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Lee RM, Ethun CG, Gamboa AC, Turgeon MK, Tran T, Poultsides G, Grignol V, Bedi M, Mogal H, Clarke CN, Tseng J, Roggin KK, Chouliaras K, Votanopoulos K, Krasnick BA, Fields RC, Oskouei SV, Monson DK, Reimer NB, Maithel SK, Pickens A, Cardona K. A novel preoperative risk score to guide patient selection for resection of soft tissue sarcoma lung metastases: An analysis from the United States Sarcoma Collaborative. J Surg Oncol 2021; 124:1477-1484. [PMID: 34374088 DOI: 10.1002/jso.26635] [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: 04/28/2021] [Revised: 07/02/2021] [Accepted: 07/29/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Surgical resection for sarcoma lung metastases has been associated with improved overall survival (OS). METHODS Patients who underwent curative-intent resection of sarcoma lung metastases (2000-2016) were identified from the US Sarcoma Collaborative. Patients with extrapulmonary metastatic disease or R2 resections of primary tumor or metastases were excluded. Primary endpoint was OS. RESULTS Three hundred and fifty-two patients met inclusion criteria. Location of primary tumor was truncal/extremity in 85% (n = 270) and retroperitoneal in 15% (n = 49). Forty-nine percent (n = 171) of patients had solitary and 51% (n = 180) had multiple lung metastasis. Median OS was 49 months; 5-year OS 42%. Age ≥55 (HR 1.77), retroperitoneal primary (HR 1.67), R1 resection of primary (HR 1.72), and multiple (≥2) lung metastases (HR 1.77) were associated with decreased OS(all p < 0.05). Assigning one point for each factor, we developed a risk score from 0 to 4. Patients were then divided into two risk groups: low (0-1 factor) and high (2-4 factors). The low-risk group (n = 159) had significantly better 5-year OS compared to the high-risk group (n = 108) (51% vs. 16%, p < 0.001). CONCLUSION We identified four characteristics that in aggregate portend a worse OS and created a novel prognostic risk score for patients with sarcoma lung metastases. Given that patients in the high-risk group have a projected OS of <20% at 5 years, this risk score, after external validation, will be an important tool to aid in preoperative counseling and consideration for multimodal therapy.
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Affiliation(s)
- Rachel M Lee
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Cecilia G Ethun
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Adriana C Gamboa
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Michael K Turgeon
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Thuy Tran
- Department of Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - George Poultsides
- Department of Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Valerie Grignol
- Department of Surgery, Division of Surgical Oncology, The Ohio State University, Columbus, Ohio, USA
| | - Meena Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Harveshp Mogal
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Callisia N Clarke
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer Tseng
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Kevin K Roggin
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | | | | | - Bradley A Krasnick
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Ryan C Fields
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Shervin V Oskouei
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - David K Monson
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Nickolas B Reimer
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Shishir K Maithel
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Allan Pickens
- Department of Surgery, Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, USA
| | - Kenneth Cardona
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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Songür N, Dinç M, Ozdilekcan C, Eke S, Ok U, Oz M. Analysis of lung metastases in patients with primary extremity sarcoma. Sarcoma 2011; 7:63-7. [PMID: 18521370 PMCID: PMC2395516 DOI: 10.1080/13577140310001607284] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose: To investigate the incidence, radiographic findings, and the time course for the appearence of lung metastases from
primary extremity sarcoma. Patients and methods: Four-hundred patients with extremity sarcoma were evaluated retrospectively for lung metastases.
Multiple clinical factors were analyzed for possible influence on the metastases-free interval and subsequent metastases
development. Radiographic findings of metastases were also reviewed. Results: Ninety of 400 patients (23%) developed lung metastases. Median time from presentation to detection of metastasis
was 8.0 ± 1.1 months (95% CI: 6.02–9.98). More than 75% of patients developed metastases within 1 year after presentation
of the primary sarcoma. As disease grade increased, the metastases-free intervals shortened significantly. Histologically,
synoviosarcoma and osteogenic sarcoma were more often associated with the development of lung metastases. In this
subgroup, 54 patients (60%), the presence of solitary (11) or multiple (43) nodular metastases was the only radiological
finding. In 36 of 90 patients (40%), parenchymal mass, pleural effusion, hilar lymphadenopathy and pneumothorax were
found. Conclusions: Twenty-three percent of patients in our study developed lung metastases. As the grade of the disease increased,
metastases-free intervals are shortened. Although it has been reported that lung metastases in patients with extremity
sarcomas may present as solitary or multiple nodules in earlier trials with radiographic screening methods, the current review
of 400 patients found that a substantial number of patients may present radiological appearances other than nodular
formations.
