1
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Judson I, Jones RL, Wong NACS, Dileo P, Bulusu R, Smith M, Almond M. Gastrointestinal stromal tumour (GIST): British Sarcoma Group clinical practice guidelines. Br J Cancer 2024:10.1038/s41416-024-02672-0. [PMID: 38840030 DOI: 10.1038/s41416-024-02672-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND British Sarcoma Group guidelines for the management of GIST were initially informed by those published by the European Society of Clinical Oncology. This update was written by a group of experts to includes a discussion of the highlight improvements in our knowledge of the disease and recent treatment developments. The guidelines include sections on Incidence, Aetiology, Diagnosis, including risk assessment, Treatment and Follow-up. METHODS A careful review of the literature was performed to ensure that wherever possible recommendations are supported by the results of clinical trials or substantive retrospective reports. Areas of uncertainty are indicated appropriately. CONCLUSION Guidelines represent a consensus view of current best clinical practice. Where appropriate, key recommendations are given and the levels of evidence and strength of recommendation gradings are those used by the European Society for Medical Oncology (ESMO).
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Affiliation(s)
- Ian Judson
- The Institute of Cancer Research, London, UK.
| | | | | | | | | | - Myles Smith
- Royal Marsden NHS Foundation Trust, London, UK
| | - Max Almond
- Birmingham University Hospitals, Birmingham, UK
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2
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Rehman S, Harikrishna A, Silwal A, Sumie BR, Mohamed S, Kolhe N, Maddi M, Huynh L, Gutierrez J, Annepu YR, Farrukh AM. Ovarian angiosarcoma: A systematic review of literature and survival analysis. Ann Diagn Pathol 2024; 73:152331. [PMID: 38811255 DOI: 10.1016/j.anndiagpath.2024.152331] [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: 05/08/2024] [Accepted: 05/14/2024] [Indexed: 05/31/2024]
Abstract
Ovarian angiosarcoma (OA) is rare, with only sporadic cases reported in English literature. We performed a systematic review of cases published in the PubMed, Science Direct, and Google Scholar databases with the aim of describing the reported clinicopathological features of OA. Fifty-three articles that reported 60 patients were reviewed. Of the 60 patients, 7 (11.6 %) were diagnosed with secondary (metastatic) ovarian angiosarcoma and 53 (88.3 %) were diagnosed with primary ovarian angiosarcoma. The mean age at presentation for ovarian angiosarcoma was 38.3±17.8 years. The average tumor size for ovarian angiosarcoma was 11.9±6.1 cm. Abdominal distention was reported in 45/60 (75 %). Microscopic examination revealed necrosis in 28/60 (46.7 %), pleomorphism in 32/59 (54.2 %), mitotic figures in 44/60 (73.3 %), spindle-shaped cells in 27/36 (75 %), epithelioid-shaped cells in 20/36 (55.5 %), and mixed epithelioid and spindle-shaped cells in 12/36 (33.3 %) patients. On immunohistochemistry CD 31 was positive in 41/41 (100 %), CD 34 in 38/39 (97.4 %), and Factor VIII related antigen in 18/21 (85.7 %) patients. Metastasis was present in 43/60 (71.6 %) patients. Chemotherapy and surgery was performed in 36/52 (69.2 %). The median follow-up time for ovarian angiosarcoma was 7 months (IQR1-IQR3:2-13.5 months). 24 (48 %) of the 50 patients with available survival data were alive and 26/50 (52 %) were dead of disease. Survival analyses (KM curves) revealed that the presence of necrosis (log-rank test; p = 0.05) and absence of spindle-shaped cells (log rank test; p = 0.04) on histopathology were associated with worse outcomes, while treatment with combined chemotherapy and surgical excision was associated with better survival (P < 0.001) therefore, prompt diagnosis and early treatment with combined chemotherapy and surgical excision can prolong survival in OA.
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Affiliation(s)
- Shafi Rehman
- Department of Histopathology, Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Pakistan.
| | | | - Amisha Silwal
- Cagayan State University College of Medicine, Philippines
| | - B R Sumie
- KMCH Medical College Hospital, India
| | - Safdar Mohamed
- Nicolae Testemitanu State University of Medicine and Pharmacy, Republic of Moldova
| | | | - Meghana Maddi
- Kamineni Academy of Medical Sciences and Research Center, Hyderabad, India
| | - Linh Huynh
- Kansas College of Osteopathic Medicine, United States of America
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3
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Dou Y, Li X, Tao J, Dong Y, Xu N, Wang S. Prediction of high-grade soft-tissue sarcoma using a combined intratumoural and peritumoural MRI-based radiomics nomogram. Clin Radiol 2023; 78:e1032-e1040. [PMID: 37748959 DOI: 10.1016/j.crad.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 08/03/2023] [Accepted: 08/29/2023] [Indexed: 09/27/2023]
Abstract
AIM To develop an intratumoural and peritumoural magnetic resonance imaging (MRI)-based radiomics nomogram for predicting tumour grade to improve clinical treatment and long-term prognosis. MATERIALS AND METHODS MRI (3 T) features and T2-weighted imaging with fat-saturation (T2WI-FS)-based radiomics features of 57 patients with soft-tissue sarcoma (STS) were analysed retrospectively. Tumour size, ratio of width and length, relative depth to the peripheral fascia, peritumoural oedema, heterogeneity on T2WI, necrosis signal, enhancement model, and peritumoural enhancement were obtained. Independent risk factors were screened to construct an MRI feature nomogram. Radiomics features were obtained from intratumoural and peritumoural images on T2WI-FS. The optimal radiomics model was selected by the four-step dimensionality reduction method of minimum and maximum normalisation, optimal feature selection, selection based on support vector machine with L1-norm regularisation model, and iterative feature selection. MRI features and optimal radiomics features were used to construct a radiomics nomogram. The MRI feature nomogram model, the radiomics model, and the radiomics nomogram model were assessed by receiver operating characteristic (ROC) curves and calibration curves of the training and validation sets. RESULTS Heterogeneity on T2WI and peritumoural enhancement were independent risk factors for predicting high-grade STS. The areas under the curves of the training set and verification set of the three models were as follows: MRI feature nomogram, 0.86 and 0.83, respectively; intratumoural and peritumoural combined radiomics model, 0.99 and 0.86, respectively; and radiomics nomogram model, 0.98 and 0.96, respectively. CONCLUSION The radiomics nomogram model based on MRI features and combined intratumoural and peritumoural radiomic features was best able to predict high-grade STS.
