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Peeken JC, Etzel L, Tomov T, Münch S, Schüttrumpf L, Shaktour JH, Kiechle J, Knebel C, Schaub SK, Mayr NA, Woodruff HC, Lambin P, Gersing AS, Bernhardt D, Nyflot MJ, Menze B, Combs SE, Navarro F. Development and benchmarking of a Deep Learning-based MRI-guided gross tumor segmentation algorithm for Radiomics analyses in extremity soft tissue sarcomas. Radiother Oncol 2024; 197:110338. [PMID: 38782301 DOI: 10.1016/j.radonc.2024.110338] [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: 07/30/2023] [Revised: 05/05/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Volume of interest (VOI) segmentation is a crucial step for Radiomics analyses and radiotherapy (RT) treatment planning. Because it can be time-consuming and subject to inter-observer variability, we developed and tested a Deep Learning-based automatic segmentation (DLBAS) algorithm to reproducibly predict the primary gross tumor as VOI for Radiomics analyses in extremity soft tissue sarcomas (STS). METHODS A DLBAS algorithm was trained on a cohort of 157 patients and externally tested on an independent cohort of 87 patients using contrast-enhanced MRI. Manual tumor delineations by a radiation oncologist served as ground truths (GTs). A benchmark study with 20 cases from the test cohort compared the DLBAS predictions against manual VOI segmentations of two residents (ERs) and clinical delineations of two radiation oncologists (ROs). The ROs rated DLBAS predictions regarding their direct applicability. RESULTS The DLBAS achieved a median dice similarity coefficient (DSC) of 0.88 against the GTs in the entire test cohort (interquartile range (IQR): 0.11) and a median DSC of 0.89 (IQR 0.07) and 0.82 (IQR 0.10) in comparison to ERs and ROs, respectively. Radiomics feature stability was high with a median intraclass correlation coefficient of 0.97, 0.95 and 0.94 for GTs, ERs, and ROs, respectively. DLBAS predictions were deemed clinically suitable by the two ROs in 35% and 20% of cases, respectively. CONCLUSION The results demonstrate that the DLBAS algorithm provides reproducible VOI predictions for radiomics feature extraction. Variability remains regarding direct clinical applicability of predictions for RT treatment planning.
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Affiliation(s)
- Jan C Peeken
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany; German Consortium for Translational Cancer Research (DKTK), Partner Site Munich, Munich, Germany; Institute of Radiation Medicine (IRM), Helmholtz Zentrum München (HMGU), German Research Center for Environmental Health GmbH, Neuherberg, Germany; Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Lucas Etzel
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany; German Consortium for Translational Cancer Research (DKTK), Partner Site Munich, Munich, Germany.
| | - Tim Tomov
- Department of Informatics, Technical University of Munich (TUM), Garching, Germany
| | - Stefan Münch
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Lars Schüttrumpf
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Julius H Shaktour
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Johannes Kiechle
- Department of Informatics, Technical University of Munich (TUM), Garching, Germany
| | - Carolin Knebel
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Stephanie K Schaub
- Department of Radiation Oncology, University of Washington, Seattle, USA
| | - Nina A Mayr
- College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Henry C Woodruff
- Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands; Department of Radiology and Nuclear Imaging, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, the Netherlands
| | - Philippe Lambin
- Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands; Department of Radiology and Nuclear Imaging, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, the Netherlands
| | | | - Denise Bernhardt
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Matthew J Nyflot
- Department of Radiation Oncology, University of Washington, Seattle, USA; Department of Radiology, University of Washington, Seattle, USA
| | - Bjoern Menze
- Department of Informatics, Technical University of Munich (TUM), Garching, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany; German Consortium for Translational Cancer Research (DKTK), Partner Site Munich, Munich, Germany; Institute of Radiation Medicine (IRM), Helmholtz Zentrum München (HMGU), German Research Center for Environmental Health GmbH, Neuherberg, Germany
| | - Fernando Navarro
- Department of Informatics, Technical University of Munich (TUM), Garching, Germany
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Levy A, Deutsch E, Le Péchoux C. Local Immunoradiotherapy in Patients With Metastatic Soft-Tissue Sarcoma. JAMA Oncol 2024:2817454. [PMID: 38602668 DOI: 10.1001/jamaoncol.2024.0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Antonin Levy
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
- INSERM U1030 lab, Molecular Radiotherapy and Therapeutic Innovations, Villejuif, France
- Faculté de Médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Eric Deutsch
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
- INSERM U1030 lab, Molecular Radiotherapy and Therapeutic Innovations, Villejuif, France
- Faculté de Médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Cécile Le Péchoux
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
- INSERM U1030 lab, Molecular Radiotherapy and Therapeutic Innovations, Villejuif, France
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Roohani S, Wiltink LM, Kaul D, Spałek MJ, Haas RL. Update on Dosing and Fractionation for Neoadjuvant Radiotherapy for Localized Soft Tissue Sarcoma. Curr Treat Options Oncol 2024; 25:543-555. [PMID: 38478330 PMCID: PMC10997691 DOI: 10.1007/s11864-024-01188-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 04/06/2024]
Abstract
OPINION STATEMENT Neoadjuvant radiotherapy (RT) over 5-6 weeks with daily doses of 1.8-2.0 Gy to a total dose of 50-50.4 Gy is standard of care for localized high-grade soft tissue sarcomas (STS) of the extremities and trunk wall. One exception is myxoid liposarcomas where the phase II DOREMY trial applying a preoperative dose of 36 Gy in 2 Gy fractions (3-4 weeks treatment) has achieved excellent local control rates of 100% after a median follow-up of 25 months.Hypofractionated preoperative RT has been investigated in a number of phase II single-arm studies suggesting that daily doses of 2.75-8 Gy over 1-3 weeks can achieve similar oncological outcomes to conventional neoadjuvant RT. Prospective data with direct head-to-head comparison to conventional neoadjuvant RT investigating oncological outcomes and toxicity profiles is eagerly awaited.For the entire group of retroperitoneal sarcomas, RT is not the standard of care. The randomized multi-center STRASS trial did not find a benefit in abdominal recurrence-free survival by the addition of preoperative RT. However, for the largest histological subgroup of well-differentiated and grades I and II dedifferentiated liposarcomas, the STRASS trial and the post-hoc propensity-matched STREXIT analysis have identified a possible benefit in survival by preoperative RT. These patients deserve to be informed about the pros and cons of preoperative RT while the longer follow-up data from the STRASS trial is awaited.
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Affiliation(s)
- Siyer Roohani
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- BIH Charité Junior Clinician Scientist Program, BIH Biomedical Innovation Academy, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- German Cancer Consortium (DKTK), Partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Lisette M Wiltink
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - David Kaul
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- German Cancer Consortium (DKTK), Partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mateusz Jacek Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Department of Radiotherapy I, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Rick L Haas
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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Vogin G, Lepage M, Salleron J, Cuenin M, Blum A, Gondim Teixeira PA. Evaluation of the Prognostic Value of Pretherapeutic Magnetic Resonance Imaging in Predicting Soft Tissue Sarcoma Radiation Response: A Retrospective Study from a Large Institutional Sarcoma Imaging Database. Cancers (Basel) 2024; 16:878. [PMID: 38473238 DOI: 10.3390/cancers16050878] [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: 12/04/2023] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Abstract
Background: RT-induced hyalinization/fibrosis was recently evidenced as a significant independent predictor for complete response to neoadjuvant radiotherapy (RT) and survival in patients with soft tissue sarcoma (STS). Purpose: Non-invasive predictive markers of histologic response after neoadjuvant RT of STS are expected. Materials and Methods: From May 2010 to April 2017, patients with a diagnosis of STS who underwent neoadjuvant RT for limb STS were retrieved from a single center prospective clinical imaging database. Tumor Apparent Diffusion Coefficients (ADC) and areas under the time-intensity perfusion curve (AUC) were compared with the histologic necrosis ratio, fibrosis, and cellularity in post-surgical specimens. Results: We retrieved 29 patients. The median ADC value was 134.3 × 10-3 mm2/s. ADC values positively correlated with the post-treatment tumor necrosis ratio (p = 0.013). Median ADC values were lower in patients with less than 50% necrosis and higher in those with more than 50% (120.3 × 10-3 mm2/s and 202.0 × 10-3 mm2/s, respectively (p = 0.020). ADC values higher than 161 × 10-3 mm2/s presented a 95% sensitivity and a 55% specificity for the identification of tumors with more than 50% tumor necrosis ratio. Tumor-to-muscle AUC ratios were associated with histologic fibrosis (p = 0.036). Conclusions: ADC and perfusion AUC correlated, respectively, with radiation-induced tumor necrosis and fibrosis.
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Affiliation(s)
- Guillaume Vogin
- Department of Radiation Therapy, Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
- Centre François Baclesse, Centre National de Radiothérapie du Luxembourg, BP436, L-4005 Esch-sur-Alzette, Luxembourg
- UMR 7365 CNRS-UL IMoPA, Biopôle de l'Université de Lorraine, Campus Brabois Santé, 9 Avenue de la Forêt de Haye, BP 20199, 54505 Vandœuvre-lès-Nancy, France
| | - Matthias Lepage
- Guilloz Imaging Department, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France
| | - Julia Salleron
- Biostatistics Unit, Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Mathilde Cuenin
- Department of Radiation Therapy, Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Alain Blum
- Guilloz Imaging Department, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France
| | - Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France
- Université de Lorraine, IADI, Inserm U1254, Bâtiment Recherche CHRU de Nancy Brabois, 5 Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
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Kantzos AJ, Fayad LM, Abiad JE, Ahlawat S, Sabharwal S, Vaynrub M, Morris CD. The role of imaging in extremity sarcoma surgery. Skeletal Radiol 2024:10.1007/s00256-024-04586-7. [PMID: 38233634 DOI: 10.1007/s00256-024-04586-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
The surgical management of extremity bone and soft tissue sarcomas has evolved significantly over the last 50 years. The introduction and refinement of high-resolution cross-sectional imaging has allowed accurate assessment of anatomy and tumor extent, and in the current era more than 90% of patients can successfully undergo limb-salvage surgery. Advances in imaging have also revolutionized the clinician's ability to assess treatment response, detect metastatic disease, and perform intraoperative surgical navigation. This review summarizes the broad and essential role radiology plays in caring for sarcoma patients from diagnosis to post-treatment surveillance. Present evidence-based imaging paradigms are highlighted along with key future directions.
