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Czarnecka AM, Skoczylas J, Bartnik E, Świtaj T, Rutkowski P. Management Strategies for Adults with Locally Advanced, Unresectable or Metastatic Malignant Perivascular Epithelioid Cell Tumor (PEComa): Challenges and Solutions. Cancer Manag Res 2023; 15:615-623. [PMID: 37440783 PMCID: PMC10335286 DOI: 10.2147/cmar.s351284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
PEComa (PEC tumor; perivascular epithelioid cell tumors) is a rare group of tumors of mesenchymal origin composed of perivascular epithelioid cells (PEC) with features of melanotic and smooth muscle differentiation. In this article, we would like to present the current treatment options for this group of tumors. PEComas are classified as tumors of uncertain malignant potential because recurrences occur after radical treatment. The primary treatment is surgical resection with negative margins. Due to the different locations of the tumors, often the cooperation of multispecialty surgeons is required during the operations. In locally advanced cases, cytoreduction and HIPEC may be effective but still are an experimental treatment. For nonresectable PEComa chemotherapy, mTOR inhibitors and VEGFR inhibitors are used.
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Affiliation(s)
- Anna M Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Jacek Skoczylas
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Ewa Bartnik
- Institute of Genetics and Biotechnology, Faculty of Biology, University of Warsaw, Warsaw, Poland
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
| | - Tomasz Świtaj
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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Hennon M. Sarcoma Pulmonary Metastatic Disease: Still a Chance for Cure. Surg Clin North Am 2022; 102:615-624. [PMID: 35952691 DOI: 10.1016/j.suc.2022.05.001] [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: 10/15/2022]
Abstract
Tumors of soft tissue origin are not common but are increasing in incidence. Given the rare and heterogeneous nature of the disease, deciding on an effective treatment approach to the patient can be challenging. Approximately 20-50% of patients with sarcoma will develop metastases to the lung via hematogenous spread. Despite improvements in systemic therapy options for patients with metastatic disease to the lung, surgical resection of metastases is often the preferred option in patients who are safe surgical candidates. Clearance of metastatic disease with surgical resection has been proven to be cost-effective and can improve chances for long term survival. Deciding on who may benefit from surgical resection is best achieved in a multidisciplinary setting.
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Affiliation(s)
- Mark Hennon
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY 14263, USA; Department of Surgery, Jacobs School of Medicine, State University of New York at Buffalo, 100 High Street, Buffalo, NY 14203, USA.
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Tortorelli I, Navarria F, Maggio AD, Banzato A, Lestuzzi C, Nicosia L, Chiusole B, Galiano A, Sbaraglia M, Zagonel V, Brunello A. Trabectedin and Radiation Therapy for Cardiac Metastasis From Leiomyosarcoma: A Case Report and Review of the Literature. Front Oncol 2022; 12:838114. [PMID: 35574369 PMCID: PMC9097915 DOI: 10.3389/fonc.2022.838114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Leiomyosarcoma (LMS) is one of the most frequent subtypes of soft-tissue sarcomas (STSs). Metastatic spread to the heart in cancer patients carries a poor prognosis and there is no known effective treatment. Cardiac metastases of STSs are very rare. Here we present the case of a 55-year-old patient who underwent surgical resection of a retroperitoneal leiomyosarcoma and then developed widespread metastatic disease, treated with a combination of local treatment and systemic therapy. Three years after surgical resection she presented with a cardiac intraventricular mass, which was treated with radiation therapy, while receiving systemic therapy with trabectedin. Such combination therapy was well-tolerated and effective, allowing a substantial dimensional reduction which is perduring to date, 18 months after diagnosis of cardiac metastasis. Available literature and data point to the feasibility and good tolerability of radiation therapy and trabectedin in metastatic sarcoma, yet this is the first report on the effectiveness of the combination for the treatment of cardiac disease. The extended survival since a metastatic relapse (more than 3 years) is likely the result of integrated systemic and loco-regional treatment, which should be always discussed within the framework of a multiprofessional and multidisciplinary setting.