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Affiliation(s)
- Y Dou
- Department of Ultrasound, The First Affiliated Hospital, Dalian Medical University, Dalian, China; Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - X Li
- Department of Radiology, Huashan Hospital Fudan University, Shanghai, China
| | - J Tao
- Department of Pathology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Y Dong
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - N Xu
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - S Wang
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China.
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4
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Wah NW, Mok Y, Omar N, Chang KTE, Tay TKY, Hue SSS, Lee VKM. Clinicopathologic and Molecular Characteristics of Epstein-Barr Virus-Associated Smooth Muscle Tumor Compared With Those of Leiomyoma and Leiomyosarcoma. Mod Pathol 2023; 36:100127. [PMID: 36965331 DOI: 10.1016/j.modpat.2023.100127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/28/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023]
Abstract
Epstein-Barr virus (EBV)-associated smooth muscle tumors (EBV-SMTs) are rare smooth muscle neoplasms exclusively associated with immunosuppression, such as in patients with HIV/AIDS, posttransplant, and congenital immunodeficiency. However, the genomic landscape of EBV-SMTs is poorly understood. Leiomyosarcomas harbor genomic instability and multiple recurrent DNA copy number alterations, whereas leiomyomas lack such changes. Thus, this study aimed to fill this knowledge gap by characterizing copy number alterations in EBV-SMTs and correlating this information with clinicopathologic characteristics. Our study investigated and compared the pathologic characteristics and copy number profiles of 9 EBV-SMTs (from 7 post-transplant and AIDS patients), 6 leiomyomas, and 7 leiomyosarcomas, using chromosomal microarray platforms. Our results showed a lower copy number alteration burden in EBV-SMTs and leiomyoma than in leiomyosarcoma. This contrast in the molecular profile between EBV-SMTs and leiomyosarcoma is concordant with the different clinical behaviors and pathologic characteristics exhibited by these tumors. Despite having an overall copy number alteration profile closer to leiomyoma, recurrent copy number gain of oncogenes, such as RUNX1, CCND2, and ETS2, was found in EBV-SMTs. Epigenetic alterations may play an important role in tumorigenesis as recurrent copy number gains were found in histone deacetylases. A gene enrichment analysis also demonstrated enrichment of genes involved in the host response to viral infection, suggesting that the tumor immune microenvironment may play an important role in EBV-SMT tumorigenesis.
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Affiliation(s)
- Naw Wah Wah
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yingting Mok
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Pathology, National University Hospital, National University Health System, Singapore; Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | | | - Kenneth Tou En Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | | | - Susan Swee-Shan Hue
- Department of Pathology, National University Hospital, National University Health System, Singapore
| | - Victor Kwan Min Lee
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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5
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Arthur A, Johnston EW, Winfield JM, Blackledge MD, Jones RL, Huang PH, Messiou C. Virtual Biopsy in Soft Tissue Sarcoma. How Close Are We? Front Oncol 2022; 12:892620. [PMID: 35847882 PMCID: PMC9286756 DOI: 10.3389/fonc.2022.892620] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/31/2022] [Indexed: 12/13/2022] Open
Abstract
A shift in radiology to a data-driven specialty has been unlocked by synergistic developments in imaging biomarkers (IB) and computational science. This is advancing the capability to deliver “virtual biopsies” within oncology. The ability to non-invasively probe tumour biology both spatially and temporally would fulfil the potential of imaging to inform management of complex tumours; improving diagnostic accuracy, providing new insights into inter- and intra-tumoral heterogeneity and individualised treatment planning and monitoring. Soft tissue sarcomas (STS) are rare tumours of mesenchymal origin with over 150 histological subtypes and notorious heterogeneity. The combination of inter- and intra-tumoural heterogeneity and the rarity of the disease remain major barriers to effective treatments. We provide an overview of the process of successful IB development, the key imaging and computational advancements in STS including quantitative magnetic resonance imaging, radiomics and artificial intelligence, and the studies to date that have explored the potential biological surrogates to imaging metrics. We discuss the promising future directions of IBs in STS and illustrate how the routine clinical implementation of a virtual biopsy has the potential to revolutionise the management of this group of complex cancers and improve clinical outcomes.
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Affiliation(s)
- Amani Arthur
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom
| | - Edward W. Johnston
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Jessica M. Winfield
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Matthew D. Blackledge
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom
| | - Robin L. Jones
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Paul H. Huang
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton, United Kingdom
- *Correspondence: Paul H. Huang, ; Christina Messiou,
| | - Christina Messiou
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- *Correspondence: Paul H. Huang, ; Christina Messiou,
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6
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Chapel DB, Sharma A, Lastra RR, Maccio L, Bragantini E, Zannoni GF, George S, Quade BJ, Parra-Herran C, Nucci MR. A novel morphology-based risk stratification model for stage I uterine leiomyosarcoma: an analysis of 203 cases. Mod Pathol 2022; 35:794-807. [PMID: 35121810 DOI: 10.1038/s41379-022-01011-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/23/2022]
Abstract
Uterine leiomyosarcoma is the most common uterine mesenchymal malignancy. The majority present at stage I, and clinical outcomes vary widely. However, no widely accepted risk stratification system for stage I uterine leiomyosarcoma is currently available. We studied 17 routinely evaluated clinicopathologic parameters in 203 stage I uterine leiomyosarcoma from three institutions to generate a novel risk stratification model for these tumors. Mitoses >25 per 2.4 mm2 (10 high-power fields), atypical mitoses, coagulative necrosis, lymphovascular invasion, and serosal abutment were significantly associated with disease-free and disease-specific survival in univariate and multivariate analyses. These prognostic parameters were each scored as binary ("yes" or "no") variables and fitted to a single optimized algebraic risk model:Risk score = (coagulative necrosis)(1) + (mitoses > 25 per 2.4 mm2)(2) + (atypical mitoses)(2) + (lymphovascular invasion)(3) + (serosal abutment)(5)By logistic regression, the risk model was significantly associated with 5-year disease-free (AUC = 0.9270) and 5-year disease-specific survival (AUC = 0.8517). Internal and external validation substantiated the model. The continuous score (range, 0-13) was optimally divided into 3 risk groups with distinct 5-year disease-free and disease-specific survival: low risk (0-2 points), intermediate risk (3-5 points), and high risk (6-13 points) groups. Our novel risk model performed significantly better than alternative uterine leiomyosarcoma risk stratification systems in predicting 5-year disease-free and disease-specific survival in stage I tumors. A simplified risk model, omitting terms for serosal abutment and lymphovascular invasion, can be accurately applied to myomectomy or morcellated specimens. We advocate routine application of this novel risk model in stage I uterine leiomyosarcoma to facilitate patient counseling and proper risk stratification for clinical trials.