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Affiliation(s)
- Andrew J Kantzos
- Orthopedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA
| | - Laura M Fayad
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
| | | | - Shivani Ahlawat
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA
| | - Samir Sabharwal
- Orthopedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA
| | - Max Vaynrub
- Orthopedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA
| | - Carol D Morris
- Orthopedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.
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Hanslik N, Bourgier C, Thezenas S, Carrère S, Firmin N, Riou O, Azria D, Llacer-Moscardo C. [Predictive factors assessment of pathological response to neoadjuvant radiotherapy of soft tissue sarcomas]. Cancer Radiother 2023; 27:689-697. [PMID: 37813717 DOI: 10.1016/j.canrad.2023.02.003] [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: 09/23/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Conserving surgery combined with radiotherapy in presence of local recurrence risk factors is standard treatment of soft tissue sarcomas, a group of rare and heterogeneous tumours. Radiotherapy is performed before or after surgery. In neoadjuvant setting, late radiation-induced toxicity is reduced and pathological response to radiotherapy could be achieved. A complete pathological response to radiotherapy has recently been shown to predict better survival. Our study aims at identifying predictive factors of pathological response to neoadjuvant radiotherapy (clinical, radiological or histological) of soft tissue sarcomas. PATIENTS AND METHODS Clinical, imaging (MRI: perilesional oedema, necrosis, tumour heterogeneity, vasculonervous relationships) and pathological (pathological subtype, tumour grade, anticipated/obtained resection quality) data were retrospectively collected. Tumour response (imaging and pathological), patient outcome, acute and late radiation-induced toxicity, predictive factors of pathological response to neoadjuvant radiotherapy were studied. The 2-test or exact-Fisher test (qualitative variables) and by Student's t-test or Kruskal-Wallis test (quantitative variables) were used for statistical analysis. RESULTS From April 2017 to April 2021, neoadjuvant radiotherapy (50Gy in 25 fractions) followed by surgical excision was performed to 36 consecutive patients with liposarcomas (n=17/36), or undifferentiated sarcomas (n=8/36). MRI response was complete in 1 patient, partial in 9 patients (n=9/36, 25%), stable in 21 patients (n=21/36, 58%) or in progression in 5 patients (n=5/36, 14%). Pathological response was observed in 22 patients (61%). No grade 3-4 acute radiation-induced toxicity was observed. Regarding late toxicity, 28% of patients had grade 1-2 oedema (n=10/36), 39% had a grade 1 fibrosis (n=14/36), and 30% grade 1 pain (n=11/36). No predictive factors of response to radiotherapy was statistically significant. CONCLUSIONS Neoadjuvant radiotherapy is well-tolerated. No clinical, radiological or pathological predictive factors was identified for radiotherapy tumour response.
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Affiliation(s)
- N Hanslik
- Fédération universitaire d'oncologie radiothérapie, ICM, institut régional du cancer Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France
| | - C Bourgier
- Fédération universitaire d'oncologie radiothérapie, ICM, institut régional du cancer Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France; IRCM, institut de recherche en cancérologie de Montpellier, Inserm U1194, université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France
| | - S Thezenas
- Unité de biostatistiques, ICM, institut régional du cancer Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France
| | - S Carrère
- Service de chirurgie, ICM, institut régional du cancer Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France
| | - N Firmin
- Département d'oncologie, ICM, institut régional du Cancer Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France
| | - O Riou
- Fédération universitaire d'oncologie radiothérapie, ICM, institut régional du cancer Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France
| | - D Azria
- Fédération universitaire d'oncologie radiothérapie, ICM, institut régional du cancer Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France; IRCM, institut de recherche en cancérologie de Montpellier, Inserm U1194, université de Montpellier, avenue des Apothicaires, 34298 Montpellier cedex 05, France
| | - C Llacer-Moscardo
- Fédération universitaire d'oncologie radiothérapie, ICM, institut régional du cancer Montpellier, rue Croix-Verte, 34298 Montpellier cedex 05, France.
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van Ravensteijn SG, Nederkoorn MJL, Wal TCP, Versleijen-Jonkers YMH, Braam PM, Flucke UE, Bonenkamp JJ, Schreuder BHW, van Herpen CML, de Wilt JHW, Desar IME, de Rooy JWJ. The Prognostic Relevance of MRI Characteristics in Myxofibrosarcoma Patients Treated with Neoadjuvant Radiotherapy. Cancers (Basel) 2023; 15:2843. [PMID: 37345181 DOI: 10.3390/cancers15102843] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 06/23/2023] Open
Abstract
To improve local control, neoadjuvant radiotherapy (nRT) followed by surgery is the standard of care in myxofibrosarcoma (MFS) because of its infiltrative growth pattern. Nevertheless, local recurrence rates are high. Data on prognostic factors for poor clinical outcomes are lacking. This retrospective study thus investigates the prognostic relevance of magnetic resonance imaging (MRI) characteristics before and after nRT in 40 MFS patients, as well as their association with disease-free survival (DFS) and overall survival (OS). A vascular pedicle, defined as extra-tumoral vessels at the tumor periphery, was observed in 12 patients (30.0%) pre-nRT and remained present post-nRT in all cases. Patients with a vascular pedicle had worse DFS (HR 5.85; 95% CI 1.56-21.90; p = 0.009) and OS (HR 9.58; 95% CI 1.91-48.00; p = 0.006). An infiltrative growth pattern, referred to as a tail sign, was observed in 22 patients (55.0%) pre-nRT and in 19 patients (47.5%) post-nRT, and was associated with worse DFS post-nRT (HR 6.99; 95% CI 1.39-35.35; p = 0.019). The percentage of tumor necrosis estimated by MRI was increased post-nRT, but was not associated with survival outcomes. The presence of a tail sign or vascular pedicle on MRI could support the identification of patients at risk for poor clinical outcomes after nRT.
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Affiliation(s)
- Stefan G van Ravensteijn
- Department of Medical Oncology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Maikel J L Nederkoorn
- Department of Medical Oncology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Tom C P Wal
- Department of Medical Oncology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | | | - Pètra M Braam
- Department of Radiotherapy, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Uta E Flucke
- Department of Pathology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Johannes J Bonenkamp
- Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Bart H W Schreuder
- Department of Orthopedics, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Carla M L van Herpen
- Department of Medical Oncology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Ingrid M E Desar
- Department of Medical Oncology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Jacky W J de Rooy
- Department of Radiology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
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8
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Crombé A, Matcuk GR, Fadli D, Sambri A, Patel DB, Paioli A, Kind M, Spinnato P. Role of Imaging in Initial Prognostication of Locally Advanced Soft Tissue Sarcomas. Acad Radiol 2023; 30:322-340. [PMID: 35534392 DOI: 10.1016/j.acra.2022.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/21/2022] [Accepted: 04/06/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although imaging is central in the initial staging of patients with soft tissue sarcomas (STS), it remains underused and few radiological features are currently used in practice for prognostication and to help guide the best therapeutic strategy. Yet, several prognostic qualitative and quantitative characteristics from magnetic resonance imaging (MRI) and positron emission tomography (PET) have been identified over these last decades. OBJECTIVE After an overview of the current validated prognostic features based on baseline imaging and their integration into prognostic tools, such as nomograms used by clinicians, the aim of this review is to summarize more complex and innovative MRI, PET, and radiomics features, and to highlight their role to predict indirectly (through histologic grade) or directly the patients' outcomes.
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Affiliation(s)
- Amandine Crombé
- Department of Diagnostic and Interventional Oncological Imaging, Institut Bergonié, Regional Comprehensive Cancer of Nouvelle-Aquitaine, 229, cours de l'Argonne, F-33076, Bordeaux, France; Department of musculoskeletal imaging, Pellegrin University Hospital, 2, place Amélie Raba-Léon, F-33000, Bordeaux, France; Models in Oncology (MONC) Team, INRIA Bordeaux Sud-Ouest, CNRS UMR 5251, Institut de Mathématiques de Bordeaux & Bordeaux University, 351 cours de la libération, F-33400 Talence, France.
