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Borghi A, Gronchi A. Sarculator: how to improve further prognostication of all sarcomas. Curr Opin Oncol 2024; 36:253-262. [PMID: 38726834 DOI: 10.1097/cco.0000000000001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW Prognostication of soft tissue sarcomas is challenging due to the diversity of prognostic factors, compounded by the rarity of these tumors. Nomograms are useful predictive tools that assess multiple variables simultaneously, providing estimates of individual likelihoods of specific outcomes at defined time points. Although these models show promising predictive ability, their use underscores the need for further methodological refinement to address gaps in prognosis accuracy. RECENT FINDINGS Ongoing efforts focus on improving prognostic tools by either enhancing existing models based on established parameters or integrating novel prognostic markers, such as radiomics, genomic, proteomic, and immunologic factors. Artificial intelligence is a new field that is starting to be explored, as it has the capacity to combine and analyze vast and intricate amounts of relevant data, ranging from multiomics information to real-time patient outcomes. SUMMARY The integration of these innovative markers and methods could enhance the prognostic ability of nomograms such as Sarculator and ultimately enable more accurate and individualized healthcare. Currently, clinical variables continue to be the most significant and effective factors in terms of predicting outcomes in patients with STS. This review firstly introduces the rationale for developing and employing nomograms such as Sarculator, secondly, reflects on some of the latest and ongoing methodological refinements, and provides future perspectives in the field of prognostication of sarcomas.
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Affiliation(s)
- Alessandra Borghi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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2
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Khan M, Baia M, Fiore M, Colombo C, Callegaro D, Pasquali S, Gronchi A, Radaelli S. Initial local resection versus early referral for spermatic cord sarcoma: Any impact on treatment timelines and oncological outcomes? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108269. [PMID: 38520783 DOI: 10.1016/j.ejso.2024.108269] [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: 01/01/2024] [Revised: 02/27/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES Spermatic cord sarcomas are exceedingly rare, often misdiagnosed and subsequently improperly treated at local hospitals. This retrospective study looked at the oncological outcomes of spermatic cord sarcoma cases managed with curative intent resection at a tertiary referral sarcoma centre. We specifically studied how initial inadequate resections impact the oncologic outcomes compared to primary tumour resections at the reference centre. METHODS One hundred eighteen consecutive patients affected by primary, localized spermatic cord sarcoma surgically managed at our reference centre from January 2001 through January 2021 were included. Primary endpoints were local relapse free (LRFS), distant metastasis free (DMFS) and overall survival (OS). These outcomes were evaluated with multi-nomial logistic regression and Cox proportional hazards regression models for a co-relation to known patient, tumour and treatment-related prognostic factors, including a prior inadequate resection and time from diagnosis to a complete oncologic resection as independent variables. Secondarily, we compared the above variables and treatment intervals among the subgroups of primary versus re-resection surgery. RESULTS Over a median follow-up of 54 months (IQR 25-105), 12 patients (10.2%) developed local recurrence (LR) and 14 (11.6%) had distant metastasis (DM). 5-year local relapse (LRFS) and distant metastasis-free survival (DMFS) were 89.3% and 86.5%, respectively. Higher tumour grade and size were associated with a worse DMFS (p=<0.05). Likewise, marginal (R1) resection correlated with an inferior LRFS (p=< 0.05). Eighty-four patients (71.2%) had their initial diagnosis established on an inadequate surgical excision performed in a local hospital, followed by a re-excision at our centre (Re-resection group). During the same period, 34 (28.8%) were managed primarily with biopsy and treatment at our reference centre (Primary-resection group). The two groups had statistically significant differences in tumour size, histopathology, surgery duration, rate of postoperative complication and R0 resection (p < 0.005). Additionally, the difference in time intervals to achieve the treatment targets was statistically insignificant and did not correlate to the risk of recurrence as an independent variable. Residual disease was present in 51.2 % (n = 43) of the re-excision specimens. However, following a complete R0 resection, this did not correlate with a higher risk of recurrence (p = 0.481). CONCLUSION Prompt referral to a tertiary centre, where multidisciplinary evaluation and sound oncologic resections are the standard of treatment, can align the OS and DFS of patients receiving incomplete surgery elsewhere to those treated primarily in referral centres. The primary determinant of prognosis remains surgical margin, tumour size and grade.
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Affiliation(s)
| | - Marco Baia
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Fiore
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Colombo
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dario Callegaro
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sandro Pasquali
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Radaelli
- Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Hayes AJ, Nixon IF, Strauss DC, Seddon BM, Desai A, Benson C, Judson IR, Dangoor A. UK guidelines for the management of soft tissue sarcomas. Br J Cancer 2024:10.1038/s41416-024-02674-y. [PMID: 38734790 DOI: 10.1038/s41416-024-02674-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 05/13/2024] Open
Abstract
Soft tissue sarcomas (STS) are rare tumours arising in mesenchymal tissues and can occur almost anywhere in the body. Their rarity, and the heterogeneity of subtype and location, means that developing evidence-based guidelines is complicated by the limitations of the data available. This makes it more important that STS are managed by expert multidisciplinary teams, to ensure consistent and optimal treatment, recruitment to clinical trials, and the ongoing accumulation of further data and knowledge. The development of appropriate guidance, by an experienced panel referring to the evidence available, is therefore a useful foundation on which to build progress in the field. These guidelines are an update of the previous versions published in 2010 and 2016 [1, 2]. The original guidelines were drawn up by a panel of UK sarcoma specialists convened under the auspices of the British Sarcoma Group (BSG) and were intended to provide a framework for the multidisciplinary care of patients with soft tissue sarcomas. This iteration of the guidance, as well as updating the general multidisciplinary management of soft tissue sarcoma, includes specific sections relating to the management of sarcomas at defined anatomical sites: gynaecological sarcomas, retroperitoneal sarcomas, breast sarcomas, and skin sarcomas. These are generally managed collaboratively by site specific multidisciplinary teams linked to the regional sarcoma specialist team, as stipulated in the recently published sarcoma service specification [3]. In the UK, any patient with a suspected soft tissue sarcoma should be referred to a specialist regional soft tissues sarcoma service, to be managed by a specialist sarcoma multidisciplinary team. Once the diagnosis has been confirmed using appropriate imaging and a tissue biopsy, the main modality of management is usually surgical excision performed by a specialist surgeon, combined with pre- or post-operative radiotherapy for tumours at higher risk for local recurrence. Systemic anti-cancer therapy (SACT) may be utilised in cases where the histological subtype is considered more sensitive to systemic treatment. Regular follow-up is recommended to assess local control, development of metastatic disease, and any late effects of treatment.
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Affiliation(s)
- Andrew J Hayes
- The Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK.
- The Institute of Cancer Research, London, SM2 5NG, UK.
| | - Ioanna F Nixon
- Department of Clinical Oncology, The Beatson West of Scotland Cancer Center, Glasgow, G12 0YN, UK
| | - Dirk C Strauss
- The Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Beatrice M Seddon
- Department of Medical Oncology, University College London Hospital NHS Foundation Trust, London, NW1 2BU, UK
| | - Anant Desai
- The Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
| | - Charlotte Benson
- The Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - Ian R Judson
- The Institute of Cancer Research, London, SM2 5NG, UK
| | - Adam Dangoor
- Department of Medical Oncology, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, BS1 3NU, UK
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Fiore M, Sarre-Lazcano C, Smith M, Khan M, Raut CP, Honoré C, Sargos P, Cananzi F, Grignani G, Iwata S, Gronchi A. Primary pelvic soft tissue sarcomas (PELVISARC): outcomes from the TransAtlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG). Br J Surg 2024; 111:znae128. [PMID: 38805374 PMCID: PMC11132121 DOI: 10.1093/bjs/znae128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/20/2024] [Accepted: 04/30/2024] [Indexed: 05/30/2024]
Affiliation(s)
- Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Catherine Sarre-Lazcano
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán General Surgery, Mexico City, Mexico
| | - Myles Smith
- Sarcoma Unit, Royal Marsden Hospital, London, UK
| | - Misbah Khan
- Sarcoma Unit, Royal Marsden Hospital, London, UK
| | - Chandrajit P Raut
- Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Charles Honoré
- Department of Surgical Oncology, Institut Gustave Roussy, Paris, France
| | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - Ferdinando Cananzi
- Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, Candiolo, Italy
| | - Shintaro Iwata
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Callegaro D, Barretta F, Raut CP, Johnston W, Strauss DC, Honoré C, Bonvalot S, Fairweather M, Rutkowski P, van Houdt WJ, Gladdy RA, Tirotta F, Tzanis D, Skoczylas J, Haas RL, Miceli R, Swallow CJ, Gronchi A. New Sarculator Prognostic Nomograms for Patients With Primary Retroperitoneal Sarcoma: Case Volume Does Matter. Ann Surg 2024; 279:857-865. [PMID: 37753660 DOI: 10.1097/sla.0000000000006098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
OBJECTIVE To update the current Sarculator retroperitoneal sarcoma (RPS) prognostic nomograms considering the improvement in patient prognosis and the case volume effect. BACKGROUND Survival of patients with primary RPS has been increasing over time, and the volume-outcome relationship has been well recognized. Nevertheless, the specific impact on prognostic nomograms is unknown. METHODS All consecutive adult patients with primary localized RPS treated at 8 European and North American sarcoma reference centers between 2010 and 2017 were included. Patients were divided into 2 groups: high-volume centers (HVC, ≥13 cases/year) and low-volume centers (LVC, <13 cases/year). Primary end points were overall survival (OS) and disease-free survival (DFS). Multivariable analyses for OS and DFS were performed. The nomograms were updated by recalibration. Nomograms performance was assessed in terms of discrimination (Harrell C index) and calibration (calibration plot). RESULTS The HVC and LVC groups comprised 857 and 244 patients, respectively. The median annual primary RPS case volume (interquartile range) was 24.0 in HVC (15.0-41.3) and 9.0 in LVC (1.8-10.3). Five-year OS was 71.4% (95% CI: 68.3%-74.7%) in the HVC cohort and 63.3% (56.8%-70.5%) in the LVC cohort ( P =0.012). Case volume was associated with both OS (LVC vs. HVC hazard ratio 1.40, 95% CI: 1.08-1.82, P =0.011) and DFS (hazard ratio 1.93, 95% CI: 1.57-2.37, P <0.001) at multivariable analyses. When applied to the study cohorts, the Sarculator nomograms showed good discrimination (Harrell C index between 0.68 and 0.73). The recalibrated nomograms showed good calibration in the HVC group, whereas the original nomograms showed good calibration in the LVC group. CONCLUSIONS New nomograms for patients with primary RPS treated with surgery at high-volume versus low-volume sarcoma reference centers are available in the Sarculator app.
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Affiliation(s)
- Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Barretta
- Department of Biostatistics for Clinical Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Wendy Johnston
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Dirk C Strauss
- Sarcoma Unit, Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Charles Honoré
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | | | - Mark Fairweather
- Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rebecca A Gladdy
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Fabio Tirotta
- Sarcoma Unit, Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Jacek Skoczylas
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Rick L Haas
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rosalba Miceli
- Department of Biostatistics for Clinical Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carol J Swallow
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Webster S, Vargas AC, Maclean F, Vu J, Tong E, Coker D, Ward I, Connolly EA, Zhou DDX, Mar J, Lazarakis S, Gyorki DE, Hong AM. What is the association of preoperative biopsy with recurrence and survival in retroperitoneal sarcoma? A systematic review by the Australia and New Zealand Sarcoma Association clinical practice guidelines working party. Crit Rev Oncol Hematol 2024; 197:104354. [PMID: 38614268 DOI: 10.1016/j.critrevonc.2024.104354] [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: 10/13/2023] [Revised: 03/31/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024] Open
Abstract
Preoperative biopsy for retroperitoneal sarcoma (RPS) enables appropriate multidisciplinary treatment planning. A systematic review of literature from 1990 to June 2022 was conducted using the population, intervention, comparison and outcome model to evaluate the local recurrence and overall survival of preoperative biopsy compared to those that had not. Of 3192 studies screened, five retrospective cohort studies were identified. Three reported on biopsy needle tract seeding, with only one study reporting biopsy site recurrence of 2 %. Two found no significant difference in local recurrence and one found higher 5-year local recurrence rates in those who had not been biopsied. Three studies reported overall survival, including one with propensity matching, did not show a difference in overall survival. In conclusion, preoperative core needle biopsy of RPS is not associated with increased local recurrence or adverse survival outcomes.
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Affiliation(s)
- Stephanie Webster
- Department of Radiation Oncology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Ana Cristina Vargas
- Douglass Hanly Moir Pathology, 4 Giffnock Avenue, Macquarie Park, NSW 2113, Australia; Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, NSW 2006, Australia
| | - Fiona Maclean
- Douglass Hanly Moir Pathology, 4 Giffnock Avenue, Macquarie Park, NSW 2113, Australia
| | - Jennifer Vu
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, NSW 2006, Australia
| | - Elissa Tong
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - David Coker
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, NSW 2006, Australia; Department of Melanoma and Surgical Oncology, and Upper Gastrointestinal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Iain Ward
- Canterbury Cancer and Haematology Service, Christchurch Hospital, Christchurch 8011, New Zealand
| | - Elizabeth A Connolly
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, NSW 2006, Australia; Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Deborah Di-Xin Zhou
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia; NHMRC Clinical Trials Centre, The University of Sydney, NSW 2006, Australia
| | - Jasmine Mar
- Australia and New Zealand Sarcoma Association, Parkville, Victoria 3010, Australia
| | - Smaro Lazarakis
- Health Sciences Library, Royal Melbourne Hospital, Parkville, Victoria 3010, Australia
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Angela M Hong
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, NSW 2006, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia.
