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Nolan MW, Gieger TL. Update in Veterinary Radiation Oncology: Focus on Stereotactic Radiation Therapy. Vet Clin North Am Small Anim Pract 2024; 54:559-575. [PMID: 38160099 DOI: 10.1016/j.cvsm.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Stereotactic radiotherapy (SRT) involves the precise delivery of highly conformal, dose-intense radiation to well-demarcated tumors. Special equipment and expertise are needed, and a unique biological mechanism distinguishes SRT from other forms of external beam radiotherapy. Families find the convenient schedules and minimal acute toxicity of SRT appealing. Common indications in veterinary oncology include nasal, brain, and bone tumors. Many other solid tumors can also be treated, including spinal, oral, lung, heart-base, liver, adrenal, and prostatic malignancies. Accessibility of SRT is improving, and new data are constantly emerging to define parameters for appropriate case selection, radiation dose prescription, and long-term follow-up.
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Affiliation(s)
- Michael W Nolan
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA.
| | - Tracy L Gieger
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA
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Long Q, Li Z, Yang W, Huang K, Du G. Necroptosis-related lncRNA-based novel signature to predict the prognosis and immune landscape in soft tissue sarcomas. J Cancer Res Clin Oncol 2024; 150:203. [PMID: 38635069 PMCID: PMC11026213 DOI: 10.1007/s00432-024-05682-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/04/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Necroptosis-related long noncoding RNAs (lncRNAs) play crucial roles in cancer initiation and progression. Nevertheless, the role and mechanism of necroptosis-related lncRNAs in soft tissue sarcomas (STS) is so far unknown and needs to be explored further. METHODS Clinical and genomic data were obtained from the UCSC Xena database. All STS patients' subclusters were performed by unsupervised consensus clustering method based on the prognosis-specific lncRNAs, and then assessed their survival advantage and immune infiltrates. In addition, we explored the pathways and biological processes in subclusters through gene set enrichment analysis. At last, we established the necroptosis-related lncRNA-based risk signature (NRLncSig) using the least absolute shrinkage and selection operator (LASSO) method, and explored the prediction performance and immune microenvironment of this signature in STS. RESULTS A total of 911 normal soft tissue samples and 259 STS patients were included in current study. 39 prognosis-specific necroptosis-related lncRNAs were selected. Cluster 2 had a worse survival than the cluster 1 and characterized by different immune landscape in STS. A worse outcome in the high-risk group was observed by survival analysis and indicated an immunosuppressive microenvironment. The ROC curve analyses illustrated that the NRLncSig performing competitively in prediction of prognosis for STS patients. In addition, the nomogram presents excellent performance in predicting prognosis, which may be more beneficial towards STS patients' treatment. CONCLUSIONS Our result indicated that the NRLncSig could be a good independent predictor of prognosis, and significantly connected with immune microenvironment, thereby providing new insights into the roles of necroptosis-related lncRNAs in STS.
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Affiliation(s)
- Qiuzhong Long
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Zhengtian Li
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Wenkang Yang
- Guangxi Medical University, Nanning, Guangxi, China
| | - Ke Huang
- Wuming Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
| | - Gang Du
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
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Naghavi AO, Bryant JM, Kim Y, Weygand J, Redler G, Sim AJ, Miller J, Coucoules K, Michael LT, Gloria WE, Yang G, Rosenberg SA, Ahmed K, Bui MM, Henderson-Jackson EB, Lee A, Lee CD, Gonzalez RJ, Feygelman V, Eschrich SA, Scott JG, Torres-Roca J, Latifi K, Parikh N, Costello J. Habitat escalated adaptive therapy (HEAT): a phase 2 trial utilizing radiomic habitat-directed and genomic-adjusted radiation dose (GARD) optimization for high-grade soft tissue sarcoma. BMC Cancer 2024; 24:437. [PMID: 38594603 PMCID: PMC11003059 DOI: 10.1186/s12885-024-12151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/20/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Soft tissue sarcomas (STS), have significant inter- and intra-tumoral heterogeneity, with poor response to standard neoadjuvant radiotherapy (RT). Achieving a favorable pathologic response (FPR ≥ 95%) from RT is associated with improved patient outcome. Genomic adjusted radiation dose (GARD), a radiation-specific metric that quantifies the expected RT treatment effect as a function of tumor dose and genomics, proposed that STS is significantly underdosed. STS have significant radiomic heterogeneity, where radiomic habitats can delineate regions of intra-tumoral hypoxia and radioresistance. We designed a novel clinical trial, Habitat Escalated Adaptive Therapy (HEAT), utilizing radiomic habitats to identify areas of radioresistance within the tumor and targeting them with GARD-optimized doses, to improve FPR in high-grade STS. METHODS Phase 2 non-randomized single-arm clinical trial includes non-metastatic, resectable high-grade STS patients. Pre-treatment multiparametric MRIs (mpMRI) delineate three distinct intra-tumoral habitats based on apparent diffusion coefficient (ADC) and dynamic contrast enhanced (DCE) sequences. GARD estimates that simultaneous integrated boost (SIB) doses of 70 and 60 Gy in 25 fractions to the highest and intermediate radioresistant habitats, while the remaining volume receives standard 50 Gy, would lead to a > 3 fold FPR increase to 24%. Pre-treatment CT guided biopsies of each habitat along with clip placement will be performed for pathologic evaluation, future genomic studies, and response assessment. An mpMRI taken between weeks two and three of treatment will be used for biological plan adaptation to account for tumor response, in addition to an mpMRI after the completion of radiotherapy in addition to pathologic response, toxicity, radiomic response, disease control, and survival will be evaluated as secondary endpoints. Furthermore, liquid biopsy will be performed with mpMRI for future ancillary studies. DISCUSSION This is the first clinical trial to test a novel genomic-based RT dose optimization (GARD) and to utilize radiomic habitats to identify and target radioresistance regions, as a strategy to improve the outcome of RT-treated STS patients. Its success could usher in a new phase in radiation oncology, integrating genomic and radiomic insights into clinical practice and trial designs, and may reveal new radiomic and genomic biomarkers, refining personalized treatment strategies for STS. TRIAL REGISTRATION NCT05301283. TRIAL STATUS The trial started recruitment on March 17, 2022.
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Affiliation(s)
- Arash O Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
| | - J M Bryant
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Youngchul Kim
- Department of Bioinformatics and Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Joseph Weygand
- Department of Radiation Oncology and Applied Sciences, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Gage Redler
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Austin J Sim
- Department of Radiation Oncology, James Cancer Hospital, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Justin Miller
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kaitlyn Coucoules
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Lauren Taylor Michael
- Clinical Trials Office, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Warren E Gloria
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - George Yang
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Stephen A Rosenberg
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kamran Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Marilyn M Bui
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Andrew Lee
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Caitlin D Lee
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ricardo J Gonzalez
- Department of Sarcoma, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Vladimir Feygelman
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Steven A Eschrich
- Department of Bioinformatics and Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jacob G Scott
- Translational Hematology and Oncology Research, Radiation Oncology Department, Cleveland Clinic, Cleveland, OH, USA
| | - Javier Torres-Roca
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kujtim Latifi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Nainesh Parikh
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - James Costello
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Hua Z, Ye Q, Yan W, Wu Z. Wide resection and extensive reconstruction of soft tissue sarcomas in the upper limb. A case report. Int J Surg Case Rep 2024; 117:109530. [PMID: 38518472 PMCID: PMC10972817 DOI: 10.1016/j.ijscr.2024.109530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024] Open
Abstract
INTRODUCTION Upper limb soft tissue sarcomas are extremely rare and can be misdiagnosed as benign, leading to unplanned excisions. Unplanned excisions and local recurrences pose significant challenges for the subsequent treatment of patients. PRESENTATION OF CASE A patient with a forearm soft tissue sarcoma who underwent unplanned excisions and experienced multiple recurrences. In the most recent treatment, she underwent wide tumor excision combined with thigh free flap transplantation for reconstruction. The reconstruction surgery successfully addressed the extensive soft tissue defect. During the three-year follow-up, there was no tumor recurrence observed, alongside the restoration of upper arm function. DISCUSSION Challenges and considerations in the treatment of soft tissue sarcomas (STS) are discussed. CONCLUSION Unplanned excisions and local recurrences of upper limb soft tissue sarcomas present significant challenges for surgery. Patients should be referred to specialized cancer centers for multidisciplinary diagnosis and treatment.
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Affiliation(s)
- Zhanqiang Hua
- Department of Orthopedics, Shanghai Electric Power Hospital, Shanghai 200050, China
| | - Qingrong Ye
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Wangjun Yan
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
| | - Zhiqiang Wu
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
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Martinez C, Asso RN, Rastogi N, Freeman CR, Cury FL. Neutrophil-to-lymphocyte ratio for the prediction of soft tissue sarcomas response to pre-operative radiation therapy. Radiother Oncol 2024; 195:110239. [PMID: 38521165 DOI: 10.1016/j.radonc.2024.110239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/27/2024] [Accepted: 03/19/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE/OBJECTIVE This study aims to assess the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in soft tissue sarcomas (STS) treated with pre-operative hypofractionated radiotherapy (HFRT). MATERIALS/METHODS This retrospective analysis included patients treated with pre-operative HFRT of 30 Gy in 5 fractions between 2016 and 2023. Clinical, demographic, and complete blood count (CBC) data were collected. NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Only patients with CBCs conducted within 6 months after radiotherapy were included. Cox proportional-hazard regression models were used to assess the impact of NLR and different variables on outcomes. Kaplan Meier were used to illustrate survival curves. A p-value < 0.05 was considered significant, and 95 % confidence intervals (CI) were employed. RESULTS A total of 40 patients received HFRT and had CBCs within 6 months after radiotherapy. There were 17 (42.5 %) females and 23 (57.5 %) males with a mean age of 66 years. The mean largest tumor size dimension was 7.1 cm, and the mean NLR post-RT was 5.3. The most frequent histological subtypes were myxofibrosarcoma (17.5 %), pleomorphic spindle cell sarcoma (10 %), leiomyosarcoma (7.5 %), and myxoid liposarcoma (5 %). The median follow-up period was 15.4 months. From all patients, 14 patients had disease progression, 12 metastatic disease and 3 died of disease. Multivariable Cox proportional-hazards regression analysis displayed that a higher post-RT NLR was associated with worse disease-free survival (DFS) (HR: 1.303 [1.098-1.548], p = 0.003), and distant metastasis-free survival (DMFS) (HR: 1.38 [1.115-1.710], p = 0.003). Moreover, post-NLR ≥ 4 as a single variable was associated with worse DFS, DMFS, but not worse local recurrence or overall survival. CONCLUSION This study is the first to evaluate NLR as a prognostic biomarker in STS patients treated with pre-operative radiotherapy. A higher NLR after pre-operative radiotherapy was associated with increased disease progression.
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Affiliation(s)
- Constanza Martinez
- Division of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Rie N Asso
- Division of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Neelabh Rastogi
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Carolyn R Freeman
- Division of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Fabio L Cury
- Division of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada.
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Lodoli C, El Halabieh MA, Santullo F, Abatini C, Gallotta V, Pacelli F. Robotic resection of left renal vein with preservation of left kidney for leiomyosarcoma: Case report and review of the literature. Int J Surg Case Rep 2024; 116:109381. [PMID: 38359584 PMCID: PMC10943925 DOI: 10.1016/j.ijscr.2024.109381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Radical surgical resection with negative margins is the mainstay of treatment for retroperitoneal vascular leiomyosarcomas. Given the retroperitoneal location of these tumors, open surgery is, historically, the chosen surgical approach, however, it is burdened with high postoperative morbidity. In selected cases, the small dimension of the tumor and a favorable location, allow to perform a minimally invasive treatment. PRESENTATION OF CASE A 67-year-old female patient with a diagnosis of a leiomyosarcoma arising from the left renal vein underwent a robotic resection of the left renal vein with preservation of the left kidney and a relative outflow trough the gonadal vessels. The patient was discharged on the fourth postoperative day without any complications and there was no tumor recurrence noted during the 24-month follow-up period. DISCUSSION Vascular retroperitoneal leiomyosarcomas are very rare tumors requiring a complete en bloc gross tumor resection in order to achieving microscopically negative margins on the vein of origin. Thanks to the preoperative histological diagnosis and radiological study of the neoplasm, it was possible to proceed to a highly personalized and minimally invasive treatment with respect of oncological criteria. CONCLUSION In selected cases, a minimally invasive surgery of vascular leiomyosarcoma could be a feasible and safe treatment option.
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Affiliation(s)
- Claudio Lodoli
- Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy
| | - Miriam Attalla El Halabieh
- Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy.
| | - Francesco Santullo
- Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy.
| | - Carlo Abatini
- Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy
| | - Valerio Gallotta
- Division of Gynecologic Oncology, Department of Women and Children's Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy
| | - Fabio Pacelli
- Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy
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Pokupec Bilić A, Bilić I, Radić Brkanac S, Simetić L, Blažičević K, Herceg D, Mikloš M, Tonković Đurišević I, Domijan AM. Impact of anthracycline-based chemotherapy on RB1 gene methylation in peripheral blood leukocytes and biomarkers of oxidative stress and inflammation in sarcoma patients. Clin Transl Oncol 2024:10.1007/s12094-023-03375-3. [PMID: 38310203 DOI: 10.1007/s12094-023-03375-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/11/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE We investigated the impact of anthracycline-based chemotherapy on methylation status of RB1 gene in peripheral blood leukocytes together with parameters of oxidative stress and inflammation in sarcoma patients. PATIENTS/METHODS Blood samples were collected from 51 consecutive newly diagnosed sarcoma patients admitted to University Hospital Center Zagreb (Zagreb, Croatia) for first-line chemotherapy before the first cycle and post-chemotherapy. Methylation and copy number variation (CNV) of leukocyte RB1 gene were assessed using MS-MLPA probes. In addition, in blood samples, parameters of oxidative stress (ROS, MDA, SOD, and GSH) and inflammation (CRP, WBC, and NBC) were followed. RESULTS In pre-chemotherapy samples, no CNVs and aberrant methylation of CpG106 promoter region of RB1 gene were detected; however, one patient had hypermethylation (by approximately 10%) of imprinted locus CpG85 in intron 2 of RB1 gene. In addition, a very good correlation of the tumor burden and CRP and tumor burden and GSH was found. The anthracycline-based chemotherapy reverts methylation of RB1 gene-imprinted locus CpG85 to normal level. Moreover, inflammation and oxidative stress parameters such as CRP, WBC, ROS, and MDA were significantly decreased in post-chemotherapy samples. CONCLUSION This single-centered study on a cohort of consecutive sarcoma patients indicates that sarcoma patients can have aberrant germline DNA methylation and confirms the relationship of tumor burden with inflammation and oxidative stress. The applied chemotherapy protocols reverted RB1 gene methylation to normal level and decreased the level of inflammation and oxidative damage, thus indicating chemotherapy benefit to the patient's health status.