| | - George R Matcuk
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | - David Fadli
- Department of musculoskeletal imaging, Pellegrin University Hospital, 2, place Amélie Raba-Léon, F-33000, Bordeaux, France
| | - Andrea Sambri
- Alma Mater Studiorum, University of Bologna, Bologna, Italy; IRCCS Policlinico di Sant'Orsola, Bologna, Italy
| | - Dakshesh B Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Anna Paioli
- Osteoncology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Michele Kind
- Department of Diagnostic and Interventional Oncological Imaging, Institut Bergonié, Regional Comprehensive Cancer of Nouvelle-Aquitaine, 229, cours de l'Argonne, F-33076, Bordeaux, France
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Reijers SJM, Gennaro N, Bruining A, van Boven H, Snaebjornsson P, Bekers EM, van Coevorden F, Scholten AN, Schrage Y, van der Graaf WTA, Haas RLM, van Houdt WJ. Correlation of radiological and histopathological response after neoadjuvant radiotherapy in soft tissue sarcoma. Acta Oncol 2023; 62:25-32. [PMID: 36637511 DOI: 10.1080/0284186x.2023.2166427] [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: 01/14/2023]
Abstract
BACKGROUND The aim of this study was to assess the association between radiological and histopathological response after neoadjuvant radiotherapy (nRT) in soft tissue sarcoma (STS), as well as the prognostic value of the different response evaluation methods on the oncological outcome. METHODS A retrospective cohort of patients with localized STS of the extremity and trunk wall, treated with nRT followed by resection were included. The radiological response was assessed by RECIST 1.1 (RECIST) and MR-adapted Choi (Choi), histopathologic response was evaluated according to the EORTC-STBSG recommendations. Oncological outcome parameters of interest were local recurrence-free survival (LRFS), disease metastases-free survival (DMFS), and overall survival (OS). RESULTS For 107 patients, complete pre- and postoperative pathology and imaging datasets were available. Most tumors were high-grade (77%) and the most common histological subtypes were undifferentiated pleomorphic sarcoma/not otherwise specified (UPS/NOS, 40%), myxoid liposarcoma (MLS, 21%) and myxofibrosarcoma (MFS, 16%). When comparing RECIST to Choi, the response was differently categorized in 58%, with a higher response rate (CR + PR) with Choi. Radiological responders showed a significant lower median percentage of viable cells (RECIST p = .050, Choi p = .015) and necrosis (RECIST p < .001), and a higher median percentage of fibrosis (RECIST p = .005, Choi p = .008), compared to radiological non-responders (SD + PD). RECIST, Choi, fibrosis, and viable cells were not significantly associated with altered oncological outcome, more necrosis was associated with poorer OS (p = .038). CONCLUSION RECIST, Choi and the EORTC-STBSG response score show incongruent results in response evaluation. The radiological response was significantly correlated with a lower percentage of viable cells and necrosis, but a higher percentage of fibrosis. Apart from necrosis, radiological nor other histopathological parameters were associated with oncologic outcomes.
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Affiliation(s)
- Sophie J M Reijers
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nicolò Gennaro
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annemarie Bruining
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hester van Boven
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Petur Snaebjornsson
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elise M Bekers
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frits van Coevorden
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Astrid N Scholten
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Yvonne Schrage
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Rick L M Haas
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Winan J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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10
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Miao L, Ma ST, Jiang X, Zhang HH, Wang YM, Li M. Prediction of the therapeutic efficacy of epirubicin combined with ifosfamide in patients with lung metastases from soft tissue sarcoma based on contrast-enhanced CT radiomics features. BMC Med Imaging 2022; 22:131. [PMID: 35883116 PMCID: PMC9316811 DOI: 10.1186/s12880-022-00859-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/18/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate the value of contrast-enhanced computed tomography (CECT) radiomics features in predicting the efficacy of epirubicin combined with ifosfamide in patients with pulmonary metastases from soft tissue sarcoma. Methods A retrospective analysis of 51 patients with pulmonary metastases from soft tissue sarcoma who received the chemotherapy regimen of epirubicin combined with ifosfamide was performed, and efficacy was evaluated by Recist1.1. ROIs (1 or 2) were selected for each patient. Lung metastases were used as target lesions (86 target lesions total), and the patients were divided into a progression group (n = 29) and a non-progressive group (n = 57); the latter included a stable group (n = 34) and a partial response group (n = 23). Information on lung metastases was extracted from CECT images before chemotherapy, and all lesions were delineated by ITK-SNAP software manually or semiautomatically. The decision tree classifier had a better performance in all radiomics models. A receiver operating characteristic curve was plotted to evaluate the predictive performance of the radiomics model. Results In total, 851 CECT radiomics features were extracted for each target lesion and finally reduced to 2 radiomics features, which were then used to construct a radiomics model. Areas under the curves of the model for predicting lesion progression were 0.917 and 0.856 in training and testing groups, respectively. Conclusion The model established based on the radiomics features of CECT before treatment has certain predictive value for assessing the efficacy of chemotherapy for patients with soft tissue sarcoma lung metastases. Supplementary Information The online version contains supplementary material available at 10.1186/s12880-022-00859-6.
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Affiliation(s)
- Lei Miao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Shu-Tao Ma
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Xu Jiang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Huan-Huan Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yan-Mei Wang
- GE Healthcare China, Pudong New Town, Shanghai, People's Republic of China
| | - Meng Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
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11
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Thrussell I, Winfield JM, Orton MR, Miah AB, Zaidi SH, Arthur A, Thway K, Strauss DC, Collins DJ, Koh DM, Oelfke U, Huang PH, O’Connor JPB, Messiou C, Blackledge MD. Radiomic Features From Diffusion-Weighted MRI of Retroperitoneal Soft-Tissue Sarcomas Are Repeatable and Exhibit Change After Radiotherapy. Front Oncol 2022; 12:899180. [PMID: 35924167 PMCID: PMC9343063 DOI: 10.3389/fonc.2022.899180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Size-based assessments are inaccurate indicators of tumor response in soft-tissue sarcoma (STS), motivating the requirement for new response imaging biomarkers for this rare and heterogeneous disease. In this study, we assess the test-retest repeatability of radiomic features from MR diffusion-weighted imaging (DWI) and derived maps of apparent diffusion coefficient (ADC) in retroperitoneal STS and compare baseline repeatability with changes in radiomic features following radiotherapy (RT). Materials and Methods Thirty patients with retroperitoneal STS received an MR examination prior to treatment, of whom 23/30 were investigated in our repeatability analysis having received repeat baseline examinations and 14/30 patients were investigated in our post-treatment analysis having received an MR examination after completing pre-operative RT. One hundred and seven radiomic features were extracted from the full manually delineated tumor region using PyRadiomics. Test-retest repeatability was assessed using an intraclass correlation coefficient (baseline ICC), and post-radiotherapy variance analysis (post-RT-IMS) was used to compare the change in radiomic feature value to baseline repeatability. Results For the ADC maps and DWI images, 101 and 102 features demonstrated good baseline repeatability (baseline ICC > 0.85), respectively. Forty-three and 2 features demonstrated both good baseline repeatability and a high post-RT-IMS (>0.85), respectively. Pearson correlation between the baseline ICC and post-RT-IMS was weak (0.432 and 0.133, respectively). Conclusions The ADC-based radiomic analysis shows better test-retest repeatability compared with features derived from DWI images in STS, and some of these features are sensitive to post-treatment change. However, good repeatability at baseline does not imply sensitivity to post-treatment change.
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Affiliation(s)
- Imogen Thrussell
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, United Kingdom
| | - Jessica M. Winfield
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, United Kingdom
| | - Matthew R. Orton
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, United Kingdom
| | - Aisha B. Miah
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Shane H. Zaidi
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Amani Arthur
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, United Kingdom
| | - Khin Thway
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Department of Histopathology, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Dirk C. Strauss
- Department of Surgery, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - David J. Collins
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, United Kingdom
| | - Dow-Mu Koh
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, United Kingdom
| | - Uwe Oelfke
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Paul H. Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
| | - James P. B. O’Connor
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Department of Radiology, The Christie Hospital, Manchester, United Kingdom
| | - Christina Messiou
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, United Kingdom
| | - Matthew D. Blackledge
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden National Health Service (NHS) Foundation Trust, Sutton, United Kingdom
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12
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Isaac C, Kavanagh J, Griffin AM, Dickie CI, Mohankumar R, Chung PW, Catton CN, Shultz D, Ferguson PC, Wunder JS. Radiological progression of extremity soft tissue sarcoma following pre-operative radiotherapy predicts for poor survival. Br J Radiol 2022; 95:20210936. [PMID: 34826230 PMCID: PMC8822555 DOI: 10.1259/bjr.20210936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To determine if radiological response to pre-operative radiotherapy is related to oncologic outcome in patients with extremity soft tissue sarcomas (STSs). METHODS 309 patients with extremity STS who underwent pre-operative radiation and wide resection were identified from a prospective database. Pre- and post-radiation MRI scans were retrospectively reviewed. Radiological response was defined by the modified Response Evaluation Criteria in Solid Tumours. Local recurrence-free, metastasis-free (MFS) and overall survival (OS) were compared across response groups. RESULTS Tumour volume decreased in 106 patients (34.3%; PR - partial responders), remained stable in 97 (31.4%; SD - stable disease), increased in 106 (34.3%; PD - progressive disease). The PD group were older (p = 0.007), had more upper extremity (p = 0.03) and high-grade tumours (p < 0.001). 81% of myxoid liposarcomas showed substantial decrease in size. There was no difference in initial tumour diameter (p = 0.5), type of surgery (p = 0.5), margin status (p = 0.4), or complications (p = 0.8) between the three groups. There were 10 (3.2%) local recurrences with no differences between the three response groups (p = 0.06). 5-year MFS was 52.1% for the PD group vs 73.8 and 78.5% for the PR and SD groups, respectively (p < 0.001). OS was similar (p < 0.001). Following multivariable analysis, worse MFS and OS were associated with higher grade, larger tumour size at diagnosis and tumour growth following pre-operative radiation. Older age was also associated with worse OS. CONCLUSION STS that enlarge according to Response Evaluation Criteria in Solid Tumour criteria following pre-operative radiotherapy identify a high risk group of patients with worse systemic outcomes but equivalent local control. ADVANCES IN KNOWLEDGE Post-radiation therapy, STS enlargement may identify patients with potential for worse systemic outcomes but equivalent local control. Therefore, adjunct therapeutic approaches could be considered in these patients.