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Xue G, Wang Z, Liu B, Li C, Lv A, Tian X, Wu J, Qiu H, Hao C. Short- and long-term post-nephrectomy outcomes for retroperitoneal liposarcoma from a high-volume sarcoma center: a propensity score matching analysis. Int J Clin Oncol 2024:10.1007/s10147-024-02530-2. [PMID: 38652434 DOI: 10.1007/s10147-024-02530-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/06/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Multivisceral en bloc resection with the ipsilateral kidney is commonly performed in patients with retroperitoneal liposarcoma (RLPS). We evaluated the effect of nephrectomy on short- and long-term outcomes in patients with RLPS. METHODS Data from a prospectively maintained database of the Peking University Cancer Hospital Sarcoma Center between April 2011 and August 2022 were analyzed. We classified the RLPS patients who underwent surgery into nephrectomy group (NP) and non-nephrectomy group (non-NP). Patients were matched using a 1:1 propensity score to eliminate baseline differences between groups. Postoperative renal function outcomes, major morbidity, and mortality were analyzed to compare short-term outcomes after nephrectomy. Differences in local recurrence-free survival (LRFS) and overall survival (OS) were compared by Kaplan-Meier analysis with respect to oncological benefits. RESULTS In the matched cohort, patients in the NP group had significantly higher postoperative eGFR and CKD stages, but none required dialysis. Patients between NP and non-NP had a comparable major morbidity (p = 0.820) and 60-day mortality (p = 0.475). Patients in the NP group had a higher 5-year LRFS rates than those in the non-NP group (34.5 vs. 17.8%, p = 0.015), and similar 5-year OS rates (52.4 vs. 47.1%, p = 0.401). Nephrectomy was an independent risk factor for LRFS, but not for major morbidity or OS. CONCLUSIONS RLPS resection with nephrectomy is related to a mild progression of renal impairment; however, dialysis is rare. En bloc nephrectomy for complete resection of RLPS is safe and improves local control.
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Affiliation(s)
- Guoqiang Xue
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Zhen Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Bonan Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Chengpeng Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Ang Lv
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Xiuyun Tian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Jianhui Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Hui Qiu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China.
| | - Chunyi Hao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepato-Pancreato-Biliary Surgery/Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China.
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Othman H, Shapiro J, Chung P, Gladdy RA. Progress in Retroperitoneal Sarcoma Management: Surgical and Radiotherapy Approaches. Semin Radiat Oncol 2024; 34:164-171. [PMID: 38508781 DOI: 10.1016/j.semradonc.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Surgical resection is the cornerstone of curative treatment for retroperitoneal sarcomas (RPS), aiming for complete excision, yet the complexity of RPS with its proximity to vital structures continues to lead to high local recurrence rates after surgery alone. Thus, the role of radiotherapy (RT) continues to be refined to improve local control, which remains an important goal to prevent RPS recurrence. The recently completed global randomized trial to evaluate the role of surgery with and without preoperative RT - STRASS1, did not demonstrate a significant overall benefit for neoadjuvant RT based on the pre-specified definition of abdominal recurrence-free survival, however, sensitivity analysis using a standard definition of local recurrence and analysis of outcomes by compliance to the RT protocol suggests histology-specific benefit in well- and some de-differentiated liposarcomas. Ultimately, multidisciplinary collaboration and personalized approaches that consider histological sarcoma types and patient-specific factors are imperative for optimizing the therapeutic strategy in the management of RPS.
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Affiliation(s)
- Hiba Othman
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Department of Radiation Oncology, University of Toronto, Ontario, Canada
| | - Joel Shapiro
- Department of Surgery, Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada, Department of Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Department of Radiation Oncology, University of Toronto, Ontario, Canada
| | - Rebecca A Gladdy
- Department of Surgery, Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada, Department of Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Ontario, Canada..
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9
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Shafique HS, Commander SJ, Blazer DG, Kim Y, Southerland KW, Williams ZF. Surgical outcomes of patients with inferior vena cava leiomyosarcoma. J Vasc Surg Venous Lymphat Disord 2024:101885. [PMID: 38552955 DOI: 10.1016/j.jvsv.2024.101885] [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: 01/05/2024] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Primary vascular leiomyosarcomas are incredibly rare and have a poor prognosis. The purpose of this study was to analyze the surgical outcomes of patients with primary inferior vena cava (IVC) leiomyosarcoma. METHODS We performed a retrospective review of IVC leiomyosarcoma resections performed at a single tertiary care hospital from 2014 to 2023. A total of 13 cases were analyzed, including 10 women and 3 men. The presenting symptoms, tumor characteristics, operative management, postoperative complications, and survival rates were assessed for each patient. RESULTS The median patient age was 59 years (quartile [Q]1, 52 years; Q3, 68 years). The median tumor size was 7.0 cm (Q1, 6 cm; Q3, 12 cm). The median mitotic rate was 6 per 10 high-power fields (Q1, 2.5; Q3, 15.5). All 13 patients underwent grossly negative tumor resection, with 9 (69%) having microscopically negative margins (R0). No patient had lymph node involvement. The IVCs were managed with ligation in four patients for tumors already occluding the IVC and bovine pericardial patch angioplasty in seven patients or primary repair in two patients for patent IVCs. Concomitant right nephrectomy was performed in seven patients. Left renal vein ligation was performed in three patients, but no left nephrectomies were performed. Significant postoperative complications included one patient with lower extremity compartment syndrome, two patients with severe leg swelling, and one patient with arm swelling. The 30-day mortality rate was zero. Using the Kaplan-Meier product limit method, disease-specific survival was estimated to be 93%. CONCLUSIONS Surgical resection is a feasible and effective oncologic treatment option for patients with IVC leiomyosarcoma. The IVC can be safely managed by ligation, primary repair, or patch angioplasty, depending on the prior patency of the IVC.
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Affiliation(s)
| | - Sarah Jane Commander
- Division of Endovascular and Vascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Dan G Blazer
- Division of Surgical Oncology, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Young Kim
- Division of Endovascular and Vascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Kevin W Southerland
- Division of Endovascular and Vascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Zachary F Williams
- Division of Endovascular and Vascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
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10
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Ruff SM, Heh V, Konieczkowski DJ, Onuma A, Dunlop HM, Kim AC, Grignol VP, Contreras CM, Pawlik TM, Pollock R, Beane JD. Radiation therapy for retroperitoneal sarcoma: practice patterns in North America. Radiat Oncol 2024; 19:38. [PMID: 38491404 PMCID: PMC10943830 DOI: 10.1186/s13014-024-02407-8] [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: 11/15/2023] [Accepted: 01/16/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The addition of radiation therapy (RT) to surgery in retroperitoneal sarcoma (RPS) remains controversial. We examined practice patterns in the use of RT for patients with RPS over time in a large, national cohort. METHODS Patients in the National Cancer Database (2004-2017) who underwent resection of RPS were included. Trends over time for proportions were calculated using contingency tables with Cochran-Armitage Trend test. RESULTS Of 7,485 patients who underwent resection, 1,821 (24.3%) received RT (adjuvant: 59.9%, neoadjuvant: 40.1%). The use of RT decreased annually by < 1% (p = 0.0178). There was an average annual increase of neoadjuvant RT by 13% compared to an average annual decrease of adjuvant RT by 6% (p < 0.0001). Treatment at high-volume centers (OR 14.795, p < 0.0001) and tumor > 10 cm (OR 2.009, p = 0.001) were associated with neoadjuvant RT. In contrast liposarcomas (OR 0.574, p = 0.001) were associated with adjuvant RT. There was no statistically significant difference in overall survival between patients treated with surgery alone versus surgery and RT (p = 0.07). CONCLUSION In the United States, the use of RT for RPS has decreased over time, with a shift towards neoadjuvant RT. However, a large percentage of patients are still receiving adjuvant RT and this mostly occurs at low-volume hospitals.
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Affiliation(s)
- Samantha M Ruff
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Victor Heh
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - David J Konieczkowski
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | - Amblessed Onuma
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Hayley M Dunlop
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Alex C Kim
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Valerie P Grignol
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Carlo M Contreras
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Raphael Pollock
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Joal D Beane
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, N924 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA.
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11
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Zhao S, Sun L, Zhou J, Li R, Sun Q, Wang W, Wang D. Advancements in Diagnosis and Multimodal Treatment Strategies for Retroperitoneal Tumors: A Comprehensive Review. Am J Clin Oncol 2024:00000421-990000000-00178. [PMID: 38476111 DOI: 10.1097/coc.0000000000001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Retroperitoneal tumors (RPTs) encompass both benign and malignant entities, constituting ~0.1% to 0.2% of all malignant tumors, of which 70% to 80% manifest malignancy. Predominantly, retroperitoneal sarcomas (RPS) represent the most prevalent subtype among RPT. With over 70 histologic forms identified, liposarcomas and leiomyosarcomas emerge as the primary constituents of RPS. Accurate diagnosis of RPTs necessitates preoperative core-needle biopsy and comprehensive imaging assessment. The current staging protocol for RPS relies on the eighth edition of the American Joint Committee on Cancer/TNM classification. Surgical excision remains the established gold standard for treating RPS. Therapeutic approaches vary according to the underlying pathophysiology. Although chemotherapy and radiotherapy exhibit efficacy in managing metastatic and recurrent unresectable RPS, their role in primary RPS remains unresolved, necessitating further clinical trials for validation. Concurrently, ongoing research explores the potential of targeted therapies and immunotherapy. This literature review aims to provide a comprehensive overview of existing research, delineating diagnostic pathways and optimal therapeutic strategies for RPT.
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Affiliation(s)
- Shuai Zhao
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University
| | - Longhe Sun
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou
| | - Jiajie Zhou
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University
| | - Ruiqi Li
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University
| | - Qiannan Sun
- Department of General Surgery, Taizhou Fourth People's Hospital
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Wei Wang
- Department of General Surgery, Taizhou Fourth People's Hospital
| | - Daorong Wang
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University
- Department of General Surgery, Taizhou Fourth People's Hospital
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
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12
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Ramanovic M, Novak M, Perhavec A, Jordan T, Popuri K, Kozjek NR. Influence of nutritional status and body composition on postoperative events and outcome in patients treated for primary localized retroperitoneal sarcoma. Radiol Oncol 2024; 58:110-123. [PMID: 38378038 PMCID: PMC10878779 DOI: 10.2478/raon-2024-0013] [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: 07/26/2023] [Accepted: 11/03/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Retroperitoneal sarcomas (RPS) are rare tumours of mesenchymal origin, commonly presented as a large tumour mass at time of diagnosis. We investigated the impact of body composition on outcome in patients operated on for primary localized RPS. PATIENTS AND METHODS We retrospectively analysed data for all patients operated on for primary RPS at our institution between 1999 and 2020. Preoperative skeletal muscle area (SMA), visceral and subcutaneous adipose tissue area (VAT and SAT) and muscle radiation attenuation (MRA) were calculated using computed tomography scans at the level of third lumbar vertebra. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were applied to define myopenia. Using maximum log-rank statistic method we determined the optimal cut-off values of body composition parameters. Myosteatosis was defined based on determined MRA cut-offs. RESULTS In total 58 patient were eligible for the study. With a median follow-up of 116 months, the estimated 5-year overall survival (OS) and local-recurrence free survival (LRFS) were 66.8% and 77.6%, respectively. Patients with myopenia had significantly lower 5-year OS compared to non-myopenic (p = 0.009). Skeletal muscle index and subcutaneous adipose tissue index predicted LRFS on univariate analysis (p = 0.052 and p = 0.039, respectively). In multivariate analysis high visceral-to-subcutaneous adipose tissue area ratio (VSR) independently predicted higher postoperative complication rate (89.2% vs. 10.8%, p = 0.008). Myosteatosis was associated with higher postoperative morbidity. CONCLUSIONS Myopenia affected survival, but not postoperative outcome in RPS. Visceral obesity, VSR (> 0.26) and myosteatosis were associated with higher postoperative morbidity. VSR was better prognostic factor than VAT in RPS.
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Affiliation(s)
- Manuel Ramanovic
- Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Marko Novak
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Andraz Perhavec
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Taja Jordan
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Department for Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Karteek Popuri
- Department of Computer Science, Memorial University of Newfoundland, Newfundland, Canada
| | - Nada Rotovnik Kozjek
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Department of Clinical Nutrition, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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13
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Lodoli C, El Halabieh MA, Santullo F, Abatini C, Gallotta V, Pacelli F. Robotic resection of left renal vein with preservation of left kidney for leiomyosarcoma: Case report and review of the literature. Int J Surg Case Rep 2024; 116:109381. [PMID: 38359584 PMCID: PMC10943925 DOI: 10.1016/j.ijscr.2024.109381] [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: 01/04/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Radical surgical resection with negative margins is the mainstay of treatment for retroperitoneal vascular leiomyosarcomas. Given the retroperitoneal location of these tumors, open surgery is, historically, the chosen surgical approach, however, it is burdened with high postoperative morbidity. In selected cases, the small dimension of the tumor and a favorable location, allow to perform a minimally invasive treatment. PRESENTATION OF CASE A 67-year-old female patient with a diagnosis of a leiomyosarcoma arising from the left renal vein underwent a robotic resection of the left renal vein with preservation of the left kidney and a relative outflow trough the gonadal vessels. The patient was discharged on the fourth postoperative day without any complications and there was no tumor recurrence noted during the 24-month follow-up period. DISCUSSION Vascular retroperitoneal leiomyosarcomas are very rare tumors requiring a complete en bloc gross tumor resection in order to achieving microscopically negative margins on the vein of origin. Thanks to the preoperative histological diagnosis and radiological study of the neoplasm, it was possible to proceed to a highly personalized and minimally invasive treatment with respect of oncological criteria. CONCLUSION In selected cases, a minimally invasive surgery of vascular leiomyosarcoma could be a feasible and safe treatment option.