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Affiliation(s)
- Anita Pokupec Bilić
- Division of Cytogenetics, Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | - Ivan Bilić
- Department of Pathophysiology, University of Zagreb School of Medicine, Šalata 2, Zagreb, Croatia
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | - Sandra Radić Brkanac
- Department of Biology, University of Zagreb Faculty of Science, Ravnice 48, Zagreb, Croatia
| | - Luka Simetić
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | - Krešimir Blažičević
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | - Davorin Herceg
- Department of Oncology, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | - Morana Mikloš
- Division of Cytogenetics, Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | - Ivana Tonković Đurišević
- Division of Cytogenetics, Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | - Ana-Marija Domijan
- University of Zagreb Faculty of Pharmacy and Biochemistry, Kovačićeva 1, Zagreb, Croatia.
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Gutierrez-Sainz L, Martinez-Fdez S, Pedregosa-Barbas J, Peña J, Alameda M, Viñal D, Villamayor J, Martinez-Recio S, Perez-Wert P, Pertejo-Fernandez A, Gallego A, Martinez-Marin V, Zamora P, Espinosa E, Mendiola M, Feliu J, Redondo A. Efficacy of second and third lines of treatment in advanced soft tissue sarcomas: a real-world study. Clin Transl Oncol 2023; 25:3519-3526. [PMID: 37329429 DOI: 10.1007/s12094-023-03221-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/19/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Soft tissue sarcomas (STSs) are an uncommon and heterogeneous group of tumours. Several drugs and combinations have been used in clinical practice as second-line (2L) and third-line (3L) treatment. The growth modulation index (GMI) has previously been used as an exploratory efficacy endpoint of drug activity and represents an intra-patient comparison. METHODS We performed a real-world retrospective study including all patients with advanced STS who had received at least 2 different lines of treatment for advanced disease between 2010 and 2020 at a single institution. The objective was to study the efficacy of both 2L and 3L treatments, analysing the time to progression (TTP) and the GMI (defined as the ratio of TTP between 2 consecutive lines of therapy). RESULTS Eighty-one patients were included. The median TTP after 2L and 3L treatment was 3.16 and 3.06 months, and the median GMI was 0.81 and 0.74, respectively. The regimens most frequently used in both treatments were trabectedin, gemcitabine-dacarbazine, gemcitabine-docetaxel, pazopanib and ifosfamide. The median TTP by each of these regimens was 2.80, 2.23, 2.83, 4.10, and 5.00 months, and the median GMI was 0.78, 0.73, 0.67, 1.08, and 0.94, respectively. In terms of histotype, we highlight the activity (GMI > 1.33) of gemcitabine-dacarbazine in undifferentiated pleomorphic sarcoma (UPS) and in leiomyosarcoma, pazopanib in UPS, and ifosfamide in synovial sarcoma. CONCLUSIONS In our cohort, regimens commonly used after first-line STS treatment showed only slight differences in efficacy, although we found significant activity of specific regimens by histotype.
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Affiliation(s)
- Laura Gutierrez-Sainz
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - Sara Martinez-Fdez
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Jorge Pedregosa-Barbas
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Jesus Peña
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Maria Alameda
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| | - David Viñal
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Julia Villamayor
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Sergio Martinez-Recio
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pablo Perez-Wert
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Ana Pertejo-Fernandez
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Alejandro Gallego
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
- Department of Medical Oncology, Clínica Universidad de Navarra, Madrid, Spain
| | - Virginia Martinez-Marin
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
- Translational Oncology Group, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Pilar Zamora
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
- Translational Oncology Group, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain
- Cátedra UAM-AMGEN, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Enrique Espinosa
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
- Translational Oncology Group, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain
- Cátedra UAM-AMGEN, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Mendiola
- Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
- Molecular Pathology and Therapeutic Targets Group, IdiPAZ, Madrid, Spain
| | - Jaime Feliu
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain
- Translational Oncology Group, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain
- Cátedra UAM-AMGEN, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - Andres Redondo
- Department of Medical Oncology, La Paz University Hospital-Institute for Health Research (IdiPAZ), Paseo de la Castellana 261, 28046, Madrid, Spain.
- Translational Oncology Group, IdiPAZ, Paseo de la Castellana 261, 28046, Madrid, Spain.
- Cátedra UAM-AMGEN, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
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Nakata E, Fujiwara T, Kunisada T, Nakahara R, Katayama H, Itano T, Ozaki T. Results of resection of forearm soft tissue sarcoma. J Orthop Surg Res 2023; 18:599. [PMID: 37580775 PMCID: PMC10424346 DOI: 10.1186/s13018-023-04088-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/09/2023] [Indexed: 08/16/2023] Open
Abstract
PURPOSE Soft tissue sarcomas (STS) of the forearm are rare. We aim to assess their oncological and functional outcomes. METHODS We retrospectively evaluated 34 patients who underwent surgical excision for forearm STS at our institution between 1993 and 2020. We analyzed postoperative Musculoskeletal Tumor Society rating scale (MSTS) and local recurrence-free survival (LRFS), metastasis-free survival, and overall survival (OS) rates. The significance of the following variables was determined: age, sex, histology, tumor size, Fédération Nationale des Centres de Lutte contre le Cancer grade, American Joint Committee on Cancer stage, surgical margin, unplanned excision, metastases upon initial presentation, receipt of chemotherapy, and radiotherapy (RT). RESULTS The postoperative median MSTS score was 28. Bone resection or major nerve palsy was the only factor that influenced MSTS scores. The median MSTS scores in patients with or without bone resection or major nerve palsy were 24 and 29, respectively (P < 0.001). The 5-year LRFS rates was 87%. Univariate analysis revealed that the histological diagnosis of myxofibrosarcoma was the only factor that influenced LRFS (P = 0.047). The 5-year MFS rates was 71%. In univariate analysis, no factors were associated with MFS. The 5-year OS rates was 79%. Age was the only factor that influenced OS (P = 0.01). CONCLUSION In the treatment of forearm STS, reconstruction of the skin and tendon can compensate for function, while bone resection and major nerve disturbance cannot. Careful follow-up is important, especially in patients with myxofibrosarcoma, due to its likelihood of local recurrence.
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Affiliation(s)
- Eiji Nakata
- Department of Orthopedic Surgery, Okayama University Hospital, 2-5-1, Shikata-Cho, Okayama City, Okayama, 700-8558, Japan.
| | - Tomohiro Fujiwara
- Department of Orthopedic Surgery, Okayama University Hospital, 2-5-1, Shikata-Cho, Okayama City, Okayama, 700-8558, Japan
| | - Toshiyuki Kunisada
- Department of Orthopedic Surgery, Okayama University Hospital, 2-5-1, Shikata-Cho, Okayama City, Okayama, 700-8558, Japan
| | - Ryuichi Nakahara
- Department of Orthopedic Surgery, Okayama University Hospital, 2-5-1, Shikata-Cho, Okayama City, Okayama, 700-8558, Japan
| | - Haruyoshi Katayama
- Department of Orthopedic Surgery, Okayama University Hospital, 2-5-1, Shikata-Cho, Okayama City, Okayama, 700-8558, Japan
| | - Takuto Itano
- Department of Orthopedic Surgery, Okayama University Hospital, 2-5-1, Shikata-Cho, Okayama City, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopedic Surgery, Okayama University Hospital, 2-5-1, Shikata-Cho, Okayama City, Okayama, 700-8558, Japan
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10
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Ahmed TM, Blanco A, Weisberg EM, Fishman EK. CT of retroperitoneal solitary fibrous tumor. Radiol Case Rep 2023; 18:2241-2244. [PMID: 37123044 PMCID: PMC10139852 DOI: 10.1016/j.radcr.2023.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
Solitary fibrous tumors are rare tumors of pluripotent fibroblastic or myofibroblastic origin that generally arise among older individuals, with a mean age of onset ranging from 55 to 65 years. Though typically associated with pleural involvement, solitary fibrous tumors can emerge in virtually every anatomic location within the body. Although most solitary fibrous tumors are benign, approximately 20% may exhibit malignant features such as local invasion, recurrence, and metastases. In this article, we report the case of a 58-year-old male with a diagnosis of a retroperitoneal solitary fibrous tumor. We analyze computed tomography imaging findings and additionally correlate imaging features with the patient's unique pathological and genotypic findings to optimize diagnosis.
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Abstract
Pelvic soft tissue sarcomas (PSTS) are a rare, heterogeneous group of tumors. They have been usually analyzed with retroperitoneal sarcomas (RPS), but actually have key differences. Due to their unique anatomic location, symptomatic presentation of PSTS may be more common than RPS. Adequate imaging approach is paramount for guiding differential diagnosis, while preoperative biopsy is mandatory, especially when preoperative treatment may be considered as initial approach. The most frequent histologic subtype is leiomyosarcoma, which is different as expected in the retroperitoneum where liposarcoma is the commonest histology. Also solitary fibrous tumor is commonly diagnosed in the pelvis. Surgical approach for PSTS differs from that for RPS mainly due to anatomic relations. Similarly, in the lack of definite evidence from specific trials about neoadjuvant and adjuvant treatments, the anatomic constraints to obtain wide margins in the pelvis as well as the expected functional outcome in case of organ resections should be factored into decision for individualized treatment offer. Vascular and genitourinary involvement are frequent, as well as herniation through pelvic foramina. For these reasons a multidisciplinary surgical team should always be considered. Early referral of these patients to high-volume centers is critical and may impact on survival, given that optimal initial resection is a major predictor of curative treatment. International consensus on PSTS treatment is advocated, similarly to the recent efforts realized for RPS.
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Affiliation(s)
- Catherine Sarre-Lazcano
- Department of Surgery, Salvador Zubiran National Institute of Medical Sciences and Nutrition: Salvador Zubiran, Mexico City, Mexico
| | - Sinziana Dumitra
- Department of Surgery, McGill University Health Centre, Montreal, Canada
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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12
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Husain M, Quiroga D, Kim HG, Lenobel S, Xu M, Iwenofu H, Chen JL, Verschraegen C, Liebner D, Tinoco G. Clinical markers of immunotherapy outcomes in advanced sarcoma. BMC Cancer 2023; 23:326. [PMID: 37029351 PMCID: PMC10080913 DOI: 10.1186/s12885-023-10758-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/21/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Despite immunotherapy's promise in oncology, its use for sarcoma remains challenging. There are no sarcoma-specific biomarkers for immune checkpoint inhibitors (ICI). Previously, we reported our institutional experience highlighting ICI activity in 29 patients with sarcoma. In this study, we explore responses to ICI based on ICI regimen and other covariates to identify significant clinical factors in advanced sarcoma outcomes. METHODS Patients in The Ohio State University Sarcoma Clinics were enrolled in the Sarcoma Retrospective ICI database from January 1, 2015 through November 1, 2021. Data included treatment regimen (single-agent ICI or ICI + combination) along with clinical covariates. ICI + combination was further categorized into ICI + medication, ICI + radiation, ICI + surgery, or ICI + multiple (more than 2 modalities). Statistical analysis included log-rank tests and proportional hazard regression. The primary objective was to evaluate overall survival (OS) and progression-free survival (PFS). RESULTS Of the patients in the database, 135 met inclusion criteria. We demonstrated improved OS in patients treated with ICI + combination (p = 0.014, median 64 weeks), but no effect on PFS (p = 0.471, median 31 weeks). Patients with a documented immune-related adverse event (irAE) of dermatitis had improved OS, but only in the ICI + combination cohort (p = 0.021). Patients who received single-agent ICI and whose change in the neutrophil-to-lymphocyte ratio (NLR) was less than 5 had an improved OS (p = 0.002); this was not seen in patients who received ICI + combination therapy (p = 0.441). There were no differences in OS based on age, gender, histology, or subcategories of ICI + combination. This was not the case for PFS; patients who received any ICI regimen and were younger than 70 had a worse PFS (p = 0.036) compared with their older counterparts in this dataset. Patients who developed an irAE, specifically colitis (p = 0.009), hepatitis (p = 0.048), or dermatitis (p = 0.003), had an improved PFS. There were no differences in PFS based on ICI regimen (or subcategories of ICI + combination), gender, histology, change in NLR, or grade of irAE. CONCLUSIONS This retrospective study demonstrates that ICI + combination therapy can improve OS in some patients with advanced sarcoma. This is consistent with our prior results of ICI in sarcoma.
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Affiliation(s)
- Marium Husain
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1240C, 43210, Columbus, OH, USA
| | - Dionisia Quiroga
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1240C, 43210, Columbus, OH, USA
| | - Han Gil Kim
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1240C, 43210, Columbus, OH, USA
| | - Scott Lenobel
- Department of Radiology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Menglin Xu
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1240C, 43210, Columbus, OH, USA
| | - Hans Iwenofu
- Department of Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - James L Chen
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1240C, 43210, Columbus, OH, USA
| | - Claire Verschraegen
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1240C, 43210, Columbus, OH, USA
| | - David Liebner
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1240C, 43210, Columbus, OH, USA
| | - Gabriel Tinoco
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, 1800 Cannon Drive, Suite 1240C, 43210, Columbus, OH, USA.
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13
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Kerrison WGJ, Thway K, Jones RL, Huang PH. The biology and treatment of leiomyosarcomas. Crit Rev Oncol Hematol 2023; 184:103955. [PMID: 36893945 DOI: 10.1016/j.critrevonc.2023.103955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023] Open
Abstract
Leiomyosarcoma (LMS) is a soft tissue sarcoma of smooth muscle origin that can arise in multiple anatomical sites and is broadly classified as extra-uterine LMS or uterine LMS. There is substantial interpatient heterogeneity within this histological subtype, and despite multi-modal therapy, clinical management remains challenging with poor patient prognosis and few new therapies available. Here we discuss the current treatment landscape of LMS in both the localised and advanced disease setting. We further describe the latest advances in our evolving understanding of the genetics and biology of this group of heterogeneous diseases and summarise the key studies delineating the mechanisms of acquired and intrinsic chemotherapy resistance in this histological subtype. We conclude by providing a perspective on how novel targeted agents such as PARP inhibitors may usher in a new paradigm of biomarker-driven therapies that will ultimately impact the outcomes of patients with LMS.