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Affiliation(s)
- Christian Isaac
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
| | - John Kavanagh
- Department of Medical Imaging, Mount Sinai Hospital and Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | | | - Colleen I Dickie
- Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada
| | - Rakesh Mohankumar
- Department of Medical Imaging, Mount Sinai Hospital and Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | - Peter W Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada
| | - Charles N Catton
- Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada
| | - David Shultz
- Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada
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13
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Crombé A, Fadli D, Spinnato P, Michot A, Cousin S, Le Loarer F, Kind M. Natural speed of growth of untreated soft-tissue sarcomas: A dimension-based imaging analysis. Eur J Radiol 2021; 146:110082. [PMID: 34871937 DOI: 10.1016/j.ejrad.2021.110082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/05/2021] [Accepted: 11/28/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE The interval from first symptoms to diagnosis, staging and referral to reference center can last months for soft-tissue sarcoma (STS) patients. Meanwhile, patients can undergo different imaging that capture the 'natural' tumor changes, before medical intervention. Aim was to depict these 'natural' dimensional variations and to correlate them with patients' outcome. METHODS Single-center retrospective study including all consecutive adults with newly-diagnosed STS, ≥2 pre-treatment imaging (CT-scan or MRI) on the tumor (Exam-0 and Exam-1), and managed in reference center between 2007 and 2018. Longest diameter (LD) and volume were calculated on both examinations to obtain the naïve dimensional growth before any intervention. SARCULATOR nomogram was applied on data at Exam-0 and Exam-1. Correlations with overall, metastatic and local relapse-free survivals (OS, MFS and LFS), and with pre-treatment pathological features were performed. RESULTS 137 patients were included (median age: 65 years). Average naïve growth was +39.4% in LD and +503% in volume during an average Exam-0-to-Exam-1 interval of 130 days. The 10-year distant metastasis and OS predictions were different at Exam-0 and Exam-1 (P < 0.0001 for both). All the changes in radiological measurements significantly correlated with pre-treatment number of mitosis, grade and complex genomic (P-value range: <0.0001-0.0481). Multivariate Cox modeling identified the relative change in LD/month and absolute change in LD/month as independent predictors for OS and LFS, respectively (P = 0.0003 and 0.0001, respectively). CONCLUSION When available, the natural speed of growth on pre-treatment imaging should be evaluated to improve the estimation of pre-treatment histological grade and patients' OS and LFS.
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Affiliation(s)
- Amandine Crombé
- Department of Oncologic Imaging, Bergonié Institut, Regional Comprehensive Cancer Center of Bordeaux, F-33076 Bordeaux, France; University of Bordeaux, F-33000 Bordeaux, France; Models in Oncology (MONC) Team, INRIA Bordeaux Sud-Ouest, CNRS, UMR 5251, F-33405 Talence, France.
| | - David Fadli
- Department of Oncologic Imaging, Bergonié Institut, Regional Comprehensive Cancer Center of Bordeaux, F-33076 Bordeaux, France
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Audrey Michot
- University of Bordeaux, F-33000 Bordeaux, France; Department of Oncologic Surgery, Bergonié Institut, Regional Comprehensive Cancer Center of Bordeaux, F-33076 Bordeaux, France
| | - Sophie Cousin
- Department of Medical Oncology, Bergonié Institut, Regional Comprehensive Cancer Center of Bordeaux, F-33076 Bordeaux, France
| | - François Le Loarer
- University of Bordeaux, F-33000 Bordeaux, France; Department of Pathology, Bergonié Institut, Regional Comprehensive Cancer Center of Bordeaux, F-33076 Bordeaux, France
| | - Michèle Kind
- Department of Oncologic Imaging, Bergonié Institut, Regional Comprehensive Cancer Center of Bordeaux, F-33076 Bordeaux, France
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A moderate dose of preoperative radiotherapy may improve resectability in myxoid liposarcoma. Eur J Surg Oncol 2021; 47:2633-2639. [PMID: 34233858 DOI: 10.1016/j.ejso.2021.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/31/2021] [Accepted: 06/16/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Histotype specific neoadjuvant therapy response data is scarce in soft tissue sarcomas. This study aimed to assess the impact of a moderate radiotherapy (RT) dose on resectability and to correlate MRI parameters to pathological treatment response in Myxoid Liposarcoma (MLS). METHODS This prospective, multicenter, single-arm, phase 2 trial assessed the radiological effects of 36 Gy of preoperative radiotherapy in primary non-metastatic MLS (n=34). Distance of the tumor to the neurovascular bundle, tumor dimensions, fat fraction, enhancing fraction were determined on MRI scans at baseline, after 8 and 16 fractions, and preoperatively. Pathological response was established by central pathology review. RESULTS Preoperative radiotherapy resulted in a median increase of 2 mm (IQR 0 to 6) of the distance of the tumor to the neurovascular bundle. As compared to baseline, the median change of the tumor volume, craniocaudal diameter and axial diameter at preoperative MRI were -60% (IQR -74 to -41), -19% (IQR -23 to -7) and -20% (IQR -29 to -12), respectively. The median fat fraction of 0.1 (IQR 0.0-0.1) and enhancing fraction of 0.8 (IQR 0.6 to 0.9) at baseline, changed to 0.2 (IQR 0.1 to 0.5) and to 0.5(IQR 0.4 to 0.9) preoperatively, respectively. Radiological signs of response in terms of volume, enhancing fraction and fat fraction were correlated with specific pathological signs of response like hyalinization, necrosis and fatty maturation. CONCLUSIONS A moderate dose of preoperative radiotherapy may improve resectability in MLS and could facilitate achievement of clear margins and function preservation. MRI features which were predictive for expressions of pathological response, can play a role in further personalization of neoadjuvant treatment strategies in order to improve outcome in MLS.
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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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Spałek MJ, Koseła-Paterczyk H, Borkowska A, Wągrodzki M, Szumera-Ciećkiewicz A, Czarnecka AM, Castaneda-Wysocka P, Kalinowska I, Poleszczuk J, Dąbrowska-Szewczyk E, Cieszanowski A, Rutkowski P. Combined Preoperative Hypofractionated Radiotherapy With Doxorubicin-Ifosfamide Chemotherapy in Marginally Resectable Soft Tissue Sarcomas: Results of a Phase 2 Clinical Trial. Int J Radiat Oncol Biol Phys 2021; 110:1053-1063. [PMID: 33600887 DOI: 10.1016/j.ijrobp.2021.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/26/2021] [Accepted: 02/09/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE There is no standard treatment for marginally resectable soft tissue sarcomas (STSs) of the extremities and trunk wall, and current approaches produce unsatisfactory results. We hypothesized that the combination of doxorubicin-ifosfamide (AI) chemotherapy and 5 × 5 Gy hypofractionated radiotherapy can generate a higher ratio of limb-sparing or conservative surgeries with negative microscopic margins (R0) and acceptable treatment toxicity. METHODS AND MATERIALS We conducted a single-arm prospective clinical trial. Treatment combined 1 cycle of AI with subsequent 5 × 5 Gy radiotherapy within 1 week, followed by 2 cycles of AI and surgery. The primary endpoint was to assess the number of patients in whom en bloc R0 resection was achieved. RESULTS Forty-six patients met the eligibility criteria. Three patients had resectable lung metastases at baseline. Forty-two received the planned protocol treatment. In 2 patients, the treatment was prematurely stopped because of the toxicity of chemotherapy. One patient died of septic shock because of severe bone marrow suppression after the second AI cycle; a second death was not related to treatment for STS. Three patients underwent amputation. In 72% of patients in the intention-to-treat analysis, we achieved en bloc R0 resections. Grade 3+ Common Terminology Criteria for Adverse Events 4.03 chemotherapy toxicity requiring dose reduction or treatment interruption occurred in 15 patients. Wound complications occurred in 18 patients, but they were severe in only 6 patients. CONCLUSIONS Preoperative AI combined with 5 × 5 Gy radiotherapy is a promising method for the management of marginally resectable STS. This protocol enables a high ratio of R0 limb-sparing or conservative surgeries. Further evaluation of this strategy is warranted.
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Affiliation(s)
- Mateusz J Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
| | - Hanna Koseła-Paterczyk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Aneta Borkowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Michał Wągrodzki
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Diagnostic Hematology Department, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Anna M Czarnecka
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Patricia Castaneda-Wysocka
- Department of Radiology I, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Iwona Kalinowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Jan Poleszczuk
- Department of Computational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Edyta Dąbrowska-Szewczyk
- Department of Medical Physics, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Biomedical Physics Division, Faculty of Physics, University of Warsaw, Warsaw, Poland
| | - Andrzej Cieszanowski
- Department of Radiology I, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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17
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Polverari G, Ceci F, Passera R, Crane J, Du L, Li G, Fanti S, Bernthal N, Eilber FC, Allen-Auerbach M, Czernin J, Calais J, Federman N. [ 18F]FDG PET/CT for evaluating early response to neoadjuvant chemotherapy in pediatric patients with sarcoma: a prospective single-center trial. EJNMMI Res 2020; 10:122. [PMID: 33063147 PMCID: PMC7561652 DOI: 10.1186/s13550-020-00715-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/24/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION This is a prospective, single-center trial in pediatric patients with sarcoma aiming to evaluate [18F]FDG PET/CT as a tool for early response assessment to neoadjuvant chemotherapy (neo-CTX). METHODS Bone or soft tissue sarcoma patients with (1) baseline [18F]FDG PET/CT within 4 weeks prior to the start of neo-CTX (PET1), (2) early interim [18F]FDG PET/CT (6 weeks after the start of neo-CTX (PET2), (3) evaluation of neo-CTX response by histology or MRI, and (4) definitive therapy after neo-CTX (surgery or radiation) were included. Semiquantitative PET parameters (SUVmax, SUVmean, SUVpeak, MTV and TLG) and their changes from PET1 to PET2 (ΔPET) were obtained. The primary endpoint was to evaluate the predictive value of PET1, PET2 and ΔPET parameters for overall survival (OS) and time to progression (TTP). The secondary outcome was to evaluate if [18F]FDG PET/CT can predict the response to neo-CTX assessed by histopathology or MRI. Primary and secondary outcomes were also evaluated in a subpopulation of patients with bone involvement only. RESULTS Thirty-four consecutive patients were enrolled (10 females; 24 males; median age 15.1 years). 17/34 patients (50%) had osteosarcoma, 13/34 (38%) Ewing's sarcoma, 2/34 (6%) synovial sarcoma and 2/34 (6%) embryonal liver sarcoma. Median follow-up was 39 months (range 16-84). Eight of 34 patients (24%) died, 9/34 (27%) were alive with disease, and 17/34 (50%) had no evidence of residual/recurrent disease. Fifteen of 34 (44%) and 19/34 (56%) were responders and non-responders, respectively. PET2-parameters were associated with longer TTP (p < 0.02). ΔMTV was associated with tissue response to neo-CTX (p = 0.047). None of the PET1, PET2 or ΔPET parameters were associated with OS. CONCLUSION [18F]FDG PET/CT performed 6 weeks after the start of neo-CTX can serve as an early interim biomarker for TTP and pathologic response but not for OS in pediatric patients with sarcoma.