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Affiliation(s)
- Claudio Lodoli
- Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy
| | - Miriam Attalla El Halabieh
- Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy.
| | - Francesco Santullo
- Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy.
| | - Carlo Abatini
- Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy
| | - Valerio Gallotta
- Division of Gynecologic Oncology, Department of Women and Children's Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy
| | - Fabio Pacelli
- Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy
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14
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Mor E, Lonie S, Mitchell C, Henderson M, Webb A, Gyorki DE, Snow H. Pleomorphic dermal sarcoma of the scalp - A single-centre experience. Surg Oncol 2024; 52:102017. [PMID: 38091877 DOI: 10.1016/j.suronc.2023.102017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/12/2023] [Accepted: 11/28/2023] [Indexed: 02/19/2024]
Abstract
BACKGROUND Pleomorphic dermal sarcoma (PDS) of the scalp is a rare tumour which is usually slow growing, but occasionally displays rapid growth and has a low rate of local recurrence. Surgical resection is the mainstay of treatment, with or without radiotherapy. The aim of this study is to describe the surgical approach and the additional benefit of radiotherapy to the treatment of these patients. METHODS Retrospective, single-centre analysis of patients with PDS of the scalp that underwent surgical resection between 2007 and 2021 (n = 24). Treatment variables including depth of resection (superficial or deep to the galea aponeurotica) and adjuvant radiotherapy were investigated. RESULTS Twenty-four patients were included in this study. Median age was 80 (range, 52-95), with a median ASA score of 3 (2-3). Sixteen (66.6 %) patients underwent surgical resection including the galea, while the rest (n = 8) did not or was not known. Radiotherapy was given in 7 (29 %) patients in which only 3 (12.5 %) were in the galeal resection group. Reasons for radiotherapy administration were concomitant SCC found at the same area of resection and close margins. In a median follow-up of was 26.2 months (range, 13.6-102.5) there was only one recurrence event. CONCLUSIONS PDS of the scalp can be safely managed with a surgical resection if clear surgical margins are achieved without radiotherapy with good oncological outcomes.
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Affiliation(s)
- Eyal Mor
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
| | - Sarah Lonie
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Catherine Mitchell
- Department of Anatomical Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Henderson
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Angela Webb
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Hayden Snow
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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15
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Nardi W, Nicolas N, El Zein S, Tzanis D, Bouhadiba T, Helfre S, Watson S, Brisse HJ, Servois V, Bonvalot S. Diagnostic accuracy and safety of percutaneous core needle biopsy of retroperitoneal tumours. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107298. [PMID: 38086314 DOI: 10.1016/j.ejso.2023.107298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/10/2023] [Accepted: 11/21/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Histologic subtype of cancer guides treatment sequencing and the extent of surgery for retroperitoneal tumours (RPTs) but concerns persist regarding percutaneous core needle biopsy (CNB). OBJECTIVE Endpoints were the incidence of early complications, needle tract seeding (NTS) after CNB, diagnostic accuracy. METHODS Between 2015 and 2022, data from patients with RPT who underwent a CNB and who operated on at Institut Curie were collected. We retrospectively reviewed the medical records and microscopic analysis of both CNB and surgical specimens to evaluate the diagnostic accuracy of CNB (quantified using positive and negative predictive values, PPV/NPV). RESULTS 313 patients underwent CNB. In 10/326 (3 %) procedures, minor complications were observed. One of 212 (0.47 %) resected RPSs exhibited a local recurrence compatible with NTS. Microscopic analysis of CNB specimens allowed the classification of tumours between groups of cancers and benign/intermediate mesenchymal tumours in 307/313 (98 %) patients. Among the 204 patients with retroperitoneal sarcoma, the overall concordance between CNB and final pathology following resection was 178/204 (87.2 %). The respective PPVs of solitary fibrous tumour, dedifferentiated liposarcoma, leiomyosarcoma and well-differentiated liposarcoma were 100 %, 98 %, 97 % and 68 %, respectively. The diagnosis of a high-grade (G 2-3) sarcoma resulted in a high specificity (97 %) and PPV (98 %) but low sensitivity (76 %). CONCLUSIONS CNB allowed the classification of RPT in the vast majority of patients with a low morbidity rate. Concordance with final diagnosis was high for sarcomas with the exception of well-differentiated liposarcoma. As a result, CNB results should be integrated with imaging/radiomics by multidisciplinary tumour boards.
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Affiliation(s)
- Walter Nardi
- Department of Surgical Oncology, Institut Curie, Paris, France; Department of General Surgery, Surgical Oncology Unit, Buenos Aires British Hospital, Buenos Aires, Argentina.
| | | | - Sophie El Zein
- Department of Biopathology, Institut Curie, Paris, France.
| | - Dimitri Tzanis
- Department of Surgical Oncology, Institut Curie, Paris, France.
| | | | - Sylvie Helfre
- Department of Radiotherapy, Institut Curie, Paris, France.
| | - Sarah Watson
- Department of Medical Oncology and INSERM U830, Institut Curie, Paris, France.
| | | | | | - Sylvie Bonvalot
- Department of Surgical Oncology, Institut Curie, Paris, France.
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16
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Gao X, Ding P, Zhang Z, Li Y, Zhao Q, Wang D, Zhao X, Liu Y, Tan B. Analysis of recurrence and metastasis patterns and prognosis after complete resection of retroperitoneal liposarcoma. Front Oncol 2023; 13:1273169. [PMID: 38188302 PMCID: PMC10771260 DOI: 10.3389/fonc.2023.1273169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
Objective To analyze the recurrence and metastasis patterns and prognosis after complete resection of retroperitoneal liposarcoma. Methods The clinical postoperative follow-up data and results of patients who underwent complete resection of retroperitoneal liposarcoma from September 10, 2014, to September 8, 2021, at Hebei Medical University hospital were collected retrospectively. Results A total of 60 patients with complete resection of retroperitoneal liposarcoma, including 33 cases of retroperitoneal liposarcoma recurrence, 2 cases of liver metastasis, and 1 case of lung metastasis, were included. The results showed that 100% of the recurrent sites were located in the primary region of the tumor, with most recurrences located near the kidney, paracolic sulci, and iliac vessels. Three patients had distant metastasis without obvious recurrence on imaging examination. The pathological type of retroperitoneal liposarcoma, Ki67 expression, and presence of serum albumin were risk factors for recurrence and metastasis after complete resection of retroperitoneal liposarcoma. The malignancy and Ki67 expression were independent risk factors for recurrence and metastasis as well as for overall survival of patients undergoing complete resection of retroperitoneal liposarcoma. Conclusion Complete resection remains the most effective method to treat retroperitoneal liposarcoma. Patients with pathological types of retroperitoneal liposarcoma showing dedifferentiation, pleomorphism, mixed type, and high Ki67 expression should be closely monitored and observed after complete resection, especially for imaging changes in the primary tumor area.
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Affiliation(s)
| | | | - Zhidong Zhang
- Hebei Cancer Clinical Medical Research Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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17
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de Bree E, Michelakis D, Heretis I, Kontopodis N, Spanakis K, Lagoudaki E, Tolia M, Zografakis-Sfakianakis M, Ioannou C, Mavroudis D. Retroperitoneal Soft Tissue Sarcoma: Emerging Therapeutic Strategies. Cancers (Basel) 2023; 15:5469. [PMID: 38001729 PMCID: PMC10670057 DOI: 10.3390/cancers15225469] [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: 10/07/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Retroperitoneal soft tissue sarcoma (RPS) is a rare and heterogenous disease for which surgery is the cornerstone of treatment. However, the local recurrence rate is much higher than in soft tissue sarcoma of the extremities since wide resection is usually unfeasible in RPS due to its large size, indistinct tumour borders, anatomical constraints and the thinness of the overlying peritoneum. Local recurrence is the leading cause of death for low-grade RPS, whereas high-grade tumours are prone to distant metastases. In recent decades, the role of emerging therapeutic strategies, such as more extended surgery and (neo)adjuvant treatments to improve oncological outcome in primary localised RPS, has been extensively investigated. In this review, the recent data on the evolving multidisciplinary management of primary localised RPS are comprehensively discussed. The heterogeneity of RPS, with their different histological subtypes and biological behaviour, renders a standard therapeutic 'one-size-fits-all' approach inappropriate, and treatment should be modified according to histological type and malignancy grade. There is sufficient evidence that frontline extended surgery with compartmental resection including all ipsilateral retroperitoneal fat and liberal en bloc resection of adjacent organs and structures, even if they are not macroscopically involved, increases local tumour control in low-grade sarcoma and liposarcoma, but not in leiomyosarcoma for which complete macroscopic resection seems sufficient. Additionally, preoperative radiotherapy is not indicated for all RPSs, but seems to be beneficial in well-differentiated liposarcoma and grade I/II dedifferentiated liposarcoma, and probably in solitary fibrous tumour. Whether neoadjuvant chemotherapy is of benefit in high-grade RPS remains unclear from retrospective data and is subject of the ongoing randomised STRASS 2 trial, from which the results are eagerly awaited. Personalised, histology-tailored multimodality treatment is promising and will likely further evolve as our understanding of the molecular and genetic characteristics within RPS improves.
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Affiliation(s)
- Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, 71110 Heraklion, Greece;
| | - Dimosthenis Michelakis
- Department of Surgical Oncology, Medical School of Crete University Hospital, 71110 Heraklion, Greece;
| | - Ioannis Heretis
- Department of Urology, Medical School of Crete University Hospital, 71110 Heraklion, Greece;
| | - Nikolaos Kontopodis
- Department of Vascular Surgery, Medical School of Crete University Hospital, 71110 Heraklion, Greece; (N.K.); (C.I.)
| | - Konstantinos Spanakis
- Department of Medical Imaging, Medical School of Crete University Hospital, 71110 Heraklion, Greece;
| | - Eleni Lagoudaki
- Department of Pathology, Medical School of Crete University Hospital, 71110 Heraklion, Greece;
| | - Maria Tolia
- Department of Radiation Oncology, Medical School of Crete University Hospital, 71110 Heraklion, Greece;
| | | | - Christos Ioannou
- Department of Vascular Surgery, Medical School of Crete University Hospital, 71110 Heraklion, Greece; (N.K.); (C.I.)
| | - Dimitrios Mavroudis
- Department of Medical Oncology, Medical School of Crete University Hospital, 71110 Heraklion, Greece;
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18
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Lawless A, Zhou DDX, McDonough J, Lo H, Mar J, Lazarakis S, Ward I, Connor J, Thompson SR, Coker D, Johnston A, Gyorki DE, Hong AM. The role of radiation therapy in the management of primary retroperitoneal sarcoma: A systematic review and clinical practice guidelines from the Australia and New Zealand Sarcoma Association. Cancer Treat Rev 2023; 120:102620. [PMID: 37657126 DOI: 10.1016/j.ctrv.2023.102620] [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: 07/29/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/03/2023]
Abstract
While surgery is the mainstay of treatment for localised retroperitoneal sarcoma, the use of radiotherapy (RT) remains controversial. This systematic review aimed to evaluate the role of RT for retroperitoneal sarcoma. A systematic review using the population, intervention, comparison, and outcome model from 1990 to 2022 identified 66 studies (a mixture of preoperative and postoperative RT); one randomised controlled trial (RCT) with two publications, 18 registry studies, and 46 retrospective studies. In the RCT of preoperative RT, there was no difference in local/abdominal recurrence. The pooled analysis of this RCT and a retrospective study showed a significant abdominal recurrence free survival benefit with preoperative RT in low grade liposarcoma. The RCT and the majority of retrospective series found RT did not improve recurrence free survival (11 of 16 no difference in combined local and distant RFS, 11 of 13 no difference in distant metastasis free survival), disease specific survival (9 of 12 studies) or overall survival (33 of 49 studies). The majority of studies found no association between RT and perioperative morbidity. In summary, preoperative RT may improve local control for low grade (well-differentiated or grades 1-2 dedifferentiated) liposarcoma, but not other histological subtypes. There is no strong evidence that perioperative RT provides an overall survival benefit. Patients with low grade retroperitoneal liposarcoma can be considered for preoperative RT to improve abdominal recurrence free survival. The rationale and level of evidence in this scenario should be carefully discussed by the multidisciplinary team with patients. RT should not be routinely recommended for other histological subtypes.
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Affiliation(s)
- Anna Lawless
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Deborah Di-Xin Zhou
- NHMRC Clinical Trials Centre, The University of Sydney, NSW 2006, Australia; Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Joshua McDonough
- Mental Health and Suicide Prevention Research and Education Group, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Helen Lo
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Jasmine Mar
- Australia and New Zealand Sarcoma Association, Parkville, Victoria 3010, Australia
| | - Smaro Lazarakis
- Health Sciences Library, Royal Melbourne Hospital, Parkville, Victoria 3010, Australia
| | - Iain Ward
- Christchurch Hospital, Christchurch 8011, New Zealand
| | - Joanna Connor
- Te Pūriri o Te Ora, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand
| | - Stephen R Thompson
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia; School of Clinical Medicine, UNSW Sydney, Randwick Clinical Campus, Australia
| | - David Coker
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Australia; Department of Melanoma and Surgical Oncology, and Upper Gastrointestinal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Andrew Johnston
- North Island Sarcoma Service, Auckland City Hospital, Auckland 1023, New Zealand
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Angela M Hong
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia.