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Affiliation(s)
- William G J Kerrison
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
| | - Khin Thway
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Robin L Jones
- The Royal Marsden NHS Foundation Trust, London, United Kingdom; Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Paul H Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom.
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14
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Toffanin G, Ozaniak A, Bartolini R, Komarc M, Novysedlak R, Rataj M, Smetanova J, Rosato A, Lischke R, Bartunkova J, Strizova Z. Oncostatin M and Nivolumab Affect the Cytotoxic T-Cell Proportions and the Susceptibility to TRAIL-Induced Death in Non-Leukocyte Cell Subpopulations in Soft Tissue Sarcomas. Pharmacology 2023; 108:274-285. [PMID: 36996792 DOI: 10.1159/000529811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/13/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Soft tissue sarcomas (STSs) are malignant tumors arising from mesenchymal tissues. Patients with advanced and metastatic STSs have low overall survival rates and relatively limited treatment options. Oncostatin M (OSM) is a pleiotropic cytokine that was shown to carry both pro- and anti-tumorigenic properties in various cancer types. However, the role of OSM in STSs has not yet been elucidated. Moreover, the potential additive effects of combining OSM and anti-PD-1 therapy have not been carried out so far. METHODS The aim of this study was to determine the effects of in vitro OSM administration on liposarcoma, leiomyosarcoma, and myxofibrosarcoma immune cells isolated from peripheral blood and tumor tissues and the potential cooperative nature of OSM and nivolumab in treating these STSs. We designed a cohort study to explore novel histology-driven therapies in our target STSs. The immune cells were isolated from the peripheral blood and tumors of patients with STS, and the proportions and phenotypes of immune cells were evaluated with flow cytometry after cultivation with therapeutic monoclonal antibodies. RESULTS The proportion of peripheral CD45+ cells was not affected by OSM but was significantly increased by nivolumab, whereas both treatments had an effect on CD8+ T cells. In tumor tissues, CD8+ T cell and CD45‒ TRAIL+ cell cultures were boosted by nivolumab and significantly enriched by OSM. Our data suggest that OSM may play a role in the treatment of leiomyosarcoma, myxofibrosarcoma, and liposarcoma. CONCLUSION In conclusion, the biological efficacy of OSM is reflected in the tumor microenvironment rather than in the peripheral blood of the patients in our cohort, and nivolumab could potentiate its mechanism of action in selected cases. Nevertheless, more histotype-tailored studies are needed to fully understand the functions of OSM in STSs.
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Affiliation(s)
- Giulia Toffanin
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Andrej Ozaniak
- 3rd Department of Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Robin Bartolini
- Chemokine Research Group, Institute of Infection, Immunity, and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czechia
| | - Rene Novysedlak
- 3rd Department of Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Michal Rataj
- Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Jitka Smetanova
- Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Antonio Rosato
- Department of Surgery Oncology and Gastroenterology, University of Padova, Padova, Italy
- Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Robert Lischke
- 3rd Department of Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Jirina Bartunkova
- Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Zuzana Strizova
- Department of Immunology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
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15
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Crombé A, Matcuk GR, Fadli D, Sambri A, Patel DB, Paioli A, Kind M, Spinnato P. Role of Imaging in Initial Prognostication of Locally Advanced Soft Tissue Sarcomas. Acad Radiol 2023; 30:322-340. [PMID: 35534392 DOI: 10.1016/j.acra.2022.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/21/2022] [Accepted: 04/06/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although imaging is central in the initial staging of patients with soft tissue sarcomas (STS), it remains underused and few radiological features are currently used in practice for prognostication and to help guide the best therapeutic strategy. Yet, several prognostic qualitative and quantitative characteristics from magnetic resonance imaging (MRI) and positron emission tomography (PET) have been identified over these last decades. OBJECTIVE After an overview of the current validated prognostic features based on baseline imaging and their integration into prognostic tools, such as nomograms used by clinicians, the aim of this review is to summarize more complex and innovative MRI, PET, and radiomics features, and to highlight their role to predict indirectly (through histologic grade) or directly the patients' outcomes.
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Affiliation(s)
- Amandine Crombé
- Department of Diagnostic and Interventional Oncological Imaging, Institut Bergonié, Regional Comprehensive Cancer of Nouvelle-Aquitaine, 229, cours de l'Argonne, F-33076, Bordeaux, France; Department of musculoskeletal imaging, Pellegrin University Hospital, 2, place Amélie Raba-Léon, F-33000, Bordeaux, France; Models in Oncology (MONC) Team, INRIA Bordeaux Sud-Ouest, CNRS UMR 5251, Institut de Mathématiques de Bordeaux & Bordeaux University, 351 cours de la libération, F-33400 Talence, France.
| | - George R Matcuk
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | - David Fadli
- Department of musculoskeletal imaging, Pellegrin University Hospital, 2, place Amélie Raba-Léon, F-33000, Bordeaux, France
| | - Andrea Sambri
- Alma Mater Studiorum, University of Bologna, Bologna, Italy; IRCCS Policlinico di Sant'Orsola, Bologna, Italy
| | - Dakshesh B Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Anna Paioli
- Osteoncology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Michele Kind
- Department of Diagnostic and Interventional Oncological Imaging, Institut Bergonié, Regional Comprehensive Cancer of Nouvelle-Aquitaine, 229, cours de l'Argonne, F-33076, Bordeaux, France
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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16
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Gurusamy VM, Al-Hammadi N, Caparrotti P, Divakar SR, Hammoud RW, Shaikh G. Real-world clinical outcomes with daily image-guided IMRT in extremity soft tissue sarcomas. Cancer Treat Res Commun 2022; 33:100655. [PMID: 36356354 DOI: 10.1016/j.ctarc.2022.100655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE We report the clinical outcomes of patients with soft tissue sarcomas (STS) arising in extremities treated with image-guided intensity modulated radiotherapy (IG-IMRT) at our institute. Local control of the tumors treated with RT was the primary end point of this study. Analyzing overall survival and long-term toxicities were the secondary objectives. METHODS AND MATERIALS The database of the patients with STS who received wide local excision and IG-IMRT at our institution from January 2012 to December 2020 was reviewed. Radiation was offered either preoperatively or postoperatively as part of multi-modality treatment. RESULTS Thirty-three consecutive patients were identified and included for analysis. Twenty-eight patients (84.8%) received postoperative adjuvant radiotherapy. Dedicated MRI simulation studies were performed in 31 patients (93.9%) in the treatment position. RapidArc IMRT technique was used in 31 patients (93.9%). A total of 2954 images were acquired during 991 treatment sessions. Errors exceeding 1 mm in the x, y and z directions were corrected online before the treatment. With a median follow-up of 36 months, two patients (6.1%) developed local recurrence. The 3-year local control was 90.9% (95% CI, 0.76 - 0.98), and the 5-year overall survival was 71.7% (95% CI, 0.44 - 0.88). One patient (3.03%) sustained a pathological fracture during the follow-up period. CONCLUSION Our results showed that IMRT with daily imaging offered excellent local control with acceptable long-term toxicity, as well as being feasible and practical to implement in our routine clinical practice.
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Affiliation(s)
- Venkada Manickam Gurusamy
- Department of Radiation Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar.
| | - Noora Al-Hammadi
- Department of Radiation Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Palmira Caparrotti
- Department of Radiation Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Saju Raveendran Divakar
- Department of Radiation Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Rabih Wafiq Hammoud
- Department of Radiation Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Ghazia Shaikh
- Department of Radiation Oncology, National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
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Boudin L, de Nonneville A, Finetti P, Mescam L, Le Cesne A, Italiano A, Blay JY, Birnbaum D, Mamessier E, Bertucci F. CSPG4 expression in soft tissue sarcomas is associated with poor prognosis and low cytotoxic immune response. Lab Invest 2022; 20:464. [PMID: 36221119 PMCID: PMC9552405 DOI: 10.1186/s12967-022-03679-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/29/2022] [Indexed: 11/10/2022]
Abstract
Background Soft tissue sarcomas (STS) are heterogeneous and pro-metastatic tumors. Identification of accurate prognostic factors and novel therapeutic targets are crucial. CSPG4 is a cell surface proteoglycan with oncogenic functions. It recently emerged as a potential target for immunotherapy, including cell therapy based on CSPG4-specific chimeric antigen receptor (CAR)-redirected cytokine-induced killer lymphocytes (CSPG4-CAR.CIKs) in STS. However, expression of CSPG4 is poorly known in STS so far. Methods We analyzed CSPG4 gene expression in 1378 localized STS clinical samples, and searched for correlations with clinicopathological data, including disease-free survival (DFS), and with tumor immune features. Results CSPG4 expression was heterogeneous across samples. High expression was associated with younger patients’ age, more frequent undifferentiated pleomorphic sarcoma and myxofibrosarcoma pathological subtypes, more frequent internal trunk tumor site, and more CINSARC high-risk samples. No correlation existed with pathological tumor size and grade, and tumor depth. Patients with high CSPG4 expression displayed 49% (95% CI 42–57) 5-year DFS versus 61% (95% CI 56–68) in patients with low expression (p = 3.17E−03), representing a 49% increased risk of event in the “CSPG4-high” group (HR = 1.49, 95% CI 1.14–1.94). This unfavorable prognostic value persisted in multivariate analysis, independently from other variables. There were significant differences in immune variables between “CSPG4-high” and “CSPG4-low” tumors. The "CSPG4-low" tumors displayed profiles suggesting higher anti-tumor cytotoxic immune response and higher potential vulnerability to immune checkpoint inhibitors (ICI). By contrast, the "CSPG4-high" tumors displayed profiles implying an immune-excluded tumor microenvironment, potentially induced by hypoxia, resulting from an immature chaotic microvasculature, and/or the presence of contractile myofibroblasts. Conclusions Patients with “CSPG4-high” STS, theoretically candidate for CAR.CIKs, display shorter DFS and an immune environment unfavorable to vulnerability to CAR.CIKs, which could be improved by combining anti-angiogenic drugs able to normalize the tumor vasculature. By contrast, “CSPG4-low” STS are better candidates for immune therapy involving ICI. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-022-03679-y.
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Affiliation(s)
- Laurys Boudin
- Laboratory of Predictive Oncology, Centre de Recherche en Cancérologie de Marseille, Institut Paoli-Calmettes, Aix-Marseille Université, INSERM UMR1068, CNRS UMR725, Marseille, France
| | - A de Nonneville
- Laboratory of Predictive Oncology, Centre de Recherche en Cancérologie de Marseille, Institut Paoli-Calmettes, Aix-Marseille Université, INSERM UMR1068, CNRS UMR725, Marseille, France.,Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Pascal Finetti
- Laboratory of Predictive Oncology, Centre de Recherche en Cancérologie de Marseille, Institut Paoli-Calmettes, Aix-Marseille Université, INSERM UMR1068, CNRS UMR725, Marseille, France
| | - Léna Mescam
- French Sarcoma Group, Lyon, France.,Department of Pathology, Institut Paoli-Calmettes, 232 Bd. Sainte-Marguerite, 13009, Marseille, France
| | - A Le Cesne
- French Sarcoma Group, Lyon, France.,Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Antoine Italiano
- French Sarcoma Group, Lyon, France.,Department of Medical Oncology, Institut Bergonie, Bordeaux, France
| | - Jean-Yves Blay
- French Sarcoma Group, Lyon, France.,Department of Medical Oncology, Centre Léon Bérard, UNICANCER &, Université Claude Bernard Lyon I, Lyon, France
| | - Daniel Birnbaum
- Laboratory of Predictive Oncology, Centre de Recherche en Cancérologie de Marseille, Institut Paoli-Calmettes, Aix-Marseille Université, INSERM UMR1068, CNRS UMR725, Marseille, France
| | - Emilie Mamessier
- Laboratory of Predictive Oncology, Centre de Recherche en Cancérologie de Marseille, Institut Paoli-Calmettes, Aix-Marseille Université, INSERM UMR1068, CNRS UMR725, Marseille, France
| | - François Bertucci
- Laboratory of Predictive Oncology, Centre de Recherche en Cancérologie de Marseille, Institut Paoli-Calmettes, Aix-Marseille Université, INSERM UMR1068, CNRS UMR725, Marseille, France. .,Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France. .,French Sarcoma Group, Lyon, France.
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18
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El Koubaiti R, Mazti A, Maaroufi M, El Idrissi M, El Ibrahimi A, El Mrini A, Bouhafa T, El Fakir S, Ouldim K, Arifi S, Chbani L. Molecular classification of soft tissue sarcomas for adequate diagnosis: A study on the northeast population of Morocco. Heliyon 2022; 8:e10673. [PMID: 36164527 DOI: 10.1016/j.heliyon.2022.e10673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/24/2022] [Accepted: 09/12/2022] [Indexed: 11/21/2022] Open
Abstract
Background Soft tissue sarcomas (STS) are a heterogeneous group of tumors. For adequate therapeutic management, an accurate diagnosis is necessary. In Morocco, the diagnosis is essentially based on the morphological and immunohistochemical study. Compared to other techniques, fluorescence in situ hybridization (FISH) is easier to develop and less expensive. This study aims to assess the feasibility and utility of implementing FISH technique to improve diagnostic accuracy and establish a good classification. Material and methods This is a retrospective cohort study. 211 cases of mesenchymal tumors were included. Hematoxylin Eosin Safran (HES) staining was performed in all cases followed by immunohistochemistry (IHC). FISH was performed in all cases with suspected STS. The probes used were EWSR1, MDM2 and SS18. The performance of FISH and histopathological test were evaluated by the ROC curve method (receiver operating characteristic). We evaluated the concordance between FISH and real time PCR by Cohen test. Results The real-time PCR technique showed good agreement with the FISH test by a Kappa coefficient of 60% (p = 0.035). FISH was able to confirm that it is more accurate (Youden's Index = 91%) than histological/immunohistochemical analysis (Youden's Index = 51%), as well as the positive predictive value was higher (100%) with an ROC curve finding a larger area under the curve of 0.953 (95% CI: 0.918-0.988), p = 0.000 which supports that FISH shows high performance to present an accurate final diagnosis. Conclusion This is the first and the largest Moroccan series for the molecular diagnosis of STS by FISH. Our study shows that paraffin FISH is a sensitive and specific ancillary tool in the diagnosis of STS when used in the appropriate clinicopathological context.
