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Singh R, Konrad A, Roubil JG, Jenkins J, Davis J, Austin Vargo J, Gogineni E, Sharma S. Improved local control following dose-escalated stereotactic ablative radiation therapy (SABR) for metastatic sarcomas: An international multi-institutional experience. Radiother Oncol 2024; 190:110020. [PMID: 38007042 DOI: 10.1016/j.radonc.2023.110020] [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: 08/07/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND We aimed to characterize local control (LC) and overall survival (OS) following stereotactic ablative radiation therapy (SABR) for extracranial sarcoma metastases. METHODS A prospectively-maintained institutional registry was queried for patients with metastases from sarcoma primaries managed with SABR. Kaplan-Meier analysis was utilized for univariate analyses to assess potential prognostic factors regarding LC and OS. A Cox proportional hazards multivariate (MVA) model was employed to further assess initially identified independent variables. RESULTS A total of 94 patients with 118 lesions with LC information were identified. Common metastatic sites treated were lung (77), non-spinal bone (15), and spine (10). The median biologically effective dose (BED4) was 175 Gy4 (range56.3 Gy4-360 Gy4) with a median dose/fractionation schedule of 50 Gy/5 fractions. One- and 2-year OS rates were 81.3 % (95 % CI: 71.2-88.1 %6) and 50.5 % (95 % CI: 38.6-61.3 %, respectively. On Cox MVA, advanced age and non-lung metastases were associated with inferior OS (p < 0.03) with patients with 0-2 of these risk factors having estimated 2-year OS of 65.1 %, 38.9 %, and N/A, respectively. One- and 2-year LC rates were 85.3 % (95 % CI: 77.7-90.9 %) and 78.2 % (95 % CI: 67.9-85.6 %), respectively. On MVA, only BED4 < 175 Gy was associated with inferior LC (hazard ratio (HR) = 3.33; p = 0.01). Ten of 118 treated lesions had treatment-related toxicities (all Grade 1-2). CONCLUSION Age and lung vs. non-lung metastases were prognostic of OS and should be considered in patient selection for SABR. Dose escalation when feasible with BED4 ≥ 175 Gy is recommended given durable LC achieved without a subsequent increase in toxicity.
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Affiliation(s)
- Raj Singh
- The Ohio State University Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, Department of Radiation Oncology, Columbus, OH, USA.
| | - Alec Konrad
- Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
| | - John G Roubil
- Viginia Commonwealth University Health System, Department of Radiation Oncology, Richmond, VA, USA
| | | | | | - John Austin Vargo
- University of Pittsburgh Hillman Cancer Center, Department of Radiation Oncology, Pittsburgh, PA, USA
| | - Emile Gogineni
- The Ohio State University Comprehensive Cancer Center, The James Cancer Hospital and Solove Research Institute, Department of Radiation Oncology, Columbus, OH, USA
| | - Sanjeev Sharma
- St. Mary's Medical Center, Department of Radiation Oncology, Huntington, WV, USA
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The oligometastatic spectrum in the era of improved detection and modern systemic therapy. Nat Rev Clin Oncol 2022; 19:585-599. [PMID: 35831494 DOI: 10.1038/s41571-022-00655-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 12/11/2022]
Abstract
Metastases remain the leading cause of cancer-related mortality. The oligometastasis hypothesis postulates that a spectrum of metastatic spread exists and that some patients with a limited burden of metastases can be cured with ablative therapy. Over the past decade, substantial advances in systemic therapies have resulted in considerable improvements in the outcomes of patients with metastatic cancers, warranting re-examination of the oligometastatic paradigm and the role of local ablative therapies within the context of the improved therapeutic responses, shifting patterns of disease recurrence and possible synergy with systemic treatments. Herein, we reframe the oligometastatic phenotype as a dynamic state for which locally ablative, metastasis-directed therapy improves clinical outcomes, including by prolonging survival and increasing cure rates. Important risk factors defining the metastatic spectrum are highlighted that inform both staging and therapy. Finally, we synthesize the literature on combining local therapies with modern systemic treatments, identifying general themes to optimally integrate ablative therapies in this context.
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Prognostic Factors of Pulmonary Metastasectomy for Soft Tissue Sarcomas Arising in the Trunk Wall and Extremities. Cancers (Basel) 2022; 14:cancers14143329. [PMID: 35884389 PMCID: PMC9322058 DOI: 10.3390/cancers14143329] [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: 06/01/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 02/01/2023] Open
Abstract
Although there is no evidence from prospective randomized controlled trials to support this practice, pulmonary metastases of sarcomas are often treated surgically if they are resectable. The purpose of this retrospective study was to evaluate the prognostic factors and outcome of pulmonary metastasectomy (PM) for soft tissue sarcomas (STSs) arising in the trunk wall and extremities in 66 consecutive patients. Prognostic factors associated with disease-specific survival after PM were evaluated using univariate and multivariate analyses. The patients included 38 men and 28 women, with a median age of 49 years. The median disease-specific survival after PM was 48 months, and the 5-year survival rate was 45%. No major perioperative complications occurred. Disease-free interval (<12 months), size of largest lung lesion (≥20 mm), and non-curative resection were independent prognostic factors in multivariate analysis. PM was effective in selected patients with pulmonary metastases from STSs arising in the trunk wall and extremities. Disease-free interval, maximum size of metastases, and resectability were identified as prognostic factors.
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Metastasectomy in Leiomyosarcoma: A Systematic Review and Pooled Survival Analysis. Cancers (Basel) 2022; 14:cancers14133055. [PMID: 35804827 PMCID: PMC9264936 DOI: 10.3390/cancers14133055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Leiomyosarcoma (LMS) is an aggressive soft tissue sarcoma with a poor prognosis. Approximately 40% of patients will develop metastatic disease. The optimal treatment for patients with metastatic LMS is not well established, and there are no randomized controlled trials regarding metastasectomy. This systematic review and pooled survival analysis aims to assess the survival in patients undergoing a metastasectomy for LMS and compare the outcomes based on the site of metastasectomy. We identified that patients with LMS metastases in the lungs, liver, spine, and brain can undergo metastasectomy with acceptable survival. Two studies have compared survival outcomes between patients treated and not treated with metastasectomy; despite their low quality, these studies support a survival benefit associated with metastasectomy. Abstract This study assesses the survival in patients undergoing metastasectomy for leiomyosarcoma (LMS) and compares the outcomes by the site of metastasectomy. We conducted a systematic review and pooled survival analysis of patients undergoing metastasectomy for LMS. Survival was compared between sites of metastasectomy. We identified 23 studies including 573 patients undergoing metastasectomy for LMS. The pooled median survival was 59.6 months (95% CI 33.3 to 66.0). The pooled median survival was longest for lung metastasectomy (72.8 months 95% CI 63.0 to 82.5), followed by liver (34.8 months 95% CI 22.3 to 47.2), spine (14.1 months 95% CI 8.6 to 19.7), and brain (14 months 95% CI 6.7 to 21.3). Two studies compared the survival outcomes between patients who did, versus who did not undergo metastasectomy; both demonstrated a significantly improved survival with metastasectomy. We conclude that surgery is currently being utilized for LMS metastases to the lung, liver, spine, and brain with acceptable survival. Although low quality, comparative studies support a survival benefit with metastasectomy. In the absence of randomized studies, it is impossible to determine whether the survival benefit associated with metastasectomy is due to careful patient selection rather than a surgical advantage; limited data were included about patient selection.
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Jacob LA, A. S, Ninutha S, Dasappa L, MC SB, KN L, AH R, LK R, Saldanha S. Soft Tissue Sarcomas with Special Reference to Molecular Aberration, Chemotherapy, and Recent Advances: A Review Article. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0041-1740324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractSoft tissue sarcomas (STS) are a diverse group of rare solid tumors of mesenchymal cell origin with distinct clinical and pathological features. They account for less than 1% of all adult malignancies and 15% of pediatric neoplasms. They include over hundreds of different histological subtypes. Many of these subtypes can occur at any age and are not confined to a specific site. Each subtype displays variable clinical behavior. Low incidence, variable presentation, behavior, and long-term outcomes further make it challenging to treat. There are multiple ongoing trials that focus on the anatomic site and histologic subtype to tailor the treatment. Further rarity of each histotype is a major barrier to recruit patients to randomized controlled trials. A multidisciplinary approach is mandatory in all cases of soft tissue sarcomas.The purpose of this review is to thoroughly understand the existing literature on history, incidence, epidemiology, etiology, histology, pathogenesis, diagnostic modalities, prognosis, management, and post treatment surveillance of STS. Uterine sarcomas, gastrointestinal stromal tumors (GIST), and pediatric sarcomas are not included here. It briefly highlights various molecular aberrations, changes in staging as per the American Joint Committee on Cancer (AJCC) 8, drugs that are used off-label in specific subtypes of sarcoma along with the recent advances. The classification of STS is undergoing continuous evolution. A wide variety of subtypes can only be diagnosed accurately with sophisticated molecular diagnostic tests and with the involvement of expert geneticists and pathologists to interpret it.There is no clarity on tailoring the treatment of STS to date. There is always a question on how best we can incorporate chemotherapy and radiotherapy along with surgery as a part of multimodality treatment. The heterogeneity of STS has hindered the development of robust, evidence-based treatment strategies, and our therapeutic approach is neither histology-specific nor widely standardized. Increased knowledge about sarcoma biology could help to discover new and more effective treatment strategies and help overcome the therapeutic challenge imposed by this deadly disease. Continued collaboration among various sarcoma centers globally will be of prime importance to optimize STS management. This will allow studies to be both sufficiently large and reasonably focused to generate evidence that is clinically meaningful in specific STS patient populations.