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Zheng J, Zhuang A, Xia X, Miao F, Wang Z, Kong X, Ren Y, Ma Y, Lin Z, Lu W, Li W. Nomogram development and external validation for predicting overall survival and cancer-specific survival in patients with primary retroperitoneal sarcoma: a retrospective cohort study. Discov Oncol 2023; 14:197. [PMID: 37910291 PMCID: PMC10620366 DOI: 10.1007/s12672-023-00804-1] [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: 05/20/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Primary retroperitoneal sarcoma (RPS) comprises over 70 histologic subtypes, yet there are limited studies that have developed prognostic nomograms for RPS patients to predict overall survival (OS) and cancer-specific survival (CSS). The objective of this study was to construct prognostic nomograms for predicting OS and CSS in RPS patients. METHODS We identified a total of 1166 RPS patients from the Surveillance, Epidemiology and End Results (SEER) database, and an additional 261 cases were collected from a tertiary cancer center. The study incorporated various clinicopathological and epidemiologic features as variables, and prediction windows for overall survival (OS) and cancer-specific survival (CSS) were set at 3, 5, and 7 years. Multivariable Cox models were utilized to develop the nomograms, and variable selection was performed using a backward procedure based on the Akaike Information Criterion. To evaluate the performance of the nomograms in terms of calibration and discrimination, we used calibration plots, coherence index, and area under the curve. FINDINGS The study included 818 patients in the development cohort, 348 patients in the internal validation cohort, and 261 patients in the external validation cohort. The backward procedure selected the following variables: age, French Federation of Cancer Centers Sarcoma Group (FNCLCC) grade, pre-/postoperative chemotherapy, tumor size, primary site surgery, and tumor multifocality. The validation results demonstrated that the nomograms had good calibration and discrimination, with C-indices of 0.76 for OS and 0.81 for CSS. Calibration plots also showed good consistency between the predicted and actual survival rates. Furthermore, the areas under the time-dependent receiver operating characteristic curves for the 3-, 5-, and 7-year OS (0.84, 0.82, and 0.78, respectively) and CSS (0.88, 0.88, and 0.85, respectively) confirmed the accuracy of the nomograms. INTERPRETATION Our study developed accurate nomograms to predict OS and CSS in patients with RPS. These nomograms have important clinical implications and can assist healthcare providers in making informed decisions regarding patient care and treatment options. They may also aid in patient counseling and stratification in clinical trials.
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Affiliation(s)
- Jialiang Zheng
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Aobo Zhuang
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Xiaogang Xia
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Fenglin Miao
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Zhao Wang
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Xu Kong
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Yantao Ren
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China
| | - Yuan Ma
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
| | - Zhenhang Lin
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China
| | - Weiqi Lu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200000, China.
| | - Wengang Li
- Cancer Research Center, Department of Hepatobiliary Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361102, Fujian, China.
- Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, 361102, Fujian, China.
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20
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Sicklick JK, Swallow CJ, Raut CP, Callegaro D, Fiore M, Strauss DC, Gronchi A. Creation and Implementation of a Monthly International Tumor Board: Experience of the Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG). Ann Surg Oncol 2023; 30:6287-6289. [PMID: 37488393 DOI: 10.1245/s10434-023-13978-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Affiliation(s)
- Jason K Sicklick
- Department of Surgery, Division of Surgical Oncology, University of California, San Diego, San Diego, CA, USA.
- Department of Pharmacology, UC San Diego, San Diego, CA, USA.
- Moores Cancer Center, UC San Diego, La Jolla, CA, USA.
| | - Carol J Swallow
- Department of Surgical Oncology, Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dirk C Strauss
- Sarcoma Unit, Department of Academic Surgery, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, London, UK
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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21
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Radaelli S, Baia M, Drohan A, Morosi C, Sangalli C, Colombo C, Callegaro D, Fiore M, Gronchi A. Six Surgical Stages in the Resection of Primary Right Retroperitoneal Liposarcoma: A Standardized Comprehensive Approach. Ann Surg Oncol 2023; 30:6896-6897. [PMID: 37301773 DOI: 10.1245/s10434-023-13660-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/07/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Surgery is the treatment mainstay in retroperitoneal sarcoma (RPS), a frontline comprehensive approach based on tumor removal en bloc with adherent viscera is mandatory especially for liposarcoma, where the normal retroperitoneal fat is undistinguishable from the well-differentiated tumor component.1-5 In this video, a reproducible and standardized six-stage approach to a primary right retroperitoneal liposarcoma is presented. PATIENT AND METHODS A 23-cm right retroperitoneal, well-differentiated liposarcoma was diagnosed in a 68-year-old female patient in December 2021. The tumor involved the right kidney and adrenal gland; displacing anteriorly the right colon, the duodenum, and the pancreatic head; and invading part of the ipsilateral psoas muscle. After the publication of the STRASS trial and STREXIT results,6,7 neoadjuvant radiotherapy was delivered to a total dose of 50.4 Gy in 28 fractions with stable disease. Virtual 3D reconstruction of regional anatomy by Visible Patient was performed preoperatively. RESULTS The patient underwent right retroperitoneal mass resection en bloc with ipsilateral kidney and adrenal gland, colon, psoas muscle, and portion of ipsilateral diaphragm. Of note, the resection of the psoas muscle was performed to obtain a safe posterior margin and accomplish a better clearance of fat of the posterior abdominal wall. This can be limited to the psoas fascia whenever the tumor is not adherent to it. A six-stage approach was performed, as described in the supplementary video file. CONCLUSIONS RPS resection is complex and requires a broad range of surgical expertise. A staged approach that can be followed in virtually all cases is highly recommended to achieve an optimal tumor resection.
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Affiliation(s)
- Stefano Radaelli
- Department of Surgery, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy.
| | - Marco Baia
- Department of Surgery, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Ashley Drohan
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Carlo Morosi
- Department of Radiology and Radiation Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Sangalli
- Department of Radiology and Radiation Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Colombo
- Department of Surgery, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Dario Callegaro
- Department of Surgery, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
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22
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Hu H, Guo Q, Zhao J, Huang B, Du X. Aggressive surgical approach with vascular resection and reconstruction for retroperitoneal sarcomas: a systematic review. BMC Surg 2023; 23:275. [PMID: 37700246 PMCID: PMC10498574 DOI: 10.1186/s12893-023-02178-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND AND AIM Surgery is the mainstay of treatment and completeness of surgical resection is critical to achieve local control for retroperitoneal sarcoma (RPS). En-bloc resection of adjacent organs, including major abdominal vessels, is often required to achieve negative margins. The aim of this review was to summarise the available evidence to assess the relative benefits and disadvantages of an aggressive surgical approach with vascular resection in patients with retroperitoneal sarcoma (RPS). METHODS We searched PubMed, the Cochrane Library, and EMBASE for relevant studies published from inception up to August 1, 2022. We performed a systematic review of the available studies to assess the safety and long-term survival results of vascular resection for RPS. RESULTS We identified a total of 23 studies for our review. Overall postoperative in-hospital or 30-day mortality rate of patients with primary iliocaval leiomyosarcoma was 3% (11/359), and the major complication rate was 13%. The recurrence-free survival (RFS) rates after the follow-up period varied between 15% and 52%, and the 5-year overall survival (OS) rates ranged from 25 to 78%. Overall postoperative in-hospital or 30-day mortality rate of patients with RPSs receiving vascular resection was 3%, and the major complication rate was 27%. The RFS rates after the follow-up period were 18-86%, and the 5-year OS rates varied between 50% and 73%. There were no significant differences in the rates of RFS (HR: 0.97; 95% CI: 0.74-1.19; p = 0.945) and OS (HR: 1.01; 95% CI: 0.66-1.36; p = 0.774) between the extended resection group and tumour resection alone group. CONCLUSIONS With adequate preparation and proper management, for patients with RPSs involving major vessels, aggressive surgical approach with vascular resection can achieve R0/R1 resection and improve survival.
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Affiliation(s)
- Hankui Hu
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Qiang Guo
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | - Jichun Zhao
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Bin Huang
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Xiaojiong Du
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
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23
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Li X, Zhang W. Clinical application of real-time PET/CT guided targeted retroperitoneal masses biopsy in diagnosing malignant tumors. BMC Cancer 2023; 23:829. [PMID: 37670264 PMCID: PMC10481464 DOI: 10.1186/s12885-023-11334-y] [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] [Received: 06/07/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVE To explore the feasibility, safety, and clinical application value based on the fusion image of 18 F-FDG PET/CT, for guiding retroperitoneal puncture biopsy technology and to determine the diagnosis of retroperitoneal masses in diagnosing malignant tumors. METHODS From March 2019 to January 2023, 42 patients underwent 18 F-FDG PET/CT imaging and were found to have retroperitoneal lesions that required definite diagnosis; 22 were male, 20 were female, and the average age was(59.17 ± 13.23) years. According to the fused 18 F-FDG PET/CT tomographic image, the target point with the highest metabolic activity, the safest, and expected maximum sample size was selected. CT scans were acquired with the same machine and fused with 18 F-FDG PET, guiding the puncture biopsy needle to approach the expected target zone, enabling timely delivery of pathological and immunohistochemical examination of the biopsy. Success rate, total examination time, biopsy operation time, complications, CT radiation dose, pathological, and immunohistochemical results were recorded. RESULTS All 42 patients were sampled successfully with the successful rate being 100%. The site of sampling of 42 patients accurately targeted the highest metabolic activity, the safest, and the expected maximum sample size. All 42 patients received clear diagnosis (25 cases of malignant tumors and cases of 17 benign tissues). 15 cases of patients had a change in clinical diagnosis, accounting for 35.7% of all patients, and affecting subsequent treatment plans. The average total examination time for patients was (41.3 ± 7.3) minutes, and the biopsy operation time was (29.1 ± 8.7) minutes. The effective radiation dose generated by the entire examination generated by CT guidance was (2.0 ± 0.5) mSv; no severe complications occurred in the patients. CONCLUSION Real-time-guided retroperitoneal puncture biopsy based on 18 F-FDG PET/CT fusion image is safe, accurate, and feasible, and can provide patients of retroperitoneal mass with clear pathological diagnosis and immunohistochemical evaluation.
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Affiliation(s)
- Xiaomin Li
- Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Longcheng Street NO.99, 030032 Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Wanchun Zhang
- Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Longcheng Street NO.99, 030032 Taiyuan, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
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24
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Robinson TP, Milgrom DP, Nagaraju S, Goggins WC, Samy KP, Koniaris LG. Bilateral Renal Auto-Transplantation for Retroperitoneal Sarcomas: Is It Underutilized? Curr Oncol 2023; 30:7620-7626. [PMID: 37623033 PMCID: PMC10453660 DOI: 10.3390/curroncol30080552] [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] [Received: 07/19/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
Sarcomas are a rare tumor of mesenchymal origin. The liposarcoma is the most common sarcoma of the retroperitoneum. Liposarcomas are typically low grade, and present at an advanced stage and a large size. We report a case of a large retroperitoneal liposarcoma, approximately 50 kg, encasing both kidneys, which was managed via a two-stage resection and staged renal auto-transplantation into the intra-peritoneal pelvis. The patient maintained normal renal function throughout, and remains disease free two years post-resection. Renal auto-transplantation with pelvic placement may facilitate improved margin-free resection. Renal relocation may allow the use of curative-intent ablative therapies such as radiofrequency ablation and radiation in cases of retroperitoneal recurrence.
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Affiliation(s)
- Tyler P. Robinson
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Daniel P. Milgrom
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Providence Saint John’s Cancer Institute, Santa Monica, CA 90404, USA
| | - Santosh Nagaraju
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Renal Transplant Division, Charleston Area Medical Center, Charleston, WV 25301, USA
| | - William C. Goggins
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Kannan P. Samy
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Department of Surgery, Duke University Medical Center, Durham, NC 27707, USA
| | - Leonidas G. Koniaris
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Department of Surgery, Oregon Health and Science University, Portland, OR 97239, USA
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25
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Tirotta F, Hodson J, Alcorn D, Al-Mukhtar A, Ayre G, Barlow A, Chong P, Cosker T, Dileo P, Figueiredo R, French J, Gulamhusein A, Jones R, Hayes A, Key C, Malik H, Mahrous A, Mihai R, Nixon I, Partington K, Quinn M, Roberts J, Sayyed R, Shankar A, Strauss D, Turner P, Desai A. Assessment of inter-centre agreement across multidisciplinary team meetings for patients with retroperitoneal sarcoma. Br J Surg 2023; 110:1189-1196. [PMID: 37317571 DOI: 10.1093/bjs/znad157] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Decision-making in the management of patients with retroperitoneal sarcoma is complex and requires input from a number of different specialists. The aim of this study was to evaluate the levels of agreement in terms of resectability, treatment allocation, and organs proposed to be resected across different retroperitoneal sarcoma multidisciplinary team meetings. METHODS The CT scans and clinical information of 21 anonymized retroperitoneal sarcoma patients were sent to all of the retroperitoneal sarcoma multidisciplinary team meetings in Great Britain, which were asked to give an opinion about resectability, treatment allocation, and organs proposed to be resected. The main outcome was inter-centre reliability, which was quantified using overall agreement, as well as the chance-corrected Krippendorff's alpha statistic. Based on the latter, the level of agreement was classified as: 'slight' (0.00-0.20), 'fair' (0.21-0.40), 'moderate' (0.41-0.60), 'substantial' (0.61-0.80), or 'near-perfect' (>0.80). RESULTS Twenty-one patients were reviewed at 12 retroperitoneal sarcoma multidisciplinary team meetings, giving a total of 252 assessments for analysis. Consistency between centres was only 'slight' to 'fair', with rates of overall agreement and Krippendorff's alpha statistics of 85.4 per cent (211 of 247) and 0.37 (95 per cent c.i. 0.11 to 0.57) for resectability; 80.4 per cent (201 of 250) and 0.39 (95 per cent c.i. 0.33 to 0.45) for treatment allocation; and 53.0 per cent (131 of 247) and 0.20 (95 per cent c.i. 0.17 to 0.23) for the organs proposed to be resected. Depending on the centre that they had attended, 12 of 21 patients could either have been deemed resectable or unresectable, and 10 of 21 could have received either potentially curative or palliative treatment. CONCLUSIONS Inter-centre agreement between retroperitoneal sarcoma multidisciplinary team meetings was low. Multidisciplinary team meetings may not provide the same standard of care for patients with retroperitoneal sarcoma across Great Britain.
