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Gagnet P, Nelson J, Wallace N, McCarthy C, Robbins C, Kessler J, Biermann JS, Siegel G. Analysis of the Effect of the Size and Grade of Soft Tissue Sarcoma on Rates of Unplanned Resection, Metastatic Disease, Mortality, and Morbid Re-Resection Over 20 Years. Orthopedics 2021; 44:166-171. [PMID: 33416896 DOI: 10.3928/01477447-20210104-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Soft tissue sarcomas are rare malignancies that are often presumed to be benign and are resected without the typical preoperative workup, such as imaging or biopsy. These unplanned resections occur in approximately 30% of all cases and frequently require further morbid treatments, resulting in worse oncologic outcomes. A retrospective review was performed of all patients who presented to a tertiary sarcoma center with a diagnosis of sarcoma between 1996 and 2017. In-depth chart reviews were performed for the 2600 patients who were identified, with 836 having a primary diagnosis of soft tissue sarcoma in an upper or lower extremity. Data collected included histologic features, grade, size, resection status, demographic features, referral information, metastatic disease, morbid procedures, and mortality rate. Patients were divided into 2 groups based on whether the tumor size was greater or less than 5 cm. This classification was in keeping with the guideline of referring patients to a tertiary sarcoma center for workup for tumors "larger than a golf ball." The difference in the rate of unplanned resection for tumors measuring less than 5 cm (41.6%) and those measuring 5 cm or greater (18.8%) was statistically significant (P<.001), with smaller tumors more likely to undergo unplanned resection, in keeping with the success of the "golf ball rule." The rate of metastatic disease for unplanned resection for tumors measuring 5 cm or greater (50.7%) was significantly greater than that for tumors measuring less than 5 cm (19.7%) (P<.001). The authors found a great deal of morbidity associated with unplanned resection, regardless of tumor size. Before resection is planned, delineation is required beyond tumor size. [Orthopedics. 2021;44(3):166-171.].
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Jo OI, Choong PFM. Centre-Based Care for Bone and Soft Tissue Sarcoma. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
Inadvertent excision of lumps which turn out to be sarcomas is not uncommon.Imaging has a limited role in detecting microscopic residual disease but can show the extent of the previous surgical field.Standard treatment is wide re-excision, usually combined with radiotherapy.Residual tumour is found in an average of 50% of reported cases.The presence of residual disease is an adverse prognostic factor.All lumps bigger than a golf ball should have a diagnosis prior to excision. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180060.
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Kattepur A, Pareekutty N, Alapatt J, Satheesan B. Unplanned excision in soft-tissue sarcomas – Is it the unkindest cut of all? CANCER RESEARCH, STATISTICS, AND TREATMENT 2019. [DOI: 10.4103/crst.crst_72_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Martin-Broto J, Hindi N, Cruz J, Martinez-Trufero J, Valverde C, De Sande LM, Sala A, Bellido L, De Juan A, Rubió-Casadevall J, Diaz-Beveridge R, Cubedo R, Tendero O, Salinas D, Gracia I, Ramos R, Baguè S, Gutierrez A, Duran-Moreno J, Lopez-Pousa A. Relevance of Reference Centers in Sarcoma Care and Quality Item Evaluation: Results from the Prospective Registry of the Spanish Group for Research in Sarcoma (GEIS). Oncologist 2018; 24:e338-e346. [PMID: 30409793 DOI: 10.1634/theoncologist.2018-0121] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 08/28/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Reference centers (RCs) are a key point for improving the survival of patients with soft-tissue sarcomas (STS). The aim of this study was to evaluate selected items in the management of patients with STS, comparing results between RC and local hospitals (LHs). MATERIALS AND METHODS Diagnostic and therapeutic data from patients diagnosed between January 2004 and December 2011 were collected. Correlation with outcome was performed. RESULTS A total of 622 sarcomas were analyzed, with a median follow-up of 40 months. Imaging of primary tumor preoperatively (yes vs. no) correlated with a higher probability of free surgical margins (77.4% versus 53.7%; p = .006). The provenance of the biopsy (RC vs. LH) significantly affected relapse-free survival (RFS; 3-year RFS 66% vs. 46%, respectively; p = .019). Likewise, 3-year RFS was significantly worse in cases with infiltrated (55.6%) or unknown (43.4%) microscopic surgical margins compared with free margins (63.6%; p < .001). Patients managed by RCs had a better 3-year overall survival compared with those managed by LHs (82% vs. 70.4%, respectively; p = .003). Perioperative chemotherapy in high-risk STS, more frequently administered in RCs than in LHs, resulted in significantly better 3-year RFS (66% vs. 44%; p = .011). In addition, patients with stage IV disease treated in RCs survived significantly longer compared with those in LHs (30.4 months vs. 18.5 months; p = .036). CONCLUSION Our series indicate that selected quality-of-care items were accomplished better by RCs over LHs, all with significant prognostic value in patients with STS. Early referral to an RC should be mandatory if the aim is to improve the survival of patients with STS. IMPLICATIONS FOR PRACTICE This prospective study in patients diagnosed with soft-tissue sarcoma shows the prognostic impact of reference centers in the management of these patients. The magnitude of this impact encompasses all steps of the process, from the initial management (performing diagnostic biopsy) to the advanced disease setting. This is the first prospective evidence showing improvement in outcomes of patients with metastatic disease when they are managed in centers with expertise. This study provides extra data supporting referral of patients with sarcoma to reference centers.
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Affiliation(s)
- Javier Martin-Broto
- Biomedicine Institute of Seville (IBIS), Lab 215, CSIC, University of Seville, Seville, Spain
- Medical Oncology Department, Virgen del Rocio University Hospital, Seville, Spain
| | - Nadia Hindi
- Biomedicine Institute of Seville (IBIS), Lab 215, CSIC, University of Seville, Seville, Spain
- Medical Oncology Department, Virgen del Rocio University Hospital, Seville, Spain
| | - Josefina Cruz
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Claudia Valverde
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Angeles Sala
- Medical Oncology Department, Hospital de Basurto, Bilbao, Spain
| | - Lorena Bellido
- Medical Oncology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Ana De Juan
- Medical Oncology Department, Hospitalario Universitario Marqués de Valdecilla, Santander, Spain
| | - Jordi Rubió-Casadevall
- Medical Oncology Department, Hospital Josep Trueta, Instituto Catalán de Oncología, Girona, Spain
| | | | - Ricardo Cubedo
- Medical Oncology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Oscar Tendero
- Department of Orthopedic Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Diego Salinas
- Department of Orthopedic Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Isidro Gracia
- Department of Orthopedic Surgery, Hospital Universitari Sant Pau, Barcelona, Spain
| | - Rafael Ramos
- Department of Pathology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Silvia Baguè
- Department of Pathology, Hospital Universitari Sant Pau, Barcelona, Spain
| | - Antonio Gutierrez
- Department of Hematology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - José Duran-Moreno
- Department of Medical Oncology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Antonio Lopez-Pousa
- Department of Medical Oncology, Hospital Universitari Sant Pau, Barcelona, Spain
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Charoenlap C, Imanishi J, Tanaka T, Slavin J, Ngan SY, Chander S, Dowsey MM, Goyal C, Choong PFM. Outcomes of unplanned sarcoma excision: impact of residual disease. Cancer Med 2016; 5:980-8. [PMID: 26929181 PMCID: PMC4924354 DOI: 10.1002/cam4.615] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/16/2015] [Accepted: 11/22/2015] [Indexed: 12/29/2022] Open
Abstract