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Affiliation(s)
- David B Chapel
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA.
- Department of Pathology, University of Michigan - Michigan Medicine, Ann Arbor, MI, 48109, USA.
| | - Aarti Sharma
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
- Department of Pathology, University of Chicago Medicine, Chicago, IL, 60637, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago Medicine, Chicago, IL, 60637, USA
| | - Livia Maccio
- Unit of Surgical Pathology, S. Chiara Hospital, Trient, Italy
| | - Emma Bragantini
- Unit of Surgical Pathology, S. Chiara Hospital, Trient, Italy
| | | | - Suzanne George
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02115, USA
| | - Bradley J Quade
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Carlos Parra-Herran
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Marisa R Nucci
- Division of Women's and Perinatal Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
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7
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Meuten DJ, Moore FM, Donovan TA, Bertram CA, Klopfleisch R, Foster RA, Smedley RC, Dark MJ, Milovancev M, Stromberg P, Williams BH, Aubreville M, Avallone G, Bolfa P, Cullen J, Dennis MM, Goldschmidt M, Luong R, Miller AD, Miller MA, Munday JS, Roccabianca P, Salas EN, Schulman FY, Laufer-Amorim R, Asakawa MG, Craig L, Dervisis N, Esplin DG, George JW, Hauck M, Kagawa Y, Kiupel M, Linder K, Meichner K, Marconato L, Oblak ML, Santos RL, Simpson RM, Tvedten H, Whitley D. International Guidelines for Veterinary Tumor Pathology: A Call to Action. Vet Pathol 2021; 58:766-794. [PMID: 34282984 DOI: 10.1177/03009858211013712] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Standardization of tumor assessment lays the foundation for validation of grading systems, permits reproducibility of oncologic studies among investigators, and increases confidence in the significance of study results. Currently, there is minimal methodological standardization for assessing tumors in veterinary medicine, with few attempts to validate published protocols and grading schemes. The current article attempts to address these shortcomings by providing standard guidelines for tumor assessment parameters and protocols for evaluating specific tumor types. More detailed information is available in the Supplemental Files, the intention of which is 2-fold: publication as part of this commentary, but more importantly, these will be available as "living documents" on a website (www.vetcancerprotocols.org), which will be updated as new information is presented in the peer-reviewed literature. Our hope is that veterinary pathologists will agree that this initiative is needed, and will contribute to and utilize this information for routine diagnostic work and oncologic studies. Journal editors and reviewers can utilize checklists to ensure publications include sufficient detail and standardized methods of tumor assessment. To maintain the relevance of the guidelines and protocols, it is critical that the information is periodically updated and revised as new studies are published and validated with the intent of providing a repository of this information. Our hope is that this initiative (a continuation of efforts published in this journal in 2011) will facilitate collaboration and reproducibility between pathologists and institutions, increase case numbers, and strengthen clinical research findings, thus ensuring continued progress in veterinary oncologic pathology and improving patient care.
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Affiliation(s)
| | | | | | - Christof A Bertram
- Freie Universität Berlin, Berlin, Germany.,University of Veterinary Medicine, Vienna, Austria
| | | | | | | | | | | | | | | | | | | | - Pompei Bolfa
- Ross University, Basseterre, Saint Kitts and Nevis
| | - John Cullen
- North Carolina State University, Raleigh, NC, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Nick Dervisis
- VA-MD College of Veterinary Medicine, Blacksburg, VA, USA
| | | | | | | | | | | | - Keith Linder
- North Carolina State University, Raleigh, NC, USA
| | | | | | | | - Renato L Santos
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - R Mark Simpson
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Harold Tvedten
- Swedish University of Agricultural Sciences, Uppsala, Sweden
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8
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Gennaro N, Reijers S, Bruining A, Messiou C, Haas R, Colombo P, Bodalal Z, Beets-Tan R, van Houdt W, van der Graaf WTA. Imaging response evaluation after neoadjuvant treatment in soft tissue sarcomas: Where do we stand? Crit Rev Oncol Hematol 2021; 160:103309. [PMID: 33757836 DOI: 10.1016/j.critrevonc.2021.103309] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/15/2021] [Accepted: 03/03/2021] [Indexed: 12/16/2022] Open
Abstract
Soft tissue sarcomas (STS) represent a broad family of rare tumours for which surgery with radiotherapy represents first-line treatment. Recently, neoadjuvant chemo-radiotherapy has been increasingly used in high-risk patients in an effort to reduce surgical morbidity and improve clinical outcomes. An adequate understanding of the efficacy of neoadjuvant therapies would optimise patient care, allowing a tailored approach. Although response evaluation criteria in solid tumours (RECIST) is the most common imaging method to assess tumour response, Choi criteria and functional and molecular imaging (DWI, DCE-MRI and 18F-FDG-PET) seem to outperform it in the discrimination between responders and non-responders. Moreover, the radiologic-pathology correlation of treatment-related changes remains poorly understood. In this review, we provide an overview of the imaging assessment of tumour response in STS undergoing neoadjuvant treatment, including conventional imaging (CT, MRI, PET) and advanced imaging analysis. Future directions will be presented to shed light on potential advances in pre-surgical imaging assessments that have clinical implications for sarcoma patients.