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Affiliation(s)
- Fabio Tirotta
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - James Hodson
- Research Development and Innovation, Institute of Translational Medicine, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Des Alcorn
- Department of Radiology, The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Ahmed Al-Mukhtar
- Department of Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Gareth Ayre
- Department of Oncology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Adam Barlow
- Department of Surgery, The Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Peter Chong
- Department of Surgery, The Beatson West of Scotland Cancer Center, Glasgow, UK
| | - Thomas Cosker
- Nuffield Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Palma Dileo
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rodrigo Figueiredo
- Department of Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Jeremy French
- Department of Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Aziz Gulamhusein
- Department of Urology, The CHRISTIE NHS Foundation Trust, Manchester, UK
| | - Robert Jones
- Department of Surgery, Royal Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Andrew Hayes
- Department of Academic Surgery, Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Catherine Key
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Hassan Malik
- Department of Surgery, Royal Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
| | - Ahmed Mahrous
- Department of Urology, North Bristol NHS Trust, Bristol, UK
| | - Radu Mihai
- Nuffield Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Ioanna Nixon
- Department of Oncology, The Beatson West of Scotland Cancer Center, Glasgow, UK
| | - Karen Partington
- Department of Radiology, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Martha Quinn
- Department of Surgery, The Beatson West of Scotland Cancer Center, Glasgow, UK
| | - James Roberts
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Raza Sayyed
- Department of Academic Surgery, Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Arjun Shankar
- Department of Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Dirk Strauss
- Department of Academic Surgery, Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Paul Turner
- Department of Radiology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Anant Desai
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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26
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Kamarajah SK, Baia M, Naumann DN, Mahmood F, Parente A, Almond M, Tirotta F, Ford SJ, Dahdaleh F, Desai A. Association between centre volume and allocation to curative surgery and long-term survival for retroperitoneal sarcoma. BJS Open 2023; 7:zrad059. [PMID: 37498965 PMCID: PMC10373904 DOI: 10.1093/bjsopen/zrad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/09/2023] [Accepted: 04/29/2023] [Indexed: 07/29/2023] Open
Affiliation(s)
- Sivesh K Kamarajah
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
- Academic Department of Surgery, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Marco Baia
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - David N Naumann
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Fahad Mahmood
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Alessandro Parente
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Max Almond
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Fabio Tirotta
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Samuel J Ford
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Fadi Dahdaleh
- Edward-Elmhurst Health Hospital, Chicago, Illinois, USA
| | - Anant Desai
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK
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27
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Tirotta F, Bacon A, Collins S, Desai A, Liu H, Paley L, Strauss D, Strauss SJ. Primary retroperitoneal sarcoma: A comparison of survival outcomes in specialist and non-specialist sarcoma centres. Eur J Cancer 2023; 188:20-28. [PMID: 37178646 DOI: 10.1016/j.ejca.2023.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Consensus guidelines outline that patients with primary retroperitoneal sarcoma (RPS) should be managed within specialist sarcoma centres (SSC). There is, however, a paucity of population-based data detailing incidence and outcomes in these patients. Hence, we aimed to evaluate patterns of care among RPS patients in England and compare outcomes for those undergoing surgery in high-volume specialist sarcoma centres (HV-SSC), low-volume SSC (LV-SSC), and non-SSC (N-SSC). METHODS Data on patients diagnosed with primary RPS between 2013 and 2018 were extracted from NHS Digital's National Cancer Registration and Analysis Service using the national cancer registration dataset. Diagnostic pathways, treatment, and survival outcomes were compared between HV-SSC, LV-SSC, and N-SSC. Uni- and multivariate analyses were calculated. RESULTS Of 1878 patients diagnosed with RPS, 1120 (60%) underwent surgery within 12 months of diagnosis, with 847 (76%) operated on at SSC; of these, 432 patients (51%) were operated on in HV-SSC, and 415 (49%) in LV-SSC. One- and 5-year estimated overall survival (OS) rates for patients undergoing surgery in N-SSC were 70.6% (95% confidence interval [CI]: 64.8-75.7) and 42.0% (CI: 35.9-47.9), compared to 85.0% (CI: 81.1-88.1) and 51.7% (CI: 46.6-56.6) in LV-SSC (p < 0.01), and 87.4% (CI: 83.9-90.2) and 62.8% (CI: 57.9-67.4) in HV-SSC, (p < 0.01). After adjusting for patient- and treatment-related factors, patients treated in HV-SSC were found to have significantly longer OS than those treated at LV-SSC, with an adjusted hazard ratio of 0.78 (CI: 0.62-0.96, p < 0.05). CONCLUSION Patients with RPS undergoing surgery in HV-SSC have significantly better survival outcomes than those treated in N-SSC and L-SSC.
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Affiliation(s)
- Fabio Tirotta
- Department of Sarcoma and General Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Andrew Bacon
- National Cancer Registration and Analysis Service, NHS Digital, Wellington Place, Leeds LS1 4AP, UK
| | - Shane Collins
- National Cancer Registration and Analysis Service, NHS Digital, Wellington Place, Leeds LS1 4AP, UK; Research Department of Oncology, University College London Cancer Institute, London, UK
| | - Anant Desai
- Department of Sarcoma and General Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hanhua Liu
- National Cancer Registration and Analysis Service, NHS Digital, Wellington Place, Leeds LS1 4AP, UK
| | - Lizz Paley
- National Cancer Registration and Analysis Service, NHS Digital, Wellington Place, Leeds LS1 4AP, UK
| | - Dirk Strauss
- Sarcoma Unit, Department of Academic Surgery, The Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK
| | - Sandra J Strauss
- National Cancer Registration and Analysis Service, NHS Digital, Wellington Place, Leeds LS1 4AP, UK; Research Department of Oncology, University College London Cancer Institute, London, UK.
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Di Prata C, Renouf B, Tzanis D, Bouhadiba T, Watson S, Zein SE, Helfre S, Nicolas N, Perlbarg-Samson J, Brenet O, Bonvalot S. Significant Predictors of Postoperative Morbidity After Radical Resection of Retroperitoneal Sarcoma in a Tertiary Center. Ann Surg Oncol 2023; 30:4515-4526. [PMID: 37160805 DOI: 10.1245/s10434-023-13459-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/16/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND The safety of multivisceral resection of retroperitoneal sarcoma is an issue. Previous reports have investigated its associations with the pattern of resection and factors recognized mostly per operatively. METHODS All consecutive RPS resections from May 2015 to April 2022 were studied retrospectively with respect to adverse events. Two univariate and multivariate logistic regression analyses were performed to investigate the associations between severe adverse events and factors recognized pre- and per operatively. Associations of adverse events with overall survival (OS) and local recurrence (LR) were investigated. RESULTS A total of 265 surgical interventions corresponding to 251 patients were recorded (38 RPS surgeries/year). Severe postoperative adverse events (Clavien-Dindo ≥ 3) occurred in 50 patients (18.9%), 15 (5.6%) patients underwent an iterative laparotomy, and 6 patients (2.3%) died within 90 days. On multivariate analysis including all parameters known preoperatively, male sex, performance status, dedifferentiated liposarcoma histology, and low serum albumin level were found to be significant predictors of major complications, whereas the timing of surgery and preoperative treatment were not. On univariate analysis including all per operative parameters, transfusion requirement, operative time, number of digestive anastomoses, and pancreas and/or major arterial resection were found to entail higher operative risk. On multivariate analysis, only transfusion requirement was significant. There was no impact of postoperative adverse events on OS or LR. CONCLUSIONS The recognition of preoperative parameters that impact safety could mitigate the extent of the surgery, specifically the resection of adherent organs not overtly invaded. For the best decision, this surgery should be performed in referral centers.
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Affiliation(s)
- Claudia Di Prata
- Department of Surgical Oncology, Institute Curie, Paris, France
- Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Benjamin Renouf
- Department of Hospital Research Direction, Institute Curie, Paris, France
| | - Dimitri Tzanis
- Department of Surgical Oncology, Institute Curie, Paris, France
| | | | - Sarah Watson
- Department of Medical Oncology, Institute Curie, Paris, France
| | - Sophie El Zein
- Department of Biopathology, Institute Curie, Paris, France
| | - Sylvie Helfre
- Department of Radiotherapy, Institute Curie, Paris, France
| | - Nayla Nicolas
- Department of Radiology, Institute Curie, Paris, France
| | | | - Olivier Brenet
- Department of Anesthesiology, Institute Curie, Paris, France
| | - Sylvie Bonvalot
- Department of Surgical Oncology, Institute Curie, Paris, France.
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Ng D, Bertrand A, Sanfilippo R, Callegaro D. Deciding individual treatment for primary retroperitoneal sarcoma. Expert Rev Anticancer Ther 2023; 23:1169-1178. [PMID: 37791587 DOI: 10.1080/14737140.2023.2266137] [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: 06/14/2023] [Accepted: 09/28/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION Retroperitoneal sarcomas (RPS) are rare mesenchymal tumors that account for only 0.1-0.2% of all malignancies. Management of this disease is challenging, and resection remains the cornerstone of treatment. Ongoing international collaboration has expanded our knowledge of this disease, allowing for a more personalized approach to RPS patients resulting in improved survival over time. Due to the heterogeneity of RPS, with differing recurrence patterns and sensitivities to neoadjuvant therapies based on histology and grade, management of RPS should be tailored to the individual patient. AREAS COVERED Our review focuses on a histology-driven approach in the management of primary RPS. We searched relevant articles from 1993 to 2023 that investigated prognostic factors and treatment of patients with RPS and summarized recent advances and future directions in the field. EXPERT OPINION Deeper understanding of the role of neoadjuvant radiotherapy and ongoing trials investigating the role of neoadjuvant chemotherapy will potentially contribute to the development of individualized treatment pathways.
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Affiliation(s)
- Deanna Ng
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Roberta Sanfilippo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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30
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Improta L, Pasquali S, Iadecola S, Barisella M, Fiore M, Radaelli S, Colombo C, Alloni R, Callegaro D, Valeri S, Miceli R, Gronchi A. Organ Infiltration and Patient Risk After Multivisceral Surgery for Primary Retroperitoneal Liposarcomas. Ann Surg Oncol 2023; 30:4500-4510. [PMID: 36930371 DOI: 10.1245/s10434-023-13314-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/16/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The extent of histological organ involvement (HOI) to organs and structures of a retroperitoneal liposarcoma may have prognostic implications. This study investigated incidence, characteristics, and risk association of HOI in these patients. PATIENTS AND METHODS Data of patients who underwent multivisceral resection for primary liposarcoma (2009-2014) were retrospectively analyzed. HOI was the variable of interest and was classified into four degrees: absent (HOI-0), perivisceral (HOI-1), initial (HOI-2), and advanced (HOI-3). Primary endpoint was overall survival (OS). Secondary endpoint was disease-free survival (DFS). The prognostic value of HOI was adjusted for preoperative treatment and the Sarculator nomogram score. RESULTS A total of 109 patients were included. HOI-0, HOI-1, HOI-2, and HOI-3 were detected in 9 (8.3%), 11 (10.1%), 43 (39.4%), and 46 (42.2%) patients. Median follow-up was 8.4 years [interquartile range (IQR) 7.2-9.6 years]. There were 68 recurrences and 50 patient deaths observed, resulting in a 10-year OS and DFS of 51.1% [95% confidence interval (CI) 41.9-62.1%] and 34.1% (95% CI 25.2-46.1%), respectively. Clinically relevant HOIs (HOI-2 and HOI-3) were found in 35/45 (77.8%) and 54/64 (84.4%) cases of well- and de-differentiated liposarcomas, respectively. On multivariable survival analysis, patients with HOI-3 had significantly shorter OS (HOI-3 vs HOI-0/HOI-1 HR 2.92; p = 0.012) and DFS (HOI-3 vs HOI-0/HOI-1 HR 2.23; p = 0.045), independently of the nomogram score (OS: HR 2.93; p < 0.001; DFS: HR 1.78; p = 0.003). CONCLUSIONS Initial and advanced HOIs are frequently detected in both well-differentiated and de-differentiated liposarcomas, supporting that multivisceral resection may be needed. HOI stratifies the risk of patients with primary retroperitoneal liposarcoma.