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Affiliation(s)
- N Songür
- Department of Chest Diseases Cancer Research Hospital Ankara 06660 Turkey
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3
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Weksler B, Ng B, Lenert JT, Burt ME. Isolated single-lung perfusion: a study of the optimal perfusate and other pharmacokinetic factors. Ann Thorac Surg 1995; 60:624-9. [PMID: 7545890 DOI: 10.1016/0003-4975(95)00401-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Isolated single-lung perfusion with doxorubicin hydrochloride was shown to be effective in clearing experimental sarcoma lung metastases in the rat. The best perfusate to be used for isolated lung perfusion and factors affecting the final lung concentration of doxorubicin are the subject of the present study. METHODS In experiment 1, 60 animals were randomized to undergo isolated left lung perfusion with doxorubicin with six different perfusates (n = 10 per group): saline, low-potassium-dextran, 5% albumin, 6% hetastarch, 5% buffered albumin, and 6% buffered hetastarch. Five animals served as negative controls. After perfusion, the lung wet to dry ratio and final lung doxorubicin concentration were determined. In experiment 2, 60 animals underwent isolated left lung perfusion with either 80 micrograms/mL or 320 micrograms/mL of doxorubicin. Animals were perfused at either 0.5 mL/min or 1 mL/min and for 2, 6, or 10 minutes. At the end of the perfusion period, the left lung doxorubicin concentration was measured. Statistical analysis included analysis of variance, the Duncan test for multiple comparisons, and multiple linear regression analysis. Significance was defined as a p value of less than 0.05. RESULTS In experiment 1, perfusion with 6% buffered hetastarch resulted in the lowest lung wet to dry ratio, significantly different from all groups except the controls. Perfusion with low-potassium-dextran solution led to the highest final lung concentration of doxorubicin. In experiment 2, a model to predict final lung doxorubicin concentration was constructed: Log (final lung concentration) = 1.9 + 0.0071.P + 0.186.T, where P is the measured perfusate concentration of doxorubicin, and T is the time of perfusion in minutes. The R2 was 0.91 and p, less than 0.001. The dose of doxorubicin per kilogram of animal body weight, the dose of doxorubicin per square meter of body surface area, the total amount of doxorubicin delivered, and the rate of perfusion did not meet the criteria to enter the equation. CONCLUSIONS Isolated lung perfusion experiments should use 6% buffered hetastarch as the perfusate. The perfusate doxorubicin concentration and the duration of perfusion are the only factors determining the final lung concentration of doxorubicin. In lung perfusion experiments, the dose of chemotherapy is not as important as the perfusate concentration and the duration of the perfusion. Animals should be perfused at a lower rate so the lungs are exposed to less doxorubicin without changing the final lung concentration.
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Affiliation(s)
- B Weksler
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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4
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Gadd MA, Casper ES, Woodruff JM, McCormack PM, Brennan MF. Development and treatment of pulmonary metastases in adult patients with extremity soft tissue sarcoma. Ann Surg 1993; 218:705-12. [PMID: 8257219 PMCID: PMC1243064 DOI: 10.1097/00000658-199312000-00002] [Citation(s) in RCA: 204] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The authors reviewed a series of adult patients with extremity soft tissue sarcoma to determine the incidence of pulmonary metastases and outcome after treatment. METHODS Of 716 patients admitted between January 1983 and December 1990, 135 (19%) had isolated pulmonary metastases as the initial site of distant recurrence. Fifty-eight percent (78 of 135) of the patients were treated surgically, and 83% of them had their tumors completely resected. RESULTS The median survival after complete resection was 19 months; incomplete resection, 10 months; and no operation, 8 months (p = 0.005). The 3-year survival rate after complete resection was 23%, compared with a 2% rate (1 of 57) in those treated nonsurgically (p < 0.001). Factors associated with an increased risk of pulmonary metastases included high tumor grade, tumor size greater than 5 cm, lower extremity site, and histologic type (spindle cell, tendosynovial, and extraskeletal osteosarcoma). Factors associated with complete resectability were the histologic types of spindle cell and extraskeletal osteosarcoma. CONCLUSIONS Complete surgical resection remains the only possibility for cure from pulmonary metastases in soft tissue sarcoma; however, only 11% of the 19% of patients with an extremity sarcoma whose first distant recurrence is in the lung will be alive at 3 years, despite therapy. Complete resection and the development of more effective adjuvant treatments are imperative to improve outcome for this group of patients.