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Affiliation(s)
- Giulia Polverari
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite B114-61, Los Angeles, CA, 90095, USA.,Nuclear Medicine, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.,PET/CT Center, Affidea IRMET, Turin, Italy
| | - Francesco Ceci
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite B114-61, Los Angeles, CA, 90095, USA.,Nuclear Medicine, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Roberto Passera
- Nuclear Medicine, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Jacquelyn Crane
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Lin Du
- Department of Biostatistics, Jonathan and Karin Fielding of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Gang Li
- Department of Biostatistics, Jonathan and Karin Fielding of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Stefano Fanti
- Nuclear Medicine, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Nicholas Bernthal
- Department of Orthopedics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Fritz C Eilber
- Division of Surgical Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Martin Allen-Auerbach
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite B114-61, Los Angeles, CA, 90095, USA
| | - Johannes Czernin
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite B114-61, Los Angeles, CA, 90095, USA.,Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite B114-61, Los Angeles, CA, 90095, USA. .,Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA.
| | - Noah Federman
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Orthopedics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA, USA
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18
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Llacer-Moscardo C, Terlizzi M, Bonvalot S, Le Loarer F, Carrère S, Tetrau R, D'ascoli A, Lerouge D, Le Péchoux C, Thariat J. Pre- or postoperative radiotherapy for soft tissue sarcomas. Cancer Radiother 2020; 24:501-512. [PMID: 32807685 DOI: 10.1016/j.canrad.2020.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 11/17/2022]
Abstract
Sarcomas are rare tumours arising from mesenchymal tissue. A multimodal management in an expert centre combining surgery and radiotherapy is the current standard of care for localized soft-tissue sarcomas of the extremities, to enable limb-sparing strategies. The delivery of pre- radiotherapy or postoperative radiotherapy offers similar local control and survival rates but the toxicity profile is quite different: preoperative radiotherapy increases the risk of wound complications and postoperative radiotherapy affects long-term functional outcomes. While postoperative radiotherapy has long been the rule, especially in Europe, technical improvements with image-guided- and intensity-modulated radiotherapy associated with a better management of postoperative wounds has tended to change practices with more frequent preoperative radiotherapy. More recently the possibilities of a hypofractionated regimen or potentiation by nanoparticles to increase the therapeutic index plead in favour of a preoperative delivery of radiotherapy. The aim of this paper is to report pros and cons of pre- and post-operative radiotherapy for soft-tissue sarcomas.
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Affiliation(s)
- C Llacer-Moscardo
- Radiation Oncology Department, institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France.
| | - M Terlizzi
- Radiation Oncology Department, hôpital Haut-Lévêque, CHU de Bordeaux, 1, avenue Magellan, 33600 Pessac, France
| | - S Bonvalot
- Department of Surgical Oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - F Le Loarer
- Department of Pathology, institut Bergonié, 229, cours de l'Argonne, CS 61283, 33076 Bordeaux cedex, France
| | - S Carrère
- Department of Surgical Oncology, institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France
| | - R Tetrau
- Radiology Department, institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, parc Euromédecine, 34298 Montpellier cedex 5, France
| | - A D'ascoli
- Department of Orthopaedics and Sports Surgery, hôpital Pasteur 2, Institut universitaire locomoteur et sports (IULS), 30, voie Romaine, 06000 Nice, France
| | - D Lerouge
- Radiation Oncology Department, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France; Association Advance Resource Centre for Hadrontherapy in Europe (Archade), 3, avenue General-Harris, 14000 Caen, France
| | - C Le Péchoux
- Radiation Oncology Department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - J Thariat
- Radiation Oncology Department, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France; Association Advance Resource Centre for Hadrontherapy in Europe (Archade), 3, avenue General-Harris, 14000 Caen, France
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19
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Spałek MJ, Kozak K, Czarnecka AM, Bartnik E, Borkowska A, Rutkowski P. Neoadjuvant Treatment Options in Soft Tissue Sarcomas. Cancers (Basel) 2020; 12:cancers12082061. [PMID: 32722580 PMCID: PMC7464514 DOI: 10.3390/cancers12082061] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 12/24/2022] Open
Abstract
Due to the heterogeneity of soft tissue sarcomas (STS), the choice of the proper perioperative treatment regimen is challenging. Neoadjuvant therapy has attracted increasing attention due to several advantages, particularly in patients with locally advanced disease. The number of available neoadjuvant modalities is growing continuously. We may consider radiotherapy, chemotherapy, targeted therapy, radiosensitizers, hyperthermia, and their combinations. This review discusses possible neoadjuvant treatment options in STS with an emphasis on available evidence, indications for each treatment type, and related risks. Finally, we summarize current recommendations of the STS neoadjuvant therapy response assessment.
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Affiliation(s)
- Mateusz Jacek Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.K.); (A.M.C.); (A.B.); (P.R.)
- Correspondence: ; Tel.: +48-22-546-24-55
| | - Katarzyna Kozak
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.K.); (A.M.C.); (A.B.); (P.R.)
| | - Anna Małgorzata Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.K.); (A.M.C.); (A.B.); (P.R.)
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Ewa Bartnik
- Institute of Genetics and Biotechnology, Faculty of Biology, University of Warsaw, 02-106 Warsaw, Poland;
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Aneta Borkowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.K.); (A.M.C.); (A.B.); (P.R.)
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (K.K.); (A.M.C.); (A.B.); (P.R.)
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20
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Blackledge MD, Winfield JM, Miah A, Strauss D, Thway K, Morgan VA, Collins DJ, Koh DM, Leach MO, Messiou C. Supervised Machine-Learning Enables Segmentation and Evaluation of Heterogeneous Post-treatment Changes in Multi-Parametric MRI of Soft-Tissue Sarcoma. Front Oncol 2019; 9:941. [PMID: 31649872 PMCID: PMC6795696 DOI: 10.3389/fonc.2019.00941] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/06/2019] [Indexed: 01/12/2023] Open
Abstract
Background: Multi-parametric MRI provides non-invasive methods for response assessment of soft-tissue sarcoma (STS) from non-surgical treatments. However, evaluation of MRI parameters over the whole tumor volume may not reveal the full extent of post-treatment changes as STS tumors are often highly heterogeneous, including cellular tumor, fat, necrosis, and cystic tissue compartments. In this pilot study, we investigate the use of machine-learning approaches to automatically delineate tissue compartments in STS, and use this approach to monitor post-radiotherapy changes. Methods: Eighteen patients with retroperitoneal sarcoma were imaged using multi-parametric MRI; 8/18 received a follow-up imaging study 2-4 weeks after pre-operative radiotherapy. Eight commonly-used supervised machine-learning techniques were optimized for classifying pixels into one of five tissue sub-types using an exhaustive cross-validation approach and expert-defined regions of interest as a gold standard. Final pixel classification was smoothed using a Markov Random Field (MRF) prior distribution on the final machine-learning models. Findings: 5/8 machine-learning techniques demonstrated high median cross-validation accuracies (82.2%, range 80.5-82.5%) with no significant difference between these five methods. One technique was selected (Naïve-Bayes) due to its relatively short training and class-prediction times (median 0.73 and 0.69 ms, respectively on a 3.5 GHz personal machine). When combined with the MRF-prior, this approach was successfully applied in all eight post-radiotherapy imaging studies and provided visualization and quantification of changes to independent STS sub-regions following radiotherapy for heterogeneous response assessment. Interpretation: Supervised machine-learning approaches to tissue classification in multi-parametric MRI of soft-tissue sarcomas provide quantitative evaluation of heterogeneous tissue changes following radiotherapy.
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Affiliation(s)
- Matthew D. Blackledge
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Jessica M. Winfield
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Aisha Miah
- Sarcoma Unit, Department of Radiotherapy and Physics, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Dirk Strauss
- Department of Surgery, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Khin Thway
- Sarcoma Unit, Department of Radiotherapy and Physics, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Veronica A. Morgan
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - David J. Collins
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Dow-Mu Koh
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Martin O. Leach
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Christina Messiou
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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21
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Kollár A, Rothermundt C, Klenke F, Bode B, Baumhoer D, Arndt V, Feller A. Incidence, mortality, and survival trends of soft tissue and bone sarcoma in Switzerland between 1996 and 2015. Cancer Epidemiol 2019; 63:101596. [PMID: 31520938 DOI: 10.1016/j.canep.2019.101596] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/26/2019] [Accepted: 09/02/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Research on soft-tissue sarcoma (STS) and bone sarcoma (BS) is increasingly in the focus of physicians and pharmaceutical companies. Expanding knowledge has improved the management of sarcoma and possibly survival. Here we provide the first population-based data on time trends of incidence, mortality, and survival of STS and BS diagnosed in Switzerland between 1996 and 2015. METHODS We performed a retrospective registry study with data from the National Institute for Cancer Epidemiology and Registration (NICER) database in Switzerland between 1996 and 2015. RESULTS We identified 5384 STS patients and 940 BS patients. The three most common STS subtypes were undifferentiated/unclassified sarcoma (22.3%), liposarcoma (20.6%) and leiomyosarcoma (20.6%). Chondrosarcoma, osteosarcoma and Ewing sarcoma represented 40.4%, 27.0% and 15.2% of the BS group, respectively. The age-standardized incidence and mortality rates in 2011-2015 were 4.43 and 1.42 per 100,000 person-years for STS, and 0.91 and 0.42 for BS. Age-standardized incidence of STS in males was significantly higher during 1996-2000 than during 2001-2015; however, mortality rates did not change significantly over time. Five-year relative survival (RS) for STS improved significantly from 56.4% (95%CI 52.9-59.7 for 1996-2001) to 61.6% (95%CI 58.6-64.4 for 2011-2015) (p = 0.025). No improvement in 5-year RS for BS could be observed (RS 1996-2000: 69.6%, 95%CI 61.2-76.6; RS 2011-2015: 73.1%, 95%CI 66.6-78.6; p = 0.479). CONCLUSION Incidence rates of STS and BS have been stable since 2001. The longer RS in STS can be attributed to advances in sarcoma patient management.