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Spinnato P, Kind M, Le Loarer F, Bianchi G, Colangeli M, Sambri A, Ponti F, van Langevelde K, Crombé A. Soft Tissue Sarcomas: The Role of Quantitative MRI in Treatment Response Evaluation. Acad Radiol 2022; 29:1065-84. [PMID: 34548230 DOI: 10.1016/j.acra.2021.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/29/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although curative surgery remains the cornerstone of the therapeutic strategy in patients with soft tissue sarcomas (STS), neoadjuvant radiotherapy and chemotherapy (NART and NACT, respectively) are increasingly used to improve operability, surgical margins and patient outcome. The best imaging modality for locoregional assessment of STS is MRI but these tumors are mostly evaluated in a qualitative manner. OBJECTIVE After an overview of the current standard of care regarding treatment for patients with locally advanced STS, this review aims to summarize the principles and limitations of (i) the current methods used to evaluate response to neoadjuvant treatment in clinical practice and clinical trials in STS (RECIST 1.1 and modified Choi criteria), (ii) quantitative MRI sequences (i.e., diffusion weighted imaging and dynamic contrast enhanced MRI), and (iii) texture analyses and (delta-) radiomics.
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20
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Tanriverdi O, Yildiz A. Current molecular and therapeutic advances in liposarcoma, rhabdomyosarcoma, leiomyosarcoma, synovial sarcoma, and angiosarcoma. J Oncol Pharm Pract 2022; 28:635-645. [PMID: 35043739 DOI: 10.1177/10781552211073139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sarcomas probably develop after malignant transformation of embryonic mesenchymal cells and have broad spectrum histopathologically since they can develop from striated skeletal muscle and smooth muscle, fat and fibrous tissue, bone, cartilage and other mesenchymal tissues. The most common histological subtypes of soft tissue sarcoma in adults are: liposarcoma, leiomyosarcoma, poorly differentiated pleomorphic sarcoma, and gastrointestinal stromal tumor. Molecular and genetic studies of soft tissue sarcomas, which are considered as heterogeneous groups in terms of their molecular and clinical characteristics, are still an important area of interest The heterogeneity of the molecular and genetic alterations of these malignancies, which are mostly treated with surgery and chemotherapy, also offers hope to the researchers in terms of treatment targets. In this article, molecular biologic features of the soft tissue sarcomas including liposarcoma, rhabdomyosarcoma, leiomyosarcoma, synovial sarcoma, and angiosarcoma are discussed in the light of recent developments in molecular biology, targeted therapies and immunotherapy.
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Affiliation(s)
- Ozgur Tanriverdi
- Department of Medical Oncology, Faculty of Medicine, 175646Mugla Sitki Kocman University, Mugla, Turkey.,Department of Molecular Biology and Genetics, Graduate School of Natural and Applied Sciences, 52986Mugla Sitki Kocman University, Mugla, Turkey
| | - Aysegul Yildiz
- Department of Molecular Biology and Genetics, Graduate School of Natural and Applied Sciences, 52986Mugla Sitki Kocman University, Mugla, Turkey.,Department of Molecular Biology and Genetics, Faculty of Science, Mugla Sitki Kocman University, Mugla, Turkey
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21
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Qiao J, Mao H, Wen L, Xu L, Zhu Z, Qiu Y, Xiong J, Wang S. Reconstruction of Soft Tissue Defect With a Free Vascularized Anterolateral Thigh Flap After Resection of Soft Tissue Sarcoma in Extremities. Orthop Surg 2021; 14:215-220. [PMID: 34898047 PMCID: PMC8867411 DOI: 10.1111/os.12840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 09/14/2020] [Accepted: 09/28/2020] [Indexed: 01/12/2023] Open
Abstract
Objective This study aims to determine outcomes and complications in functional reconstruction of soft tissue defects after surgical resection for soft tissue sarcomas (STSs) of extremities. Methods A retrospective chart review was performed on patients with STSs of extremities from May 2015 to April 2019 who underwent radical resection of STSs and reconstruction of soft tissue defect with free vascularized anterolateral thigh flap (FVALTP). A minimum 3‐month follow‐up was required for all the patients. Patient demographics and comorbidities, flap characteristics, postoperative complications, and time to heal were recorded. The functional outcomes of the reconstructed limbs were assessed by the Musculoskeletal Tumour Society(MSTS) scoring system. Results A total of 11 patients (four males and seven females) were included in the study. The mean age was 62 years (range: 29–84 years). The mean surface area was 151.4 cm2 (range: from 64 cm2 to 418cm2). The mean operation time was 126 min (range: 95–296 min). The mean follow‐up was 17.5 months (range: 6–34 months). The mean score of MSTS at last follow‐up was 26.2 (range: 12–29). Incision healed by first intention in eight patients. Incision healed by second intention in three patients. A patient who had received preoperative radiotherapy experienced delayed union. After debridement, the patient successfully got union. Another two patients experienced marginal necrosis of flap due to vascular crisis. After 3‐week dressing changes, the patients also got satisfactory union. One case suffered from vascular crisis during surgery in which the procedure was changed into skin grafting to cover resection site. Conclusion FVALTP technique can be effectively applied to the reconstruction of soft tissue defect after STSs resection. The short‐term follow‐up indicated satisfactory functional outcome and low incidence of previously known complications. It was necessary to further validate its efficacy in reconstruction of soft tissue defect after malignant extremity soft tissue sarcoma resection.
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Affiliation(s)
- Jun Qiao
- Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Haijun Mao
- Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Li Wen
- Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Leilei Xu
- Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zezhang Zhu
- Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jin Xiong
- Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Shoufeng Wang
- Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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22
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Verbeke S, Perret R, Chaire V, Richard E, Velasco V, Giles F, Cavalcante L, Italiano A. GSK3-beta as a candidate therapeutic target in soft tissue sarcomas. J Hematol Oncol 2021; 14:202. [PMID: 34857030 PMCID: PMC8641200 DOI: 10.1186/s13045-021-01215-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/09/2021] [Indexed: 01/13/2023] Open
Abstract
Soft tissue sarcoma (STS) is a predominantly fatal rare malignancy with inadequate treatment options. Glycogen synthase kinase 3β (GSK-3β) is an emerging target in human malignancies. Its therapeutic relevance in STS is unknown. We analyzed the prognostic impact of GSK-3β gene and protein expression in two independent cohorts of patients with STS. We then treated STS cell lines and mice xenografts with a novel GSK-3 inhibitor 9-ING-41 alone or in combination with chemotherapy. We demonstrated that 9-ING-41 treatment induced significant STS cells apoptosis and was synergistic in vivo when combined with chemotherapy. Mechanistically, 9-ING-41 induces significant apoptosis of STS cells via suppression of NF-κB-mediated X-linked inhibitor of apoptosis protein (XIAP) expression. These data support the inclusion of patients with STS in clinical studies of 9-ING-41 alone and in combination with chemotherapy.
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Affiliation(s)
- S Verbeke
- Sarcoma Unit, Institut Bergonié, 229 cours de l'Argonne, 33000, Bordeaux, France
- INSERM, U1218, Bordeaux, France
| | - R Perret
- Department of Pathology, Institut Bergonié, Bordeaux, France
| | - V Chaire
- Sarcoma Unit, Institut Bergonié, 229 cours de l'Argonne, 33000, Bordeaux, France
- INSERM, U1218, Bordeaux, France
| | | | - V Velasco
- Department of Pathology, Institut Bergonié, Bordeaux, France
| | - F Giles
- Actuate Therapeutics, Fort Worth, TX, USA
| | | | - A Italiano
- Sarcoma Unit, Institut Bergonié, 229 cours de l'Argonne, 33000, Bordeaux, France.
- INSERM, U1218, Bordeaux, France.
- Faculty of Medicine, University of Bordeaux, Bordeaux, France.
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Selvaraj K, Kuppusami B, Ramachandran M, Kannan R, Sundaram RK. An unusual occurrence of synovial sarcoma in forearm: a case report. Pan Afr Med J 2021; 40:187. [PMID: 35059107 PMCID: PMC8728798 DOI: 10.11604/pamj.2021.40.187.32269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/16/2021] [Indexed: 12/03/2022] Open
Abstract
Soft tissue sarcomas are group of malignant tumours arising from extra skeletal mesenchymal tissue. Presenting a patient with swelling over the posterior aspect of left arm for 6 months, gradually increasing in size for four months and rapidly increasing in size for last 2 months and not associated with pain. Peripheral pulses felt. Ultrasound showed large solid cystic intramuscular lesion arising from triceps muscle and Trucut biopsy showed poorly differentiated malignancy. Magnetic resonance imaging (MRI) left arm impression was large lobulated solid cystic space occupying lesion in triceps muscle, possibility of neoplastic lesion. Here the patient underwent wide local excision and reconstruction procedure followed by Radiotherapy, chemotherapy and regular follow up.
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Affiliation(s)
- Karthikeyan Selvaraj
- Department of General Surgery, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Bharathiraja Kuppusami
- Department of General Surgery, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Manimaran Ramachandran
- Department of General Surgery, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Rajiv Kannan
- Department of General Surgery, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India,Corresponding author: Rajiv Kannan, Department of General Surgery, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India.
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Reyes Marlés RH, Navarro Fernández JL, Puertas García-Sandoval JP, Santonja Medina F, Mohamed Salem L, Frutos Esteban L, Contreras Gutiérrez JF, Castellón Sánchez MI, Ruiz Merino G, Claver Valderas MA. Clinical value of baseline 18F-FDG PET/CT in soft tissue sarcomas. Eur J Hybrid Imaging 2021; 5:16. [PMID: 34476632 PMCID: PMC8413431 DOI: 10.1186/s41824-021-00110-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/24/2021] [Indexed: 01/18/2023] Open
Abstract
Background The use of 18F-FDG Positron emission tomography/Computed tomography (PET/CT) in the initial staging of many cancers is clearly established. Most soft tissue sarcoma (STS) has a high affinity for 18F-FDG, which is why 18F-FDG PET/CT has been proposed as a non-invasive method, useful in diagnosis and follow-up. The standardized uptake value values (SUV), the volume-based metabolic parameters MTV (metabolic tumor volume), and TLG (total lesion glycolysis) determine tumor viability and provide its total volume and the total activity of metabolically active tumor cells. The histological grade is the most important predictor of metastases and mortality associated with STS, and a significant relationship between the metabolic parameters of 18F-FDG PET/CT and the histological grade has been described. Methods A retrospective study was conducted on STS patients, who had histological grade according to the FNCLCC (Fédération Nationale des Centres de Lutte Contre Le Cancer) criteria, as well as a baseline PET/CT. SUV (SUVmax, SUVmean, and SUVpeak), MTV, and TLG were quantified. A T-student test was performed to establish the relationship between the metabolic biomarkers and the histological grade. Their usefulness as predictors of the histological grade was verified using receiver operator characteristic (ROC) curves. A survival function study was performed using the Kaplan–Meier method. To assess the prognostic utility of the metabolic biomarkers we use the Log-Rank method. Results The SUV values were useful to discriminate high-grade STS. We found a significant relationship between the histological grade and the SUV values. SUVmax, SUVpeak, MTV, and TLG were predictors of overall survival (OS). There were no significant differences in the OS for the SUVmean, or in the disease-free survival (DFS) for SUVmax, SUVmean, SUVpeak, MTV, and TLG. Conclusions The SUVmax, SUVmean, and SUVpeak values correlate with the HG and are useful to discriminate high-grade from low-grade STS. Patients with high SUVmax, SUVpeak, MTV, and TLG have a significantly lower OS.
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Affiliation(s)
- Rafael Hernando Reyes Marlés
- Nuclear Medicine Division (DIMEC), Hospitales Universitarios San Roque, Las Palmas de Gran Canaria, Las Palmas, Spain. .,Nuclear Medicine Department, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
| | | | | | - Fernando Santonja Medina
- Orthopedics and Traumatology Department, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Laroussi Mohamed Salem
- Nuclear Medicine Department, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Laura Frutos Esteban
- Nuclear Medicine Department, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | | | | | - Guadalupe Ruiz Merino
- Data Analytics Department, Instituto Murciano de Investigación Biosanitaria (IMIB) Virgen de la Arrixaca, El Palmar, Murcia, Spain
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Liu S, Sun W, Yang S, Duan L, Huang C, Xu J, Hou F, Hao D, Yu T, Wang H. Deep learning radiomic nomogram to predict recurrence in soft tissue sarcoma: a multi-institutional study. Eur Radiol 2021. [PMID: 34448928 DOI: 10.1007/s00330-021-08221-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/19/2021] [Accepted: 07/15/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To evaluate the performance of a deep learning radiomic nomogram (DLRN) model at predicting tumor relapse in patients with soft tissue sarcomas (STS) who underwent surgical resection. METHODS In total, 282 patients who underwent MRI and resection for STS at three independent centers were retrospectively enrolled. In addition, 113 of the 282 patients received additional contrast-enhanced MRI scans. We separated the participants into a development cohort and an external test cohort. The development cohort consisted of patients from one center and the external test cohort consisted of patients from two other centers. Two MRI-based DLRNs for prediction of tumor relapse after resection of STS were established. We universally tested the DLRNs and compared them with other prediction models constructed by using widespread adopted predictors (i.e., staging systems and Ki67) instead of radiomics features. RESULTS The DLRN1 model incorporated plain MRI-based radiomics signature into the clinical data, and the DLRN2 model integrated radiomics signature extracted from plain and contrast-enhanced MRI with the clinical predictors. Across both study sets, the two MRI-based DLRNs had relatively better prognostic capability (C index ≥ 0.721 and median AUC ≥ 0.746; p < 0.05 compared with most other models and predictors) and less opportunity for prediction error (integrated Brier score ≤ 0.159). The decision curve analysis indicates that the DLRNs have greater benefits than staging systems, Ki67, and other models. We selected appropriate cutoff values for the DLRNs to divide STS recurrence into three risk strata (low, medium, and high) and calculated those groups' cumulative risk rates. CONCLUSION The DLRNs were shown to be a reliable and externally validated tool for predicting STS recurrence by comparing with other prediction models. KEY POINTS • The prediction of a high recurrence rate of STS before emergence of local recurrence can help to determine whether more active treatment should be implemented. • Two MRI-based DLRNs for prediction of tumor relapse were shown to be a reliable and externally validated tool for predicting STS recurrence. • We used the DLRNs to divide STS recurrence into three risk strata (low, medium, and high) to facilitate more targeted postoperative management in the clinic.