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Affiliation(s)
- Linu Abraham Jacob
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - Sreevalli A.
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - Shwetha Ninutha
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - Lokanatha Dasappa
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - Suresh Babu MC
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - Lokesh KN
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - Rudresha AH
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - Rajeev LK
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - Smitha Saldanha
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
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Volume Doubling Times of Pulmonary Metastases in Patients With Bone and Soft Tissue Sarcomas: Associations With Subsequent New Metastases and Survival After Metastasectomy. AJR Am J Roentgenol 2021; 218:624-632. [PMID: 34730372 DOI: 10.2214/ajr.21.26859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Pulmonary metastases of bone and soft tissue sarcoma are common and have a high recurrence rate after metastatectomy. Factors associated with post-metastatectomy recurrence are not well studied. Objective: To investigate the association of the volume doubling time (VDT) of pulmonary metastases with the subsequent development of new pulmonary nodules and survival after metastasectomy in patients with bone or soft tissue sarcoma. Methods: This retrospective study included patients with bone or soft tissue sarcoma who, between July 2020 and December 2020, underwent first complete metastasectomy of pulmonary nodules visualized on two sequential preoperative CT scans. Semi-automatic volumetric segmentation of the pulmonary metastases was performed on the two CT scans, and VDTs were calculated. VDT was compared between patients with and without subsequent new metastases after metastatectomy. Cox proportional hazards regression analyses were performed to determine risk factors for recurrence-free survival (RFS) after metastasectomy and for post-metastasectomy overall survival (OS). Results: Forty patients (21 women, 19 men; mean age, 51.1±14.3 years) were included. Of these patients, 23 (57.5%) developed new metastatic nodules after metastasectomy, and 10 (25%) died during follow-up. Median VDT was shorter in patients with, versus without, new metastases after metastasectomy (56 vs. 140 days, p=.002). Only four of 23 patients with new metastases had VDT ≥140 days. In multivariable analysis, older age [hazard ratio (HR), 1.06; p=.004), female sex (HR, 2.80; p=.03), and VDT <140 days (hazard ratio [HR], 4.22; p=.01) were independent predictors of worse RFS. Also in multivariable analysis, only older age (HR, 1.17; p=.005) and VDT <50 days (HR, 8.60; p=.02) were independent predictors of worse OS. OS was significantly worse in patients with VDT <140 days (10 deaths among 27 patients) than in patients with VDT ≥140 days (no deaths in 13 patients) (p=.01). Conclusions: In patients with bone and soft tissue sarcoma, shorter VDT of pulmonary metastases is independently associated with subsequent new metastases after metastasectomy and worse OS. Clinical Impact: VDT of pulmonary nodules may be considered in patient selection for pulmonary metastasectomy and in postoperative patient management.
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Gutiontov SI, Pitroda SP, Weichselbaum RR. Oligometastasis: Past, Present, Future. Int J Radiat Oncol Biol Phys 2021; 108:530-538. [PMID: 32976785 DOI: 10.1016/j.ijrobp.2020.02.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/05/2020] [Accepted: 02/09/2020] [Indexed: 01/12/2023]
Abstract
In this review, we discuss the oligometastatic state, with a focus on its current and future relevance within the field of radiation therapy. We first outline the scope of the problem and the evolving understanding of metastatic disease existing along a spectrum. We then transition to a discussion of the clinical data that led to the formulation of the oligometastatic hypothesis, delving in some detail into the clinical factors associated with improved outcomes in the setting of local therapy-whether surgical or radiotherapeutic. In particular, we highlight the marked limitations of using clinical criteria alone to determine the absence or presence of true extracranial oligometastatic disease. After this, we briefly discuss the radiation therapy literature that has recently demonstrated benefits in cancer-specific outcomes with ablative treatment of oligometastatic disease. We emphasize data in the setting of non-small cell lung cancer and prostate cancer and briefly discuss the importance of our enhanced ability to detect occult metastatic disease with improved imaging technologies. After noting that resulted and ongoing prospective trials of ablative radiation therapy use the most rudimentary of oligometastatic classifiers-number of metastases-as their inclusion criteria, we transition to our core argument: a growing body of preclinical and translational work aims to refine the definition of oligometastatic disease using molecular features. We address genomic, epigenetic, and immunologic features that have, across histology, demonstrated an improved ability to prognosticate when combined with classic clinical correlates of oligometastatic disease. We also discuss studies that suggest particular molecular targets which, when manipulated for therapeutic purposes, have the potential to revert the polymetastatic phenotype to the oligometastatic one. We conclude with what we believe are the repercussions of this work for radiation therapy trials and clinical practice, and the importance of enriching and supporting these inquiries for the future of our field.
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Affiliation(s)
- Stanley I Gutiontov
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Sean P Pitroda
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Ralph R Weichselbaum
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois.
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8
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Cytoreduction and the Optimization Of Immune Checkpoint Inhibition with Radiation Therapy. Int J Radiat Oncol Biol Phys 2021; 108:17-26. [PMID: 32819613 DOI: 10.1016/j.ijrobp.2019.12.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/10/2019] [Accepted: 12/24/2019] [Indexed: 12/29/2022]
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9
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Stamenovic D, Hohenberger P, Roessner E. Pulmonary metastasectomy in soft tissue sarcomas: a systematic review. J Thorac Dis 2021; 13:2649-2660. [PMID: 34012614 PMCID: PMC8107546 DOI: 10.21037/jtd-2019-pm-13] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Soft tissue sarcoma (STS) tend to metastasis to the lungs. Pulmonary metastasectomy seems to be a common practice always when plausible. The objective of this article was to review systematically the results of a literature search on pulmonary metastasectomy for STSs published in the last ten years and to offer a brief overview about the current practice as well. Methods Eight retrospective studies published in the period 2010–2020, which included patients with pulmonary metastases and metastasectomy were selected. Indication for surgery, survival rate and factors influencing survival were the primary outcomes, while further interesting findings in the studies were also collected and evaluated. Results Cumulative 1,004 patients participated in these studies. The most common histological types were leiomyosarcoma, malignant fibrous histiocytoma (MFH) and synovial sarcoma, being present together at 60% of the study population. Five-year survival was reported to be in the range from 20–58%, better survival going along with a fewer (preferably one) metastases, longer disease free interval (DFI) and R0 resection in most of the cases. Conclusions Complete resection of the metastatic lesions seems to be the most effective treatment for long-term survival, or even achieving cure in selected patients. At selection of the patients amenable for surgery, a high probability of R0 resection, as well as a disease free period of at least 12 months should perhaps bear a higher specific value.
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Affiliation(s)
- Davor Stamenovic
- Mainz University Thoracic Center, Thoracic Surgery and Pulmonary Medicine, Mainz, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center, Mannheim, Germany
| | - Eric Roessner
- Mainz University Thoracic Center, Thoracic Surgery and Pulmonary Medicine, Mainz, Germany
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10
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Tetta C, Carpenzano M, Algargoush ATJ, Algargoosh M, Londero F, Maessen JG, Gelsomino S. Non-surgical Treatments for Lung Metastases in Patients with Soft Tissue Sarcoma: Stereotactic Body Radiation Therapy (SBRT) and Radiofrequency Ablation (RFA). Curr Med Imaging 2021; 17:261-275. [PMID: 32819261 DOI: 10.2174/1573405616999200819165709] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radio-frequency ablation (RFA) and Stereotactic Body Radiation Therapy (SBRT) are two emerging therapies for lung metastases. INTRODUCTION Aliterature review was performed to evaluate the outcomes and complications of these procedures in patients with lung metastases from soft tissue sarcoma (STS). METHODS After selection, seven studies were included for each treatment encompassing a total of 424 patients: 218 in the SBRT group and 206 in the RFA group. RESULTS The mean age ranged from 47.9 to 64 years in the SBRT group and from 48 to 62.7 years in the RFA group. The most common histologic subtype was, in both groups, leiomyosarcoma. In the SBRT group, median overall survival ranged from 25.2 to 69 months and median disease- free interval was from 8.4 to 45 months. Two out of seven studies reported G3 and one G3 toxicity, respectively. In RFA patients, overall survival ranged from 15 to 50 months. The most frequent complication was pneumothorax. Local control showed a high percentage for both procedures. CONCLUSION SBRT is recommended in patients unsuitable to surgery, in synchronous bilateral pulmonary metastases, in case of deep lesions and patients receiving high-risk systemic therapies. RFA is indicated in case of a long disease-free interval, in oligometastatic disease, when only the lung is involved, in small size lesions far from large vessels. Further large randomized studies are necessary to establish whether these treatments may also represent a reliable alternative to surgery.