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Affiliation(s)
- M A Gadd
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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Mentzer SJ, Antman KH, Attinger C, Shemin R, Corson JM, Sugarbaker DJ. Selected benefits of thoracotomy and chemotherapy for sarcoma metastatic to the lung. J Surg Oncol 1993; 53:54-9. [PMID: 8479198 DOI: 10.1002/jso.2930530114] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To determine the benefit of aggressive surgical therapy, we studied 77 consecutive patients presenting to our sarcoma registry with pulmonary metastases. Detailed follow-up was available on all patients; the median follow-up of the 13 long-term survivors was 72 months from the date of diagnosis of the primary tumor. Survival of these 77 patients with metastatic disease was independent of the size, location, and histology of the primary tumor. Once metastases developed, survival of patients with pulmonary metastases was not influenced by the extent of surgical resection of the primary tumor or by the use of radiation therapy. Pulmonary metastases were initially treated with thoracotomy and metastasectomy in 34 patients. The median survival after thoracotomy was 26 months. Seven patients were alive more than 4 years after their diagnosis. Pulmonary metastases were treated with chemotherapy alone in 43 patients. Although the survival was shorter (median survival 14 months) in patients treated with chemotherapy, an objective response to chemotherapy was obtained in 13 (30%) patients. Four of these patients were alive 4 years after their diagnosis. These data demonstrate that both thoracotomy and chemotherapy are associated with long-term survival of patients with sarcoma metastatic to the lung.
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Affiliation(s)
- S J Mentzer
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115
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6
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Abstract
Seventy-two consecutive patients with disseminated soft tissue sarcoma in the abdomen were prospectively placed in a program of debulking surgery. The tumor was completely resectable in 64% of the patients. Following the first exploration, the median survival was 23 months for those with resection of metastases and 9 months for those without resection (p less than or equal to 0.01); the former group had a survival rate of 28% at 3 years, 18% at 4 years, and 4% at 5 years (44%, 37%, and 10%, respectively, for low-grade sarcomas, i.e., grade I or II sarcomas), whereas in the latter group, none survived for 3 years. In the group with resection, patients with grade III tumors had a median survival longer by 6 months, and those with low-grade tumors by 28 months (p less than or equal to 0.001), over the respective median survival of patients with unresectable tumors. Metastasectomy appeared to prolong survival in all patients and significantly so in patients with low-grade tumors and those with long disease-free intervals.
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Affiliation(s)
- C P Karakousis
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York 14263
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7
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Filderman AE, Coppage L, Shaw C, Matthay RA. Pulmonary and Pleural Manifestations of Extrathoracic Malignancies. Clin Chest Med 1989. [DOI: 10.1016/s0272-5231(21)00662-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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8
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Ruka W, Emrich LJ, Driscoll DL, Karakousis CP. Tumor size/symptom duration ratio as a prognostic factor in patients with high-grade soft tissue sarcomas. EUROPEAN JOURNAL OF CANCER & CLINICAL ONCOLOGY 1988; 24:1583-8. [PMID: 3208802 DOI: 10.1016/0277-5379(88)90049-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Two hundred sixty-seven patients with high-grade (G2,G3) soft tissue sarcomas but without distant metastases, were studied retrospectively with respect to their duration of symptoms and size of tumor. Prognosis was significantly related to the size of the tumor (P = 0.0039). Small tumors (5 cm or less) had a 5-year survival rate of 49% compared to 28% for large tumors (more than 5 cm in diameter). Symptom duration was not related significantly to survival time (P = 0.2490). The ratio of the size of the tumor (greatest diameter, recorded in cm) to duration of symptoms (recorded in months), reflecting the growth rate of the tumor, is introduced as a potentially important prognostic variable. Analysis revealed a highly significant relation between an increasing size/duration ratio and shorter overall survival time (P less than 0.0001) and time to distant metastases (P = 0.0034). Moreover, an optimal cut-off point of 1.0 for the size/duration ratio offers prognostic information independent of the G-TNM classification and other prognostic factors.