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Affiliation(s)
- Ilaria Tortorelli
- Oncology 1 Unit, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Federico Navarria
- Radiation Oncology Department, National Cancer Institute (CRO)- IRCCS, Aviano, Italy
| | - Antonio Di Maggio
- Oncologic Radiology Unit, Department of Radiology and Medical Physics, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Alberto Banzato
- Cardiology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Chiara Lestuzzi
- Cardiology and Cardio-Oncology Rehabilitation S.D.S, Department of Cardio-Cerebro-Vascular Physiopathology, Azienda Sanitaria Friuli Occidentale (AS FO), Aviano, Italy
| | - Luca Nicosia
- Advanced Radiation Oncology Department, Sacro Cuore Don Calabria Hospital IRCCS, Negrar, Italy
| | - Benedetta Chiusole
- Oncology 1 Unit, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Antonella Galiano
- Oncology 1 Unit, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Marta Sbaraglia
- Department of Pathology, Azienda Ospedale Università Padova, Padua, Italy
| | - Vittorina Zagonel
- Oncology 1 Unit, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Antonella Brunello
- Oncology 1 Unit, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
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Integrating multiple genomic imaging data for the study of lung metastasis in sarcomas using multi-dimensional constrained joint non-negative matrix factorization. Inf Sci (N Y) 2021. [DOI: 10.1016/j.ins.2021.06.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Gusho CA, Seder CW, Lopez-Hisijos N, Blank AT, Batus M. Pulmonary metastasectomy in bone and soft tissue sarcoma with metastasis to the lung. Interact Cardiovasc Thorac Surg 2021; 33:879-884. [PMID: 34516633 PMCID: PMC8632785 DOI: 10.1093/icvts/ivab178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/06/2021] [Accepted: 05/16/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES This study investigated the outcomes of sarcoma patients with lung metastases who underwent pulmonary metastasectomy (PM), compared to patients who underwent medical management alone. The secondary objective was to compare survival after PM between variables of interest. METHODS This was a retrospective review of 565 sarcoma patients with confirmed, isolated pulmonary metastasis identified from the Surveillance, Epidemiology and End Results database between 2010 and 2015. 1:4 propensity score matching was used to select PM and non-PM groups. The multivariable Cox proportional hazards model was used to analyse prognostic factors of disease-free survival (DFS). RESULTS Of the eligible 565 patients, 59 PM patients were matched to 202 non-PM patients in a final ratio of 3.4. After propensity matching, there were no significant differences in baseline characteristics between PM and non-PM patients. The median DFS after PM was 32 months (interquartile range 18–59), compared to 20 months (interquartile range 7–40) in patients without PM (P = 0.032). Using a multivariable Cox proportional hazards model, metastasectomy (hazard ratio 0.536, 95% confidence interval 0.33–0.85; P = 0.008) was associated with improved DFS. In a subset analysis of patients who underwent PM only, the median DFS was longer in males compared to females (P = 0.021), as well as in bone sarcoma compared to soft tissue sarcoma (P = 0.014). CONCLUSIONS For sarcoma patients with metastatic lung disease, PM appears to improve the prognosis compared to medical management. Furthermore, there may be a survival association with gender and tumour origin in patients who underwent PM. These data may be used to inform the surgical indications and eligibility criteria for metastasectomy in this setting.
