01.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/31/2013] [Accepted: 01/17/2014] [Indexed: 11/24/2022] Open
Abstract
AIMS To evaluate tumour volume changes after preoperative radiotherapy (PRT) for borderline operable soft tissue sarcomas (STS). MATERIALS AND METHODS A retrospective review was performed of 68 patients who received PRT between December 2004 and July 2011. Endpoints were radiological response, surgical margins, local control and survival. RESULTS Median tumour size was 12.5 cm. Tumour location was extremity (87%), trunk (12%), and neck (1%). Commonest histological subtypes were myxoid liposarcoma (32%) and myxofibrosarcoma (16%). The majority of patients (88%) received 50 Gy in 25 fractions. Post-radiotherapy imaging was available in 55 cases. By RECIST there was stable disease in 89%, partial response in 7% and progressive disease in 4%. Tumour volumes reduced in 80%. Median change in maximal tumour dimension was -13.6%; median change in volume was greater, at -33.3%. Tumour volumes increased in 11 cases (20%). However, surgical margins were clear in all 11 cases, with no local recurrences in this group. For the entire group, surgical margins were clear in 93%, and microscopically positive in 7%. Eight patients (12%) had local relapse at 2-24.8 months after surgery. Two year local relapse free survival was 87.5%; 2 year overall survival was 74.7%. CONCLUSION The majority of tumours showed reduction in volume. A small number of tumours increased in volume, but there was no definite relationship between volume increase and poor surgical outcomes or lower local control rates. Local control was equivalent to published series' of PRT. PRT is a reasonable approach in patients with borderline resectable tumours.
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Sherman KL, Wayne JD, Chung J, Agulnik M, Attar S, Hayes JP, Laskin WB, Peabody TD, Bentrem DJ, Pollock RE, Bilimoria KY. Assessment of multimodality therapy use for extremity sarcoma in the United States. J Surg Oncol 2013; 109:395-404. [DOI: 10.1002/jso.23520] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 11/06/2013] [Indexed: 01/01/2023]
Affiliation(s)
- Karen L. Sherman
- Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago Illinois
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - Jeffrey D. Wayne
- Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago Illinois
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - Jeanette Chung
- Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago Illinois
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - Mark Agulnik
- Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago Illinois
- Division of Hematology/Oncology; Department of Medicine; Northwestern University; Chicago Illinois
| | - Samer Attar
- Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago Illinois
- Department of Orthopedic Surgery; Northwestern University; Chicago Illinois
| | - John P. Hayes
- Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago Illinois
- Department of Radiation Oncology; Northwestern University; Chicago Illinois
| | - William B. Laskin
- Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago Illinois
- Department of Pathology; Northwestern University; Chicago Illinois
| | - Terrance D. Peabody
- Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago Illinois
- Department of Orthopedic Surgery; Northwestern University; Chicago Illinois
| | - David J. Bentrem
- Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago Illinois
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine; Northwestern University; Chicago Illinois
- Department of Surgery; Jesse Brown VA Medical Center; Chicago Illinois
| | - Raphael E. Pollock
- Department of Surgical Oncology; University of Texas MD Anderson Cancer Center; Houston Texas
| | - Karl Y. Bilimoria
- Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology; Robert H. Lurie Comprehensive Cancer Center; Chicago Illinois
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine; Northwestern University; Chicago Illinois
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Jebsen NL, Engellau J, Engström K, Bauer HC, Monge OR, Muren LP, Eide GE, Trovik CS, Bruland OS. Patterns of local recurrence and dose fractionation of adjuvant radiation therapy in 462 patients with soft tissue sarcoma of extremity and trunk wall. Int J Radiat Oncol Biol Phys 2013; 86:949-55. [PMID: 23725998 DOI: 10.1016/j.ijrobp.2013.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 04/08/2013] [Accepted: 04/10/2013] [Indexed: 01/29/2023]
Abstract
PURPOSE To study the impact of dose fractionation of adjuvant radiation therapy (RT) on local recurrence (LR) and the relation of LR to radiation fields. METHODS AND MATERIALS LR rates were analyzed in 462 adult patients with soft tissue sarcoma who underwent surgical excision and adjuvant RT at five Scandinavian sarcoma centers from 1998 to 2009. Medical records were reviewed for dose fractionation parameters and to determine the location of the LR relative to the radiation portals. RESULTS Fifty-five of 462 patients developed a LR (11.9%). Negative prognostic factors included intralesional surgical margin (hazard ratio [HR]: 7.83, 95% confidence interval [CI]: 3.08-20.0), high malignancy grade (HR: 5.82, 95% CI: 1.31-25.8), age at diagnosis (HR per 10 years: 1.27, 95% CI: 1.03-1.56), and malignant peripheral nerve sheath tumor histological subtype (HR: 6.66, 95% CI: 2.56-17.3). RT dose was tailored to margin status. No correlation between RT dose and LR rate was found in multiple Cox regression analysis. The majority (65%) of LRs occurred within the primary RT volume. CONCLUSIONS No significant dose-response effect of adjuvant RT was demonstrated. Interestingly, patients given 45-Gy accelerated RT (1.8 Gy twice daily/2.5 weeks) had the best local outcome. A total dose of 50 Gy in 25 fractions seemed adequate following wide margin surgery. The risk of LR was associated with histopathologic subtype, which should be included in the treatment algorithm of adjuvant RT in soft tissue sarcoma.
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Affiliation(s)
- Nina L Jebsen
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
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