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Affiliation(s)
- W Ruka
- Department of Surgical Oncology, New York State Department of Health, Roswell Park Memorial Institute, Buffalo 14263
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9
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Abstract
Osteosarcoma is the most common bone tumor of children and adolescents. The peak incidence of the disease is in the 15 to 19 year age group. The disease is more commonly seen in males than females. While several factors, including exposure to radiation, genetic disorders such as retinoblastoma, and high rate of bone growth, have been associated with osteosarcoma, in most cases no definite etiology can be established. Osteosarcoma usually originates in the metaphyseal region of long bones and extends through the cortex, causing varying degrees of bone destruction and expansion of periosteum. The radiographic appearance caused by this process is often referred to as "sun burst" sign. Positive diagnosis of osteosarcoma is made by histopathology. The histopathological classification of osteosarcoma can also predict the degree of aggressive behavior of this tumor and thus has prognostic significance. Surgery, including amputation or limb-salvage procedure, is the mainstay of treatment of osteosarcoma. It is now unequivocally established that adjuvant chemotherapy will prolong the survival of patients with this disease. Chemotherapy agents often used include platinum derivates, methotrexate, vincristine, cyclophosphamide, adriamycin, actinomycin D, bleomycin and DTIC. Depending on surgical decision, these agents can be used prior to or after the operation. Immediate fitting with prosthesis and provision of appropriate medical and psychological support in the care of these patients is essential.
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Affiliation(s)
- C K Tebbi
- Department of Pediatrics, Roswell Park Memorial Institute, Buffalo, New York 14263
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10
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Lawrence W. Concepts in limb-sparing treatment of adult soft tissue sarcomas. SEMINARS IN SURGICAL ONCOLOGY 1988; 4:73-7. [PMID: 3281215 DOI: 10.1002/ssu.2980040114] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Pretreatment assessment of patients with soft tissue sarcomas of the extremities requires careful attention to a biopsy approach that will establish the precise diagnosis and will not compromise the subsequent definitive operative procedure. Also, staging procedures are required to evaluate the status of both local and distant sites. Limb-sparing surgery for high grade extremity soft tissue sarcomas is a feasible and appropriate approach in approximately 90% of patients with such lesions. Wide gross surgical margins around the sarcoma are the optimal operative approach. Circumstantial evidence is convincing that local treatment failure can be reduced by adjuvant regional radiation treatment when surgical margins are narrow, and end results appear to be equal to those obtained by more extensive surgical resection alone. Adjuvant radiation following operation with optimal gross surgical margins has not been established as adding benefit. Although some groups treating soft tissue sarcomas do use intraarterial chemotherapy in conjunction with these other modalities, there is, as yet, no convincing evidence that this aspect of the multimodality treatment adds to local and/or systemic disease control. The efficacy of adjuvant systemic chemotherapy for high grade soft tissue sarcomas remains to be established within the context of prospective clinical trials.