This study aimed to compare the oncological results between unplanned excision (UE) and planned excision (PE) of malignant soft tissue tumor and to examine the impact of residual tumor (ReT) after UE. Nonmetastatic soft tissue sarcomas surgically treated in 1996-2012 were included in this study. Disease-specific survival (DSS), metastasis-free survival (MFS), and local-recurrence-free survival (LRFS) were stratified according to the tumor location and American Joint Committee on Cancer Classification 7th edition stage. Independent prognostic parameters were identified by Cox proportional hazard models. Two-hundred and ninety PEs and 161 UEs were identified. Significant difference in oncological outcome was observed only for LRFS probability of retroperitoneal sarcomas (5-year LRFS: 33.0% [UE] vs. 71.0% [PE], P = 0.018). Among the 142 UEs of extremity and trunk, ReT in re-excision specimen were found in 75 cases (53%). UEs with ReT had significantly lower survival probabilities and a higher amputation rate than UEs without ReT (5-year DSS: 68.8% vs. 92%, P < 0.001; MFS: 56.1% vs. 90.9%, P < 0.001; LRFS: 75.8% vs. 98.4%, P = <0.001; amputation rate 18.5% vs. 1.8%, P = 0.003). The presence of ReT was an independent poor prognostic predictor for DSS, MFS, and LRFS with hazard ratios of 2.02 (95% confidence interval (CI), 1.25-3.26), 1.62 (95% CI, 1.05-2.51) and 1.94 (95% CI, 1.05-3.59), respectively. Soft tissue sarcomas should be treated in specialized centers and UE should be avoided because of its detrimental effect especially when ReT remains after UE.
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Affiliation(s)
- Chris Charoenlap
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Victoria, Australia.,Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok 10400, Thiland, Thailand
| | - Jungo Imanishi
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Takaaki Tanaka
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Victoria, Australia
| | - John Slavin
- Department of Pathology, St. Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy 3065, Victoria, Australia
| | - Samuel Y Ngan
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne 3002, Victoria, Australia.,Bone and Soft Tissue Sarcoma Unit, Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne 3002, Victoria, Australia
| | - Sarat Chander
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne 3002, Victoria, Australia.,Bone and Soft Tissue Sarcoma Unit, Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne 3002, Victoria, Australia
| | - Michelle Maree Dowsey
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, 29 Regent Street, Fitzroy 3065, Victoria, Australia
| | - Chatar Goyal
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Peter F M Choong
- Department of Orthopaedics, St. Vincent's Hospital Melbourne, Victoria, Australia.,Bone and Soft Tissue Sarcoma Unit, Peter MacCallum Cancer Centre, 2 St Andrews Place, East Melbourne 3002, Victoria, Australia.,Department of Surgery, University of Melbourne, 29 Regent Street, Fitzroy 3065, Victoria, Australia
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Delisca GO, Alamanda VK, Archer KR, Song Y, Schwartz HS, Holt GE. Tumor size increase following preoperative radiation of soft tissue sarcomas does not affect prognosis. J Surg Oncol 2013; 107:723-7. [PMID: 23400806 DOI: 10.1002/jso.23322] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 01/07/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Administration of preoperative radiotherapy for extremity soft tissue sarcoma improves local control, while allowing for a more conservative surgical resection. During radiation treatment tumor size typically decreases or remains constant. In a subset of patients, however, a size increase in the tumor occurs. Our goal was to investigate the prognosis of patients who had a size increase of at least 20% over the course of preoperative radiotherapy versus those who did not. METHODS This retrospective study evaluated 70 patients treated for localized primary STS of the extremities between January 2000 and December 2008. Kaplan-Meier curves for disease-specific and metastasis-free survival were calculated for both groups. RESULTS Sixty-one patients had stable or decrease local tumor size following preoperative radiotherapy and nine patients had an increase of at least 20% in tumor size. There were no statistically significant differences found in disease-specific survival and metastasis-free survival (Gray's test, P = 0.93 and P = 0.68, respectively) among the two groups. CONCLUSION Our results indicate that a 20% increase in tumor size following preoperative radiotherapy did not result in a worse outcome for patients when compared to those who had stable or decrease local tumor size following preoperative radiotherapy.
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Affiliation(s)
- Gadini O Delisca
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee 37232-8774, USA
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