Staged reconstruction brachytherapy has lower overall cost in recurrent soft-tissue sarcoma

Assessing the Safety and Utility of Wound VAC Temporization of the Sarcoma or Benign Aggressive Tumor Bed Until Final Margins Are Achieved

BACKGROUND

Local recurrence of microinvasive sarcoma or benign aggressive pathologies can be limb- and life-threatening. Although frozen pathology is reliable, tumor microinvasion can be subtle or missed, having an impact on surgical margins and postoperative radiation planning. The authors' service has begun to temporize the tumor bed after primary tumor excision with a wound vacuum-assisted closure (VAC) pending formal margin analysis, with coverage performed in the setting of final negative margins.

METHODS

This retrospective analysis included all patients managed at a tertiary referral cancer center with VAC temporization after soft tissue sarcoma or benign aggressive tumor excision from 1 January 2000 to 1 January 2019 and at least 2 years of oncologic follow-up evaluation. The primary outcome was local recurrence. The secondary outcomes were distant recurrence, unplanned return to the operating room for wound/infectious indications, thromboembolic events, and tumor-related deaths.

RESULTS

For 62 patients, VAC temporization was performed. The mean age of the patients was 62.2 ± 22.3 years (median 66.5 years; 95% confidence interval [CI] 61.7-72.5 years), and the mean age-adjusted Charlson Comorbidity Index was 5.3 ± 1.9. The most common tumor histology was myxofibrosarcoma (51.6%, 32/62). The mean volume was 124.8 ± 324.1 cm³, and 35.5% (22/62) of the cases were subfascial. Local recurrences occurred for 8.1% (5/62) of the patients. Three of these five patients had planned positive margins, and 17.7% (11/62) of the patients had an unplanned return to the operating room. No demographic or tumor factors were associated with unplanned surgery.

CONCLUSIONS

The findings showed that VAC-temporized management of microinvasive sarcoma and benign aggressive pathologies yields favorable local recurrence and unplanned operating room rates suggestive of oncologic and technical safety. These findings will need validation in a future randomized controlled trial.

The Future of Radiation Oncology in Soft Tissue Sarcoma

Radiotherapy (RT) is an important component of the treatment of soft tissue sarcomas (STS) and has been traditionally incorporated with a homogenous approach despite the reality that STS displays a known heterogeneity in clinicopathologic features and treatment outcomes. In this article, we explore the principle components of personalized medicine, including genomics, radiomics, and treatment response, along with their impact on the future of radiation therapy for STS. We propose a shift in the treatment paradigm for STS from a one-size-fits-all technique to one that implements the tenets of personalized medicine and includes the framework for a potential clinical trial technique in this heterogeneous disease.

Multifunctional Gold Nanoparticle-Based Fluorescence Resonance Energy-Transfer Probe for Target Drug Delivery and Cell Fluorescence Imaging

Drug delivery system has a profound significance for imaging capabilities and monitoring apoptosis process precisely in cancer therapeutic field. Herein, we designed cysteamine (CS)-stabilized gold nanoparticles, CS-gold nanoparticles (AuNPs)-doxorubicin (DOX), for fluorescence-enhanced cell imaging and target drug delivery. For cancer therapy, DOX was incorporated to CS-AuNPs by disulfide linkages which could be cleaved by glutathione (GSH) in cancer cells specifically. In addition, red-emissive DOX was quenched effectively by particular quenching effect of fluorescence resonance energy transfer from DOX to AuNPs, rendering monitoring target drug release by visual luminescence. The released DOX-SH acted as an indicator for cancer cells with red fluorescence and was further used for stimuli-responsive drug therapy. After an overall investigation of detection for GSH, proapoptosis for cancer cells, and inhibition for tumor tissues in vivo, the CS-AuNPs-DOX nanoprobe shows an obviously enhanced performance. This proposal provides an intelligent strategy for cell imaging and drug delivery, which serves as a promising candidate for anticancer therapeutic applications.

Fabrication of BSA@AuNC-Based Nanostructures for Cell Fluoresce Imaging and Target Drug Delivery

Drug delivery which can offer efficient and localized drug transportation together with imaging capabilities is highly demanded in the development of cancer theranostic approaches. Herein, we report the construction of bovine serum albumin (BSA) gold nanoclusters (BSA@AuNCs) for cell fluoresce imaging and target drug delivery. BSA@AuNCs were modified with cyclic arginine-glycine-aspartate with the product RGD-BSA@AuNCs to enhance cell internalization of the nanoclusters. Furthermore, doxorubicin hydrochloride or doxorubicin (DOX), a widely used chemotherapy drug, was also used to modify RGD-BSA@AuNCs. The final design of the DOX/RGD-BSA@AuNC system was constructed through the disulfide bond. The physical microstructure and biological characterization of the BSA@AuNCs were realized through high-resolution transmission electron microscopy and confocal laser fluorescence microscopy. As the disulfide bonds were cleaved by glutathione in cancer cells, DOX-SH molecules were released from the nanosystem to inhibit the growth of cancer cells. The as-prepared DOX/RGD-BSA@AuNC system can be used not only to deliver drug but also to achieve the antitumor effect by in vivo imaging, demonstrating its promising applications in cancer treatment.