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Affiliation(s)
- Cecilia Tetta
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Carpenzano
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, Netherlands
| | - Areej T J Algargoush
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, Netherlands
| | - Marwah Algargoosh
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, Netherlands
| | - Francesco Londero
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jos G Maessen
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, Netherlands
| | - Sandro Gelsomino
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, Netherlands
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11
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Li GZ, Raut CP, Hunt KK, Feng M, Chugh R. Breast Sarcomas, Phyllodes Tumors, and Desmoid Tumors: Epidemiology, Diagnosis, Staging, and Histology-Specific Management Considerations. Am Soc Clin Oncol Educ Book 2021; 41:390-404. [PMID: 34010054 DOI: 10.1200/edbk_321341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Breast sarcomas arise from connective tissues of the breast and account for fewer than 1% of all breast malignancies. They can be subclassified as primary breast sarcomas, which arise de novo and are histologically diverse, and secondary breast sarcomas, which arise as a result of radiation or lymphedema and are most commonly angiosarcomas. Two other connective tissue neoplasms that occur within the breast include phyllodes tumors and desmoid tumors, which exhibit a spectrum of behaviors. Malignant phyllodes tumors are biologically similar to primary breast sarcomas, whereas desmoid tumors are technically benign but often locally aggressive. Patients with breast sarcomas often present with a rapidly growing mass or, in cases of radiation-associated angiosarcoma, violaceous cutaneous lesions. Core needle biopsy is generally required to confirm the diagnosis of sarcomas. Staging workup includes MRI and chest imaging, although these are not required in the case of benign phyllodes or desmoid tumors. In general, localized breast sarcomas should be resected, with the extent of resection tailored to histologic subtype. Radiation and chemotherapy can be used in the neoadjuvant or adjuvant setting, but data are limited, so treatment decisions should be made on an individualized basis. Systemic therapy options for metastatic disease and refractory breast desmoids mimic those used for the same histologies when present in other sites. Given the rarity and heterogeneity of breast sarcoma, as well as limited literature describing these entities, expert multidisciplinary evaluation is crucial for optimal decision making.
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Affiliation(s)
- George Z Li
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mary Feng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Rashmi Chugh
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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12
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Prognostic influence of the treatment approach for pulmonary metastasis in patients with soft tissue sarcoma. Clin Exp Metastasis 2020; 37:509-517. [PMID: 32436018 DOI: 10.1007/s10585-020-10038-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
Soft tissue sarcomas (STSs) are rare heterogeneous malignancies of mesenchymal origin. Pulmonary metastases develop in approximately 50% of the patients with high-grade STS, being the major cause of mortality in patients with metastatic STS. Pulmonary metastasectomy has been reported to contribute to long-term survival; however, an appropriate treatment has not been established. We aimed to identify factors associated with post-metastasis survival in STS patients with pulmonary metastasis and determine the appropriate treatment for each patient. We retrospectively reviewed the records of metastatic STS patients treated between 2000 and 2017 and analyzed the clinico-pathologic variables to identify factors associated with the survival. The median survival after pulmonary metastasis was 20.6 months, and the 1-, 3-, and 5-year survival rates were 68.6%, 36.0%, and 25.1%, respectively. The survival was significantly greater in patients who underwent pulmonary metastasectomy than in those without surgery (38.9 months vs. 10.5 months; p < 0.0001). Among those who did not undergo surgery, the survival was significantly greater in patients who received chemotherapy than in those without chemotherapy (19.1 months vs. 6.3 months, p = 0.037). Multivariate analysis identified pulmonary metastasectomy as the most important prognostic factor for post-metastasis survival (Hazard ratio 5.623; 95% Confidence Interval 2.733-11.572; p < 0.0001). In conclusion, pulmonary metastasectomy was the most important prognostic factor for post-metastasis survival in patients with metastatic STS. In addition, chemotherapy could prolong survival in patients who were not eligible for pulmonary resection. Although we should carefully weigh the risks and benefits, appropriate treatment for pulmonary metastases could contribute to long-time survival.
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Gamboa AC, Gronchi A, Cardona K. Soft-tissue sarcoma in adults: An update on the current state of histiotype-specific management in an era of personalized medicine. CA Cancer J Clin 2020; 70:200-229. [PMID: 32275330 DOI: 10.3322/caac.21605] [Citation(s) in RCA: 249] [Impact Index Per Article: 62.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 12/13/2022] Open
Abstract
Soft-tissue sarcomas (STS) are rare tumors that account for 1% of all adult malignancies, with over 100 different histologic subtypes occurring predominately in the trunk, extremity, and retroperitoneum. This low incidence is further complicated by their variable presentation, behavior, and long-term outcomes, which emphasize the importance of centralized care in specialized centers with a multidisciplinary team approach. In the last decade, there has been an effort to improve the quality of care for patients with STS based on anatomic site and histology, and multiple ongoing clinical trials are focusing on tailoring therapy to histologic subtype. This report summarizes the latest evidence guiding the histiotype-specific management of extremity/truncal and retroperitoneal STS with regard to surgery, radiation, and chemotherapy.
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Affiliation(s)
- Adriana C Gamboa
- Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, Georgia
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Kenneth Cardona
- Division of Surgical Oncology, Winship Cancer Institute, Emory University Hospital Midtown, Atlanta, Georgia
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14
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Onderdonk BE, Gutiontov SI, Chmura SJ. The Evolution (and Future) of Stereotactic Body Radiotherapy in the Treatment of Oligometastatic Disease. Hematol Oncol Clin North Am 2020; 34:307-320. [DOI: 10.1016/j.hoc.2019.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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15
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Management of metastatic retroperitoneal sarcoma: a consensus approach from the Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG). Ann Oncol 2019; 29:857-871. [PMID: 29432564 DOI: 10.1093/annonc/mdy052] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction Retroperitoneal sarcoma (RPS) is a rare disease accounting for 0.1%-0.2% of all malignancies. Management of RPS is complex and requires multidisciplinary, tailored treatment strategies at all stages, but especially in the context of metastatic or multifocal recurrent disease. Due to the rarity and heterogeneity of this family of diseases, the literature to guide management is limited. Methods The Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG) is an international collaboration of sarcoma experts from all disciplines convened in an effort to overcome these limitations. The TARPSWG has compiled the available evidence surrounding metastatic and multifocally recurrent RPS along with expert opinion in an iterative process to generate a consensus document regarding the complex management of this disease. The objective of this document is to guide sarcoma specialists from all disciplines in the diagnosis and treatment of multifocal recurrent or metastatic RPS. Results All aspects of patient assessment, diagnostic processes, local and systemic treatments, and palliation are reviewed in this document, and consensus recommendations provided accordingly. Recommendations were guided by available evidence, in conjunction with expert opinion where evidence was lacking. Conclusions This consensus document combines the available literature regarding the management of multifocally recurrent or metastastic RPS with the practical expertise of high-volume sarcoma centers from multiple countries. It is designed as a tool for decision making in the complex multidisciplinary management of this condition and is expected to standardize management across centers, thereby ensuring that patients receive the highest quality care.