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Affiliation(s)
- W Lawrence
- Division of Surgical Oncology, Medical College of Virginia, Virginia Commonwealth University, Richmond
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11
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Lawrence W, Donegan WL, Natarajan N, Mettlin C, Beart R, Winchester D. Adult soft tissue sarcomas. A pattern of care survey of the American College of Surgeons. Ann Surg 1987; 205:349-59. [PMID: 3566372 PMCID: PMC1492738 DOI: 10.1097/00000658-198704000-00003] [Citation(s) in RCA: 267] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A nationwide survey of the clinical presentation, pathology, and management of soft tissue sarcomas in adults was carried out under the auspices of the Commission on Cancer of the American College of Surgeons. Two separate 2-year periods were used to allow assessment of changes in patterns of care. Data were obtained from 504 hospitals in 1977-1978 (2355 patients) and 645 institutions in 1983-1984 (3457 patients). Pretreatment findings of interest included some evidence of physician delay in diagnosis, overuse of excisional biopsy as opposed to the generally preferred approach of incisional biopsy, a low rate of usage of the American Joint Committee for Cancer Staging (AJCSS) system, and major reliance on CT for pretreatment patient evaluation. Operation was the primary treatment, with or without adjuvant therapies, in approximately three fourths of the patients. The other one fourth were primarily patients with distant metastasis at the time of diagnosis. Some increase in multimodal therapy did occur in the second period but the rate of amputation was low (approximately 10%) in both periods studied. Survival curves support the prognostic validity of the AJCCS system and the value of complete resection of soft tissue sarcomas. Adverse prognostic factors included positive surgical margins, large tumors, retroperitoneal or mediastinal primary sites, some histologic types, and the perceived need for adjuvant therapy. Patients receiving adjuvant radiation or chemotherapy had less favorable survival data than those treated by operation alone due to criteria used for selecting patients for these therapies. Approximately one half of the treatment failures in the 1977-1978 series were locoregional, whereas 18% were limited to lung metastasis. Salvage therapy for these two forms of treatment failure yielded 61% and 21% 5-year survival rates.
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Potter DA, Kinsella T, Glatstein E, Wesley R, White DE, Seipp CA, Chang AE, Lack EE, Costa J, Rosenberg SA. High-grade soft tissue sarcomas of the extremities. Cancer 1986; 58:190-205. [PMID: 3518911 DOI: 10.1002/1097-0142(19860701)58:1<190::aid-cncr2820580133>3.0.co;2-5] [Citation(s) in RCA: 228] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
From July 1975 to December 1982, 358 patients were referred to the Surgery Branch of the National Cancer Institute (NCI) with the diagnosis of soft tissue sarcoma of the extremities. Two hundred eleven of these patients presented with resectable, localized high-grade soft-tissue sarcomas and have been included in the present analysis of the management and outcome of patients with high-grade soft tissue sarcomas of the extremity treated at the NCI. One hundred forty-seven of these 211 patients have been included in randomized prospective trials. The remaining 64 patients in this analysis have been followed at the NCI, but were not included in randomized trials because of patient refusal or ineligibility. Tumor size was identified as a highly significant prognostic variable for disease-free and overall survival (P2 = 0.00001 and 0.0081, respectively). Tumor site, histologic type, and microscopic margins of resection were not significant prognostic variables. There was no difference between patients undergoing amputation compared to those undergoing limb-sparing procedures plus postoperative radiotherapy in disease-free or overall survival for all 211 patients in this study (P2 = 0.068 and 0.131, respectively). A significantly greater frequency of local failure among patients treated by local excision was noted compared to patients undergoing amputation (12/128 versus 0/83, P2 = 0.004), but this did not result in decreased overall survival in patients undergoing combined modality limb-sparing procedures. Adjuvant chemotherapy significantly prolonged disease-free survival (P2 = 0.005) for the 124/211 patients treated with adjuvant chemotherapy, although analysis of overall survival did not reveal a significant increase (P2 = 0.10). In a subset of 65 patients included in a prospective randomized trial evaluating the efficacy of adjuvant chemotherapy, a significant improvement in both disease-free (P2 = 0.033) and overall (P2 = 0.055) survival was seen in patients receiving chemotherapy. Sixty-five patients developed recurrent disease (65/211, 31%) and 42 of these patients were rendered disease-free surgically. Survival from the time of first recurrence was significantly prolonged among the 42 patients who were rendered disease-free (median survival, 31 months) compared to those who were not (median survival, 9 months, P2 less than 0.001).