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Affiliation(s)
- Attila Kollár
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Christian Rothermundt
- Department of Medical Oncology and Hematology, Cantonal Hospital St Gallen, Rorschacher Strasse 95, CH-9007 St Gallen, Switzerland
| | - Frank Klenke
- Department of Orthopedic Surgery, Inselspital, Bern University Hospital, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Beata Bode
- University of Zurich and Institute of Pathology Enge, Hardturmstrasse 133, CH-8005 Zurich, Switzerland
| | - Daniel Baumhoer
- Bone Tumour Reference Centre at the Institute of Pathology, University Hospital and University of Basel, Schoenbeinstrasse 40, CH-4031 Basel, Switzerland
| | - Volker Arndt
- Foundation National Institute for Cancer Epidemiology and Registration (NICER) c/o University of Zurich, Seilergraben 49, CH-8001 Zurich, Switzerland; Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research & Epidemiological Cancer Registry Baden-Württemberg, German Cancer Research Center (dkfz), Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany
| | - Anita Feller
- Foundation National Institute for Cancer Epidemiology and Registration (NICER) c/o University of Zurich, Seilergraben 49, CH-8001 Zurich, Switzerland
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22
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Nussbaum DP. Nanoparticle augmentation of radiotherapy in sarcoma. Lancet Oncol 2019; 20:1046-1048. [PMID: 31296492 DOI: 10.1016/s1470-2045(19)30392-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Daniel P Nussbaum
- Department of Surgery, Duke University Medical Center, Duke University, Durham, NC 27710, USA.
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23
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Winfield JM, Miah AB, Strauss D, Thway K, Collins DJ, deSouza NM, Leach MO, Morgan VA, Giles SL, Moskovic E, Hayes A, Smith M, Zaidi SH, Henderson D, Messiou C. Utility of Multi-Parametric Quantitative Magnetic Resonance Imaging for Characterization and Radiotherapy Response Assessment in Soft-Tissue Sarcomas and Correlation With Histopathology. Front Oncol 2019; 9:280. [PMID: 31106141 PMCID: PMC6494941 DOI: 10.3389/fonc.2019.00280] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 03/27/2019] [Indexed: 02/05/2023] Open
Abstract
Purpose: To evaluate repeatability of quantitative multi-parametric MRI in retroperitoneal sarcomas, assess parameter changes with radiotherapy, and correlate pre-operative values with histopathological findings in the surgical specimens. Materials and Methods: Thirty patients with retroperitoneal sarcoma were imaged at baseline, of whom 27 also underwent a second baseline examination for repeatability assessment. 14/30 patients were treated with pre-operative radiotherapy and were imaged again after completing radiotherapy (50.4 Gy in 28 daily fractions, over 5.5 weeks). The following parameter estimates were assessed in the whole tumor volume at baseline and following radiotherapy: apparent diffusion coefficient (ADC), parameters of the intra-voxel incoherent motion model of diffusion-weighted MRI (D, f, D*), transverse relaxation rate, fat fraction, and enhancing fraction after gadolinium-based contrast injection. Correlation was evaluated between pre-operative quantitative parameters and histopathological assessments of cellularity and fat fraction in post-surgical specimens (ClinicalTrials.gov, registration number NCT01902667). Results: Upper and lower 95% limits of agreement were 7.1 and -6.6%, respectively for median ADC at baseline. Median ADC increased significantly post-radiotherapy. Pre-operative ADC and D were negatively correlated with cellularity (r = -0.42, p = 0.01, 95% confidence interval (CI) -0.22 to -0.59 for ADC; r = -0.45, p = 0.005, 95% CI -0.25 to -0.62 for D), and fat fraction from Dixon MRI showed strong correlation with histopathological assessment of fat fraction (r = 0.79, p = 10-7, 95% CI 0.69-0.86). Conclusion: Fat fraction on MRI corresponded to fat content on histology and therefore contributes to lesion characterization. Measurement repeatability was excellent for ADC; this parameter increased significantly post-radiotherapy even in disease categorized as stable by size criteria, and corresponded to cellularity on histology. ADC can be utilized for characterizing and assessing response in heterogeneous retroperitoneal sarcomas.
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Affiliation(s)
- Jessica M. Winfield
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Aisha B. Miah
- Sarcoma Unit, Department of Radiotherapy and Physics, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Dirk Strauss
- Department of Surgery, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Khin Thway
- Sarcoma Unit, Department of Radiotherapy and Physics, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - David J. Collins
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Nandita M. deSouza
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Martin O. Leach
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Veronica A. Morgan
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Sharon L. Giles
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Eleanor Moskovic
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Andrew Hayes
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Surgery, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Myles Smith
- Department of Surgery, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Shane H. Zaidi
- Sarcoma Unit, Department of Radiotherapy and Physics, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Daniel Henderson
- Sarcoma Unit, Department of Radiotherapy and Physics, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Christina Messiou
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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24
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Blocker SJ, Mowery YM, Holbrook MD, Qi Y, Kirsch DG, Johnson GA, Badea CT. Bridging the translational gap: Implementation of multimodal small animal imaging strategies for tumor burden assessment in a co-clinical trial. PLoS One 2019; 14:e0207555. [PMID: 30958825 PMCID: PMC6453461 DOI: 10.1371/journal.pone.0207555] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/13/2019] [Indexed: 12/17/2022] Open
Abstract
In designing co-clinical cancer studies, preclinical imaging brings unique challenges that emphasize the gap between man and mouse. Our group is developing quantitative imaging methods for the preclinical arm of a co-clinical trial studying immunotherapy and radiotherapy in a soft tissue sarcoma model. In line with treatment for patients enrolled in the clinical trial SU2C-SARC032, primary mouse sarcomas are imaged with multi-contrast micro-MRI (T1 weighted, T2 weighted, and T1 with contrast) before and after immune checkpoint inhibition and pre-operative radiation therapy. Similar to the patients, after surgery the mice will be screened for lung metastases with micro-CT using respiratory gating. A systems evaluation was undertaken to establish a quantitative baseline for both the MR and micro-CT systems against which others systems might be compared. We have constructed imaging protocols which provide clinically-relevant resolution and contrast in a genetically engineered mouse model of sarcoma. We have employed tools in 3D Slicer for semi-automated segmentation of both MR and micro-CT images to measure tumor volumes efficiently and reliably in a large number of animals. Assessment of tumor burden in the resulting images was precise, repeatable, and reproducible. Furthermore, we have implemented a publicly accessible platform for sharing imaging data collected during the study, as well as protocols, supporting information, and data analyses. In doing so, we aim to improve the clinical relevance of small animal imaging and begin establishing standards for preclinical imaging of tumors from the perspective of a co-clinical trial.
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Affiliation(s)
- S. J. Blocker
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, United States of America
| | - Y. M. Mowery
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States of America
| | - M. D. Holbrook
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, United States of America
| | - Y. Qi
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, United States of America
| | - D. G. Kirsch
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, United States of America
- Department of Pharmacology & Cancer Biology, Duke University Medical Center, Durham, NC, United States of America
| | - G. A. Johnson
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, United States of America
| | - C. T. Badea
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, United States of America
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25
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ElDaly MM, Moustafa AFI, Abdel-Meguid SMS, Shokry AM, El Wahab NA. Can MRI diffusion-weighted imaging identify postoperative residual/recurrent soft-tissue sarcomas? Indian J Radiol Imaging 2018; 28:70-77. [PMID: 29692531 PMCID: PMC5894324 DOI: 10.4103/ijri.ijri_251_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose The aim of this study was to evaluate contrast-enhanced magnetic resonance imaging (CE-MRI) and quantitative diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping in the detection of recurrent/residual postoperative soft tissue sarcomas. Materials and Methods This study included 36 patients; 27 patients had postoperative recurrent/residual soft tissue sarcomas and 9 patients had postoperative and treatment-related changes (inflammation/fibrosis). The DWI was obtained with 3 b values including 0, 400, and 800 s/mm2. Calculation of the ADC value of the lesion was done via placing the region of interest (ROI) to include the largest area of the lesion. ADC values were compared to histopathology. Results Our results showed that including CE-MRI improved the diagnostic accuracy and sensitivity in recurrence detection compared to conventional non-enhanced sequences. However, it showed low specificity (55.56%) with a high false-positive rate that may lead to an unnecessary biopsy of a mass such as region of postoperative scar tissue. Conclusion The joint use of gadolinium-enhanced MRI and quantitative DWI with ADC mapping offer added value in the detection of recurrent/residual postoperative soft tissue sarcoma. This combined use increased both the diagnostic sensitivity and specificity with a cut-off average ADC value for detecting nonmyxoid recurrent/residual lesions ≤1.3 × 10-3 mm2/s (100% specificity and 90.48% sensitivity). Our results showed limited value of DWI with ADC mapping in assessing myxoid sarcomatous tumor recurrences.