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Affiliation(s)
- Nicolò Gennaro
- Humanitas Research and Cancer Center, Dept. of Radiology, Rozzano, Italy; Humanitas University, Dept. of Biomedical Sciences, Pieve Emanuele, Italy; The Netherlands Cancer Institute, Dept. of Radiology, Amsterdam, the Netherlands.
| | - Sophie Reijers
- The Netherlands Cancer Institute, Dept. of Surgical Oncology, Amsterdam, the Netherlands
| | - Annemarie Bruining
- The Netherlands Cancer Institute, Dept. of Radiology, Amsterdam, the Netherlands
| | - Christina Messiou
- The Royal Marsden NHS Foundation Trust, Dept. Of Radiology Sarcoma Unit, Sutton, United Kingdom; The Institute of Cancer Research, Sutton, United Kingdom
| | - Rick Haas
- The Netherlands Cancer Institute, Dept. of Radiation Oncology, Amsterdam, the Netherlands; Leiden University Medical Center, Dept. of Radiation Oncology, the Netherlands
| | | | - Zuhir Bodalal
- The Netherlands Cancer Institute, Dept. of Radiology, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Regina Beets-Tan
- The Netherlands Cancer Institute, Dept. of Radiology, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands; Danish Colorectal Cancer Center South, Vejle University Hospital, Institute of Regional Health Research, University of Southern Denmark, Denmark
| | - Winan van Houdt
- The Netherlands Cancer Institute, Dept. of Surgical Oncology, Amsterdam, the Netherlands
| | - Winette T A van der Graaf
- The Netherlands Cancer Institute, Dept. of Medical Oncology, Amsterdam, the Netherlands; Erasmus MC Cancer Institute, Dept. of Medical Oncology, Erasmus University Medical Center, Rotterdam, the Netherlands
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9
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Abstract
SummarySoft tissue sarcomas are exceedingly rare cancers with more than 100 different histiologic subtypes and tremendous morphologic heterogeneity. Next generation sequencing (NGS) techniques have drastically improved our knowledge about these tumours. The possibility to use these techniques routinely changed the diagnostic standards in soft tissue pathology. Within the last few years pathologists were confronted with a growing number of exceedingly rare, partly molecularly defined, tumour entities. The proposed pathologic diagnosis dictates prognosis and treatment. Therefore, specialized soft tissue pathology units with the possibility to include molecular diagnostics into a histopathological report for diagnostic, predictive and prognostic aspects are needed. A second opinion by a soft tissue pathologist, before final treatment decision, should be mandatory to ensure optimal treatment for all patients by a multidisciplinary team in a specialized centre.
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10
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Rekhi B, Kattoor J, Jennifer A, Govindarajan N, Uppin S, Jambhekar NA, Jojo A, Chatterjee U, Banerjee D, Singh P. Grossing and reporting of a soft tissue tumor specimen in surgical pathology: Rationale, current evidence, and recommendations. Indian J Cancer 2020; 58:17-27. [PMID: 33402595 DOI: 10.4103/ijc.ijc_738_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Soft tissue tumors, including sarcomas are complex and diagnostically challenging tumors. This is as a result of their heterogeneity and overlapping clinicopathological, immunohistochemical and also molecular features, the latter to some extent. More than 80 types of sarcoma have been described. Current management, which is best offered at centers with active multidisciplinary care, is based on balancing oncologic and functional outcomes in such cases. This has transcended into the types of specimens received for grossing these rather uncommon tumors. Over the years, diagnostic specimens have reduced in their sizes from, open biopsies to core needle biopsies. These specimens need to be adequately and judiciously triaged for ancillary techniques, such as molecular testing. Conservative surgeries have led to resected specimens for marginal assessment. Lately, post neoadjuvant (chemotherapy or radiation therapy)-treated resection specimens of soft tissue sarcomas are being submitted for surgical pathology reporting. This article focuses on the grossing of soft tissue tumors, including sarcomas, in terms of types of specimens, grossing techniques including rationale, tissue triage, reporting, and recommendations from the surgical pathologists actively engaged in reporting musculoskeletal tumors, based on current evidence.
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Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Bone and Soft Tissues, Disease Management Group, Tata Memorial Hospital, Homi Bhabha National Institute University, Mumbai, Maharashtra, India
| | - Jayasree Kattoor
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Anne Jennifer
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nandini Govindarajan
- Department of Pathology, Dr Kamkashi Memorial Hospitals, Chennai, Tamil Nadu, India
| | - Shantveer Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Nirmala A Jambhekar
- Formerly, Department of Surgical Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Annie Jojo
- Department of Pathology, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Uttara Chatterjee
- Department of Pathology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Devmalya Banerjee
- Department of Pathology, Narayana Super Speciality Hospital, Howrah, Kolkata, West Bengal, India
| | - Pradyumn Singh
- Department of Pathology, Ram Manohar Lohia Hospital, Lucknow, Uttar Pradesh, India
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11
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Hahn E, Huang SH, Hosni A, Razak AA, Jones RL, Dickson BC, Sturgis EM, Patel SG, O'Sullivan B. Ending 40 years of silence: Rationale for a new staging system for soft tissue sarcoma of the head and neck. Clin Transl Radiat Oncol 2018; 15:13-19. [PMID: 30582016 PMCID: PMC6293017 DOI: 10.1016/j.ctro.2018.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 11/25/2022] Open
Abstract
For 40 years, all soft tissue sarcoma (STS) used the same TNM where T1 was <=5 cm. This staging is unsuited for STS of the head and neck (STSHN) since only a minority are >5 cm. Despite smaller size, local recurrence is higher in STSHN compared to other STS. A new T classification with 2 and 4 cm cut-offs for STSHN was introduced in TNM-8. Future requirements for STSHN Stage Group development are mentioned.