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Lung Surveillance Strategy for High-Grade Soft Tissue Sarcomas: Chest X-Ray or CT Scan? J Am Coll Surg 2019; 229:449-457. [PMID: 31377411 DOI: 10.1016/j.jamcollsurg.2019.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Given the propensity for lung metastases, National Comprehensive Cancer Network guidelines recommend lung surveillance with either chest x-ray (CXR) or CT in high-grade soft tissue sarcoma. Considering survival, diagnostic sensitivity, and cost, the optimal modality is unknown. METHODS The US Sarcoma Collaborative database (2000 to 2016) was reviewed for patients who underwent resection of a primary high-grade soft tissue sarcoma. Primary end point was overall survival (OS). Cost analysis was performed. RESULTS Among 909 patients, 83% had truncal/extremity and 17% had retroperitoneal tumors. Recurrence occurred in 48%, of which 54% were lung metastases. Lung surveillance was performed with CT in 80% and CXR in 20%. Both groups were clinically similar, although CT patients had more retroperitoneal tumors and recurrences. Regardless of modality, 85% to 90% of lung metastases were detected within the first 2 years with a similar re-intervention rate. When considering age, tumor size, location, margin status, and receipt of radiation, lung metastasis was independently associated with worse OS (hazard ratio 4.26; p < 0.01) and imaging modality was not (hazard ratio 1.01; p = 0.97). Chest x-ray patients did not have an inferior 5-year OS rate compared with CT (71% vs 60%; p < 0.01). When analyzing patients in whom no lung metastases were detected, both cohorts had a similar 5-year OS rate (73% vs 74%; p = 0.42), suggesting CXR was not missing clinically relevant lung nodules. When adhering to a guideline-specified protocol for 2018 projected 4,406 cases, surveillance with CXR for 5 years results in savings of $5 million to $8 million/year to the US healthcare system. CONCLUSIONS In this large multicenter study, lung surveillance with CXR did not result in worse overall survival compared with CT. With considerable savings, a CXR-based protocol can optimize resource use for lung surveillance in high-grade soft tissue sarcoma; prospective trials are needed.
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Andreeva-Gateva P, Chakar S. The place of trabectedin in the treatment of soft tissue sarcoma: an umbrella review of the level one evidence. Expert Opin Orphan Drugs 2019. [DOI: 10.1080/21678707.2019.1589449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Pavlina Andreeva-Gateva
- Department of Pharmacology and Toxicology, Medical University of Sofia, Sofia, Bulgaria
- Department of Pharmacology, Sofia University, Sofia, Bulgaria
| | - Shenol Chakar
- Department of Pharmacology, Sofia University, Sofia, Bulgaria
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Yamamoto Y, Kanzaki R, Kanou T, Ose N, Funaki S, Shintani Y, Minami M, Outani H, Takenaka S, Hamada K, Yoshikawa H, Okumura M. Long-term outcomes and prognostic factors of pulmonary metastasectomy for osteosarcoma and soft tissue sarcoma. Int J Clin Oncol 2019; 24:863-870. [DOI: 10.1007/s10147-019-01422-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/21/2019] [Indexed: 02/02/2023]
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Abstract
OPINION STATEMENT Soft tissue sarcomas are rare cancers with an expected incidence of about 14,000 new cases in 2018, and account for less than 1% of all cancers. It includes in excess of 75 heterogeneous subtypes with varying biology, molecular aberrations, and variable response to treatment. Because of the rarity of these tumors and the many different subtypes, there is no large-scale data to guide treatment, and hence the need for a multidisciplinary individualized approach to treatment, preferably at a high-volume tertiary referral center. For localized disease, surgery with or without radiation is the preferred treatment. In metastatic disease, the longest track record is with use of anthracyclines, either alone or in combination with ifosfamide, but the median overall survival even with combination was just over a year. There have been recent advances in understanding the heterogeneity of these tumors and the need for an individualized approach. With that new knowledge, recent approvals of trabectedin, eribulin, and pazopanib have been limited to some select histologic subtypes with improved outcomes. More recently, immunotherapy has been tested in select histotypes of sarcoma with encouraging activity and has led to further evaluation in combination with immunotherapeutic agents, as well as with chemotherapy and radiation treatments. Here, in this article, we summarize the data of the currently approved therapies in metastatic soft tissue sarcoma, with the principal focus on first-line therapies. We also review the recent encouraging data with PDGFR-targeted antibody (olaratumab) with doxorubicin which showed an impressive improvement in overall survival in phase II study. Molecular characterization of sarcoma subtypes will likely improve understanding of these very diverse tumors and improve target characterization. The ongoing efforts in better understanding these rare tumors hold the key to make a difference in the outcome of these patients.
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Affiliation(s)
- Megan Meyer
- Internal Medicine, Mayo Clinic, 5777 E Mayo Blvd., Phoenix, AZ, 85054, USA
| | - Mahesh Seetharam
- Hematology and Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, 85054, USA.
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20
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Survival Outcome and Prognostic Factors After Pulmonary Metastasectomy in Sarcoma Patients. Am J Clin Oncol 2019; 42:6-11. [DOI: 10.1097/coc.0000000000000476] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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21
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Grilley-Olson JE, Webber NP, Demos DS, Christensen JD, Kirsch DG. Multidisciplinary Management of Oligometastatic Soft Tissue Sarcoma. Am Soc Clin Oncol Educ Book 2018; 38:939-948. [PMID: 30231386 DOI: 10.1200/edbk_200573] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Soft tissue sarcomas (STS) encompass a group of rare but heterogeneous diseases. Nevertheless, many patients, particularly those with oligometastatic disease can benefit from thoughtful multimodality evaluation and treatment regardless of the STS subtype. Here, we review surgical, interventional radiology, radiation, and chemotherapy approaches to maximize disease palliation and improve survival, including occasionally long-term disease-free survival. Surgical resection can include lung or other visceral, soft tissue and bone metastases with a goal of rendering the patient disease free. Staged resections can be appropriate, and serial resection of oligometastatic recurrent disease can be appropriate. Retrospective series suggest survival benefit from this approach, although selection bias may contribute. Interventional radiology techniques such as percutaneous thermal ablation (PTA) and arterial embolization can present nonoperative local approaches in patients who are not medically fit for surgery, surgery is too morbid, or patients who decline surgery. Similarly, radiation therapy can be delivered safely to areas that are inaccessible surgically or would result in excessive morbidity. Currently no randomized trials exist comparing interventional radiologic approaches or radiation therapy to surgery but retrospective reviews show relatively similar magnitude of benefit in terms of disease palliation and survival, although it is felt unlikely that these procedures will render a patient to long-term disease-free status. Chemotherapy has evolved recently with the addition of several new treatment options, briefly reviewed here. Importantly, if a patient sustains a good response to chemotherapy resulting in true oligometastatic disease, consideration of multimodality local therapy approaches can be considered in the appropriate patient.
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Affiliation(s)
- Juneko E Grilley-Olson
- From the Department of Medicine, Division of Hematology-Oncology, UNC Lineberger Cancer Center, The University of North Carolina, Chapel Hill, NC; Orthopaedic Oncology at Aurora Cancer Care, Orthopaedic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, Aurora Healthcare, Milwaukee, WI; Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
| | - Nicholas P Webber
- From the Department of Medicine, Division of Hematology-Oncology, UNC Lineberger Cancer Center, The University of North Carolina, Chapel Hill, NC; Orthopaedic Oncology at Aurora Cancer Care, Orthopaedic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, Aurora Healthcare, Milwaukee, WI; Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
| | - David S Demos
- From the Department of Medicine, Division of Hematology-Oncology, UNC Lineberger Cancer Center, The University of North Carolina, Chapel Hill, NC; Orthopaedic Oncology at Aurora Cancer Care, Orthopaedic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, Aurora Healthcare, Milwaukee, WI; Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
| | - Jared D Christensen
- From the Department of Medicine, Division of Hematology-Oncology, UNC Lineberger Cancer Center, The University of North Carolina, Chapel Hill, NC; Orthopaedic Oncology at Aurora Cancer Care, Orthopaedic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, Aurora Healthcare, Milwaukee, WI; Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
| | - David G Kirsch
- From the Department of Medicine, Division of Hematology-Oncology, UNC Lineberger Cancer Center, The University of North Carolina, Chapel Hill, NC; Orthopaedic Oncology at Aurora Cancer Care, Orthopaedic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, Aurora Healthcare, Milwaukee, WI; Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
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Vos M, Ho VKY, Oosten AW, Verhoef C, Sleijfer S. Minimal Increase in Survival Throughout the Years in Patients with Soft Tissue Sarcoma with Synchronous Metastases: Results of a Population-Based Study. Oncologist 2018; 24:e526-e535. [PMID: 30190301 DOI: 10.1634/theoncologist.2017-0383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 07/24/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Treatment options for patients with metastatic soft tissue sarcoma (STS) have increased in the last decade. We aimed to examine whether this is associated with improved overall survival (OS) in patients with STS with synchronous metastases. PATIENTS AND METHODS Patients diagnosed with STS and synchronous metastases from 1989 to 2014 were queried from The Netherlands Cancer Registry. Trends in OS were assessed by the Kaplan-Meier method and log-rank test in time intervals of 5 years, for the whole study population and in subgroups for liposarcomas, leiomyosarcoma, and other STS subtypes. A multivariable Cox regression analysis was performed to identify characteristics prognostic for OS. RESULTS Median OS of the 1,393 identified patients did not improve significantly over the years from 5.8 months in 1989-1994 to 8.1 months in 2010-2014, but there was an evident trend. Median OS was prolonged in the subgroups of liposarcomas (3.6 to 9.3 months), leiomyosarcomas (11.3 to 14.6 months), and other STS subtypes (5.7 to 6.3 months), although there were no significant improvements in OS over the years. Primary tumor site in one of the extremities and surgery in an academic center had a favorable effect on OS, whereas significant negative predictors were no treatment, elderly age, STS subtype other than liposarcoma or leiomyosarcoma, high or unknown grade, and nodal involvement. CONCLUSION Although overall survival of patients with STS with synchronous metastases in this nationwide and "real-life" population has improved over the years, the improvement was not statistically significant, despite new treatment options. IMPLICATIONS FOR PRACTICE Treatment of patients with metastatic soft tissue sarcoma (STS) has changed in the past years, with new drugs such as trabectedin (2007) and pazopanib (2012) becoming available. By using data from the nationwide Netherlands Cancer Registry, the impact of these changes in treatment policies on survival is analyzed in a "real-life" population of patients with STS with synchronous metastases, rather than in a strictly selected trial population. Unfortunately, overall survival improved only minimally and not significantly for these patients diagnosed from 1989 to 2014. Hopefully, the advent of novel treatment options, such as eribulin and olaratumab, will further improve the outcome of this patient group.