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Affiliation(s)
- Charles A Gusho
- Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Christopher W Seder
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Alan T Blank
- Division of Orthopedic Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Marta Batus
- Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
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Dudek W, Schreiner W, Haj Khalaf M, Sirbu H. Surgery for Pulmonary Metastases: Long-Term Survival in 281 Patients. Thorac Cardiovasc Surg 2021; 69:660-665. [PMID: 33975365 DOI: 10.1055/s-0041-1725203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite weak evidence, pulmonary metastasectomy (PM) is widely performed with intent to improve patient survival. Our single-institution analysis aims to evaluate outcomes and to identify factors influencing survival of patients undergoing PM for metastases from wide range of primary tumors. MATERIALS AND METHODS All patients undergoing curative-intent PM between 2008 and 2018 were retrospectively analyzed. The impact of factors related to primary tumor, metastases, and associated therapy on overall survival (OS) was evaluated using univariable and multivariable Cox proportional hazard models. Cutoff values of continuous variables were determined by a receiver operating characteristic analysis. RESULTS In this study, 281 patients (178 male, median age 61 years) underwent PM. Two (0.7%) perioperative deaths and 23 (8.2%) major complications occurred. Median interval between the treatment of primary tumor and PM was 21 months. Median size of largest metastasis was 1.4 cm. After the median follow-up of 29 months, 134 patients (47.7%) had died. Five-year OS rate after first PM was 47.1%. Complete resection was achieved in 274 (97.5%) patients. Multivariable analysis identified genitourinary origin (hazard ratio [HR]: 0.30, 95% confidence interval [CI]: 0.15-0.60, p = 0.0008) as independent positive survival prognosticator; incomplete resection (HR: 3.53, 95% CI: 1.40-8.91, p = 0.0077) and age at PM of ≥66 years (HR: 1.97, 95% CI: 1.36-2.85, p = 0.0003) were negative prognosticators. CONCLUSION The use of PM as a part of multimodal treatment is in selected population justified. Our analysis identified age, primary tumor origin, and completeness of resection as independent survival prognosticators.
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Affiliation(s)
- Wojciech Dudek
- Department of Thoracic Surgery, University Hospital Erlangen, Erlangen, Germany.,Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Waldemar Schreiner
- Department of Thoracic Surgery, University Hospital Erlangen, Erlangen, Germany.,Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Mohamed Haj Khalaf
- Department of Thoracic Surgery, University Hospital Erlangen, Erlangen, Germany.,Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Horia Sirbu
- Department of Thoracic Surgery, University Hospital Erlangen, Erlangen, Germany.,Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Dudek W, AlMoussa E, Schreiner W, Mantsopoulos K, Sirbu H. Survival and Prognostic Analysis after Pulmonary Metastasectomy for Head and Neck Cancer. Thorac Cardiovasc Surg 2020; 69:666-671. [PMID: 32559809 DOI: 10.1055/s-0040-1713112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is no consensus on the value of pulmonary metastasectomy (PM) for head and neck cancer (HNC). The aim of our single-institution study was to evaluate outcomes and to examine factors influencing 5-year survival of patients undergoing resections for HNC lung metastases. METHODS All HNC patients undergoing curative-intent PM between January 2008 and December 2018 were retrospectively analyzed. The impact of factors related to primary tumor, metastases, and associated therapy on patient survival was evaluated using the univariable Cox proportional hazard model. Cutoff values of continuous variables were determined by a receiver operating characteristic analysis. RESULTS In total, 44 patients (32 males and 12 females, with a median age of 65 years) underwent PM for metastatic HNC. There was one perioperative death, and major complications occurred in 2 (4.5%) patients. The median interval between the treatment of primary tumor and PM was 19.4 months (range: 0-151 months). Median size of the largest resected pulmonary lesion was 1.3 cm (range: 0.3-6.9 cm). Mean follow-up was 21 months (range: 0-123 months), and 5-year overall survival (OS) rate after the first PM was 41%. Resection was complete (R0) in all patients. Larger size of pulmonary metastasis (≥1.4 cm; hazard ratio: 4.49; 95% confidence interval: 1.79-11.27) was a significantly negative prognostic factor. CONCLUSION Despite the lack of randomized controlled trials, PM for HNC is a reasonable therapeutic option with favorable survival in a selected population. In patients with larger pulmonary lesions, shorter OS after PM is to be expected.
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Affiliation(s)
- Wojciech Dudek
- Department of Thoracic Surgery, University Hospital Erlangen, Erlangen, Germany.,Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Emad AlMoussa
- Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Waldemar Schreiner
- Department of Thoracic Surgery, University Hospital Erlangen, Erlangen, Germany.,Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Horia Sirbu
- Department of Thoracic Surgery, University Hospital Erlangen, Erlangen, Germany.,Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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