The tumor, node, metastases (TNM) anatomic staging system plays a pivotal role in cancer care, research, and cancer control activities. Since the first edition of the American Joint Committee on Cancer TNM staging classification published in 1977, soft tissue sarcomas have been staged in an anatomic site agnostic fashion whereby the primary tumor size (T) was categorized as T1 if <=5 cm and T2 if >5 cm; this remained unchanged through the 7th edition of the TNM. However, soft tissue sarcomas of the head and neck (STSHN) usually present smaller than sarcomas of other sites, but carry a disproportionate risk of local recurrence. Up to 70% of tumors are less than 5 cm at presentation, and therefore classified together as T1. Given the rarity of STSHN, there is a paucity of data to guide progress in their classification. Moreover, the majority of publications only report tumor size as less than or greater than 5 cm, presumably based on conventions of the TNM system that remained unchanged for 40 years, thereby affecting progress of STSHN classification. This formed the impetus for change in the 8th edition in 2 key ways: 1) several soft tissue sarcoma site based changes occurred including STSHN now having its own system, and 2) primary tumor size cut-offs of 2 cm and 4 cm used in STSHN now reflect sizes that head and neck specialists commonly encounter in their practice. This update was pragmatic in modifying the TNM from a system with a T category not serving STSHN and which was originally based on sarcoma data from non-head and neck anatomic sites. The background to this change is outlined which provides a framework in which data can be reported to generate evidence for future staging modifications.
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Affiliation(s)
- Ezra Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, Canada
| | - Albiruni Abdul Razak
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, Canada
| | - Robin L Jones
- Royal Marsden Hospital/Institute of Cancer Research, United Kingdom
| | - Brendan C Dickson
- Department of Pathology & Laboratory Medicine, Sinai Health System, Toronto, Canada
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Snehal G Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, Canada
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12
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Zhang B, Zheng GL, Zhu HT, Zhao Y, Zheng ZC. Clinicopathological characteristics and prognosis of primary appendiceal stromal tumors. World J Surg Oncol 2018; 16:225. [PMID: 30445975 PMCID: PMC6240235 DOI: 10.1186/s12957-018-1524-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/06/2018] [Indexed: 01/30/2023] Open
Abstract
Background Gastrointestinal stromal tumors (GISTs) account for less than 1% of all gastrointestinal tumors. The biological behaviors of GISTs vary from benign to malignant. GISTs are common in the stomach (55.6%) and small intestine (31.8%), but rarely in the rectum, colon (6%), and other sites (5.5%). Currently, the majority of published reports of primary appendiceal stromal tumors (PASTs) are case reports or case series. Methods The PASTs described in this study were identified from a literature review (23 cases) and our center (one case). The relationship between PAST gross types and clinicopathological factors was analyzed and summarized. At the same time, the study also analyzed the related risk factors and survival of PASTs and GISTs. Results Twenty-four cases of PASTs were compared with 254 cases of GISTs from our center. The results showed that there was a significant difference between the two groups in tumor size (P < 0.001), histological type (P = 0.013), CD34 expression (P < 0.001), and DOG-1 expression (P < 0.001). Disease-free survival (DFS) analysis of 11 cases of PASTs and 227 cases of GISTs found that a comparison of 3-year and 5-year DFS was not statistically significant (P = 0.894 and P = 0.846, respectively). In the DFS multivariate analysis, tumor mucosal ulceration, tumor size, and NIH risk classification were independent prognostic factors in 3-year and 5-year DFS. Conclusion In this study, there was no significance in the survival of patients with appendix and gastric stromal tumors, which we hypothesized to be associated with the low sample size and incomplete follow-up records. Based on this, we conclude that the prognosis of primary appendiceal stromal tumors may be better than gastric tumors, but this needs to be confirmed in further prospective studies.
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Affiliation(s)
- Bao Zhang
- China Medical University, No.77 Puhe Road, Shenbei New District, Shenyang, 110013, Liaoning Province, People's Republic of China
| | - Guo Liang Zheng
- Department of Gastric Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No.44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China
| | - Hai Tao Zhu
- Department of Gastric Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No.44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China
| | - Yan Zhao
- Department of Gastric Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No.44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China
| | - Zhi Chao Zheng
- Department of Gastric Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No.44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China.
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Judson I, Bulusu R, Seddon B, Dangoor A, Wong N, Mudan S. UK clinical practice guidelines for the management of gastrointestinal stromal tumours (GIST). Clin Sarcoma Res 2017; 7:6. [PMID: 28465823 PMCID: PMC5408425 DOI: 10.1186/s13569-017-0072-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/06/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Soft tissue sarcomas (STS) are rare tumours arising in mesenchymal tissues. Gastrointestinal stromal tumour (GIST) is the commonest STS and arises within the wall of the gastrointestinal (GI) tract. While most GISTs occur in the stomach they do occur in all parts of the GI tract. As with other STS, it is important that GISTs are managed by expert teams, to ensure consistent and optimal treatment, as well as recruitment to clinical trials, and the ongoing accumulation of further knowledge of the disease. The development of appropriate guidance, by an experienced panel referring to the evidence available, is therefore a useful foundation on which to build progress in the field. METHODOLOGY British Sarcoma Group guidelines for the management of GIST were initially developed by a panel of physicians experienced in the management of GIST. This current version has been updated and amended with reference to other European and US guidance. We have received input from representatives of all diagnostic and treatment disciplines as well as patient representatives. Levels of evidence and strength of recommendation gradings are those used by ESMO adapted from those published by the Infectious Disease Society of America. CONCLUSIONS The guidelines cover aetiology, genetics and underlying molecular mechanisms, diagnosis and initial investigations, staging and risk stratification, surgery, neoadjuvant and adjuvant therapy, the management of advanced disease and follow-up. The importance of mutational analysis in guiding treatment is highlighted, since this can indicate the most effective treatment and avoid administration of ineffective drugs, emphasising the need for management in specialist centres.