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Affiliation(s)
- Melissa Vos
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Vincent K Y Ho
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Astrid W Oosten
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Stefan Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Pontes AK, Botelho Filho FM, Miranda ME, Rodrigues KEDS, Campos BA, Cruzeiro PCF, Picarro C, Tatsuo ES, Marinho DRT, Lazaroni TLDN, Viana RFR, Paixão RDM. Pulmonary metastases in children: are we operating unnecessarily? ACTA ACUST UNITED AC 2018; 45:e1129. [PMID: 30020321 DOI: 10.1590/0100-6991e-20181129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/14/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE to determine, in pediatric patients with malignant neoplasms, the characteristics of pulmonary nodules identified on computed tomography, as well as the possibility of differentiating benign lesions from metastases. METHODS we conducted a retrospective study of patients submitted to pulmonary resections of nodules diagnosed as metastases in a period of seven years. We compared computed tomography and surgery findings, as well as results of anatomopathological examinations. RESULTS we studied nine patients submitted to 11 surgical interventions. Among the studied variables, only nodule size greater than 12.5mm proved to be statistically significant to predict malignancy. CONCLUSION among the tomographic characteristics of pulmonary nodules in children with malignant neoplasms, only the size of the lesion was a predictor of malignancy.
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Affiliation(s)
- Andrey Kaliff Pontes
- Universidade Federal de Minas Gerais, Cirurgia Pediátrica, Belo Horizonte, Minas Gerais, Brasil
| | | | - Marcelo Eller Miranda
- Universidade Federal de Minas Gerais, Cirurgia Pediátrica, Belo Horizonte, Minas Gerais, Brasil
| | | | - Bernardo Almeida Campos
- Universidade Federal de Minas Gerais, Cirurgia Pediátrica, Belo Horizonte, Minas Gerais, Brasil
| | | | - Clecio Picarro
- Universidade Federal de Minas Gerais, Cirurgia Pediátrica, Belo Horizonte, Minas Gerais, Brasil
| | - Edson Samesima Tatsuo
- Universidade Federal de Minas Gerais, Cirurgia Pediátrica, Belo Horizonte, Minas Gerais, Brasil
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Smolle MA, van Praag VM, Posch F, Bergovec M, Leitner L, Friesenbichler J, Heregger R, Riedl JM, Pichler M, Gerger A, Szkandera J, Stöger H, Smolle-Jüttner FM, Liegl-Atzwanger B, Fiocco M, van de Sande MA, Leithner A. Surgery for metachronous metastasis of soft tissue sarcoma - A magnitude of benefit analysis using propensity score methods. Eur J Surg Oncol 2018; 45:242-248. [PMID: 30031674 DOI: 10.1016/j.ejso.2018.06.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/14/2018] [Accepted: 06/20/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Metastasectomy is hypothesised to improve OS in metastatic STS, but evidence in favour of this approach derives from non-controlled single-arm cohorts affected by selection bias. The objective was to quantify the effect of metastasectomy vs. non-surgical management on overall survival (OS) in patients with metachronous metastases from extremity- and trunk soft tissue sarcoma (STS). MATERIALS AND METHODS From a population of 1578 STS patients, 135 patients who underwent surgery for localised STS at two European centres between 1998 and 2015 and developed metachronous STS metastases were included. Propensity score analyses with inverse-probability-of-treatment-weights (IPTW) and landmark analyses were performed to control for selection and immortal time bias, respectively. RESULTS OS was significantly longer in the 68 patients undergoing metastasectomy than in the 67 patients who were treated non-invasively for their metastasis (10-year OS: 23% vs. 4%; hazard ratio (HR) = 0.34, 95% CI: 0.22-0.53, p < 0.0001). This association prevailed after IPTW-weighting of the data to control for the higher prevalence of favourable prognostic factors in the surgery group (adjusted 10-year OS: 17% vs. 3%, log-rank p < 0.0001; HR = 0.33, 95% CI: 0.20-0.52, p < 0.0001). Five-year OS estimates were 27.8% in patients who had and 14.5% in patients who had not undergone metastasectomy within the first 3 months after diagnosis of a metastasis (p < 0.0001). CONCLUSION In this observational bi-centre study, metastasectomy was associated with prolonged survival in patients with metachronous STS metastases. In the absence of randomized studies, our results indicate that metastasectomy should be considered as an important treatment option for metachronous STS metastases.
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Affiliation(s)
- Maria A Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria; Comprehensive Cancer Centre Graz, Graz, Austria.
| | - Veroniek M van Praag
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Florian Posch
- Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Marko Bergovec
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria; Comprehensive Cancer Centre Graz, Graz, Austria.
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria; Comprehensive Cancer Centre Graz, Graz, Austria.
| | - Jörg Friesenbichler
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria; Comprehensive Cancer Centre Graz, Graz, Austria.
| | - Ronald Heregger
- Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Jakob M Riedl
- Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Martin Pichler
- Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria; Department of Experimental Therapeutics, The UT MD Anderson Cancer Center, Sout Campus Research Building 4, 1901 East Road, Houston, TX, USA.
| | - Armin Gerger
- Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Joanna Szkandera
- Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Herbert Stöger
- Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Freyja-Maria Smolle-Jüttner
- Comprehensive Cancer Centre Graz, Graz, Austria; Division of Thoracic and Hyperbaric Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Austria.
| | - Bernadette Liegl-Atzwanger
- Comprehensive Cancer Centre Graz, Graz, Austria; Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, 8036, Graz, Austria.
| | - Marta Fiocco
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands; Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands; Mathematical Institute Leiden University, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Michiel Aj van de Sande
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria; Comprehensive Cancer Centre Graz, Graz, Austria.
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Lindner LH, Litière S, Sleijfer S, Benson C, Italiano A, Kasper B, Messiou C, Gelderblom H, Wardelmann E, Le Cesne A, Blay JY, Marreaud S, Hindi N, Desar IME, Gronchi A, van der Graaf WTA. Prognostic factors for soft tissue sarcoma patients with lung metastases only who are receiving first-line chemotherapy: An exploratory, retrospective analysis of the European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group (EORTC-STBSG). Int J Cancer 2018; 142:2610-2620. [PMID: 29383713 PMCID: PMC5947111 DOI: 10.1002/ijc.31286] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 12/31/2017] [Accepted: 01/18/2018] [Indexed: 01/16/2023]
Abstract
The prognosis of adult soft tissue sarcoma (STS) patients with metastases is generally poor. As little is known about the impact of the involvement of different metastatic sites and the extent of pulmonary lesions on the outcome for patients receiving first‐line chemotherapy, we aimed to establish prognostic factors for STS patients with lung metastases only. A retrospective, exploratory analysis was performed on 2,913 metastatic STS patients who received first‐line chemotherapy. Detailed information from 580 patients who had lung metastases only, was used for prognostic factor analysis. Patients with lung metastases only were more often asymptomatic and had undergone complete primary tumor resection more frequently compared to patients with additional metastases outside the lung or without lung metastases. For extremity STS, the incidence of lung metastases only was much higher compared to non‐extremity STS. Lung involvement only was an independent favorable prognostic factor for overall survival (OS) with regard to metastatic site. Within this subgroup, in a multivariate model, other factors associated with improved OS included: good performance status (PS), no progression at primary site, low histological grade, younger age, long interval between initial diagnosis and trial registration, and smaller diameter of the largest lung lesion. This unique analysis on prognostic factors in STS patients with lung metastases confirms well‐known patient factors (such as age and PS), and tumor characteristics (including tumor grade, interval between primary diagnosis, and metastases), but also identifies diameter of the largest lung lesion as a new prognostic factor. Knowledge about these factors may support decision‐making within multidisciplinary tumor boards. What's new? About 25% of soft tissue sarcoma patients develop lung metastases but prognostic factors for those who cannot get operated remain scarce. Here the authors performed a retrospective study of datasets obtained from 580 patients where metastases have not spread beyond the lung and who received first‐line chemotherapy but no resection. Interestingly, the largest diameter of a lung lesion emerged as a new prognostic factor, a finding, which may influence clinical decisions in the future.