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Pinzón-Osorio CA, Meneses-Martínez H, Botero-Espinosa L, Herrera-Luna CV. Invasive leiomyosarcoma involving the tongue of an Arabian mare. J Equine Vet Sci 2021; 104:103718. [PMID: 34416982 DOI: 10.1016/j.jevs.2021.103718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
A 10 year-old endurance Arabian mare was presented with an invasive, firm, multilobulated mass at the left ventral face of the tongue. The mare had a history of four months of ptyalism, dysphagia, severe halitosis, and dysmastication. The Evaluation of the horse included physical and oral examination, complete blood count and serum biochemistry profile, computed tomography evaluation of the head, and histopathology of the mass. The computerized tomography (CT) head scan showed the homogeneous mass in the oral cavity confirming the degree of invasion on the tongue, as well as a small mineral focus at the left dorsal mandibular border and increased density of the submandibular lymph nodes. At necropsy, gross findings in the oral cavity revealed an irregular, nodular and partially ulcerated mass at the level of the body of the tongue in the ventral aspect, with a size of approximately 10 × 15 × 8 cm. Histologically, the tongue revealed a neoplastic process of mesenchymal muscle origin. The tumor cells showed distinctive morphological and architectural patterns in some areas. An immunohistochemistry panel was done yielding a positive reaction for Calponin and Desmin, confirming diagnostics of as a soft tissue leiomyosarcoma in the tongue. Immunohistochemistry results, in combination with histopathologic morphology, were suggestive of a leiomyosarcoma originating in the perivascular wall tissue. Oral leiomyosarcoma are very rare in veterinary medicine, and to the authors' knowledge, this is the first case report to utilize histopathology, immunohistochemistry and imaginology to describe oral leiomyosarcoma in a horse.
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Affiliation(s)
- César Augusto Pinzón-Osorio
- Animal Health Department, Faculty of Veterinary Medicine and Animal Science, Universidad Nacional de Colombia, Bogotá DC, Colombia; College of Veterinary Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Henry Meneses-Martínez
- Animal Health Department, Faculty of Veterinary Medicine and Animal Science, Universidad Nacional de Colombia, Bogotá DC, Colombia
| | - Lucía Botero-Espinosa
- Animal Health Department, Faculty of Veterinary Medicine and Animal Science, Universidad Nacional de Colombia, Bogotá DC, Colombia
| | - Carlos Vladimir Herrera-Luna
- Animal Health Department, Faculty of Veterinary Medicine and Animal Science, Universidad Nacional de Colombia, Bogotá DC, Colombia
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Abstract
We reviewed the recent literature related to primary musculoskeletal tumors and metastatic bone tumors. With regard to primary bone tumors, computer navigation systems and three-dimensional-printed prostheses seem to be new treatment options, especially in challenging anatomical locations, such as the sacrum and pelvis. Regarding the treatment of giant cell tumor of bone, recent studies have suggested that denosumab administration is related to a higher local recurrence rate following curettage, but a lower local recurrence rate following en bloc resection. In addition, there was no difference in the local recurrence rate at five years after surgery between short-term and long-term denosumab therapy. With regard to soft tissue tumors, percutaneous cryoablation appears to be a new treatment option for extra-abdominal desmoid tumors, with encouraging results. Regarding soft tissue sarcomas, a negative surgical margin of < 1 mm is sufficient to control local recurrence. Pexidartinib seems to be a promising systemic therapy for the treatment of tenosynovial giant cell tumors for which surgery is not expected to improve the function of the affected limb. Finally, the life expectancy of patients is the most important factor in determining the optimal surgical procedure for patients with impending or pathological fractures of the long bone due to metastatic bone tumors. Elevated C-reactive protein level was found to be an independent poor prognostic factor at 1 year after surgery for long bone metastases.
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Affiliation(s)
- Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Andreas F Mavrogenis
- First Department of Orthopedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Street Holargos, 15562, Athens, Greece
| | - Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Nara, 634-8521, Kashihara-city, Japan
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Lansu J, Braam PM, van Werkhoven E, Scholten AN, Schrage Y, van Houdt WJ, van Langevelde K, Haas RL. A moderate dose of preoperative radiotherapy may improve resectability in myxoid liposarcoma. Eur J Surg Oncol 2021:S0748-7983(21)00584-9. [PMID: 34233858 DOI: 10.1016/j.ejso.2021.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/31/2021] [Accepted: 06/16/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Histotype specific neoadjuvant therapy response data is scarce in soft tissue sarcomas. This study aimed to assess the impact of a moderate radiotherapy (RT) dose on resectability and to correlate MRI parameters to pathological treatment response in Myxoid Liposarcoma (MLS). METHODS This prospective, multicenter, single-arm, phase 2 trial assessed the radiological effects of 36 Gy of preoperative radiotherapy in primary non-metastatic MLS (n=34). Distance of the tumor to the neurovascular bundle, tumor dimensions, fat fraction, enhancing fraction were determined on MRI scans at baseline, after 8 and 16 fractions, and preoperatively. Pathological response was established by central pathology review. RESULTS Preoperative radiotherapy resulted in a median increase of 2 mm (IQR 0 to 6) of the distance of the tumor to the neurovascular bundle. As compared to baseline, the median change of the tumor volume, craniocaudal diameter and axial diameter at preoperative MRI were -60% (IQR -74 to -41), -19% (IQR -23 to -7) and -20% (IQR -29 to -12), respectively. The median fat fraction of 0.1 (IQR 0.0-0.1) and enhancing fraction of 0.8 (IQR 0.6 to 0.9) at baseline, changed to 0.2 (IQR 0.1 to 0.5) and to 0.5(IQR 0.4 to 0.9) preoperatively, respectively. Radiological signs of response in terms of volume, enhancing fraction and fat fraction were correlated with specific pathological signs of response like hyalinization, necrosis and fatty maturation. CONCLUSIONS A moderate dose of preoperative radiotherapy may improve resectability in MLS and could facilitate achievement of clear margins and function preservation. MRI features which were predictive for expressions of pathological response, can play a role in further personalization of neoadjuvant treatment strategies in order to improve outcome in MLS.
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Merino-Rueda LR, Barrientos-Ruiz I, Bernabeu-Taboada D, Pozo-Kreilinger JJ, Peleteiro-Pensado M, Cordero-García JM, Ortiz-Cruz EJ. Radiological and histopathological assessment of bone infiltration in soft tissue sarcomas. Eur J Orthop Surg Traumatol 2021; 32:631-639. [PMID: 34057623 DOI: 10.1007/s00590-021-03018-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Deep soft tissue sarcomas are frequently in contact with bone. The therapeutic decision of a composite resection strategy may be challenging, which is usually based on clinical and radiological criteria. The aims of the study were to evaluate the overall frequency of bone and periosteal infiltration in these patients in whom composite resection was indicated, and evaluate the role of magnetic resonance imaging and bone scintigraphy in this scenario. METHODS Forty-nine patients with a composite surgical resection (soft tissue sarcoma and bone), treated at a single institution between 2006 and 2018, were retrospectively included. Presurgical planning of the resection limits was based on clinical and imaging findings (magnetic resonance imaging and bone scintigraphy). Magnetic resonance imaging was performed in all patients (100%) and bone scintigraphy in 41 (83.7% of the cases). According to magnetic resonance imaging results, patients were divided into two groups: Group A, in which the tumor is adjacent to the bone without evidence of infiltration (n = 24, 48,9%), and Group B, patients with evidence of bone involvement by magnetic resonance imaging (n = 25, 51,1%). BS showed a pathological deposit in 28 patients (68.3%). Histological analysis of the resection specimen was preceded to identify bone and periosteal infiltration. For the analysis of the diagnostic validity of imaging tests, histological diagnosis was considered as the gold standard in the evaluation of STS bone infiltration. RESULTS Histological bone infiltration was identified in 49% of patients and isolated periosteal infiltration in 14.3%. In terms of diagnostic accuracy, magnetic resonance imaging and bone scintigraphy sensitivity values were 92% and 90%, and their specificity values were 91.7% and 52.4%, respectively. CONCLUSIONS The incidence of bone and periosteal infiltration of soft tissue sarcomas in contact with bone is high. Presurgical bone assessment by MRI has proven to be a sensitive and specific tool in the diagnosis of bone infiltration. Due to its high negative predictive value, BS is a useful test to rule out it. In those cases, in which there is suspicion of bone infiltration not confirmed by MRI, new diagnostic protocols should be established in order to avoid inappropriate resections.
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Affiliation(s)
- Luis Rodrigo Merino-Rueda
- Orthopaedic Oncology Unit, "Doce de Octubre" University Hospital, Avda. De Córdoba s/n, 28041, Madrid, Spain. .,Orthopaedic Oncology Unit, La Paz University Hospital, Paseo de La Castellana, 26, 28046, Madrid, Spain.
| | - Irene Barrientos-Ruiz
- Orthopaedic Oncology Unit, La Paz University Hospital, Paseo de La Castellana, 26, 28046, Madrid, Spain
| | - Daniel Bernabeu-Taboada
- Radiology Department, La Paz University Hospital, Paseo de La Castellana, 26, 28046, Madrid, Spain
| | - José J Pozo-Kreilinger
- Pathology Department, La Paz University Hospital, Paseo de La Castellana, 26, 28046, Madrid, Spain
| | - Manuel Peleteiro-Pensado
- Orthopaedic Oncology Unit, La Paz University Hospital, Paseo de La Castellana, 26, 28046, Madrid, Spain
| | - José M Cordero-García
- Nuclear Medicine Department, La Paz University Hospital, Paseo de La Castellana, 26, 28046, Madrid, Spain
| | - Eduardo J Ortiz-Cruz
- Orthopaedic Oncology Unit, La Paz University Hospital, Paseo de La Castellana, 26, 28046, Madrid, Spain
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Artzt B, Arndt M, Wickler B, Rehart S. [Gigantic prepatellar "tumor" in rheumatoid arthritis-a case report]. Z Rheumatol 2021; 80:972-979. [PMID: 33931806 DOI: 10.1007/s00393-021-01010-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
In soft tissue tumors of the extremities it is of utmost importance to differentiate between benign and malignant entities. The majority of the swellings vary from benign tissue changes through soft tissue sarcomas up to pseudotumors. Because of the low incidence of malignancy and the predominantly benign alterations together with a high heterogeneity, there is a need for a reproducible diagnostic and therapeutic concept for the treatment of all tumors of the extremities. This article reports the case of a 59-year-old patient with longstanding rheumatoid arthritis who presented to the orthopedic rheumatologic consultation with a massive swelling directly ventral to the knee joint. At that point the tumor had already grown very slowly for 5 years. The staged diagnostic process (patient history, clinical, laboratory tests, sonographic examinations, X‑ray, MRI with contrast medium) revealed no trace of malignancy whatsoever. The treatment then consisted of the complete surgical excision in accordance with the recommendations for tumor surgery. Histopathological findings confirmed the diagnosis of a massive prepatellar bursitis. Initially, the extreme and solid prepatellar swelling was suspected of being malignant; however, this could already be broadly excluded preoperatively. This article presents the rationale and the orthopedic rheumatologic approach for addressing unclear space-occupying lesions of the musculoskeletal system in patients with rheumatism. In the inflammatory systemic disease in the differential diagnosis periarticular swellings can ultimately also have benign causes, such as an organized bursitis.
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Affiliation(s)
- B Artzt
- Klinik für Orthopädie und Unfallchirurgie, AGAPLESION MARKUS KRANKENHAUS, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Deutschland.
| | - M Arndt
- Klinik für Orthopädie und Unfallchirurgie, AGAPLESION MARKUS KRANKENHAUS, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Deutschland
| | - B Wickler
- Klinik für Orthopädie und Unfallchirurgie, AGAPLESION MARKUS KRANKENHAUS, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Deutschland
| | - S Rehart
- Klinik für Orthopädie und Unfallchirurgie, AGAPLESION MARKUS KRANKENHAUS, Wilhelm-Epstein-Str. 4, 60431, Frankfurt am Main, Deutschland
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García-Ortega DY, Clara-Altamirano MA, Martín-Tellez KS, Caro-Sánchez CHS, Álvarez-Cano A, Lino-Silva LS, Salcedo-Hernández RA, Ruvalcaba-González CDLC, Martínez-Said H, Luna-Ortiz K, Villavicencio-Valencia SV, Cuellar-Hubbe M. Epidemiological profile of soft tissue sarcomas of the extremities: Incidence, histological subtypes, and primary sites. J Orthop 2021; 25:70-74. [PMID: 33935434 DOI: 10.1016/j.jor.2021.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/08/2021] [Accepted: 03/28/2021] [Indexed: 01/14/2023] Open
Abstract
Background Soft tissue sarcomas (STS) are a heterogeneous group of rare tumours that represent less than 1% of all malignant, solid tumours in adults. There is limited epidemiological information regarding STS in Latin America. Therefore, the objective of this study is to present an epidemiological profile of these tumours observed at a single reference centre. Methods A retrospective study was carried out based on hospital records obtained from a registry of 879 patients with STS of the extremities who were treated at the National Cancer Institute of Mexico from January 1, 1994 to December 31, 2017. Epidemiological variables and relevant clinical data were collected. Five-year survival rates were analysed using Kaplan-Meier estimates, and a multivariate Cox proportional-hazards model measured associations. Results A total of 879 records were collected. The median age was 45 years (15-95 years), and the ratio of men to women was 1:1, with 433 men (49.3%), and 446 women (50.7%). The median tumour size was 11.4 cm (2-49 cm). The most prevalent histological variants were liposarcomas and synovial sarcomas. The lower limb was the most frequently affected extremity, with the thigh being the most common site followed by the leg. A majority of the patients were diagnosed at clinical stages IIIA-IV. Conclusions The data collected from the present cohort provides an overview of the epidemiological profile of STS at a single reference centre in Latin America, and allow comparison with global data.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Hector Martínez-Said
- National Cancer Institute (Instituto Nacional de Cancerología) Mexico City, Mexico
| | - Kuauhyama Luna-Ortiz
- National Cancer Institute (Instituto Nacional de Cancerología) Mexico City, Mexico
| | | | - Mario Cuellar-Hubbe
- National Cancer Institute (Instituto Nacional de Cancerología) Mexico City, Mexico
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Manikis GC, Nikiforaki K, Lagoudaki E, de Bree E, Maris TG, Marias K, Karantanas AH. Differentiating low from high-grade soft tissue sarcomas using post-processed imaging parameters derived from multiple DWI models. Eur J Radiol 2021; 138:109660. [PMID: 33756189 DOI: 10.1016/j.ejrad.2021.109660] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/14/2021] [Accepted: 03/15/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To investigate and histopathologically validate the role of model selection in the design of novel parametric meta-maps towards the discrimination of low from high-grade soft tissue sarcomas (STSs) using multiple Diffusion Weighted Imaging (DWI) models. METHODS DWI data of 28 patients were quantified using the mono-exponential, bi-exponential, stretched-exponential and the diffusion kurtosis model. Akaike Weights (AW) were calculated from the corrected Akaike Information Criteria (AICc) to select the most suitable model for every pixel within the tumor volume. Pseudo-colorized classification maps were then generated to depict model suitability, hypothesizing that every single model underpins different tissue properties and cannot solely characterize the whole tumor. Single model parametric maps were turned into meta-maps using the classification map and a histological validation of the model suitability results was conducted on several subregions of different tumors. Several histogram metrics were calculated from all derived maps before and after model selection, statistical analysis was conducted using the Mann-Whitney U test, p-values were adjusted for multiple comparisons and performance of all statistically significant metrics was evaluated using the Receiver Operator Characteristic (ROC) analysis. RESULTS The histologic analysis on several tumor subregions confirmed model suitability results on these areas. Only 3 histogram metrics, all derived from the meta-maps, were found to be statistically significant in differentiating low from high-grade STSs with an AUC higher than 89 %. CONCLUSION Embedding model selection in the design of the diffusion parametric maps yields to histogram metrics of high discriminatory power in grading STSs.