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Affiliation(s)
- Ian Judson
- The Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK
| | - Ramesh Bulusu
- Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Beatrice Seddon
- University College Hospital, University College London Hospitals NHS Foundation Trust, London, UK
| | - Adam Dangoor
- Bristol Cancer Institute, University Hospitals, Bristol NHS Trust, Bristol, UK
| | - Newton Wong
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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Shah C, Wang J, Mubako T, Fisher C, Thway K. Gross examination and reporting of soft tissue tumours: evaluation of compliance with the UK Royal College of Pathologists soft tissue sarcoma dataset. J Clin Pathol 2016; 69:761-6. [DOI: 10.1136/jclinpath-2015-203495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 01/17/2016] [Indexed: 12/13/2022]
Abstract
AimsSoft tissue tumours are a heterogeneous group of neoplasms that can arise at almost every anatomical site. As they often show similar clinical and radiological findings, histology is the definitive diagnostic method and it is crucial that the surgical pathology report contains accurate, useful information for management and prognostication. The soft tissue sarcoma minimum dataset produced by the Royal College of Pathologists in the UK outlines a structure for handling and reporting soft tissue tumours, including the core data required, and aiding pathologists in forming a consistent reporting approach.MethodsWe assessed the information in surgical pathology reports for soft tissue lesions at a tertiary soft tissue centre, in 1 year prior to the development of this dataset, and 1 year after its release, to audit the comparative adequacy of macroscopic and microscopic information provided, and to assess for differences in reporting since the advent of routine ancillary molecular diagnostic testing.Results and conclusionsWe found that while essential information was always included in reports, more specific details contributing to better quality reports such as more detailed macroscopic descriptions and a higher proportion of clinical summaries with radiological correlation were included in 2011 than 2006, despite increasing workload. Specimen handling, particularly of core biopsies, was also improved, reflecting the increasing need to conserve the maximum amount of patient material for molecular investigations.
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Wardelmann E, Haas R, Bovée J, Terrier P, Lazar A, Messiou C, LePechoux C, Hartmann W, Collin F, Fisher C, Mechtersheimer G, DeiTos A, Stacchiotti S, Jones R, Gronchi A, Bonvalot S. Evaluation of response after neoadjuvant treatment in soft tissue sarcomas; the European Organization for Research and Treatment of Cancer–Soft Tissue and Bone Sarcoma Group (EORTC–STBSG) recommendations for pathological examination and reporting. Eur J Cancer 2016; 53:84-95. [DOI: 10.1016/j.ejca.2015.09.021] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/14/2015] [Accepted: 09/16/2015] [Indexed: 12/25/2022]
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Kosemehmetoglu K, Ardic F, Karslioglu Y, Kandemir O, Ozcan A. p16 expression predicts neoadjuvant tumor necrosis in osteosarcomas: reappraisal with a larger series using whole sections. Hum Pathol 2015; 50:170-5. [PMID: 26997452 DOI: 10.1016/j.humpath.2015.09.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 08/26/2015] [Accepted: 09/10/2015] [Indexed: 01/28/2023]
Abstract
The presence of greater than or equal to 90% necrosis after neoadjuvant chemotherapy is a favorable prognostic factor in osteosarcomas. A recent study using tissue microarrays of 40 conventional osteosarcomas showed that p16 expression independently predicted the necrotic response to neoadjuvant chemotherapy. In this study, we investigated this finding using whole sections in a larger group of osteosarcomas. Cases of 83 patients who had pretreatment biopsies and received neoadjuvant chemotherapy and surgical resection were collected from 3 reference hospital archives. Age, sex, tumor size, tumor subtype, location, and percentage of tumor necrosis were recorded; 4-μm sections from pretreatment biopsies were stained for p16. More than 30% strong nuclear staining was regarded as positive. The median age was 17 years (5-68 years), and male/female ratio was 2.3. The mean tumor diameter was 9.9 cm (2-30 cm). Tumors were most commonly of the osteoblastic type (60%) and located at the femur (47%). p16 positivity was seen in 66% of the patients. The median pathologic necrosis was 65%, and 39% of the patients responded favorably (≥%90 necrosis) to neoadjuvant therapy. In univariate analysis, p16 expression significantly correlated with greater than or equal to 90% response (P = .022). On multivariate analysis, p16 expression (odds ratio [OR], 7.71; P = .008), female sex (OR, 8.62; P = .006), and smaller tumor size (OR, 0.86; P = .023) were independent predictors of favorable response to neoadjuvant chemotherapy. We confirmed the finding that p16 expression predicts postchemotherapy necrotic response in conventional osteosarcomas.
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Affiliation(s)
- Kemal Kosemehmetoglu
- Department of Pathology, Hacettepe University School of Medicine, 06230 Ankara, Turkey.
| | - Fisun Ardic
- Department of Pathology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, 06200 Ankara, Turkey
| | - Yildirim Karslioglu
- Department of Pathology, Gulhane Military Medical Academy, 06010 Ankara, Turkey
| | - Olcay Kandemir
- Department of Pathology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, 06200 Ankara, Turkey
| | - Ayhan Ozcan
- Department of Pathology, Gulhane Military Medical Academy, 06010 Ankara, Turkey
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Garcia del Muro X, de Alava E, Artigas V, Bague S, Braña A, Cubedo R, Cruz J, Mulet-Margalef N, Narvaez JA, Martinez Tirado O, Valverde C, Verges R, Viñals J, Martin-Broto J. Clinical practice guidelines for the diagnosis and treatment of patients with soft tissue sarcoma by the Spanish group for research in sarcomas (GEIS). Cancer Chemother Pharmacol 2015; 77:133-46. [PMID: 26563256 PMCID: PMC4706580 DOI: 10.1007/s00280-015-2809-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/12/2015] [Indexed: 01/24/2023]
Abstract
Soft tissue sarcomas (STS) constitute an uncommon and heterogeneous group of tumours, which require a complex and specialized multidisciplinary management. The diagnostic approach should include imaging studies and core needle biopsy performed prior to undertaking surgery. Wide excision is the mainstay of treatment for localized sarcoma, and associated preoperative or postoperative radiotherapy should be administered in high-risk patients. Adjuvant chemotherapy was associated with a modest improvement in survival in a meta-analysis and constitutes a standard option in selected patients with high-risk STS. In metastatic patients, surgery must be evaluated in selected cases. In the rest of patients, chemotherapy and, in some subtypes, targeted therapy often used in a sequential strategy constitutes the treatment of election. Despite important advances in the understanding of the pathophysiology of the disease, the advances achieved in therapeutic results may be deemed still insufficient. Moreover, due to the rarity and complexity of the disease, the results in clinical practice are not always optimal. For this reason, the Spanish Group for Research on Sarcoma (GEIS) has developed a multidisciplinary clinical practice guidelines document, with the aim of facilitating the diagnosis and treatment of these patients in Spain. In the document, each practical recommendation is accompanied by level of evidence and grade of recommendation on the basis of the available data.