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Affiliation(s)
- Lars H Lindner
- Klinikum der Universität München, Interdisciplinary Tumor Center (CCC LMU), Sarcoma Unit (SarKUM), Marchioninistr. 15, München, D-81377, Germany
| | - Saskia Litière
- European Organisation for Research and Treatment of Cancer (EORTC) Data Centre, Avenue Mounier 83/11, Brussels, B-1200, Belgium
| | - Stefan Sleijfer
- Erasmus MC Cancer Institute, Groene Hilledijk 301, Rotterdam, EA, 3075, The Netherlands
| | - Charlotte Benson
- The Sarcoma Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, United Kingdom
| | - Antoine Italiano
- Department of Medical Oncology, 229 cours de l'Argonne, Institut Bergonie, Bordeaux Cedex, 33076, France
| | - Bernd Kasper
- University of Heidelberg, Mannheim University Medical Center, Interdisciplinary Tumor Center, Sarcoma Unit, Theodor-Kutzer-Ufer 1-3, Mannheim, D-68167, Germany
| | - Christina Messiou
- The Sarcoma Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, United Kingdom
| | - Hans Gelderblom
- Department of Clinical Oncology, Leiden University Medical Centre, Albinusdreef 2, Leiden, ZA, 2333, The Netherlands
| | - Eva Wardelmann
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Münster, 48149, Germany
| | | | - Jean-Yves Blay
- Department of Medicine, NetSARC and LYRIC, Centre Leon Berard, Lyon, France
| | - Sandrine Marreaud
- European Organisation for Research and Treatment of Cancer (EORTC) Data Centre, Avenue Mounier 83/11, Brussels, B-1200, Belgium
| | - Nadia Hindi
- Department of Medical Oncology, University Hospital Virgen del Rocio and Biomedicine Research Institute (IBIS), Sevilla, Spain
| | | | - Alessandro Gronchi
- Department of Surgery-Sarcoma Service, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20133, Italy
| | - Winette T A van der Graaf
- The Sarcoma Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, United Kingdom.,Division of Clinical Studies, Institute of Cancer Research, Sutton, United Kingdom
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López-Pousa A, Martin Broto J, Martinez Trufero J, Sevilla I, Valverde C, Alvarez R, Carrasco Alvarez JA, Cruz Jurado J, Hindi N, Garcia Del Muro X. SEOM Clinical Guideline of management of soft-tissue sarcoma (2016). Clin Transl Oncol 2017; 18:1213-1220. [PMID: 27905051 PMCID: PMC5138243 DOI: 10.1007/s12094-016-1574-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Soft-tissue sarcomas are uncommon and heterogeneous tumors of mesenchymal origin. A soft-tissue mass that is increasing in size, greater than 5 cm, or located under deep fascia are criteria for suspicion of sarcoma. Diagnosis, treatment, and management should preferably be performed by a multidisciplinary team in reference centers. MRI and lung CT scan are mandatory for local and distant assessment. A biopsy indicating histological type and grade is needed previous to the treatment. Wide surgical resection with tumor-free tissue margin is the primary treatment for localized disease. Radiotherapy is indicated in large, deep, high-grade tumors, or after marginal resection not likely of being improved with reexcision. Neoadjuvant and adjuvant chemotherapy improve survival in selected cases, usually in high-grade sarcomas of the extremities. In the case of metastatic disease, patients with exclusive lung metastasis could be considered for surgery. First-line treatment with anthracyclines (or in combination with ifosfamide) is the treatment of choice. New drugs have shown activity in second-line therapy and in specific histological subtypes.
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Affiliation(s)
- A López-Pousa
- Servicio de Oncología Médica, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain.
| | | | | | - I Sevilla
- Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | | | - R Alvarez
- Hospital Universitario Gregorio Marañon, Madrid, Spain
| | | | | | - N Hindi
- Hospital Virgen del Rocio, Seville, Spain
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Garcia del Muro X, de Alava E, Artigas V, Bague S, Braña A, Cubedo R, Cruz J, Mulet-Margalef N, Narvaez JA, Martinez Tirado O, Valverde C, Verges R, Viñals J, Martin-Broto J. Clinical practice guidelines for the diagnosis and treatment of patients with soft tissue sarcoma by the Spanish group for research in sarcomas (GEIS). Cancer Chemother Pharmacol 2015; 77:133-46. [PMID: 26563256 PMCID: PMC4706580 DOI: 10.1007/s00280-015-2809-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/12/2015] [Indexed: 01/24/2023]
Abstract
Soft tissue sarcomas (STS) constitute an uncommon and heterogeneous group of tumours, which require a complex and specialized multidisciplinary management. The diagnostic approach should include imaging studies and core needle biopsy performed prior to undertaking surgery. Wide excision is the mainstay of treatment for localized sarcoma, and associated preoperative or postoperative radiotherapy should be administered in high-risk patients. Adjuvant chemotherapy was associated with a modest improvement in survival in a meta-analysis and constitutes a standard option in selected patients with high-risk STS. In metastatic patients, surgery must be evaluated in selected cases. In the rest of patients, chemotherapy and, in some subtypes, targeted therapy often used in a sequential strategy constitutes the treatment of election. Despite important advances in the understanding of the pathophysiology of the disease, the advances achieved in therapeutic results may be deemed still insufficient. Moreover, due to the rarity and complexity of the disease, the results in clinical practice are not always optimal. For this reason, the Spanish Group for Research on Sarcoma (GEIS) has developed a multidisciplinary clinical practice guidelines document, with the aim of facilitating the diagnosis and treatment of these patients in Spain. In the document, each practical recommendation is accompanied by level of evidence and grade of recommendation on the basis of the available data.
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Affiliation(s)
| | | | | | - Silvia Bague
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Josefina Cruz
- Hospital Universitario de Canarias, Santa Cruz De Tenerife, Spain
| | | | | | | | | | - Ramona Verges
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Joan Viñals
- Hospital Universitario de Bellvitge, Barcelona, Spain
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Outcomes and clinical predictors of improved survival in a patients undergoing pulmonary metastasectomy for sarcoma. J Surg Oncol 2015; 112:103-6. [DOI: 10.1002/jso.23961] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 06/08/2015] [Indexed: 12/18/2022]
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Lester-Coll NH, Decker RH. The role of stereotactic body radiation therapy in the management of oligometastatic lung cancer. Lung Cancer Manag 2015. [DOI: 10.2217/lmt.15.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A growing body of evidence has surfaced over the past 20 years that supports the use of surgery for metastasis limited in number termed ‘oligometastases’. Local therapy for oligometastases results in long progression free survival in the absence of systemic therapy, including non-small-cell lung cancer (NSCLC). Stereotactic body radiation therapy (SBRT) allows for the delivery of anatomically precise, ablative doses of radiation therapy able to achieve local control rates of approximately 80% with minimal toxicity. In NSCLC, SBRT is emerging as an effective therapy in the management of sites resistant to targeted therapy. This review summarizes the published evidence for the use of local therapy in the management of oligometsatic cancer, with a focus on SBRT and NSCLC.