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Affiliation(s)
- Georgios C Manikis
- Department of Radiology, Medical School-University of Crete, Heraklion, Greece; Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas (FORTH), Heraklion, Greece.
| | - Katerina Nikiforaki
- Department of Radiology, Medical School-University of Crete, Heraklion, Greece; Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas (FORTH), Heraklion, Greece.
| | - Eleni Lagoudaki
- Department of Pathology, University Hospital of Crete, Heraklion, Greece.
| | - Eelco de Bree
- Department of Surgical Oncology, University of Crete, Heraklion, Greece.
| | - Thomas G Maris
- Department of Radiology, Medical School-University of Crete, Heraklion, Greece; Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas (FORTH), Heraklion, Greece.
| | - Kostas Marias
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas (FORTH), Heraklion, Greece; Department of Electrical & Computer Engineering, Hellenic Mediterranean University, Crete, Heraklion, Greece.
| | - Apostolos H Karantanas
- Department of Radiology, Medical School-University of Crete, Heraklion, Greece; Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas (FORTH), Heraklion, Greece; Department of Medical Imaging, University Hospital, Heraklion, Greece.
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Zou D, Wang Y, Wang M, Zhao B, Hu F, Li Y, Zhang B. Bioinformatics analysis reveals the competing endogenous RNA (ceRNA) coexpression network in the tumor microenvironment and prognostic biomarkers in soft tissue sarcomas. Bioengineered 2021; 12:496-506. [PMID: 33587010 PMCID: PMC8806339 DOI: 10.1080/21655979.2021.1879566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Soft tissue sarcomas (STSs) are rare, heterogeneous mesenchymal neoplasias. Understanding the tumor microenvironment (TME) and identifying potential biomarkers for prognosis associated with the TME of STS might provide effective clues for immune therapy. We evaluated the immune scores and stromal scores of STS patients by using the RNA sequencing dataset from The Cancer Genome Atlas (TCGA) database and the ESTIMATE algorithm. Then, the differentially expressed mRNAs (DEGs), miRNAs (DEMs) and lncRNAs (DELs) were identified after comparing the high- and low-score groups. Next, we established a competing endogenous RNA (ceRNA) network and explored the prognostic values of biomarkers involved in the network with the help of bioinformatics analysis. High immune score was significantly associated with favorable overall survival in STS patients. A total of 328 DEGs, 18 DEMs and 67 DELs commonly regulated in the immune and stromal score groups were obtained. A ceRNA network and protein-protein interaction (PPI) network identified some hub nodes with considerable importance in the network. Kaplan-Meier survival analysis demonstrated that nine mRNAs, two miRNAs and three lncRNAs were closely associated with overall survival of STS patients. Gene set enrichment analysis (GSEA) suggested that these three lncRNAs were mainly involved in immune response-associated pathways in STS patients. Finally, the expression levels of five mRNAs (APOL1, EFEMP1, LYZ, RARRES1 and TNFAIP2) were verified, which were consistent with the results of the TCGA cohort. The results of our study confirmed the prognostic value of immune scores for STS patients. We also identified several TME-related biomarkers that might contribute to prognostic prediction and immune therapy.
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Affiliation(s)
- Dandan Zou
- Department of Radiology, The First Hospital of Qinhuangdao , Qinhuangdao, Hebei, China
| | - Yang Wang
- Department of MRI, The Third Hospital of Qinhuangdao , Qinhuangdao, Hebei, China
| | - Meng Wang
- Department of Clinical Laboratory, The First Hospital of Qinhuangdao , Qinhuangdao, Hebei, China
| | - Bo Zhao
- Department of Radiology, The First Hospital of Qinhuangdao , Qinhuangdao, Hebei, China
| | - Fei Hu
- Department of Radiology, The First Hospital of Qinhuangdao , Qinhuangdao, Hebei, China
| | - Yanguo Li
- Department of Radiology, The First Hospital of Qinhuangdao , Qinhuangdao, Hebei, China
| | - Bingming Zhang
- Department of Radiology, The First Hospital of Qinhuangdao , Qinhuangdao, Hebei, China
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Zhang P, Liu J, Li X, Gao M, Feng F, Wang W, Zhang Q, Yao W. NF1 and PTEN gene polymorphisms and the susceptibility to soft tissue sarcomas in a Chinese population: A case-control study. Exp Mol Pathol 2021; 118:104603. [PMID: 33422488 DOI: 10.1016/j.yexmp.2021.104603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/01/2020] [Accepted: 01/03/2021] [Indexed: 01/05/2023]
Abstract
The aim of this study was to assess the association between NF1 and PTEN gene polymorphisms and the risk of soft tissue sarcomas (STSs). This case-control study collected peripheral blood from 136 patients with STSs and 124 healthy controls. Six single nucleotide polymorphisms (SNPs) of the NF1 gene and five SNPs of the PTEN gene were investigated and genotyped using the SNaPshot assay. The association between the polymorphisms and the risk of STSs was estimated using unconditional logistic regression analysis. The results showed that individuals with the TC/CC genotype for NF1 rs2905789 displayed a significantly increased risk of STSs compared with individuals with wild-type TT (OR = 1.702, 95% CI = 1.002-2.890, P = 0.049). There were no significant differences in the distribution of the genotype or the allele frequencies of the polymorphisms of the NF1 and PTEN genes between the STSs patients and the controls in a Chinese population. Therefore, this study's results suggest that individuals carrying the TC/CC genotype for NF1 rs2905789 may be susceptible to STSs.
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Affiliation(s)
- Peng Zhang
- Department of Bone and soft tissue cancer, The Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, Henan province 450008, China.
| | - Jinyan Liu
- Department of Bone and soft tissue cancer, The Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, Henan province 450008, China
| | - Xinling Li
- Department of Occupational Health and occupational medicine, College of Public Health, Zhengzhou University, Zhengzhou, Henan province 450001, China
| | - Min Gao
- Department of Toxicology, College of Public Health, Zhengzhou University, Zhengzhou, Henan province 450001, China
| | - Feifei Feng
- Department of Toxicology, College of Public Health, Zhengzhou University, Zhengzhou, Henan province 450001, China
| | - Wei Wang
- Department of Occupational Health and occupational medicine, College of Public Health, Zhengzhou University, Zhengzhou, Henan province 450001, China
| | - Qiao Zhang
- Department of Toxicology, College of Public Health, Zhengzhou University, Zhengzhou, Henan province 450001, China
| | - Weitao Yao
- Department of Bone and soft tissue cancer, The Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), Zhengzhou, Henan province 450008, China
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Singh S, Hassan A. Subcutaneous leiomyosarcoma of the scrotum mimickering testicular cancer. A case report and literature review. Urol Case Rep 2021; 34:101487. [PMID: 33318933 DOI: 10.1016/j.eucr.2020.101487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 11/21/2022] Open
Abstract
Leiomyosarcoma of the scrotum is a rare tumor. Johnson H Jr in 1987 reported first case. Only 39 cases been reported in the literature. A 74 years old Indian gentleman presented with progressive painless right testicular swelling for 3 months. On examination, a firm right testicular mass. We proceeded with right scrotal exploration with excision of the right scrotal mass. Histopathology showed scrotum leiomyosarcoma. We would like to discuss the rarity of presentation, dilemma of diagnosis and managing in a district hospital. We advocate wide local excision with clear margin of 2 cm which give good overall survival benefits.
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Hanna SA, Munhoz RR, de Freitas Perina AL, Gonçalves MS, da Costa FPP, de Freitas Busnardo F, de Oliveira Ferreira F. Surgical resection, intraoperative radiotherapy and immediate plastic reconstruction: A good option for the treatment of distal extremity soft tissue sarcomas. Rep Pract Oncol Radiother 2020; 25:919-26. [PMID: 33088227 DOI: 10.1016/j.rpor.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/06/2020] [Accepted: 09/10/2020] [Indexed: 12/24/2022] Open
Abstract
Aim To show three patients with soft tissue sarcomas of distal extremities conservatively treated after tumor-board discussion, involving margin-free surgery, exclusive intraoperative radiotherapy, and immediate reconstruction. Background Current guidelines show clear and robust recommendations regarding the composition of the treatment of sarcomas of extremities. However, little evidence exists regarding the application of these treatments depending on the location of the primary neoplasia. Tumors that affect the distal extremities present different challenges and make multidisciplinary discussions desirable. Methods/Results We reported 3 patients who were approached with a conservative intention, after tumor board recomendation. The goals from the treatment performed were aesthetic and functional preservation, while enruring locoregional control. We had wound healing complications in 2 of the cases, requiring additional reconstruction measures. Patients are followed up for 24, 20 and 10 months; local control is 100%, and functional preservation is 100%. Conclusions Despite being a small series, it was sufficient to illustrate successful multidisciplinary planning, generating a therapeutic result with improved quality of life for patients who had an initial indication for extremity amputation.
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Li H, Tu J, Zhao Z, Chen L, Qu Y, Li H, Yao H, Wang X, Lee DF, Shen J, Wen L, Huang G, Xie X. Molecular signatures of BRCAness analysis identifies PARP inhibitor Niraparib as a novel targeted therapeutic strategy for soft tissue Sarcomas. Am J Cancer Res 2020; 10:9477-9494. [PMID: 32863940 PMCID: PMC7449912 DOI: 10.7150/thno.45763] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 07/12/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Patients with advanced soft tissue sarcomas (STS) have a dismal prognosis with few effective therapeutic options. A defect in the homologous recombination repair (HRR) pathway can accumulate DNA repair errors and gene mutations, which can lead to tumorigenesis. BRCAness describes tumors with an HRR deficiency (HRD) in the absence of a germline BRCA1/2 mutation. However, the characteristics of BRCAness in STS remain largely unknown. Thus, this study aimed to explore the genomic and molecular landscape of BRCAness using whole exome sequencing (WES) in STS, aiming to find a potential target for STS treatment. Methods: WES was performed in 22 STS samples from the First Affiliated Hospital of Sun Yat-sen University to reveal the possible genomic and molecular characteristics. The characteristics were then validated using data of 224 STS samples from The Cancer Genome Atlas (TCGA) database and in vitro data. The analysis of the potential biomarker for BRCAness was performed. Targeted drug susceptibility and combination therapy screening of chemotherapeutics for STS were evaluated in STS cell lines, cell-line-derived xenografts (CDX), and patient-derived xenografts (PDX). Results: Compared with 30 somatic mutation signatures of cancers, high cosine-similarity (0.75) was identified for HRD signatures in the 22 STS samples using nonnegative matrix factorization. Single nucleotide polymorphism indicated a low mutation rate of BRCA1/2 in the 22 STS samples (11.76% and 5.88%, respectively). However, copy number variation analyses demonstrated widespread chromosomal instability; furthermore, 54.55% of STS samples (12/22) carried BRCAness traits. Subsequently, similar genomic and molecular characteristics were also detected in the 224 STS samples from TCGA and in vitro. Poly (ADP-ribose) polymerases (PARP)-1 could be a promising reflection of HRD and therapeutic response. Furthermore, the level of PAR formation was found to be correlated with PARP-1. Subsequently, STS cell lines were determined to be sensitive to PARP inhibitor (PARPi), niraparib. Moreover, based on the screening test of the five common PARPis and combination test among doxorubicin, ifosfamide, dacarbazine, and temozolomide (TMZ), niraparib and TMZ were the most synergistic in STS cell lines. The synergistic effect and safety of niraparib and TMZ combination were also shown in CDX and PDX. Conclusions: BRCAness might be the common genomic and molecular characteristics of majority of STS cases. PARP-1 and PAR could be potential proper and feasible theranostic biomarkers for assessing HRD in patients. STSs were sensitive to PARPi. Moreover, the combination of niraparib and TMZ showed synergistic effect. Niraparib and TMZ could be a promising targeted therapeutic strategy for patients with STS.