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Abstract
Aggressive management of malignant primary tumors and their metastatic manifestations is associated with improved survival outcomes. As investigators continue to focus attention on the ablation or control of pulmonary metastatic foci, surgery is gaining importance in the treatment of metastatic disease to the lungs and, in this context, is adjunctive to other therapeutic modalities. At Roswell Park Memorial Institute (RPMI), median sternotomy is preferred to unilateral or staged bilateral thoracotomies, since the former provides simultaneous access to both hemithoraces, whereas its lower morbidity facilitates the earlier resumption of systemic therapy. The RPMI experience, amassed from 131 patients and using this procedure, is presented and analyzed with respect to patient survival.
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Mitchell CD, Belasco JB, Ellis R. Osteogenic sarcoma. MEDICAL AND PEDIATRIC ONCOLOGY 1985; 13:129-32. [PMID: 3857431 DOI: 10.1002/mpo.2950130305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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16
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Abstract
Isolated in vivo single-lung perfusion with an Adriamycin-containing whole-blood perfusate was performed in three groups of dogs after establishing adequate controls. The procedure, performed through a left thoracotomy, was followed two weeks later by a contralateral pneumonectomy. Survival following pneumonectomy was used as the ultimate end point in assessing perfusion toxicity. Groups I and II had high mortality rates but provided valuable information concerning perfusion methods, venous drainage techniques, drug dosage schedules, and perfusate flow rates. The group III study consisted of five dogs perfused for 45 minutes at flow rates sufficient to maintain mean pulmonary artery pressure at 12-15 mm Hg. An initial Adriamycin (Adr) dosage of 0.5 micrograms/ml in the plasma perfusate resulted in mean peak Adr lung tissue levels of 3.8 +/- 1.06 micrograms/g. All animals survived right pneumonectomy 19 +/- 4 days later. Three dogs have been killed and histologic examination showed only mild focal pleural and subpleural interstitial fibrosis. Based on these studies it is concluded that isolated single-lung perfusion is a reproducibly safe technique and that a dosage of Adr has been identified which produces no apparent toxity in a large animal model. A clinical trial is currently in progress.
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Karakousis CP, Rao U, Park HC. Combination chemotherapy (CYVADIC) in metastatic soft tissue sarcomas. EUROPEAN JOURNAL OF CANCER & CLINICAL ONCOLOGY 1982; 18:33-6. [PMID: 7200893 DOI: 10.1016/0277-5379(82)90021-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Forty-one patients with metastatic sarcoma were treated with Adriamycin, 50 mg/m2 i.v. on day 1, Cyclophosphamide, 500 mg/m2 i.v. on day 1, Vincristine, 1 mg/m2 i.v. on days 1 and 5, and Dacarbazine (DTIC), 250 mg/m2 i.v. on days 1-5 (CYVADIC). Three patients had a complete regression, while 8 patients had a partial regression of greater than 50%. The combined response rate was 27%. Eight additional patients showed stabilization of disease for an average of 5 months while 22 patients progressed on CYVADIC. Ultimately, 7 patients with initial tumor regression had progression of their disease. Four patients with partial regression had excision of the regressed nodules of tumor and continued on chemotherapy for a year. They remain alive at a median follow-up of 24.5 months, suggesting that removal of partially regressed nodules may improve results.
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Karakousis CP, Park HC, Sharma SD, Kanter P. Regional chemotherapy via the pulmonary artery for pulmonary metastases. J Surg Oncol 1981; 18:249-55. [PMID: 7311553 DOI: 10.1002/jso.2930180305] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Regional chemotherapy with Adriamycin via the pulmonary artery produces significantly higher tissue levels in the infused canine lobe than systemic administration. Seven patients with soft tissue sarcomas who had received the maximum dose of Adriamycin and had shown metastatic tumor recurrence to the lungs, received small doses of 10 to 20 mg of Adriamycin in the lobar arteries supplying areas with tumor via a Swan-Ganz catheter, temporarily occluding with its inflated balloon the infused artery. One partial objective regression was noted. A total of 56 injections of Adriamycin was given through individual lobar arteries in the seven patients. This preliminary experience indicates the feasibility and relative safety of the use of the pulmonary artery for regional chemotherapy of pulmonary malignant tumors and suggests further cautious exploration of this method.
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