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Affiliation(s)
- Nataniel H Lester-Coll
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Roy H Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06510, USA
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Treating metastatic sarcomas locally: A paradoxe, a rationale, an evidence? Crit Rev Oncol Hematol 2015; 95:62-77. [DOI: 10.1016/j.critrevonc.2015.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/28/2014] [Accepted: 01/06/2015] [Indexed: 01/04/2023] Open
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Damery S, Biswas M, Billingham L, Barton P, Al-Janabi H, Grimer R. Patient preferences for clinical follow-up after primary treatment for soft tissue sarcoma: a cross-sectional survey and discrete choice experiment. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2014; 40:1655-61. [PMID: 25108811 DOI: 10.1016/j.ejso.2014.04.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 04/15/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients treated for soft tissue sarcoma (STS) require long-term follow-up to detect recurrent or metastatic disease, yet marked differences exist in clinical approaches to the length of follow-up, frequency of consultations and investigations undertaken at follow-up visits. There has been no published work assessing patient expectations or the acceptability of post-treatment follow-up strategies. This study aimed to assess the patient acceptability of different follow-up strategies following curative surgery for soft tissue sarcoma and to investigate the hypothetical levels of recurrence risk at which different follow-up regimes were acceptable. METHODS Patients were recruited from the Royal Orthopaedic Hospital in Birmingham. The study used a cross-sectional survey incorporating a best-worst scaling discrete choice experiment to assess patient preferences regarding different aspects of follow-up. RESULTS 132 patients participated (47% response). The nature of investigations undertaken during follow-up was the most important aspect of post-surgical care. Patients typically preferred appointments routinely consisting of clinical examination and chest X-ray, and for follow-up to remain in secondary care rather than general practice. CONCLUSION Clear protocols for STS patient follow-up can improve consistency and equity of care. In determining the optimum follow-up plan for STS patients from the patient perspective, this study provides valuable information that should be considered alongside the clinical effectiveness of follow-up strategies to maximise patient outcomes and use NHS resources appropriately.
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Affiliation(s)
- S Damery
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Edgbaston, West Midlands B15 2TT, United Kingdom.
| | - M Biswas
- Cancer Research UK Clinical Trials Unit and MRC Midland Hub for Trials Methodology Research, University of Birmingham, Edgbaston, West Midlands B15 2TT, United Kingdom.
| | - L Billingham
- Cancer Research UK Clinical Trials Unit and MRC Midland Hub for Trials Methodology Research, University of Birmingham, Edgbaston, West Midlands B15 2TT, United Kingdom.
| | - P Barton
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Edgbaston, West Midlands B15 2TT, United Kingdom.
| | - H Al-Janabi
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Edgbaston, West Midlands B15 2TT, United Kingdom.
| | - R Grimer
- Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham B31 2AP, United Kingdom.
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Huang F, Wu G, Yang K. Oligometastasis and oligo-recurrence: more than a mirage. Radiat Oncol 2014; 9:230. [PMID: 25359216 PMCID: PMC4222373 DOI: 10.1186/s13014-014-0230-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 10/04/2014] [Indexed: 12/22/2022] Open
Abstract
The standard treatment choice for cancer metastasis has been systemic management, including cytotoxic chemotherapy, hormonal manipulation, and targeted therapy. Emerging evidence has shown an oligometastatic state, an intermediate state between limited primary cancer and polymetastatic cancer, in which local therapy for metastatic lesions results in satisfactory survival comparable to non-metastatic disease. We provide a comprehensive introduction of evidence from experimental and clinical studies in favor of the oligometastatic phenotype, we review the efficacy and safety of surgery and stereotactic body radiotherapy in the treatment of oligometastases, and finally, we discuss the way to differentiate the oligometastatic state from polymetastasis.
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Affiliation(s)
- Fang Huang
- Wuhan Union Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
| | - Gang Wu
- Wuhan Union Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
| | - Kunyu Yang
- Wuhan Union Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
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Ohnstad HO, Bruland OS, Taksdal I, Bjerkehagen B, Nenadovic M, Sæter G, Jørgensen LH, Hall KS. Response to preoperative chemotherapy in patients undergoing resection of pulmonary metastasis from soft tissue sarcoma - a predictor of outcome? Acta Oncol 2014; 53:1180-7. [PMID: 24697744 DOI: 10.3109/0284186x.2014.899433] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Approximately 50% of patients with high-grade soft tissue sarcoma (STS) will develop pulmonary metastasis. This is the most frequent cause of death and improving treatment is warranted. Preoperative chemotherapy is used for selected patients, usually those with less favorable prognosis and mainly outside clinical trials. The predicted value of histological and radiological response to preoperative chemotherapy on outcome was the main focus for this investigation. PATIENTS AND METHODS This retrospective study comprises 93 patients with metachronous lung metastasis from STS who underwent complete metastasectomy alone (n = 41) or metastasectomy following preoperative chemotherapy (n = 52). Clinical data, histological and radiological responses to chemotherapy were recorded and survival analyses performed. RESULTS The time from initial STS diagnosis to the appearance of metastasis was shorter in the preoperative chemotherapy group than in those treated with surgery alone (p = 0.02). However, no statistical differences in post-metastasis disease-specific survival (DSS) or progression-free survival (PFS) between the groups were demonstrated. Patients in the preoperative chemotherapy group with good (complete) histological response had improved PFS compared with poor responders (p = 0.04). Radiological partial response was an independent, favorable prognostic factor for improved PFS and DSS (p = 0.003). CONCLUSION Despite having unfavorable disease characteristics, some patients may benefit from preoperative chemotherapy. Both histological and radiological responses to preoperative chemotherapy seem to be prognostic in STS patients undergoing complete pulmonary metastasectomy.
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Affiliation(s)
- Hege O Ohnstad
- Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital , Oslo , Norway
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Reza J, Sammann A, Jin C, Horvai A, Hudnall M, Jablons DM, Jahan T, Kornak J, Mann MJ. Aggressive and minimally invasive surgery for pulmonary metastasis of sarcoma. J Thorac Cardiovasc Surg 2014; 147:1193-200; discussion 1200-1. [DOI: 10.1016/j.jtcvs.2013.12.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 08/06/2013] [Accepted: 12/09/2013] [Indexed: 10/25/2022]
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Toussi MS, Bagheri R, Dayani M, Anvari K, Sheibani S. Pulmonary metastasectomy and repeat metastasectomy for soft-tissue sarcoma. Asian Cardiovasc Thorac Ann 2013; 21:437-42. [DOI: 10.1177/0218492312462710] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background For patients with lung metastases from soft-tissue sarcoma, pulmonary metastasectomy is considered to be the only chance of possible cure. In this survey, we analyzed some potential prognostic factors affecting the outcome in these patients. Patients and methods 34 patients who underwent pulmonary metastasectomy for soft-tissue sarcoma from April 1996 to April 2007, were enrolled in our study. The median follow-up period was 26 months. Survival curves, factors affecting the outcome, and treatment success rate were evaluated. Results Complete resection was achieved in 88.2% of patients. There was no perioperative mortality. The median overall survival and median disease-free survival were 42 and 27 months, respectively. Incomplete resection and bilateral lung metastases had significant adverse effects on overall survival. Shorter disease-free interval (<18 months) was a significant predictor of survival on multivariate analysis. Metastasectomy was attempted in 12 cases of whom 50% remained disease-free to the end of follow-up. Conclusion Complete resection is the most important defining factor of success rate and survival. Patients with bilateral lung metastases or a shorter disease-free interval have significantly lower success rates. Repeat metastasectomy is curative in many patients.
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Affiliation(s)
| | - Reza Bagheri
- Cardiothoracic Surgery and Transplant Research Center, Emam Reza Hospital, Mashhad, Iran
| | | | - Kazem Anvari
- Cancer Research Center, Omid Hospital, Mashhad, Iran
| | - Shima Sheibani
- Endoscopic and Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Salah S, Fayoumi S, Alibraheem A, Massad E, Abdel Jalil R, Yaser S, Albadainah F, Albaba H, Maakoseh M. The influence of pulmonary metastasectomy on survival in osteosarcoma and soft-tissue sarcomas: a retrospective analysis of survival outcomes, hospitalizations and requirements of home oxygen therapy. Interact Cardiovasc Thorac Surg 2013; 17:296-302. [PMID: 23599187 DOI: 10.1093/icvts/ivt177] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Pulmonary metastasectomy for sarcoma is a widely accepted practice. Nevertheless, no previous studies has been reported the outcomes following metastasectomy compared with chemotherapy for patients with resectable and isolated pulmonary metastases. Our aim is to compare these modalities for the subset of patients with resectable metastases. Furthermore, the outcomes for patients with unresectable lung metastases are reported. METHODS Sarcoma patients with isolated lung metastases were identified and their computed axial tomography scans were reviewed by a thoracic surgeons' committee. Patients were divided into three groups: A: patients with resectable metastases treated with metastasectomy (n=29), B: patients with resectable metastases who received systemic therapy (n=17) and C: patients with unresectable metastases (n=25). Survival outcomes were plotted and compared through log-rank test for osteosarcoma and non-osteosarcoma patients. RESULTS Seventy-one patients (32 with osteosarcoma and 39 with non-osteosarcoma) were eligible. Progression-free survival (PFS) was superior in patients who belonged to Group A compared with Groups B and C (8.0, 4.3 and 2.2 months, respectively, P=0.0002). Furthermore, overall survival (OS) was superior in patients who belonged to Group A compared with Groups B and C (39.6, 20.0 and 7.8 months, respectively, P<0.0001). A subanalysis for osteosarcoma patients showed superior PFS and OS for Group A vs B (median PFS 21.6 and 3.65 months, respectively, P=0.011 and median OS 34.0 and 12.4 months, respectively, P=0.0044). For non-osteosarcoma patients, there were no such significant survival differences between Groups A and B. Overall, patients who belonged to Group A had significantly lower mean percentage of their follow-up time spent admitted at hospital, and a trend towards lower requirements for home oxygen therapy. CONCLUSIONS Pulmonary metastasectomy is associated with improved survival of osteosarcoma patients with resectable lung metastases. For non-osteosarcoma patients, the survival benefit of metastasectomy over chemotherapy is uncertain and warrants further evaluation. Patients with unresectable metastases have poor prognosis.