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Rodríguez-Alfonso B, Simó-Perdigó M, Orcajo Rincón J. Functional image in soft tissue sarcomas: An update of the indications of 18F-FDG-PET/CT. Rev Esp Med Nucl Imagen Mol 2020; 39:233-243. [PMID: 32616457 DOI: 10.1016/j.remn.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 11/29/2022]
Abstract
Soft tissue sarcomas (STS) are a rare and heterogeneous group of tumors. They account for 1% of solid malignant tumors in adults and 7% in children and are responsible for 2% of cancer mortality. They require a multidisciplinary approach in centers with experience. This collaboration aims to update the scientific evidence to strengthen, together with clinical experience, the bases for the use and limitations of 18F-FDG-PET/CT in STSs. The general recommendations for the use of PET/CT in STS at present are summarized as the initial evaluation of soft tissue tumours when conventional image does not establish benignity with certainty and this determines the approach; in biopsy guiding in selected cases; in the initial staging, as additional tool, for rhabdomyosarcoma and STS of extremities or superficial trunk and head and neck tumours; in the suspicion of local recurrence when the CT or MRI are inconclusive and in the presence of osteosynthesis or prosthetic material and in assessment of therapy response to local/systemic therapy in stages ii/iii. In addition, PET/CT has the added value of being a surrogate marker of the histopathological response and it provides prognostic information, both in the baseline study and after treatment.
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Affiliation(s)
- B Rodríguez-Alfonso
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro de Majadahonda, Majadahonda, Madrid, España.
| | - M Simó-Perdigó
- Servicio de Medicina Nuclear, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - J Orcajo Rincón
- Servicio de Medicina Nuclear, Hospital General Universitario Gregorio Marañón, Madrid, España; Miembro del Grupo Español de Investigación en Sarcomas (GEIS)
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Martin-Tellez KS, van Houdt WJ, van Coevorden F, Colombo C, Fiore M. Isolated limb perfusion for soft tissue sarcoma: Current practices and future directions. A survey of experts and a review of literature. Cancer Treat Rev 2020; 88:102058. [PMID: 32619864 DOI: 10.1016/j.ctrv.2020.102058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/11/2020] [Indexed: 12/15/2022]
Abstract
Soft tissue sarcomas constitute 1% of adult malignant tumors. They are a heterogeneous group of more than 50 different histologic types. Isolated limb perfusion is an established treatment strategy for locally advanced sarcomas. Since its adoption for sarcomas in 1992, after the addition of TNFα, few modifications have been done and although indications for the procedure are essentially the same across centers, technical details vary widely. The procedures mainly involves a 60 min perfusion with melphalan and TNFα under mild hyperthermia, achieving a limb preservation rate of 72-96%; with an overall response rates from 72 to 82.5% and an acceptable toxicity according to the Wieberdink scale. The local failure rate is 27% after a median follow up of 14-31 months compared to 40% of distant recurrences after a follow up of 12-22 months. Currently there is no consensus regarding the benefit of ILP per histotype, and the value of addition of radiotherapy or systemic treatment. Further developments towards individualized treatments will provide a better understanding of the population that can derive maximum benefit of ILP with the least morbidity.
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Affiliation(s)
- K S Martin-Tellez
- Fellow of the European School of Soft Tissue Sarcoma, Department of Surgical Oncology, The American British Cowdray Medical Center ABC, Mexico city, Mexico.
| | - W J van Houdt
- Sarcoma Unit, Department of Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - F van Coevorden
- Sarcoma Unit, Department of Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - C Colombo
- Sarcoma Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - M Fiore
- Sarcoma Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Correa-González N, De La Calva C, Miranda I, Amaya JV, Angulo M, Baixauli-García F. Soft tissue sarcomas in the elbow region and influence of their anatomical features in their treatment. Experience in the Unit of Musculoskeletal Tumours. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:301-309. [PMID: 32561206 DOI: 10.1016/j.recot.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 04/10/2020] [Accepted: 04/21/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND AIM Soft tissue sarcomas are exceptionally located in the elbow region. The aim of this work was to study the soft tissue sarcomas of the elbow region, their epidemiological and histopathological characteristics, anatomical features, the treatment performed, and the results obtained, in a unit of musculoskeletal tumours. METHODS Retrospective review of ten patients with a mean follow-up of 65.0 ± 11.9 (range 21-132) months with soft tissue sarcomas located in the elbow region operated in our centre between 2008 and 2016. RESULTS Mean age was 60.8 ± 6.7 years. Undifferentiated pleomorphic sarcoma was the most frequent histological diagnosis. Limb preservation surgery was performed in 90% of patients. Three patients were previously operated without following surgical oncology guidelines in another hospital, and this was statistically related to the need for more than one surgery to control the disease. R1 margin was obtained in 5 patients and R0 in another 5. Adjuvant radiotherapy was used in 7 cases. In 4 patients, subsequent surgery was performed for local or systemic control of the disease. Local recurrence occurred in 3 cases and in 5 there was distant disease. CONCLUSION The elbow region presents difficulty in achieving wide margins due to the proximity of neurovascular structures, adjuvant and / or neoadjuvant therapies could play an important role in performing limb preservation surgery. It would be advisable to refer these tumours to specialized units with multidisciplinary teams.
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Affiliation(s)
- N Correa-González
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - C De La Calva
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - I Miranda
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Arnau de Vilanova, Valencia, España.
| | - J V Amaya
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - M Angulo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - F Baixauli-García
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, España
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Quiroga D, Liebner DA, Philippon JS, Hoffman S, Tan Y, Chen JL, Lenobel S, Wakely PE, Pollock R, Tinoco G. Activity of PD1 inhibitor therapy in advanced sarcoma: a single-center retrospective analysis. BMC Cancer 2020; 20:527. [PMID: 32503455 PMCID: PMC7275332 DOI: 10.1186/s12885-020-07021-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/28/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Sarcomas constitute a heterogeneous group of tumors with different clinical behaviors and variable responses to systemic therapies. Recent immunotherapy studies with PD1 inhibitors (PD1i) show promising results with use in certain soft-tissue sarcomas; however, the clinical and molecular features that best predict response to PD1i remain unclear. METHODS Demographic, imaging, histologic, and genetic sequencing data was collected for sarcoma patients who received nivolumab or pembrolizumab (PD1i) treatment at our institution between January 1st 2015 and April 23rd 2018. The primary objective was to determine progression-free survival (PFS) in patients with advanced sarcomas receiving PD1i. Secondary objectives included determining overall survival (OS) and assessment of characteristics associated with response to PD1i. Fifty-six patients who were treated with PD1i therapy met inclusion criteria for this study. RESULTS Partial response towards PD1i treatment was seen in 3 in 26 evaluable patients, but no complete responses were observed (overall response rate 11.5%). Within this group of patients, the 90 day PFS was found to be 48.8%. In patients in whom PD1 expression was known, there was a statistically significant positive correlation between expression of PD1 and longer PFS and OS rates. Patients that were treated with more than four cycles of PD1i therapy were also more likely to have a greater OS. CONCLUSIONS This study suggests activity of PD1i in a pretreated cohort of advanced sarcoma patients, particularly for the subset of patients with PD1 positive tumors. Our results highlight the importance of further research to better target the optimal patient population and markers of response.
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Affiliation(s)
- Dionisia Quiroga
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W 10th Ave, Columbus, OH, 43210, USA
| | - David A Liebner
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W 10th Ave, Columbus, OH, 43210, USA
- Department of Biomedical Informatics, The Ohio State University, 250 Lincoln Tower, 1800 Cannon Dr, Columbus, OH, 43210, USA
| | - Jennifer S Philippon
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
| | - Sarah Hoffman
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
| | - Yubo Tan
- Center for Biostatistics, The Ohio State University, 2012 Kenny Rd, Columbus, OH, 43221, USA
| | - James L Chen
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W 10th Ave, Columbus, OH, 43210, USA
- Center for Biostatistics, The Ohio State University, 2012 Kenny Rd, Columbus, OH, 43221, USA
| | - Scott Lenobel
- Department of Radiology, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
| | - Paul E Wakely
- Department of Pathology, The Ohio State University, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Raphael Pollock
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA
- Department of Surgery, The Ohio State University, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Gabriel Tinoco
- The Ohio State University Comprehensive Cancer Center, The Ohio State University, 410 W 12th Avenue, Columbus, OH, 43210, USA.
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Starling Loving Hall, 320 W 10th Ave, Columbus, OH, 43210, USA.
- The Ohio State University Comprehensive Cancer Center, 320 W 10th Ave, A444 Starling Loving Hall, Columbus, OH, 43210, USA.
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Gennatas S, Chamberlain F, Carter T, Slater S, Cojocaru E, Lambourn B, Stansfeld A, Todd R, Verrill M, Ali N, Jones RL, Simmonds P, Keay N, McCarty H, Strauss S, Karavasilis V, Dileo P, Benson C. Real-world experience with doxorubicin and olaratumab in soft tissue sarcomas in England and Northern Ireland. Clin Sarcoma Res 2020; 10:9. [PMID: 32391141 PMCID: PMC7203838 DOI: 10.1186/s13569-020-00131-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/25/2020] [Indexed: 02/02/2023] Open
Abstract
Background A randomised phase II trial demonstrated that the addition of olaratumab to doxorubicin significantly increased overall survival (OS) in patients with advanced soft tissue sarcomas (STS) compared to doxorubicin alone. The recently presented phase III study of doxorubicin and olaratumab in advanced soft tissue sarcoma was discordant with this finding. Methods We performed a retrospective analysis of adult patients with advanced-/metastatic STS treated with at least two cycles of doxorubicin and olaratumab at eight sarcoma units across England and Northern Ireland between May 2017 and March 2019. Results 172 patients were evaluable and 40 patients (23.3%) had died at the time of analysis. Median ECOG performance status (PS) was 1. Median progression free survival (PFS) was 6.8 months (95% CI 5.9–7.7 months). Leiomyosarcoma was the most common histological subtype (75 patients, 43.6%), followed by liposarcomas (19, 11.0%). The mean number of cycles was 5 (doxorubicin range 2–6; olaratumab range 2–23). Two patients (1.2%) had a complete response and 34 (19.8%) had a partial response. 79 (45.9%) had stable and 58 (33.7%) progressive disease. 57 patients (33.1%) experienced grade ≥ 3 neutropenia and 7 patients (4.1%) grade ≥ 3 febrile neutropenia. Grade ≥ 3 anaemia was seen in 21 patients (12.2%). Grade ≥ 3 non-haematological toxicities were seen in 35 patients (20.3%). A clinically significant drop in left ventricular ejection fraction was seen in 6 patients (3.5%). 48 patients (27.9%) required a dose reduction. Overall survival (OS) is pending. Conclusions Our results are in keeping with the phase III study findings: response rate, PFS and OS were similar to those reported in the phase III ANNOUNCE trial.
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Affiliation(s)
- Spyridon Gennatas
- 1Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ UK
| | | | - Thomas Carter
- 2University College Hospital London, 235 Euston Rd, London, NW1 2BU UK
| | - Susanna Slater
- 3Hammersmith Hospital, 150 Du Cane Rd, White City, London, W12 0HS UK
| | - Elena Cojocaru
- 1Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ UK
| | - Beth Lambourn
- 4Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Anna Stansfeld
- 4Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Radha Todd
- 4Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mark Verrill
- 4Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nasim Ali
- 5The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, UK
| | - Robin L Jones
- 1Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ UK.,6Institute of Cancer Research, 15 Cotswold Road, Sutton, London, SM2 5NG UK
| | - Peter Simmonds
- 7University Hospital Southampton, Tremona Rd, Southampton, SO16 6YD UK
| | - Nicola Keay
- 7University Hospital Southampton, Tremona Rd, Southampton, SO16 6YD UK
| | - Heather McCarty
- 8Belfast Health and Social Care Trust, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AB UK
| | - Sandra Strauss
- 2University College Hospital London, 235 Euston Rd, London, NW1 2BU UK
| | | | - Palma Dileo
- 2University College Hospital London, 235 Euston Rd, London, NW1 2BU UK
| | - Charlotte Benson
- 1Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ UK
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Scoccianti G, Innocenti M, Frenos F, Muratori F, Sacchetti F, Beltrami G, Capanna R, Campanacci DA. Re-excision after unplanned excision of soft tissue sarcomas: Long-term results. Surg Oncol 2020; 34:212-217. [PMID: 32891333 DOI: 10.1016/j.suronc.2020.04.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/12/2020] [Accepted: 04/25/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Unplanned excisions of soft tissue sarcomas are still not infrequent events with patients presenting to referral Centers after having received an inadequate surgical treatment. In literature, both the wait-and-see policy and the "aggressive" management with a re-excision have been advocated. The purposes of this study were to analyze the incidence of detectable residual tumor in surgical specimens following a re-excision and to verify the long-term results of patients treated with a re-excision after previous unplanned excision. METHODS We retrospectively evaluated 131 patients affected by localized soft tissue sarcoma (95 high grade; 36 low grade) of the limbs or the superficial trunk treated at our Institution, from 2000 to 2013, with a re-excision after a previous unplanned inadequate excision. Site, size, depth, histotype, grade, adjuvant therapies, time from unplanned surgery to re-excision were recorded and evaluated in association with clinical results. We specifically evaluated the disease-specific survival, local recurrence free survival, distant metastases free survival and the event free survival. RESULTS Mean follow-up for living patients was 10.9 years (median 11.2 years), with a follow-up ranging from 14 to 227 months. 34% of patients underwent a re-excision within the first 2 months after unplanned surgery, while 66% of patients at more than 2 months. Residual detectable tumor cells were found on histological examination in 54% of re-excisions. A wide margin was obtained in 123 cases, a persisting positive margin in 8 patients. Disease-specific survival was 93.5%, 91.6% and 89.6% at 5, 10 and 15 years for whole series and 90.9%, 88.2% and 85.7% for high grade tumors. Event-free survival in patients affected by high grade tumors rated 75.0% at 5 years, 72.4% at 10 years and 72.4% at 15 years. Local recurrence free survival in high grade tumors was 87.6%, 86.2% and 86.2% at 5, 10 and 15 years. The grade of the tumor (high grade) and the initial dimension of the tumor (≥5 cm) were associated with worst survival. High grade tumor impacted negatively also on local recurrence free survival and event free survival. Instead, the initial size of the tumor significantly affected the event free survival but not the local recurrence free survival. No significant differences of outcome were found analyzing tumor depth, time interval to re-excision, presence of residual tumor or margins. CONCLUSION Based on our results and literature findings, we believe that surgeons should offer a re-excision procedure in those patients presenting with an inadequate excision of a high grade soft-tissue tumor, in particular with tumors larger than 5 cm before excision. Indeed, if an adequate second treatment is performed with surgery ± radiotherapy, the long-term results of patients receiving a re-excision after unplanned excision of a high grade soft tissue sarcoma seem to be comparable to the results generally reported for wide primary excisions. More debatable is whether to perform a re-excision or not in patients with low-grade tumors. Perhaps, in this latter group a wait and see policy can eventually be offered as well as in high grade tumors when a re-excision procedure could involve major surgery or significantly affect postoperative function.