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Affiliation(s)
- Luca Improta
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Sarcoma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Sandro Pasquali
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Molecular Pharmacology Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Iadecola
- Department of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Barisella
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marco Fiore
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Radaelli
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Colombo
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rossana Alloni
- Sarcoma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Dario Callegaro
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sergio Valeri
- Sarcoma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Rosalba Miceli
- Department of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Abstract
PURPOSE OF REVIEW Retroperitoneal soft-tissue sarcomas (RPS) are a group of rare, histologically distinct tumours with variable recurrence patterns depending on histological type. This review will discuss the growing body of evidence supporting histology-specific, multidisciplinary management and highlight areas of future research for patients with RPS. RECENT FINDINGS Histology-tailored surgery is the cornerstone of management in patients with localized RPS. Further efforts to develop resectability criteria and identify patients who will benefit from neoadjuvant treatment strategies will help standardize the treatment of patients with localized RPS. Surgery for local recurrence is well tolerated in selected patients and re-iterative surgery in liposarcoma (LPS) may be beneficial at the time of local recurrence. The management of advanced RPS holds promise with several trials currently investigating systemic treatment beyond conventional chemotherapy. SUMMARY The management of RPS has made significant progress over the past decade owing to international collaboration. Ongoing efforts to identify patients who will derive the most benefit from all treatment strategies will continue to advance the field of RPS.
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Affiliation(s)
- Ashley Drohan
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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32
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Apte SS, Mor E, Mitchell C, Gyorki DE. Practical Management of Adult Ultra-Rare Primary Retroperitoneal Soft Tissue Sarcoma: A Focus on Perivascular Epithelioid Tumours and Extraosseous Ewing Sarcoma. Curr Oncol 2023; 30:5953-5972. [PMID: 37504306 PMCID: PMC10377910 DOI: 10.3390/curroncol30070445] [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: 03/22/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/29/2023] Open
Abstract
With the exception of well-differentiated liposarcoma, dedifferentiated liposarcoma, leiomyosarcoma, solitary fibrous tumour, malignant peripheral nerve sheath tumour, and undifferentiated pleomorphic sarcoma, the majority of the ≈70 histologic subtypes of retroperitoneal sarcoma are defined as 'ultra-rare' sarcomas, with an incidence of ≤1-5/1,000,000 persons/year. For most of these ultra-rare RPS subtypes, diagnosis and treatment follows international guidelines for the management of more common RPS histologies, with en bloc surgical resection as the mainstay of curative treatment, and enrolment in clinical trials where possible. Because the treatment of RPS is heavily driven by histology, the surgeon must be familiar with specific issues related to the diagnosis and management of ultra-rare sarcoma subtypes. Expert radiological and surgeon reviews are required to differentiate similarly presenting tumours where surgery can be avoided (e.g., angiomyolipoma), or where upfront systemic therapy is indicated (e.g., extraosseous Ewing's sarcoma). Thus, the management of all retroperitoneal sarcomas should occur at a sarcoma referral centre, with a multidisciplinary team of experts dedicated to the surgical and medical management of these rare tumours. In this focused review, we highlight how diagnosis and management of the ultra-rare primary RPS histologies of malignant perivascular epithelioid cell tumour (PEComa), extraosseous Ewing sarcoma (EES), extraosseous osteosarcoma (EOS), and rhabdomyosarcoma (RMS) critically diverge from the management of more common RPS subtypes.
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Affiliation(s)
- Sameer S Apte
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Division of General Surgery, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
| | - Eyal Mor
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Catherine Mitchell
- Division of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
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Álvarez Álvarez R, Manzano A, Agra Pujol C, Artigas Raventós V, Correa R, Cruz Jurado J, Fernandez JA, Garcia Del Muro X, Gonzalez JA, Hindi N, Lozano Lominchar P, Martínez-Trufero J, Méndez R, Muñoz M, Muñoz Casares C, Orbis Castellanos F, Orellana Fernandez R, Paniagua González M, Redondo A, Valverde Morales C, Asencio JM. Updated Review and Clinical Recommendations for the Diagnosis and Treatment of Patients with Retroperitoneal Sarcoma by the Spanish Sarcoma Research Group (GEIS). Cancers (Basel) 2023; 15:3194. [PMID: 37370803 DOI: 10.3390/cancers15123194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Soft tissue sarcomas (STS) are an uncommon and biologically heterogeneous group of tumors arising from mesenchymal cells. The incidence is estimated at five cases per 100,000 people per year. Retroperitoneal sarcomas (RPS) account for 10-15% of all STS, and their management depends on their anatomical characteristics and histotype. Due to their very low incidence, it is recommended that RPS be treated in reference centers and evaluated by an experienced multidisciplinary team (MDT). In Spain, the Spanish Group for Research in Sarcomas (GEIS) brings together experts from various specialties to promote research on sarcomas and improve treatment results. This paper summarizes the GEIS recommendations for the diagnosis, treatment, and follow-up of patients with RPS.
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Affiliation(s)
- Rosa Álvarez Álvarez
- Medical Oncology Department, Instituto de Investigacion Sanitaria Gregorio Marañon, Hospital Universitario Gregorio Marañon, 28007 Madrid, Spain
| | - Aránzazu Manzano
- Medical Oncology Department, Hospital Universitario Clínico San Carlos, 28040 Madrid, Spain
| | - Carolina Agra Pujol
- Pathology Department, Hospital Universitario Gregorio Marañon, Complutense University, 28007 Madrid, Spain
| | - Vicente Artigas Raventós
- Surgery Department, Hospital Universitario Sant Pau, Universidad Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Raquel Correa
- Radiation Oncology Department, Hospital Virgen de la Victoria, 29010 Malaga, Spain
| | - Josefina Cruz Jurado
- Medical Oncology Department, Hospital Universitario Canarias, 38320 Santa Cruz de Tenerife, Spain
| | - Juan Angel Fernandez
- Sarcoma Multidisciplinary Unit, Surgery Department, Hospital Virgen de la Arrixaca, 30120 Murcia, Spain
| | - Xavier Garcia Del Muro
- Sarcoma Multidisciplinary Unit, Medical Oncology Department, Idibell, Instituto Catalan Oncología Hospitalet, 08908 Barcelona, Spain
| | - Jose Antonio Gonzalez
- Surgery Department, Hospital Universitario Sant Pau, Universidad Autonoma de Barcelona, 08035 Barcelona, Spain
| | - Nadia Hindi
- Medical Oncology Department, Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain
- Medical Oncology Department, Hospital General de Villalba, 28400 Madrid, Spain
- Health Research Institute-Fundación Jiménez Díaz (IIS-FJD), Universidad Autónoma de Madrid (UAM), 28040 Madrid, Spain
| | - Pablo Lozano Lominchar
- Surgery Department, Hospital Universitario Gregorio Marañon, Complutense University, 28040 Madrid, Spain
| | | | - Ramiro Méndez
- Radiology Department, Hospital Universitario Clínico San Carlos, 28040 Madrid, Spain
| | - Mercedes Muñoz
- Radiation Oncology Department, Hospital Universitario Gregorio Marañon, Complutense University, 28007 Madrid, Spain
| | | | - Francisco Orbis Castellanos
- Sarcoma Multidisciplinary Unit, Surgery Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | | | - Miguel Paniagua González
- Radiology Department, Hospital Universitario Gregorio Marañon, Complutense University, 28007 Madrid, Spain
| | - Andres Redondo
- Medical Oncology Department, Hospital Universitario La Paz-IdiPAZ, 28046 Madrid, Spain
| | | | - Jose Manuel Asencio
- Surgery Department, Hospital Universitario Gregorio Marañon, Complutense University, 28040 Madrid, Spain
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Tirotta F, Napolitano A, Noh S, Schmitz E, Nessim C, Patel D, Sicklick JK, Smith M, Thway K, van der Hage J, Ford SJ, Tseng WW. Current management of benign retroperitoneal tumors. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1081-1090. [PMID: 35879135 DOI: 10.1016/j.ejso.2022.07.006] [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] [Received: 03/27/2022] [Revised: 06/23/2022] [Accepted: 07/05/2022] [Indexed: 11/19/2022]
Abstract
Benign retroperitoneal tumors (BRT) represent a rare group of heterogeneous diseases. The literature lacks high-quality evidence about the optimal management of BRT, and most of the information available takes the form of case reports or case series. The aim of this review is to provide an overview of current management strategies for adult patients with BRT. A literature search using PubMed indexed articles was conducted and BRT were classified into five different biological subgroups: 1) lipomatous tumors, 2) smooth muscle tumors, 3) peripheral nerve sheath tumors, 4) myofibroblastic tumors, and 5) others. Tumors that are primarily pelvic in origin were excluded. Despite the significant heterogeneity of the disease, several generic considerations have emerged and can be applied to the management of BRT. Specifically, the risk of misdiagnosing a BRT with another pathology such as retroperitoneal sarcoma is notable. When encountered, suspected BRT should therefore be referred to a specialized sarcoma center. Multidisciplinary tumor boards, present at these centers, have a pivotal role in managing BRT. The decision of whether to offer surgery, nonsurgical treatment or a "watch-and-wait" approach should be made after multidisciplinary discussion, depending on tumor histology. Moving forward, collaborative research efforts dedicated to BRT remain crucial in gathering evidence and knowledge to further optimize patient care.
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Affiliation(s)
- Fabio Tirotta
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrea Napolitano
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Sangkyu Noh
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, UC San Diego Health Sciences, 3855 Health Sciences Drive, Room 2313, Mail Code 0987, La Jolla, San Dieg, CA, 92093-0987, USA; College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, 91766-1854, USA
| | - Erika Schmitz
- Department of Surgery, The Ottawa Hospital and Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Carolyn Nessim
- Department of Surgery, The Ottawa Hospital and Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Dakshesh Patel
- Department of Radiology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Jason K Sicklick
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California, UC San Diego Health Sciences, 3855 Health Sciences Drive, Room 2313, Mail Code 0987, La Jolla, San Dieg, CA, 92093-0987, USA
| | - Myles Smith
- Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Khin Thway
- Department of Pathology, The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Jos van der Hage
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Samuel J Ford
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
| | - William W Tseng
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
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Bonvalot S, Roland C, Raut C, Le Péchoux C, Tzanis D, Frezza AM, Gronchi A. Histology-tailored multidisciplinary management of primary retroperitoneal sarcomas. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1061-1067. [PMID: 35599138 DOI: 10.1016/j.ejso.2022.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 11/28/2022]
Abstract
Until recently, the recommendation for primary retroperitoneal sarcomas (RPS) was to perform a complete en-bloc gross excision, (neo) adjuvant treatments being options which were not validated by randomized studies, with a large discrepancy of use between centers. The heterogeneity of RPS, with their different biological behaviour, renders a homogenous therapeutic and surgical approach probably inappropriate. Recent studies, both surgical and dedicated to adjuvant treatments, allow refining these recommendations. This review summarizes recent advances and directions.
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Affiliation(s)
- S Bonvalot
- Department of Surgical Oncology, Institut Curie, Paris University, Paris, France.
| | - C Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C Raut
- Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - C Le Péchoux
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - D Tzanis
- Department of Surgical Oncology, Institut Curie, Paris University, Paris, France
| | - A M Frezza
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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36
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Kang YJ, Farma J, Raut CP. Special clinical scenarios in RPS: Involvement of great vessels and pancreas and penetration across natural foramina. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1091-1101. [PMID: 36372616 DOI: 10.1016/j.ejso.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/25/2022] [Accepted: 10/18/2022] [Indexed: 11/12/2022]
Abstract
The primary treatment for retroperitoneal sarcomas is surgery. This requires a carefully planned, typically multivisceral, resection. A few complex scenarios that may arise include vascular involvement, pancreatic involvement, or herniation of the tumor into another compartment outside of the retroperitoneum. These scenarios must be anticipated before surgery to optimize preoperative preparation, minimize postoperative morbidity and mortality, and improve oncologic outcomes. Our aim is to highlight these clinically challenging anatomic presentations that can be encountered in patients with retroperitoneal sarcomas.
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Affiliation(s)
- Yun Jee Kang
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Sarcoma and Bone Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
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37
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Baia M, Ford SJ, Dumitra S, Samà L, Naumann DN, Spolverato G, Callegaro D. Follow-up of patients with retroperitoneal sarcoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1125-1132. [PMID: 35277304 DOI: 10.1016/j.ejso.2022.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
Retroperitoneal sarcomas (RPS) are rare malignancies that are potentially curable by complete surgical resection. A regular surveillance program is normally commenced following surgery due to the risk of local recurrence (LR), especially in low-intermediate grade disease, and distant metastases (DM), especially in high-grade RPS. Consensus guidelines usually advocate for more frequent imaging during the first 2-3 years and less intensive imaging over a prolonged period thereafter, reflecting the incidence pattern of LR and DM. Definitive evidence for the most effective imaging schedule has never been provided, and retrospective studies have not shown an association between follow-up intensity and survival. Improvement in the prediction of recurrence patterns has been sustained by prognostic dynamic nomograms, which are now capable of forecasting disease behaviour in each patient according to specific features. Incorporation of such tools in clinical practice may help to stratify patients and tailor ongoing surveillance to the risk of recurrence. This may help to relieve patients' anxiety while awaiting results of surveillance investigations, and also reduce the economic and environmental burden of repeated imaging. A randomized controlled study (SARveillance Trial) is proposed to shed light on this controversial topic, allowing clinicians to harmonize the follow-up protocol of patients undergoing surgery for RPS.