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Affiliation(s)
| | | | | | - Silvia Bague
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Josefina Cruz
- Hospital Universitario de Canarias, Santa Cruz De Tenerife, Spain
| | | | | | | | | | - Ramona Verges
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Joan Viñals
- Hospital Universitario de Bellvitge, Barcelona, Spain
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Abstract
OBJECTIVE Angiosarcoma is an aggressive malignancy with endothelial differentiation and notoriously poor prognosis despite aggressive therapy. Limited data are available to guide management decisions. To address this limitation, we present a large retrospective analysis of angiosarcoma patients treated at a single institution over a 25-year period. METHODS To identify factors that impact angiosarcoma outcomes, we reviewed demographic, tumor, and treatment characteristics of angiosarcoma patients evaluated at the University of Wisconsin Hospital between 1987 and 2012. RESULTS The cohort included 81 patients diagnosed at ages 19 to 90 years (median, 67 y). Fifty-five (68%) patients presented with localized disease, whereas 26 (32%) presented with metastases. The primary sites were visceral/deep soft tissue (42%), head and neck/cutaneous (37%), breast (16%), and limbs in the setting of Stewart-Treves (5%). The 5-year overall survival was 40% with a median of 16 months. By univariate analysis, significant adverse predictors of survival included metastases at presentation, visceral/deep soft tissue tumor location, tumor size > 5 cm, tumor necrosis, and the absence of surgical excision. A trend toward prolonged survival was observed with radiation therapy and for chemotherapy in patients with metastases. Age, sex, and prior radiation showed no correlation with survival. CONCLUSIONS Our large single institution series confirms the poor prognosis of angiosarcoma, supports a central role for surgical excision in management, and highlights the need for novel therapies particularly in patients who present with metastatic disease.
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Kandel R, Coakley N, Werier J, Engel J, Ghert M, Verma S. Surgical margins and handling of soft-tissue sarcoma in extremities: a clinical practice guideline. ACTA ACUST UNITED AC 2013; 20:e247-54. [PMID: 23737694 DOI: 10.3747/co.20.1308] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
QUESTIONS In limb salvage surgery for extremity soft-tissue sarcoma (sts), what is an adequate surgical margin?What is the appropriate number of samples to take from the margins of a surgical resection specimen?What is the appropriate handling of surgical resection specimens? BACKGROUND Surgery is the primary treatment for extremity sts. The combination of radiotherapy with surgery allows for limb salvage by using radiation to biologically "sterilize" microscopic extensions of tumour and to spare neurovascular and osseous structures. Adjuvant chemotherapy in sts-except for rhabdomyosarcoma and Ewing sarcoma-continues to be controversial. METHODS The medline and embase databases (1975 to June 2011) and the Cochrane Library were searched for pertinent studies. The Web sites of the main guideline organizations and the American Society of Clinical Oncology conference proceedings (2007-2010) were also searched. RESULTS AND CONCLUSIONS Thirty-three papers, including four guidelines, one protocol, and one abstract, were eligible for inclusion. The data suggest that patients with clear margins have a better prognosis, but no prospective studies have indicated how wide margins should be. In limb-salvage surgery for extremity sts, the procedure should be planned to achieve a clear margin. However, to preserve functionality, surgery may result in a very close (<1 cm) or even microscopically positive margin. In this circumstance, the use of preoperative or postoperative radiation should be considered. No studies described the optimal number of tissue sections required to assess adequacy of excision nor the appropriate handling of surgical resection specimens. The Sarcoma Disease Site Group made its recommendations based on expert opinion and consensus.
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Affiliation(s)
- R Kandel
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON
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Binitie O, Tejiram S, Conway S, Cheong D, Temple HT, Letson GD. Adult soft tissue sarcoma local recurrence after adjuvant treatment without resection of core needle biopsy tract. Clin Orthop Relat Res 2013; 471:891-8. [PMID: 22968531 PMCID: PMC3563812 DOI: 10.1007/s11999-012-2569-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Core needle biopsies of sarcomas allow a diagnosis in a high percentage of patients with few complications. However, it is unclear whether the tract needs to be excised to prevent recurrences. QUESTIONS/PURPOSES We therefore determined the rates of recurrence and metastases in patients with Stage III extremity sarcomas, who underwent wide local resection without excision of the needle tract and also received adjuvant treatment. METHODS We retrospectively reviewed 59 adult patients with deep, larger than 5 cm, high-grade soft tissue sarcomas of the upper or lower extremity treated between January 1999 and April 2009. All the patients underwent a core needle biopsy. Resection was performed with wide margins. The biopsy tract was not resected during the definitive surgery. Fifty-seven patients (97%) received preoperative and/or postoperative radiation, whereas 49 patients (83%) received chemotherapy. Local recurrence and distant recurrence rates were determined. The minimum followup was 24 months (median, 56 months; range, 24-122 months). RESULTS The local recurrence rate was 9%. Fifteen patients (25%) developed metastasis after diagnosis. Seven of the 59 patients (12%) had microscopic positive margins at resection. CONCLUSIONS Our data demonstrate no increase in local recurrence rates or rates of metastatic disease compared with previously published studies when resection of the core biopsy tract was not performed. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Odion Binitie
- />H. Lee Moffitt Cancer Center & Research Institute, Sarcoma Program, 12902 Magnolia Drive, Tampa, FL 33612 USA
| | - Shawn Tejiram
- />H. Lee Moffitt Cancer Center & Research Institute, Sarcoma Program, 12902 Magnolia Drive, Tampa, FL 33612 USA
| | - Sheila Conway
- />Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL USA
| | - David Cheong
- />H. Lee Moffitt Cancer Center & Research Institute, Sarcoma Program, 12902 Magnolia Drive, Tampa, FL 33612 USA
| | - H. Thomas Temple
- />Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL USA
| | - G. Douglas Letson
- />H. Lee Moffitt Cancer Center & Research Institute, Sarcoma Program, 12902 Magnolia Drive, Tampa, FL 33612 USA
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Amann G, Liegl-Atzwanger B. [The use of frozen sections in the handling of soft tissue tumors]. DER PATHOLOGE 2012; 33:453-8. [PMID: 22955682 DOI: 10.1007/s00292-012-1606-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Due to the multiplicity of localizations and entities, handling of soft tissue tumors is a very challenging subject requiring intensive interdisciplinary collaboration. With respect to the use of intraoperative frozen sections, the following facts are of special relevance: 1) the usual criteria for malignancy, such as infiltrative growth and high mitotic rate are only restrictedly applicable to soft tissue tumors. 2) Correct diagnosis of the tumor entity often requires not only the use of immunohistochemistry but also the identification of genetic alterations by the polymerase chain reaction and/or fluorescence in situ hybridization. In many centres, 14G core biopsies taken from different tumor areas represent the preferred method for a diagnostic biopsy. Apart from cryocollection additional frozen section investigations are used especially in case of open biopsies for quality control of the submitted material or in cases of excision biopsies to ascertain a highly probable radiological diagnosis. The use of intraoperative frozen sections to clarify the resection margins is generally undisputed but should definitely be restricted to centres specialized and experienced in the handling of soft tissue tumors.