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Affiliation(s)
- Mai Maher ElDaly
- Department of Diagnostic and Intervention Radiology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Amr Farouk Ibrahim Moustafa
- Department of Diagnostic and Intervention Radiology, National Cancer Institute, Cairo University, Cairo, Egypt
| | | | - Ahmed Mohamed Shokry
- Department of Diagnostic and Intervention Radiology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Nagui Abd El Wahab
- Department of Diagnostic and Intervention Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt
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26
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MacCarthy A, Kirtley S, de Beyer JA, Altman DG, Simera I. Reporting guidelines for oncology research: helping to maximise the impact of your research. Br J Cancer 2018; 118:619-628. [PMID: 29471308 PMCID: PMC5846057 DOI: 10.1038/bjc.2017.407] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 12/13/2022] Open
Abstract
Many reports of health research omit important information needed to assess their methodological robustness and clinical relevance. Without clear and complete reporting, it is not possible to identify flaws or biases, reproduce successful interventions, or use the findings in systematic reviews or meta-analyses. The EQUATOR Network (http://www.equator-network.org/) promotes responsible reporting and the use of reporting guidelines to improve the accuracy, completeness, and transparency of health research. EQUATOR supports researchers by providing online resources and training. EQUATOR Oncology, a project funded by Cancer Research UK, aims to support cancer researchers reporting their research through the provision of online resources. In this article, our objective is to highlight reporting issues related to oncology research publications and to introduce reporting guidelines that are designed to aid high-quality reporting. We describe generic reporting guidelines for the main study types, and explain how these guidelines should and should not be used. We also describe 37 oncology-specific reporting guidelines, covering different clinical areas (e.g., haematology or urology) and sections of the report (e.g., methods or study characteristics); most of these are little-used. We also provide some background information on EQUATOR Oncology, which focuses on addressing the reporting needs of the oncology research community.
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Affiliation(s)
- Angela MacCarthy
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford OX3 7LD, UK
| | - Shona Kirtley
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford OX3 7LD, UK
| | - Jennifer A de Beyer
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford OX3 7LD, UK
| | - Douglas G Altman
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford OX3 7LD, UK
| | - Iveta Simera
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford OX3 7LD, UK
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Haas RL, Gronchi A, van de Sande MA, Baldini EH, Gelderblom H, Messiou C, Wardelmann E, Le Cesne A. Perioperative Management of Extremity Soft Tissue Sarcomas. J Clin Oncol 2018; 36:118-124. [DOI: 10.1200/jco.2017.74.7527] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Surgery is potentially curative for primary nonmetastatic extremity soft tissue sarcomas. After surgery alone, patients may remain at risk for local recurrences and/or metastatic disease. To reduce the likelihood of a local relapse, the addition of radiotherapy (RT) to limb-sparing surgery may result in higher local control rates of at least 85%. Generally, it can be stated that local control after both preoperative and postoperative RT is comparable, but that preoperative RT comes with a more favorable toxicity profile after prolonged follow-up, albeit at the cost of a higher wound complication rate. Furthermore, recent data suggest that preoperative RT is more cost effective. To reduce the risk of subsequent metastatic disease, systemic chemotherapy can be introduced early during the primary management of these patients. These systemic chemotherapy regimens can also be applied both preoperatively and postoperatively. Finally, with the aim of increasing the antitumor response of perioperative RT, these agents may even be combined with RT, concurrently and sequentially. While designing new preoperative combination regimens, responses should be carefully monitored by both sophisticated radiologic and pathologic evaluations. This article reviews all these aspects, in addition to limb-sparing surgery.
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Affiliation(s)
- Rick L. Haas
- Rick L. Haas, The Netherlands Cancer Institute, Amsterdam; Rick L. Haas, Michiel A.J. van de Sande, and Hans Gelderblom, Leiden University Medical Centre, Leiden, the Netherlands; Alessandro Gronchi, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; Elizabeth H. Baldini, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Christina Messiou, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom; Eva Wardelmann, University Hospital
| | - Alessandro Gronchi
- Rick L. Haas, The Netherlands Cancer Institute, Amsterdam; Rick L. Haas, Michiel A.J. van de Sande, and Hans Gelderblom, Leiden University Medical Centre, Leiden, the Netherlands; Alessandro Gronchi, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; Elizabeth H. Baldini, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Christina Messiou, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom; Eva Wardelmann, University Hospital
| | - Michiel A.J. van de Sande
- Rick L. Haas, The Netherlands Cancer Institute, Amsterdam; Rick L. Haas, Michiel A.J. van de Sande, and Hans Gelderblom, Leiden University Medical Centre, Leiden, the Netherlands; Alessandro Gronchi, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; Elizabeth H. Baldini, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Christina Messiou, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom; Eva Wardelmann, University Hospital
| | - Elizabeth H. Baldini
- Rick L. Haas, The Netherlands Cancer Institute, Amsterdam; Rick L. Haas, Michiel A.J. van de Sande, and Hans Gelderblom, Leiden University Medical Centre, Leiden, the Netherlands; Alessandro Gronchi, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; Elizabeth H. Baldini, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Christina Messiou, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom; Eva Wardelmann, University Hospital
| | - Hans Gelderblom
- Rick L. Haas, The Netherlands Cancer Institute, Amsterdam; Rick L. Haas, Michiel A.J. van de Sande, and Hans Gelderblom, Leiden University Medical Centre, Leiden, the Netherlands; Alessandro Gronchi, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; Elizabeth H. Baldini, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Christina Messiou, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom; Eva Wardelmann, University Hospital
| | - Christina Messiou
- Rick L. Haas, The Netherlands Cancer Institute, Amsterdam; Rick L. Haas, Michiel A.J. van de Sande, and Hans Gelderblom, Leiden University Medical Centre, Leiden, the Netherlands; Alessandro Gronchi, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; Elizabeth H. Baldini, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Christina Messiou, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom; Eva Wardelmann, University Hospital
| | - Eva Wardelmann
- Rick L. Haas, The Netherlands Cancer Institute, Amsterdam; Rick L. Haas, Michiel A.J. van de Sande, and Hans Gelderblom, Leiden University Medical Centre, Leiden, the Netherlands; Alessandro Gronchi, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; Elizabeth H. Baldini, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Christina Messiou, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom; Eva Wardelmann, University Hospital
| | - Axel Le Cesne
- Rick L. Haas, The Netherlands Cancer Institute, Amsterdam; Rick L. Haas, Michiel A.J. van de Sande, and Hans Gelderblom, Leiden University Medical Centre, Leiden, the Netherlands; Alessandro Gronchi, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; Elizabeth H. Baldini, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA; Christina Messiou, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom; Eva Wardelmann, University Hospital
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28
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Barnes A, Alonzi R, Blackledge M, Charles-Edwards G, Collins DJ, Cook G, Coutts G, Goh V, Graves M, Kelly C, Koh DM, McCallum H, Miquel ME, O’Connor J, Padhani A, Pearson R, Priest A, Rockall A, Stirling J, Taylor S, Tunariu N, van der Meulen J, Walls D, Winfield J, Punwani S. UK quantitative WB-DWI technical workgroup: consensus meeting recommendations on optimisation, quality control, processing and analysis of quantitative whole-body diffusion-weighted imaging for cancer. Br J Radiol 2018; 91:20170577. [PMID: 29076749 PMCID: PMC5966219 DOI: 10.1259/bjr.20170577] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/09/2017] [Accepted: 10/11/2017] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Application of whole body diffusion-weighted MRI (WB-DWI) for oncology are rapidly increasing within both research and routine clinical domains. However, WB-DWI as a quantitative imaging biomarker (QIB) has significantly slower adoption. To date, challenges relating to accuracy and reproducibility, essential criteria for a good QIB, have limited widespread clinical translation. In recognition, a UK workgroup was established in 2016 to provide technical consensus guidelines (to maximise accuracy and reproducibility of WB-MRI QIBs) and accelerate the clinical translation of quantitative WB-DWI applications for oncology. METHODS A panel of experts convened from cancer centres around the UK with subspecialty expertise in quantitative imaging and/or the use of WB-MRI with DWI. A formal consensus method was used to obtain consensus agreement regarding best practice. Questions were asked about the appropriateness or otherwise on scanner hardware and software, sequence optimisation, acquisition protocols, reporting, and ongoing quality control programs to monitor precision and accuracy and agreement on quality control. RESULTS The consensus panel was able to reach consensus on 73% (255/351) items and based on consensus areas made recommendations to maximise accuracy and reproducibly of quantitative WB-DWI studies performed at 1.5T. The panel were unable to reach consensus on the majority of items related to quantitative WB-DWI performed at 3T. CONCLUSION This UK Quantitative WB-DWI Technical Workgroup consensus provides guidance on maximising accuracy and reproducibly of quantitative WB-DWI for oncology. The consensus guidance can be used by researchers and clinicians to harmonise WB-DWI protocols which will accelerate clinical translation of WB-DWI-derived QIBs.
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Affiliation(s)
- Anna Barnes
- Centre for Medical Imaging, University College London,University College London, London, UK
| | - Roberto Alonzi
- Clinical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Matthew Blackledge
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, Institute of Cancer Research,Institute of Cancer Research, Sutton, UK
| | | | | | | | - Glynn Coutts
- MR Physics, The Christie NHS Foundation Trust, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Martin Graves
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Charles Kelly
- Department of Radiology, Northern Centre for CancerCare, Newcastle upon Tyne Hospitals, NHS Foundations Trust,Northern Centre for CancerCare, Newcastle upon Tyne Hospitals, NHS Foundations Trust, Newcastle upon Tyne, UK
| | | | - Hazel McCallum
- Department of Radiology, Northern Centre for CancerCare, Newcastle upon Tyne Hospitals, NHS Foundations Trust,Northern Centre for CancerCare, Newcastle upon Tyne Hospitals, NHS Foundations Trust, Newcastle upon Tyne, UK
| | | | | | - Anwar Padhani
- Paul Strickland Cancer Centre, Mount Vernon Cancer Centre, Northwood, UK
| | | | - Andrew Priest
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Andrea Rockall
- Department of Radiology, The Royal Marsden Hospital Foundation Trust,The Royal Marsden Hospital Foundation Trust, Surrey, UK
| | | | | | | | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine,London School of Hygiene and Tropical Medicine, London, UK
| | - Darren Walls
- Institute Nuclear Medicine, University College London, London, UK
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29
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Messiou C, Morosi C. Imaging in retroperitoneal soft tissue sarcoma. J Surg Oncol 2017; 117:25-32. [PMID: 29193092 PMCID: PMC5836919 DOI: 10.1002/jso.24891] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/07/2017] [Indexed: 12/29/2022]
Abstract
Patients with retroperitoneal sarcoma can present to a variety of clinicians with non‐specific symptoms and retroperitoneal sarcomas can be incidental findings. Failure to recognize retroperitoneal sarcomas on imaging can lead to inappropriate management in non‐specialist centers. Therefore it is critical that the possibility of retroperitoneal sarcoma should be considered with prompt referral to a soft tissue sarcoma unit. This review guides clinicians through a diagnostic pathway, introduces concepts in response assessment and new imaging developments.