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Affiliation(s)
- Marco Baia
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), Queen Elizabeth Hospital Birmingham, UK
| | - Samuel J Ford
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), Queen Elizabeth Hospital Birmingham, UK
| | | | - Laura Samà
- Surgical Oncology Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - David N Naumann
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), Queen Elizabeth Hospital Birmingham, UK
| | - Gaya Spolverato
- Department of Surgical, Oncological and Gastroenterological Sciences, Section of Surgery, University of Padova, Padova, Italy
| | - Dario Callegaro
- Sarcoma Service, Department of Surgery, IRCCS Fondazione Istituto Nazionale Dei Tumori di Milano, Milan, Italy.
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38
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Rutkowski P, Bonvalot S. New roads in retroperitoneal sarcomas. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1051-1052. [PMID: 36153224 DOI: 10.1016/j.ejso.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Piotr Rutkowski
- Maria Sklodowska-Curie National Research Institute of Oncology, Department of Soft Tissue/Bone Sarcoma and Melanoma, Warsaw, Poland.
| | - Sylvie Bonvalot
- Department of Surgery, Institute Curie, Paris University, France
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Sarre-Lazcano C, Dumitra S, Fiore M. Pelvic soft tissue sarcomas. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1102-1110. [PMID: 35725682 DOI: 10.1016/j.ejso.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 05/28/2022] [Accepted: 06/01/2022] [Indexed: 12/20/2022]
Abstract
Pelvic soft tissue sarcomas (PSTS) are a rare, heterogeneous group of tumors. They have been usually analyzed with retroperitoneal sarcomas (RPS), but actually have key differences. Due to their unique anatomic location, symptomatic presentation of PSTS may be more common than RPS. Adequate imaging approach is paramount for guiding differential diagnosis, while preoperative biopsy is mandatory, especially when preoperative treatment may be considered as initial approach. The most frequent histologic subtype is leiomyosarcoma, which is different as expected in the retroperitoneum where liposarcoma is the commonest histology. Also solitary fibrous tumor is commonly diagnosed in the pelvis. Surgical approach for PSTS differs from that for RPS mainly due to anatomic relations. Similarly, in the lack of definite evidence from specific trials about neoadjuvant and adjuvant treatments, the anatomic constraints to obtain wide margins in the pelvis as well as the expected functional outcome in case of organ resections should be factored into decision for individualized treatment offer. Vascular and genitourinary involvement are frequent, as well as herniation through pelvic foramina. For these reasons a multidisciplinary surgical team should always be considered. Early referral of these patients to high-volume centers is critical and may impact on survival, given that optimal initial resection is a major predictor of curative treatment. International consensus on PSTS treatment is advocated, similarly to the recent efforts realized for RPS.
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Affiliation(s)
- Catherine Sarre-Lazcano
- Department of Surgery, Salvador Zubiran National Institute of Medical Sciences and Nutrition: Salvador Zubiran, Mexico City, Mexico
| | - Sinziana Dumitra
- Department of Surgery, McGill University Health Centre, Montreal, Canada
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Danieli M, Swallow CJ, Gronchi A. How to treat liposarcomas located in retroperitoneum. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1068-1080. [PMID: 35623985 DOI: 10.1016/j.ejso.2022.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/15/2022] [Accepted: 04/25/2022] [Indexed: 12/28/2022]
Abstract
Almost half of retroperitoneal (RP) sarcomas are liposarcomas (LPS). The large majority of RP LPS are either well-differentiated LPS (WDLPS) or dedifferentiated LPS (DDLPS), these latter further classified according to grading in G2 and G3 DDLPS. Surgery is the only potentially curative treatment to achieve local control and possibly cure in primary localized disease. Over the last decade, a better delineation of the different histology-specific patterns of failure and the development of nomograms predictors of outcome has led to a better management of these rare tumors, with a special focus on non-surgical treatments. Available evidences - although far from exhaustive - show that radiation therapy might have a role, if any, as neoadjuvant treatment in locally aggressive histologies (i.e. WDLPS and G2 DDLPS), while it does not seem beneficial for histologies with a higher metastatic risk (i.e. G3 DDLPS and leiomyosarcoma). Neoadjuvant chemotherapy, instead, can be considered to reduce the risk of distant metastasis while waiting for the results of an ongoing RCT (STRASS-2) evaluating its effect in these tumors. However, given the rarity of these diseases and the subsequent lack of strong evidences to guide treatment, outcome improvement in these patients remains a challenge. Patients' referral to a sarcoma center where a dedicated specialized multidisciplinary team tailor optimal treatment on a case-by-case basis is crucial to ensure these patients the best outcome. Refining available nomograms - e.g including molecular variables - and identifying predictors of response/toxicity to chemotherapy and immunotherapy might be significantly helpful in tailoring treatments to the patient's characteristics. Also, new systemic agents are eagerly awaited for improving the management further.
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Affiliation(s)
- Maria Danieli
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carol J Swallow
- Division of General Surgery, Mount Sinai Hospital, Toronto, ON, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Porrello G, Cannella R, Randazzo A, Badalamenti G, Brancatelli G, Vernuccio F. CT and MR Imaging of Retroperitoneal Sarcomas: A Practical Guide for the Radiologist. Cancers (Basel) 2023; 15:cancers15112985. [PMID: 37296946 DOI: 10.3390/cancers15112985] [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: 04/30/2023] [Revised: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
Primary retroperitoneal sarcomas (RPS) represent around 10-16% of all sarcomas, with liposarcomas and leiomyosarcomas being the most common subtypes. RPS have some peculiar characteristics, imaging appearances, worse prognosis, and complications compared to other locations of sarcoma. Commonly, RPS primarily present as large masses, progressively encasing adjacent structures, causing mass effect, and complications. RPS diagnosis is often challenging, and these tumors may be overlooked; however, failure to recognize RPS characteristics leads to a worse prognosis for the patients. Surgery is the only recognized curative treatment, but the anatomical constraints of the retroperitoneum limit the ability to achieve wide resection margins; therefore, these tumors have a high rate of recurrence, and require long-term follow-up. The radiologist has an important role in the diagnosis of RPS, the definition of their extent, and their follow-up. Specific knowledge of the main imaging findings is required to reach an early diagnosis, and, ultimately, to guarantee the best patient management. This article provides an overview of the current knowledge regarding cross-sectional imaging features of patients with retroperitoneal sarcomas, presenting tips and tricks to improve imaging diagnosis of RPS.
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Affiliation(s)
- Giorgia Porrello
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnosis (Bi.N.D), University of Palermo, 90127 Palermo, Italy
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127 Palermo, Italy
| | - Roberto Cannella
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnosis (Bi.N.D), University of Palermo, 90127 Palermo, Italy
| | - Angelo Randazzo
- Department of Radiology, Azienda Sanitaria Provinciale, 92100 Agrigento, Italy
| | - Giuseppe Badalamenti
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences (DICHIRONS), University of Palermo, 90127 Palermo, Italy
| | - Giuseppe Brancatelli
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnosis (Bi.N.D), University of Palermo, 90127 Palermo, Italy
| | - Federica Vernuccio
- Department of Radiology, University Hospital of Padova, 35128 Padova, Italy
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Seidensaal K, Dostal M, Kudak A, Jaekel C, Meixner E, Liermann J, Weykamp F, Hoegen P, Mechtersheimer G, Willis F, Schneider M, Debus J. Preoperative Dose-Escalated Intensity-Modulated Radiotherapy (IMRT) and Intraoperative Radiation Therapy (IORT) in Patients with Retroperitoneal Soft-Tissue Sarcoma: Final Results of a Clinical Phase I/II Trial. Cancers (Basel) 2023; 15:2747. [PMID: 37345084 DOI: 10.3390/cancers15102747] [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: 03/27/2023] [Revised: 05/06/2023] [Accepted: 05/07/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND To report the final results of a prospective, one-armed, single-center phase I/II trial (NCT01566123). METHODS Between 2007 and 2017, 37 patients with primary or recurrent (N = 6) retroperitoneal sarcomas were enrolled. Treatment included preoperative IMRT of 45-50 Gy with a simultaneous integrated boost of 50-56 Gy, surgery and IORT. The primary endpoint was local control (LC) at 5 years. The most common histology was dedifferentiated liposarcoma (51%), followed by leiomyosarcoma (24%) and well-differentiated liposarcoma (14%). The majority of lesions were high-grade (FNCLCC G1: 30%, G2: 38%, G3: 27%, two missing). Five patients were excluded from LC analysis per protocol. RESULTS The minimum follow-up of the survivors was 62 months (median: 109; maximum 162). IORT was performed for 27 patients. Thirty-five patients underwent gross total resection; the pathological resection margin was mostly R+ (80%) and, less often, R0 (20%). We observed 10 local recurrences. The 5-year LC of the whole cohort was 59.6%. Eleven patients received a dose > 50 Gy plus IORT boost; LC was 64.8%; the difference, however, was not significant (p = 0.588). Of 37 patients, 15 were alive and 22 deceased at the time of final analysis. The 5-year OS was 59.5% (68.8% per protocol). CONCLUSIONS The primary endpoint of a 5-year LC of 70% was not met. This might be explained by the inclusion of recurrent disease and the high rate of G3 lesions and leiomyosarcoma, which have been shown to profit less from radiotherapy. Stratification by grading and histology should be considered for future studies.
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Affiliation(s)
- Katharina Seidensaal
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Matthias Dostal
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Andreas Kudak
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Cornelia Jaekel
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Eva Meixner
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Jakob Liermann
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Fabian Weykamp
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Philipp Hoegen
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | | | - Franziska Willis
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, 69120 Heidelberg, Germany
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Dominguez DA, Sampath S, Agulnik M, Liang Y, Nguyen B, Trisal V, Melstrom LG, Lewis AG, Paz IB, Roberts RF, Tseng WW. Surgical Management of Retroperitoneal Sarcoma. Curr Oncol 2023; 30:4618-4631. [PMID: 37232807 DOI: 10.3390/curroncol30050349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
Surgery is the cornerstone of treatment for retroperitoneal sarcoma (RPS). Surgery should be performed by a surgical oncologist with sub-specialization in this disease and in the context of a multidisciplinary team of sarcoma specialists. For primary RPS, the goal of surgery is to achieve the complete en bloc resection of the tumor along with involved organs and structures to maximize the clearance of the disease. The extent of resection also needs to consider the risk of complications. Unfortunately, the overarching challenge in primary RPS treatment is that even with optimal surgery, tumor recurrence occurs frequently. The pattern of recurrence after surgery (e.g., local versus distant) is strongly associated with the specific histologic type of RPS. Radiation and systemic therapy may improve outcomes in RPS and there is emerging data studying the benefit of non-surgical treatments in primary disease. Topics in need of further investigation include criteria for unresectability and management of locally recurrent disease. Moving forward, global collaboration among RPS specialists will be key for continuing to advance our understanding of this disease and find more effective treatments.
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Affiliation(s)
- Dana A Dominguez
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Sagus Sampath
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Mark Agulnik
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Yu Liang
- Department of Pathology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Bao Nguyen
- Department of Diagnostic Radiology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Vijay Trisal
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Laleh G Melstrom
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Aaron G Lewis
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Isaac Benjamin Paz
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Randall F Roberts
- Division of Thoracic Surgery (Vascular Surgery Section), City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - William W Tseng
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
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Zhuang A, Chen Y, Wang J, Xu J, Tong H, Zhou Y, Zhang Y, Lu W. Multivisceral resection of primary multifocal retroperitoneal sarcomas: a retrospective study from a high-volume sarcoma center. J Clin Transl Res 2023; 9:101-109. [PMID: 37179789 PMCID: PMC10171315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/08/2023] [Accepted: 03/07/2023] [Indexed: 05/15/2023] Open
Abstract
Background Although surgery plays a key role in the treatment of the primary retroperitoneal sarcoma (RPS), there remain few reports on the primary multifocal RPS. Aims This study aimed to identify the prognostic factors for the primary multifocal RPS in an effort to optimize the clinical management of this malignancy. Methods A retrospective analysis was conducted on a cohort of 319 primary RPS patients who underwent radical resection from 2009 to 2021, with post-operative recurrence as the primary endpoint of this study. COX regression was performed to identify the risk factors for post-operative recurrence, and a comparison was made to baseline and prognostic differences between multivisceral resection (MVR) and non-MVR groups with multifocal disease. Results There were 31 (9.7%) patients with multifocal disease, the mean tumor burden placed on them was 24.1 ± 11.9 cm, and nearly half of the patients (48.4%) had MVR. Dedifferentiated liposarcoma, well-differentiated liposarcoma, and leiomyosarcoma accounted for 38.7%, 32.3%, and 16.1%, respectively. The 5-year recurrence-free survival rate reached 31.2% (95% CI, 11.2-51.2%) in the multifocal group and 51.8% (95% CI, 44.2-59.4%) in the unifocal group (P = 0.010). Age (heart rate [HR] = 0.916; P = 0.039) and complete resection (HR = 1.861; P = 0.043) were identified as the independent risk factors for the post-operative recurrence of multifocal primary RPS. Conclusions Regarding primary multifocal RPS, the overall treatment strategy can be adopted for the treatment of the primary RPS, and MVR remains effective in boosting the chance of disease control for a selected group of patients. Relevance for Patients This study is relevant to patients as it highlights the importance of receiving appropriate treatment for the primary RPS, especially for those with multifocal disease. The treatment options should be evaluated carefully to ensure that the patients receive the most effective treatment for their specific type and stage of RPS. The potential risk factors for post-operative recurrence should be well understood to minimize those risks. Ultimately, this study underscores the importance of ongoing research to optimize the clinical management of RPS and improve outcomes for patients.