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Affiliation(s)
- G Amann
- Klinisches Institut für Pathologie, Medizinische Universität Wien, Währingerstr. 18-20, 1090, Wien, Österreich.
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Lee J, Park YJ, Yang DS, Yoon WS, Lee JA, Rim CH, Kim CY. Treatment outcome of conservative surgery plus postoperative radiotherapy for extremity soft tissue sarcoma. Radiat Oncol J 2012; 30:62-9. [PMID: 22984684 PMCID: PMC3429890 DOI: 10.3857/roj.2012.30.2.62] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 06/01/2012] [Accepted: 06/14/2012] [Indexed: 11/03/2022] Open
Abstract
PURPOSE To evaluate the treatment outcome and prognostic factor of postoperative radiotherapy for extremity soft tissue sarcoma (STS). MATERIALS AND METHODS Forty three patients with extremity STS were treated with conservative surgery and postoperative radiotherapy from January 1981 to December 2010 at Korea University Medical Center. Median total 60 Gy (range, 50 to 74.4 Gy) of radiation was delivered and 7 patients were treated with chemotherapy. RESULTS The median follow-up period was 70 months (range, 5 to 302 months). Twelve patients (27.9%) sustained relapse of their disease. Local recurrence occurred in 3 patients (7.0%) and distant metastases developed in 10 patients (23.3%). The 5-year overall survival (OS) was 69.2% and disease free survival was 67.9%. The 5-year local relapse-free survival was 90.7% and distant relapse-free survival was 73.3%. On univariate analysis, no significant prognostic factors were associated with development of local recurrence. Histologic grade (p = 0.005) and stage (p = 0.02) influenced the development of distant metastases. Histologic grade was unique significant prognostic factor for the OS on univariate and multivariate analysis. Severe acute treatment-related complications, Common Terminology Criteria for Adverse Events (CTCAE) grade 3 or 4, developed in 6 patients (14.0%) and severe late complications in 2 patients (4.7%). CONCLUSION Conservative surgery with postoperative radiotherapy achieved a satisfactory rate of local control with acceptable complication rate in extremity STS. Most failures were distant metastases that correlate with tumor grade and stage. The majority of local recurrences developed within the field. Selective dose escalation of radiotherapy or development of effective systemic treatment might be considered.
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Affiliation(s)
- Jieun Lee
- Department of Radiation Oncology, Korea University Medical Center, Seoul, Korea
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Abstract
BACKGROUND Sarcomas require a wide margin of resection including a cuff of normal tissue to minimize the risk of local recurrence. The amount of tissue that constitutes a wide margin is unclear in the literature. QUESTIONS/PURPOSES We therefore determined whether a close resection margin for soft tissue sarcoma resulted in an increased incidence of locally recurrent disease and whether additional factors, including radiation therapy, outside biopsies, and tumor biology, affected the risk of local recurrence. METHODS We retrospectively reviewed 117 patients with soft tissue sarcomas resected with negative margins from 2001 to 2007. Gross specimens were inked and the closest macroscopic margins were sent for microscopic examination. Resection margins were categorized as less than 1 mm, 1-5 mm, or greater than 5 mm. We evaluated additional factors that might influence local recurrence, including radiation therapy, outside biopsies, sarcoma type, grade, and stage at presentation, and development of metastatic disease. RESULTS Four of 117 patients (3.4%) developed local recurrence. The incidence of local recurrence was similar in patients with less than 1-mm margins and greater than 1-mm margins: two of 45 patients (4.4%) and two of 64 patients (3.1%), respectively. Due to the low number of local recurrences, quantitative margin extent and the other factors evaluated did not affect local recurrence. CONCLUSIONS The extent of a margin necessary to prevent local recurrence of soft tissue sarcoma remains unclear as the power of our study was limited by the low number of local recurrences. Relatively low local recurrence rates can be achieved even with close margins. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- David M King
- Department of Orthopaedic Surgery, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Demicco EG, Lazar AJ. Clinicopathologic Considerations: How Can We Fine Tune Our Approach to Sarcoma? Semin Oncol 2011; 38 Suppl 3:S3-18. [DOI: 10.1053/j.seminoncol.2011.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Histologische Klassifikation von Weichgewebstumoren und Stadieneinteilung gemäß TNM-System. DER PATHOLOGE 2010; 32:8-13. [DOI: 10.1007/s00292-010-1391-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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