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Affiliation(s)
- Christina Messiou
- Department of Radiology, The Royal Marsden Hospital London and The Institute of Cancer Research, London, UK
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori Milan, Milan, Italy
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30
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Keung EZ, Tsai JW, Ali AM, Cormier JN, Bishop AJ, Guadagnolo BA, Torres KE, Somaiah N, Hunt KK, Wargo JA, Lazar AJ, Wang WL, Roland CL. Analysis of the immune infiltrate in undifferentiated pleomorphic sarcoma of the extremity and trunk in response to radiotherapy: Rationale for combination neoadjuvant immune checkpoint inhibition and radiotherapy. Oncoimmunology 2017; 7:e1385689. [PMID: 29308306 PMCID: PMC5749668 DOI: 10.1080/2162402x.2017.1385689] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/20/2017] [Accepted: 09/24/2017] [Indexed: 02/03/2023] Open
Abstract
Background: Undifferentiated pleomorphic sarcoma of the extremity and trunk (ET-UPS) presents a unique therapeutic challenge. Although immunotherapy has recently been employed in advanced soft tissue sarcoma, there is limited data characterizing the immune infiltrate in ET-UPS. Radiotherapy (RT) has been shown in other tumor types to promote tumor antigen release and enhance tumor-specific targeting by the adaptive immune system. The aim of this study was to 1) characterize the baseline immune infiltrate and 2) evaluate the effect of preoperative RT on the histologic appearance of and the immune infiltrate in ET-UPS. Methods: We identified 17 matched ET-UPS samples before and after RT. Immunohistochemistry was performed with CD8, CD4, PD-L1, PD1, CD3, CD163 and FoxP3 positive cells identified in all samples. Changes in the immune infiltrate following RT were examined. Results: There was a trend towards increased density of tumor infiltrating immune cells in ET-UPS following RT, with increases in median number of CD3 (158 vs 219 cells/mm2, p = 0.06), CD4 (3 vs 13 cells/mm2, p = 0.01), CD8 (55 vs 111 cells/mm2, p = 0.17), and FOXP3 (14 vs 25 cells/mm2, p = 0.23) positive cells. Interestingly, although PD-L1 was not expressed in any ET-UPS tumor at baseline, positive PD-L1 expression was observed in 21% (3/14) of tumors after RT (p = 0.07). Conclusion: An immune infiltrate is present in ET-UPS at the time of diagnosis, with a trend towards increased density of immune infiltrate and PD-L1 expression after RT. These data support prospectively evaluating immune checkpoint inhibitors with standard of care RT in the treatment of ET-UPS.
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Affiliation(s)
- Emily Z. Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jen-Wei Tsai
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ali M. Ali
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Janice N. Cormier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Andrew J. Bishop
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - B. Ashleigh Guadagnolo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Keila E. Torres
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Neeta Somaiah
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kelly K. Hunt
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer A. Wargo
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexander J. Lazar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wei-Lien Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christina L. Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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31
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Watts V GJ, Zoga AC, Abraham JA. Posttreatment Imaging in Orthopedic Oncology. Semin Roentgenol 2017; 52:291-300. [PMID: 28965548 DOI: 10.1053/j.ro.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- George J Watts V
- Department of Radiology, Musculoskeletal Imaging and Intervention, Thomas Jefferson University, Philadelphia, PA
| | - Adam C Zoga
- Department of Radiology, Musculoskeletal Imaging and Intervention, Thomas Jefferson University, Philadelphia, PA.
| | - John A Abraham
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Center, Thomas Jefferson University, Philadelphia, PA; Orthopaedic Oncology Surgery, Rothman Institute, Philadelphia, PA
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32
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Abstract
PURPOSE OF REVIEW Retroperitoneal sarcomas are rare tumors and with complex treatment. In this manuscript we give an overview of current standards in treatment of this disease and discuss new developments. RECENT FINDINGS Surgery with complete resection of the primary tumor is still the only curative modality. The role of preoperative radiotherapy is not clear and is currently being investigated in a clinical trial. Neo-adjuvant chemotherapy is not the standard of care but can be considered occasionally when complete resection is uncertain. Local and distant recurrent disease carries a dismal prognosis, although long-term survival can be achieved. Liposarcomas tend to recur locally, whereas distant recurrences are more often seen in leiomyosarcoma and other subtypes. Outcome improves when patients are treated in high volume sarcoma centers. In the metastatic setting, newer systemic agents have recently been approved. SUMMARY Treatment of retroperitoneal sarcomas is complex and all patients should be treated in multidisciplinary sarcoma centers. Increasing international collaboration of expert centers in sharing expertise and performing clinical trials might lead to better treatment and improved survival.
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33
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Gingrich AA, Bateni SB, Monjazeb AM, Darrow MA, Thorpe SW, Kirane AR, Bold RJ, Canter RJ. Neoadjuvant Radiotherapy is Associated with R0 Resection and Improved Survival for Patients with Extremity Soft Tissue Sarcoma Undergoing Surgery: A National Cancer Database Analysis. Ann Surg Oncol 2017; 24:3252-3263. [PMID: 28741123 DOI: 10.1245/s10434-017-6019-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Neoadjuvant radiotherapy (RT) is increasingly advocated for the management of soft tissue sarcoma (STS). Therefore, this study sought to characterize the impact of neoadjuvant RT on rates of R0 resection and overall survival (OS) in extremity STS patients undergoing surgery. METHODS From January 2003 to December 2012, the study identified patients with a diagnosis of extremity STS from the National Cancer Database. After exclusion of patients younger than 18 years, not treated by surgery, who had metastases at diagnosis, intraoperative RT, and missing or unknown data, 27,969 patients were identified. Logistic regression and Cox-proportional hazard analysis were used to compare rates of R0 resection among preoperative, postoperative, and no-RT cohorts and to determine predictors of R0 resection and OS. RESULTS The mean age of the patients was 59.5 ± 17.1 years, and 45.9% were female. The median tumor size was 10.5 cm. The data showed that 51% of the patients did not receive RT, 11.8% received preoperative RT, and 37.2% received postoperative RT. The rates of R0 resection were 90.1% for the preoperative RT cohort, 74.9% for the postoperative RT cohort, and 79.9% for the no-RT cohort (P < 0.001). The independent predictors for achievement of R0 resection included academic facility type (odds ratio [OR] 1.36; 95% confidence interval [CI] 1.20-1.55), histologic subtype, tumor size (OR 0.99; 95% CI 0.99-0.99), Charlson score (OR 0.92; 95% CI 0.84-0.99), and preoperative RT (OR 1.83; 95% CI 1.61-2.07). Both R0 resection and RT (pre- or post-operative) were associated with increased OS. CONCLUSIONS Preoperative RT independently predicts higher rates of R0 resection for patients with extremity STS undergoing surgical resection. Negative surgical margins and pre- or postoperative RT are associated with improved OS.
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Affiliation(s)
- Alicia A Gingrich
- Division of Surgical Oncology, Department of Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Sarah B Bateni
- Division of Surgical Oncology, Department of Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Arta M Monjazeb
- Department of Radiation Oncology, UC Davis Medical Center, Sacramento, CA, USA
| | - Morgan A Darrow
- Department of Pathology, UC Davis Medical Center, Sacramento, CA, USA
| | - Steven W Thorpe
- Department of Orthopedic Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Amanda R Kirane
- Division of Surgical Oncology, Department of Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Richard J Bold
- Division of Surgical Oncology, Department of Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Robert J Canter
- Division of Surgical Oncology, Department of Surgery, UC Davis Medical Center, Sacramento, CA, USA.
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34
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Uterine sarcoma Part II-Uterine endometrial stromal sarcoma: The TAG systematic review. Taiwan J Obstet Gynecol 2017; 55:472-9. [PMID: 27590366 DOI: 10.1016/j.tjog.2016.04.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2016] [Indexed: 12/16/2022] Open
Abstract
Endometrial stromal tumors are rare uterine tumors (<1%). Four main categories include endometrial stromal nodule, low-grade endometrial stromal sarcoma (LG-ESS), high-grade endometrial stromal sarcoma (HG-ESS), and uterine undifferentiated sarcoma (UUS). This review is a series of articles discussing the uterine sarcomas. LG-ESS, a hormone-dependent tumor harboring chromosomal rearrangement, is an indolent tumor with a favorable prognosis, but characterized by late recurrences even in patients with Stage I disease, suggesting the requirement of a long-term follow-up. Patients with HG-ESS, based on the identification of YWHAE-NUTM2A/B (YWHAE-FAM22A/B) gene fusion, typically present with advanced stage diseases and frequently have recurrences, usually within a few years after initial surgery. UUS is, a high-grade sarcoma, extremely rare, lacking a specific line of differentiation, which is a diagnosis of exclusion (the wastebasket category, which fails to fulfill the morphological and immunohistochemical criteria of translocation-positive ESS). Surgery is the main strategy in the management of uterine sarcoma. Due to rarity, complex biological characteristics, and unknown etiology and risk factors of uterine sarcomas, the role of adjuvant therapy is not clear. Only LG-ESS might respond to progestins or aromatase inhibitors.
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