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Affiliation(s)
- Aobo Zhuang
- Department of Neurology, Medical Oncology, General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Xiamen University Research Center of Retroperitoneal Tumor Committee, Xiamen University, Xiamen, Fujian, China
| | - Yangju Chen
- Department of Neurology, Medical Oncology, General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiongyuan Wang
- Department of Neurology, Medical Oncology, General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jin Xu
- Department of Neurology, Medical Oncology, General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hanxing Tong
- Department of Neurology, Medical Oncology, General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuhong Zhou
- Department of Neurology, Medical Oncology, General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Zhang
- Department of Neurology, Medical Oncology, General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Yong Zhang Department of Neurology, Medical Oncology, General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Weiqi Lu
- Department of Neurology, Medical Oncology, General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Corresponding authors: Weiqi Lu Department of Neurology, Medical Oncology, General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
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Gold L, Moser C, Fabritius MP, Seidensticker M, Ricke J, Albertsmeier M, Angele MK, Knösel T, Di Gioia D, Lindner LH, Armbruster M, Kunz WG. Diagnostic accuracy of biopsy after neoadjuvant treatment for well-differentiated and dedifferentiated retroperitoneal liposarcoma. Surg Oncol 2023; 48:101945. [PMID: 37099895 DOI: 10.1016/j.suronc.2023.101945] [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: 01/07/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE Accurate histopathological grading of percutaneous biopsies is essential to guide adequate management of patients with suspected retroperitoneal liposarcoma. In this regard, however, limited reliability has been described. Therefore, we conducted a retrospective study to assess the diagnostic accuracy in retroperitoneal soft tissue sarcomas and simultaneously investigate its impact on patients' survival. MATERIALS AND METHODS Reports of an interdisciplinary sarcoma tumor board between 2012 and 2022 were systematically screened for patients with well-differentiated (WDLPS) and dedifferentiated retroperitoneal liposarcoma (DDLPS). Histopathological grading on pre-operative biopsy was correlated with corresponding postoperative histology. Additionally, patients' survival outcomes were examined. All analyses were performed in two subgroups: patients with primary surgery and patients with neoadjuvant treatment. RESULTS A total of 82 patients met our inclusion criteria. Diagnostic accuracy of patients who underwent upfront resection (n = 32) was significantly inferior to patients with neoadjuvant treatment (n = 50) (66% versus 97% for WDLPS, p < 0.001; 59% versus 97% for DDLPS, p < 0.001). For patients with primary surgery, histopathological grading on biopsy and surgery was concordant in only 47% of cases. Sensitivity for detecting WDLPS was higher than for DDLPS (70% versus 41%). Higher histopathological grading in surgical specimens correlated with worse survival outcomes (p = 0.01). CONCLUSION Histopathological grading of RPS may no longer be reliable after neoadjuvant treatment. The true accuracy of the percutaneous biopsy may need to be studied in patients who do not receive neoadjuvant treatment. Future biopsy strategies should aim to improve identification of DDLPS to inform patient management.
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Affiliation(s)
- Lukas Gold
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Christian Moser
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Martin K Angele
- Department of Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Knösel
- Department of Pathology, University Hospital, LMU Munich, Munich, Germany
| | - Dorit Di Gioia
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Lars H Lindner
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Marco Armbruster
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
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Mor E, Assaf D, Shemla S, Ben-Ami E, Halfon M, Laks S, Perelson D, Zippel D, Ben-Yaacov A, Lawrence Y, Symon Z, Nissan A, Adileh M. IOeRT in retroperitoneal sarcoma: Towards more organ preservation with comparable oncological outcomes. Surg Oncol 2023; 48:101940. [PMID: 37079981 DOI: 10.1016/j.suronc.2023.101940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/25/2023] [Accepted: 03/28/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Retroperitoneal sarcomas (RPS) present a surgical challenge with high rates of local recurrence (LR). We investigated the role of intraoperative electron radiotherapy (IOeRT) in reducing LR after surgical resection of RPS. METHODS A retrospective analysis of all patients who underwent surgical resection for RPS between 2014 and 2021 at a tertiary academic referral center (n = 172). Patients included underwent surgical resection of their RPS and received IOeRT (n = 36) and were compared by case control matching to patients with similar tumor characteristics (recurrence status and tumor grade) that did not receive IOeRT (n = 36). RESULTS The median length of hospitalization was 8 days (range, 4-34) in the IOeRT group and 10 days (range, 2-42) in the non-IOeRT group (p = 0.25). The mean operating room (OR) time was 4h (±1.3) and 4h (±1.9) in the IOeRT and non-IOeRT groups respectively, (p = 0.37). Complete resection with R0 margins was achieved in 30 patients (83.3%) and 24 patients (66.6%) in the IOeRT and non-IOeRT groups, respectively (p = 0.1). R1 resection was achieved in 6 patients (16.6%) and 12 patients (33.3%) respectively, (p = 0.1). The resected organ weighted score was significantly different between the groups; score 0 observed in 19 (52.7%) patients in the IOeRT group and 3 (8.3%) in the non-IOeRT group (p < 0.001), score 1 observed in 7 (19.4%) in the IOeRT group and 17 (47.2%) in the non-IOeRT group (p = 0.012). The rate of severe complications (CD score>3) did not differ between the groups, 5 (13.8%) patients in the IOeRT group and 9 (25%) patients in the non-IOeRT group (p = 0.23). No radiation associated complications were noted. The 2-year local recurrence free survival (LRFS) was 75.9% in the IOeRT group and 60.3% in the non-IOeRT group (p = 0.4). The 2-year IOeRT field recurrent free survival (IRFS) was 88.4% in the IOeRT group and 60.3% in the non-IOeRT group (p = 0.04). CONCLUSIONS The use of IOeRT did not increase the rate of surgical complications and was associated with superior local control in the radiation field, improved organ preservation without an impact on overall survival.
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Devaud NA, Butte JM, De la Maza JC, von Mühlenbrock Hugo S, Cardona K. Complex Vascular Resections for Retroperitoneal Soft Tissue Sarcoma. Curr Oncol 2023; 30:3500-3515. [PMID: 36975479 PMCID: PMC10047166 DOI: 10.3390/curroncol30030266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
Retroperitoneal sarcomas (RPSs) are locally aggressive tumors that can compromise major vessels of the retroperitoneum including the inferior vena cava, aorta, or main tributary vessels. Vascular involvement can be secondary to the tumor's infiltrating growth pattern or primary vascular origin. Surgery is still the mainstay for curing this disease, and resection of RPSs may include major vascular resections to secure adequate oncologic results. Our improved knowledge in the tumor biology of RPSs, in conjunction with the growing surgical expertise in both sarcoma and vascular surgical techniques, has allowed for major vascular reconstructions within multi-visceral resections for RPSs with good perioperative results. This complex surgical approach may include the combined work of various surgical subspecialties.
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Affiliation(s)
- Nicolas A Devaud
- Sarcoma Surgery Unit, Instituto Oncologico Fundación Arturo Lopez Perez (Falp), Santiago 7500691, Chile
| | - Jean M Butte
- Sarcoma Surgery Unit, Instituto Oncologico Fundación Arturo Lopez Perez (Falp), Santiago 7500691, Chile
| | - Juan C De la Maza
- Vascular Surgery Unit, Instituto Oncologico Fundación Arturo Lopez Perez (Falp), Santiago 7500691, Chile
| | | | - Kenneth Cardona
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30307, USA
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Lv A, Sun R, Qiu H, Wu J, Tian X, Hao C. Delayed gastric emptying after aggressive surgery for retroperitoneal sarcoma - Incidence, characteristics, and risk factors. Biosci Trends 2023; 17:54-62. [PMID: 36775297 DOI: 10.5582/bst.2022.01522] [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: 02/11/2023]
Abstract
Delayed gastric emptying (DGE) after aggressive resection of retroperitoneal sarcoma (RPS) has rarely been described. This study aimed to determine the incidence and characteristics of DGE after surgery for RPS and explore its potential risk factors. Patients with RPS who had undergone surgery between January 2010 and February 2021 were retrospectively analyzed. DGE was defined and graded according to the International Study Group of Pancreatic Surgery classification and classified as primary or secondary to other complications. Patients with clinically relevant DGE (crDGE, grade B+C) were compared to those with no or mild DGE (grade A). Multivariate logistic regression analysis of clinicopathological and surgical parameters was performed to identify risk factors for crDGE. Of the 239 patients studied, 69 (28.9%) had experienced DGE and 54 (22.6%) had experienced crDGE. Patients with primary and secondary DGE accounted approximately half and half. The most common concurrent complications included abdominal infection, postoperative pancreatic fistula, and abdominal bleeding. Patients with crDGE were more likely to have multifocal tumors and the liposarcoma subtype, with a larger tumor size, longer operating time, more resected organs, and a history of combined resection of the stomach, pancreas, small intestine, and/or colon. In multivariate analysis, the tumor size, operating time, and combined pancreatic resection were independent risk factors for crDGE. In conclusion, the current results indicated that approximately one-fourth of patients experienced DGE after aggressive surgery for RPS and that DGE was primary or secondary to other underlying conditions. A large tumor involving long, difficult surgery and combined pancreatic resection highly predicted the incidence of crDGE. The prevention and management of DGE remain challenging.
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Affiliation(s)
- Ang Lv
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Hepato-Pancreato-Biliary Surgery/ Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Rongze Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Hepato-Pancreato-Biliary Surgery/ Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hui Qiu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Hepato-Pancreato-Biliary Surgery/ Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jianhui Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Hepato-Pancreato-Biliary Surgery/ Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiuyun Tian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Hepato-Pancreato-Biliary Surgery/ Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Chunyi Hao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Hepato-Pancreato-Biliary Surgery/ Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, China
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Lv A, Liu DN, Wang Z, Li CP, Liu BN, Liu Q, Tian XY, Hao CY. Short- and long-term surgical outcomes of pancreatic resection for retroperitoneal sarcoma: A long-term single-center experience of 90 cases. J Surg Oncol 2023; 127:633-644. [PMID: 36444482 DOI: 10.1002/jso.27160] [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: 10/25/2022] [Accepted: 11/19/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND AND OBJECTIVES Resection of retroperitoneal sarcoma (RPS) en bloc with pancreas is challenging and controversial. This single-center retrospective study aimed to analyze the impact of pancreatic resection (PR) and its different types on short- and long-term outcomes in patients with RPS. METHODS Data from 242 consecutive patients with RPS who underwent surgical treatment at the Peking University Cancer Hospital Sarcoma Center between January 2010 and February 2021 were analyzed. Out of these, 90 patients underwent PR, including pancreaticoduodenectomy (PD) in 31 and distal pancreatectomy (DP) in 59. RESULTS Patients in the PR group had a higher major morbidity (37.8% vs. 14.5%) and mortality (8.9% vs. 1.3%) than those in the non-PR group, with a similar 5-year overall survival (OS) rate (46.9% vs. 53.6%). Patients in the PD and DP groups had a slight difference in major morbidity (48.4% vs. 32.2%), mortality (6.4% vs. 10.2%), and 5-year OS rates (43.3% vs. 49.3%). The PR type was not an independent risk factor for major morbidity or OS. CONCLUSIONS PR in RPS resection was associated with increased morbidity and mortality with minimal influence on survival. Patients with RPS undergoing PD and DP showed slight differences in terms of safety and OS.
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Affiliation(s)
- Ang Lv
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Dao-Ning Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhen Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Cheng-Peng Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Bo-Nan Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Qiao Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiu-Yun Tian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Chun-Yi Hao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, China
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Lai C, Long JR, Larsen BT, Iturregui JM, Wilke BK, Goulding KA. Percutaneous biopsy of musculoskeletal tumors and the potential for needle tract seeding: technical considerations, current controversies, and outcomes. Skeletal Radiol 2023; 52:505-516. [PMID: 36255472 DOI: 10.1007/s00256-022-04187-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/08/2022] [Accepted: 09/16/2022] [Indexed: 02/02/2023]
Abstract
Multidisciplinary communication and planning between the musculoskeletal radiologist and orthopedic oncologist are essential for proper biopsy planning when a primary musculoskeletal malignancy is suspected. Image-guided percutaneous biopsy allows for real-time visualization of the biopsy needle and surrounding structures, combining high diagnostic accuracy with safety and cost-effectiveness. However, determining a surgically optimal biopsy trajectory for a mass can be technically challenging due to critical surrounding anatomy or challenging needle approach angles. Inappropriately placed biopsies can have serious repercussions on patient function and oncological survival. The potential for needle tract seeding and local recurrence after biopsy of sarcoma has been central to the debate regarding the need for excision of the biopsy tract. This multidisciplinary review highlights current controversies in the field, including the issue of core needle biopsy tracts and their excision, technical considerations and advances in image-guidance in the setting of challenging biopsies, advances in histopathological diagnostics with implications for targeted therapy in sarcoma, as well as surgical and oncological outcomes after needle tract biopsy.
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Affiliation(s)
- Cara Lai
- Department of Orthopedic Surgery, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | | | - Brandon T Larsen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA
| | - Jose M Iturregui
- Department of Orthopedic Surgery, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Benjamin K Wilke
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Krista A Goulding
- Department of Orthopedic Surgery, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
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