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Affiliation(s)
- Guido Scoccianti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
| | - Matteo Innocenti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
| | - Filippo Frenos
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
| | - Francesco Muratori
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
| | - Federico Sacchetti
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Giovanni Beltrami
- Department of Paediatric Orthopaedic Oncology, Meyer Children's Hospital, Azienda Ospedaliero-Universitaria Meyer, Firenze, Italy.
| | - Rodolfo Capanna
- Department of Orthopaedic and Trauma Surgery, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Domenico Andrea Campanacci
- Department of Orthopaedic Oncology and Reconstructive Surgery, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
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Abstract
Standard treatment for soft tissue sarcoma, based on complete surgical resection with or without adjuvant radiotherapy and chemotherapy, has not substantially changed during the last several decades. Nevertheless, recent advances have contributed to considerable improvement in the management of these patients; for example, new magnetic resonance imaging sequences such as diffusion-weighted imaging and magnetic resonance imaging radiomics can better assess tumor extension and even estimate its grade. Detection of circulating genetic material (liquid biopsy) and next-generation sequencing are powerful techniques for genetic analysis, which will increase our understanding of the underlying molecular mechanisms and may reveal potential therapeutic targets. The role of chemotherapy in non-metastatic disease is still controversial, and there is a need to identify patients who really benefit from this treatment. Novel chemotherapeutic regimens have entered clinical praxis and can change the outcome of patients with metastatic disease. Advances in radiotherapy have helped decrease local adverse effects and sustain good local control of the disease. The following report provides an updated view of the diagnosis, treatment, and future perspectives on the management of patients with soft tissue sarcomas.
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Affiliation(s)
- Jorge Gómez
- Department of Orthopedic Surgery, Clínica Universidad de Navarra, University of Navarra, Pamplona 31008, Spain
| | - Panagiotis Tsagozis
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm 17176, Sweden
- Muskuloskeletal Tumour Service, Karolinska University Hospital, Stockholm 17176, Sweden
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Viñal D, Martinez D, Garcia-Cuesta JA, Gutierrez-Sainz L, Martinez-Recio S, Villamayor J, Martinez-Marin V, Gallego A, Ortiz-Cruz E, Mendiola M, Pozo-Kreilinger JJ, Berjon A, Belinchon B, Bernabeu D, Espinosa E, Feliu J, Redondo A. Prognostic value of neutrophil-to-lymphocyte ratio and other inflammatory markers in patients with high-risk soft tissue sarcomas. Clin Transl Oncol 2020; 22:1849-56. [PMID: 32125644 DOI: 10.1007/s12094-020-02324-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/12/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Soft tissue sarcomas (STS) have a high risk of relapse in spite of the use of (neo)adjuvant chemotherapy. In this context, looking for new prognostic biomarkers is an interesting field of research. Our aim is to analyze the prognostic impact of neutrophil-to-lymphocyte ratio (NLR) and other serum markers in patients with STS who received chemotherapy with curative intent. MATERIALS AND METHODS This is a retrospective observational study. We included all patients with STS (primary tumor, local recurrence or resected metastatic disease) treated with high-dose ifosfamide and epirubicin with curative intent from January 2007 to December 2018. The pretreatment NLR and other serum markers were calculated, selecting the median as the cut-off value for the survival and multivariate analysis. RESULTS Seventy-nine patients were included. Median NLR, platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) were 2.83, 174.05 and 3.25, respectively. Median progression-free survival (PFS) was significantly longer in patients with low NLR [not reached (NR) vs 21, 92 months, P < 0.01]. No significant differences were found for PFS regarding PLR or LMR. For overall survival (OS), a significant survival advantage was also found for patients with low NLR (NR vs 65.45 months, P = 0.01), without differences for PLR or LMR. In multivariate analysis, NLR remains an independent prognostic factor for PFS. CONCLUSION In our cohort, low NLR was significantly associated with a longer PFS and OS, and is consolidated as an independent prognostic factor.
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Yang X, Huang WT, He RQ, Ma J, Lin P, Xie ZC, Ma FC, Chen G. Determining the prognostic significance of alternative splicing events in soft tissue sarcoma using data from The Cancer Genome Atlas. J Transl Med 2019; 17:283. [PMID: 31443718 PMCID: PMC6708253 DOI: 10.1186/s12967-019-2029-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 08/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Surgery, adjuvant chemotherapy, and radiotherapy are the primary treatment options for soft tissue sarcomas (STSs). However, identifying ways to improve the prognosis of patients with STS remains a considerable challenge. Evidence shows that the dysregulation of alternative splicing (AS) events is involved in tumor pathogenesis and progression. The present study objective was to identify survival-associated AS events that could serve as prognostic biomarkers and potentially serve as tumor-selective STS drug targets. METHODS STS-specific 'percent spliced in' (PSI) values for splicing events in 206 STS samples were downloaded from The Cancer Genome Atlas SpliceSeq® database. Prognostic analyses were performed on seven types of AS events to determine their prognostic value in STS patients, for which prediction models were constructed with the risk score formula [Formula: see text]. Prediction models were also constructed to determine the prognostic value of AS events, and Spearman's rank correlation coefficients were calculated to determine the degree of correlation between splicing factor expression and the PSI values. RESULTS A total 10,439 events were found to significantly correlate with patient survival rates. The area under the time-dependent receiver operating characteristic curve for the prognostic predictor of STS overall survival was 0.826. Notably, the splicing events of certain STS key genes were significantly associated with STS 2-year overall survival in the present study, including exon skip (ES) events in MDM2 and EWSR1, alternate terminator events in CDKN2A and HMGA2 for dedifferentiated liposarcoma, ES in MDM2 and alternate promoter events in CDKN2A for leiomyosarcoma, and ES in EWSR1 for undifferentiated pleomorphic sarcoma. Moreover, splicing correlation networks between AS events and splicing factors revealed that almost all of the AS events showed negatively correlations with the expression of splicing factors. CONCLUSION An in-depth analysis of alternative RNA splicing could provide new insights into the mechanisms of STS oncogenesis and the potential for novel approaches to this type of cancer therapy.
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Affiliation(s)
- Xia Yang
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Wen-Ting Huang
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Rong-Quan He
- Department of Medical Oncology, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Jie Ma
- Department of Medical Oncology, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Peng Lin
- Department of Medical Ultrasonics, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Zu-Cheng Xie
- Department of Medical Oncology, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Fu-Chao Ma
- Department of Medical Oncology, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Gang Chen
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, People's Republic of China.
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Ayandipo OO, Afuwape OO, Soneye OY, Orunmuyi AT, Obajimi GO. A sub-Saharan African experience in the surgical management of soft tissue sarcomas in an oncology unit in: a retrospective cohort study. Pan Afr Med J 2019; 33:207. [PMID: 31692722 PMCID: PMC6814331 DOI: 10.11604/pamj.2019.33.207.15970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 01/19/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction Soft tissue sarcomas (STS) consist of over 70 histologic subtypes and constitute only 1% of adult malignancies. The fulcrum of management is surgical resection with neoadjuvant or adjuvant treatment-chemoradiation. Methods The study is a retrospective review of consecutive STS patients who had surgery at the University College Hospital, Ibadan, between October 2007-2017. Data extraction was from the admission and operative registers, theatre records and histology reports. Statistical analysis was done using the Statistical Package for Social Sciences (SPSS) version 20 (Chicago IL USA). Results were summarized as charts and graphs. Results Five hundred and ninety six cases of STS were seen over the ten-year period. Of these, 383 (64.3%) patients had surgery and the case files of 326 (85.1%) of these patients was available for review. The duration of soft tissue swelling, ranged from 1-96 months. A third of the tumors were superficial while 68% were deep-seated. Oncoplastic reconstruction was done in 42(13%) patients. The resection margin was negative in 88%. A total of 202 patients were followed up regularly for between 24-36 months only. Conclusion Patients who benefitted from definitive surgical treatment for STS were found to be the young and middle age group. These patients had extended duration of symptoms with lesions > 5cm in size. Truncal and visceral STS had the worst prognosis. A Multi-Disciplinary Tumor (MDT) board for STS and a robust follow up would enhance the management of STS in a low resource setting.
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Affiliation(s)
| | - Oludolapo Ola Afuwape
- College of Medicine, University of Ibadan, Nigeria.,University College Hospital, Ibadan, Nigeria
| | | | | | - Gbolahan Oladele Obajimi
- College of Medicine, University of Ibadan, Nigeria.,University College Hospital, Ibadan, Nigeria
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Abstract
Objective: To assess the prognostic factors and results of limb sparing surgery and postoperative radiotherapy (PORT) in patients with non-metastatic soft tissue sarcomas (STS) of the extremities. Methods: Between 1980-2007, 114 extremity-located STS treated with PORT were analyzed retrospectively. Tumors were mostly localized in the lower extremities (71,9%). The median radiotherapy (RT) dose was 60.9 Gy. Chemotherapy was administered to 37.7% of the patients. Tumor sizes were between 3-26 cm (median 7 cm). The three most frequent histological types included undifferentiated pleomorphic sarcoma (26.3%), liposarcoma (25.4%), and synovial sarcoma (13.2%). The median follow-up for all patients was 60 months, and 81 months for survivors. Results: The 5- and 10-year local control (LC) rates were 77% and 70.4%, respectively; actuarial survival rates for 5 and 10 years were 71.8% and 69.1%, respectively. Increasing the dose above 60 Gy for all patients and the patients with positive margins demonstrated a clear benefit on 5-year LC (p=0.03 and p=0.04, respectively). Based on multivariate analysis, the addition of chemotherapy and RT dose were independent prognostic factors for LC. A recurrent presentation significantly affects the disease-free survival. Conclusions: PORT for STS of the extremities provides good long-term disease control with acceptable toxicity in a multidisciplinary approach. Level of evidence III, Retrospective study.
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Gimeno M, San Julián M, Cambeiro M, Arbea L, Jablonska P, Moreno-Jiménez M, Amillo S, Aristu J, Lecanda F, Martinez-Monge R. Long-term results of Perioperative High Dose Rate Brachytherapy (PHDRB) and external beam radiation in adult patients with soft tissue sarcomas of the extremities and the superficial trunk: Final results of a prospective controlled study. Radiother Oncol 2019; 135:91-9. [PMID: 31015176 DOI: 10.1016/j.radonc.2019.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/04/2019] [Accepted: 02/13/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND To analyze toxicity, patterns of failure, and survival in 106 adult patients with soft tissue sarcomas of the extremity and the superficial trunk treated in a prospective controlled trial of combined Perioperative High Dose Rate Brachytherapy (PHDRB) and external beam radiotherapy (EBRT). METHODS Patients were treated with surgical resection and 16 Gy or 24 Gy of PHDRB for negative or close/positive margins, respectively. EBRT (45 Gy) was added postoperatively. Adjuvant chemotherapy was given to selected patients with high-grade tumors. RESULTS The median follow-up was 7.1 years (range, 0.6-16.0). Grade ≥3 adverse events were observed in 22 patients (20.8%), and grade ≥4 events in 14 patients (13.2%). No grade 5 events were noted. Multivariate analysis (p = 0.003) found that Grade ≥3 toxic events increased with increasing implant volume (TV100). Local control, locoregional control, and distant control rates at 5 and 10 years were 89% and 87%, 82% and 80% and 75% and 69%, respectively. Multivariate analysis (p = 0.024) found that positive margins correlated with decreased local control. Disease-free survival and overall survival rates at 5 and 10 years were 64% and 59% and 73% and 62%, respectively. In multivariate analysis, disease-free survival rates decreased with increasing tumor size (p = 0.0001) and inadequate margins (p = 0.024), and overall survival decreased with increasing tumor size (p = 0.001) and male gender (p = 0.039). CONCLUSIONS The combination of conservative surgery, high-dose PHDRB, and EBRT produces adequate function and local control in the majority of patients with soft tissue sarcomas of the extremities and the superficial trunk, including a substantial percentage of cases with positive margins. Patients with larger tumors are at a higher risk of complications, treatment failure, and cancer-related death and require an individualized treatment approach.
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Ballesteros M, Montero N, López-Pousa A, Urrútia G, Solà I, Rada G, Pardo-Hernandez H, Bonfill X. Evidence mapping based on systematic reviews of therapeutic interventions for soft tissue sarcomas. Clin Transl Oncol 2019; 21:1398-1412. [PMID: 30875063 DOI: 10.1007/s12094-019-02069-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 02/22/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Soft tissue sarcomas are a heterogeneous group of rare tumours of mesenchymal origin. Evidence mapping is one of the most didactic and friendly approaches to organise and summarise the range of research activity in broad topic fields. The objective of this evidence mapping is to identify, describe and organise the current available evidence about therapeutic interventions on soft tissues sarcomas. METHODS We followed the methodology of global evidence mapping. We performed a search of the PubMed, EMBASE, The Cochrane Library and Epistemonikos to identify systematic reviews (SRs) with or without meta-analyses published between 1990 and March 2016. Two independent literature reviewers assessed eligibility and extracted data. Methodological quality of the included systematic reviews was assessed using AMSTAR. We organised the results according to identified PICO questions and used tables and a bubble plot to display the results. RESULTS The map is based on 24 SRs that met eligibility criteria and included 66 individual studies. Three-quarters were either observational or uncontrolled clinical trials. The quality of the included SRs was in general moderate or high. We identified 64 PICO questions from them. The corresponding results mostly favoured the intervention arm. CONCLUSIONS This evidence mapping was built on the basis of SRs, which mostly included non-experimental studies and were qualified by the AMSTAR tool as of moderate quality. The evidence mapping created from PICO questions is a useful approach to describe complex and huge clinical topics through graphical media and orientate further research to fulfil the existing gaps. However, it is important to delimitate the steps of the evidence mapping in a pre-established protocol.
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Affiliation(s)
- M Ballesteros
- C/Sant Antoni Maria Claret, 167, Pavelló 18, Ground Floor, 08025, Barcelona, Spain.
| | - N Montero
- Centro de Investigación en Salud Pública y Epidemiología Clínica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador
| | - A López-Pousa
- Oncología Médica y Unidad de Curas Paliativas, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - G Urrútia
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - I Solà
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - G Rada
- Evidence Based Health Care Program, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - H Pardo-Hernandez
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - X Bonfill
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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