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Affiliation(s)
- Samer Salah
- Department of Medical Oncology, King Hussein Cancer Center, Amman, Jordan.
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Paramanathan A, Wright G. Pulmonary Metastasectomy for Sarcoma of Gynaecologic Origin. Heart Lung Circ 2013; 22:270-5. [DOI: 10.1016/j.hlc.2012.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 10/26/2012] [Accepted: 11/01/2012] [Indexed: 12/31/2022]
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Corbin KS, Hellman S, Weichselbaum RR. Extracranial oligometastases: a subset of metastases curable with stereotactic radiotherapy. J Clin Oncol 2013; 31:1384-90. [PMID: 23460715 DOI: 10.1200/jco.2012.45.9651] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Dear RF, Kelly PJ, Wright GM, Stalley P, McCaughan BC, Tattersall MHN. Pulmonary metastasectomy for bone and soft tissue sarcoma in Australia: 114 patients from 1978 to 2008. Asia Pac J Clin Oncol 2012; 8:292-302. [PMID: 22897801 DOI: 10.1111/j.1743-7563.2012.01521.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study is to analyze the prognostic factors for overall and relapse-free survival that may help select patients for pulmonary metastasectomy and inform their prognosis. METHODS From 1978 to 2008 130 patients underwent pulmonary metastasectomy for bone (osteosarcoma, chondrosarcoma and Ewing's sarcoma) and soft tissue sarcomas. Outcome measures analyzed were time to death and relapse and Cox regression models analyzed the association of prognostic factors. RESULTS In total 114 patients were analyzed. The 5-year post-metastasectomy overall survival rate was 43%. The 5-year relapse-free survival rate was 19%. In the multivariate analysis, an incomplete surgical resection (P = 0.02) was associated with an increased risk of death. There was weak evidence that a diameter of the largest resected metastasis ≥ 1.8 cm (P = 0.07) and a disease-free interval of ≤ 18 months (P = 0.08) were associated with an increased risk of death. CONCLUSION Poor prognostic factors for overall survival after a pulmonary metastasectomy are an incomplete surgical resection, a large diameter of the biggest resected metastasis and a short disease-free interval. The role of perioperative chemotherapy is uncertain.
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Affiliation(s)
- Rachel F Dear
- Sydney Medical School, Room 391, Blackburn Building, D06, University of Sydney, Sydney, NSW 2006, Australia.
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41
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Kim S, Ott HC, Wright CD, Wain JC, Morse C, Gaissert HA, Donahue DM, Mathisen DJ, Lanuti M. Pulmonary Resection of Metastatic Sarcoma: Prognostic Factors Associated With Improved Outcomes. Ann Thorac Surg 2011; 92:1780-6; discussion 1786-7. [DOI: 10.1016/j.athoracsur.2011.05.081] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 05/12/2011] [Accepted: 05/16/2011] [Indexed: 12/22/2022]
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Abstract
Using the second best method of meta-analysis it is significantly shown that patients with an interval of less than 7 months between diagnosis of soft tissue sarcoma and lung surgery for metastases do not benefit.
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García Del Muro X, Martín J, Maurel J, Cubedo R, Bagué S, de Álava E, Pousa AL, Narváez JA, Ortiz E, Pomés J, Poveda A, Romasanta LP, Tendero O, Viñals JM. [Soft tissue sarcomas: clinical practice guidelines]. Med Clin (Barc) 2011; 136:408.e1-8. [PMID: 21411112 DOI: 10.1016/j.medcli.2011.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 02/03/2011] [Accepted: 02/08/2011] [Indexed: 10/18/2022]
Abstract
Soft tissue sarcomas (STS) constitute a rare heterogeneous group of tumours that include a wide variety of histological subtypes, which require a multidisciplinary and, frequently specialized and complex management. Despite advances in our understanding of the pathophysiology of the disease, there are no consensus multidisciplinary recommendations about its diagnosis and treatment in our country. The objective of these guidelines is to provide practical therapeutic recommendations that may contribute to improve the therapeutic results of this disease in our environment. With this purpose, the Spanish Group for Research in Sarcomas (GEIS) held a meeting with a multidisciplinary group of experts for the study and management of sarcomas. The results of this meeting are compiled in this document, in which recommendations on diagnosis, treatment and monitoring of soft tissue sarcomas are included. In summary, these guidelines aim to facilitate the identification and management of STS for clinical practice in Spain.
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Affiliation(s)
- Xavier García Del Muro
- Servicio de Oncología Médica, Instituto Catalán de Oncología L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, España.
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Abraham JA, Baldini EH, Butrynski JE. Management of adult soft-tissue sarcoma of the extremities and trunk. Expert Rev Anticancer Ther 2010; 10:233-48. [PMID: 20131999 DOI: 10.1586/era.09.193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Soft-tissue sarcomas are a heterogeneous group of tumors consisting of approximately 100 distinct diagnoses. Management requires a multimodality approach with the input of pathologists, surgeons, radiation oncologists, medical oncologists and radiologists. In localized disease, the primary modality of treatment is wide-resection surgery, and the use of radiation therapy has improved local control rates for high-grade tumors. Currently, most localized tumors can be managed with limb-sparing treatment, and local control rates of 80-90% can be seen with appropriate management. Improvements in classification and diagnosis of these tumors have led to the current idea that the specific histology is an important consideration when developing a treatment plan and may affect prognosis, although existing staging systems have not yet incorporated this parameter. Treatment of metastatic disease continues to be difficult, but current research focuses on clarifying molecular mechanisms of disease and identifying new potential targets for medical therapy. This review focuses on the current status of management of these tumors including a review of epidemiology, initial evaluation, and treatment including surgical, radiation, and medical aspects.
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Affiliation(s)
- John A Abraham
- Harvard Medical School, Center for Bone and Sarcoma Oncology, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115, USA.
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Early outcomes of soft tissue sarcomas presenting with metastases and treated with chemotherapy. Am J Clin Oncol 2009; 32:308-13. [PMID: 19433963 DOI: 10.1097/coc.0b013e318187dd6b] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this study is to describe outcomes for patients with metastatic soft tissue sarcoma treated with chemotherapy. METHODS We retrospectively reviewed the records of 383 soft tissue sarcoma patients treated at our institution from 1997 to 2006. Thirty-five patients met the inclusion criteria-metastatic disease on presentation; primary tumor outside the abdomen; treatment with chemotherapy; and minimum follow-up of 3 months. Treatments were individualized and determined by a multidisciplinary oncology team. Patient survival was calculated from the diagnostic biopsy to the date of death or last follow-up using the Kaplan-Meier method. RESULTS Mean age was 47 years (range 17-74 years). Most common tumors involved were MFH and leiomyosarcoma. Sixteen of 35 (46%) patients had died at last follow-up. Mean patient survival was 24 months (range 4-102). The 2-year and 5-year survival rates were 64% and 24%, respectively. Twenty-nine patients (83%) presented with pulmonary metastasis, 6 with bone metastases (17%), 4 with regional node metastases (11%), and 4 with soft tissue metastases (11%). Survival was the same for those with pulmonary and only extrapulmonary metastases. The 10 patients with complete resection or complete chemotherapy response of all detectable lesions had longer mean survival (34 months) than the 25 patients who had partial/no resection or response (20 months) (P = 0.02). CONCLUSIONS Soft tissue sarcoma patients presenting with metastatic disease have a low survival rate, but complete eradication of tumor correlated with longer survival. Longer-term studies especially those tracking the outcome of complete responders and those completely resected will help determine the efficacy of chemotherapy.
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Significance of tumor recurrence before pulmonary metastasis in pulmonary metastasectomy for soft tissue sarcoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2009; 35:660-5. [DOI: 10.1016/j.ejso.2008.07.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2008] [Revised: 07/25/2008] [Accepted: 07/28/2008] [Indexed: 11/23/2022]
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Garonzik Wang JM, Leach SD. Truncal Sarcomas and Abdominal Desmoids. Surg Clin North Am 2008; 88:571-82, vi-vii. [DOI: 10.1016/j.suc.2008.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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