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Chen CC, Wu YY, Kao JT, Chang CH, Huang SC, Shih HN. Impact of resection margin on outcome in soft-tissue sarcomas of the extremities treated with limb-sparing surgery and postoperative radiotherapy. World J Surg Oncol 2024; 22:113. [PMID: 38664776 PMCID: PMC11046795 DOI: 10.1186/s12957-024-03380-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The standard curative treatments for extremity soft tissue sarcoma (ESTS) include surgical resection with negative margins and perioperative radiotherapy. However, the optimal resection margin remains controversial. This study aimed to evaluate the outcomes in ESTS between microscopically positive margin (R1) and microscopically negative margin (R0) according to the Union for International Cancer Control (UICC) (R + 1 mm) classification. METHODS Medical records of patients with localized ESTS who underwent primary limb-sparing surgery and postoperative radiotherapy between 2004 and 2015 were retrospectively reviewed. Patients were followed for at least 5 years or till local or distant recurrence was diagnosed during follow-up. Outcomes were local and distal recurrences and survival. RESULTS A total of 52 patients were included in this study, in which 17 underwent R0 resection and 35 underwent R1 resection. No significant differences were observed in rates of local recurrence (11.4% vs. 35.3%, p = 0.062) or distant recurrence (40.0% vs. 41.18%, p = 0.935) between R0 and R1 groups. Multivariate analysis showed that distant recurrences was associated with a Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) grade (Grade III vs. I, adjusted hazard ratio (aHR): 12.53, 95% confidence interval (CI): 2.67-58.88, p = 0.001) and tumor location (lower vs. upper extremity, aHR: 0.23, 95% CI: 0.07-0.7, p = 0.01). Kaplan-Meier plots showed no significant differences in local (p = 0.444) or distant recurrent-free survival (p = 0.161) between R0 and R1 groups. CONCLUSIONS R1 margins, when complemented by radiotherapy, did not significantly alter outcomes of ESTS as R0 margins. Further studies with more histopathological types and larger cohorts are necessary to highlight the path forward.
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Affiliation(s)
- Chun-Chieh Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan.
- College of Medicine, Chang Gung University, No. 259, Wenhua 1 Road, Guishan District, Taoyuan City, 333, Taiwan.
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan.
| | - Yao-Yu Wu
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung, No. 222, Maijin Rd., Anle Dist, Keelung City, 204, Taiwan
- College of Medicine, Chang Gung University, No. 259, Wenhua 1 Road, Guishan District, Taoyuan City, 333, Taiwan
| | - Jo-Ting Kao
- Hejiang Orthopedic Clinic, No. 200, Zhongzheng E. Rd., Zhubei City, Hsinchu County, 302, Taiwan
| | - Chih-Hsiang Chang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
- College of Medicine, Chang Gung University, No. 259, Wenhua 1 Road, Guishan District, Taoyuan City, 333, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
| | - Shih-Chiang Huang
- Department of Anatomic Pathology, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
- College of Medicine, Chang Gung University, No. 259, Wenhua 1 Road, Guishan District, Taoyuan City, 333, Taiwan
| | - Hsin-Nung Shih
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
- College of Medicine, Chang Gung University, No. 259, Wenhua 1 Road, Guishan District, Taoyuan City, 333, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
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Díaz Casas SE, Villacrés JM, Lehmann Mosquera C, García Mora M, Mariño Lozano I, Ángel Aristizábal J, Suarez Rodríguez R, Duarte Torres CA, Sánchez Pedraza R. Prognostic Factors Associated with Tumor Recurrence and Overall Survival in Soft Tissue Sarcomas of the Extremities in a Colombian Reference Cancer Center. Curr Oncol 2024; 31:1725-1738. [PMID: 38668034 PMCID: PMC11049252 DOI: 10.3390/curroncol31040131] [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: 01/18/2024] [Revised: 02/28/2024] [Accepted: 03/02/2024] [Indexed: 04/28/2024] Open
Abstract
Introduction: Soft tissue sarcomas (STS) are low-incidence tumors whose clinical and histopathological factors are associated with adverse oncological outcomes. This study evaluated prognostic factors (PF) associated with tumor recurrence and overall survival (OS) in patients diagnosed with STS of the extremities, treated at the Instituto Nacional de Cancerología (INC), Bogotá, Colombia. Materials and Methods: An analytical observational study of a historical cohort was carried out, including patients diagnosed with STS and managed surgically in the Functional Unit for Breast and Soft Tissue Tumors of the INC from January 2008 to December 2018. Results: A total of 227 patients were included; 74.5% had tumors greater than 5 cm. Most patients (29.1%) were in stage IIIB at diagnosis. Age was associated with higher mortality (HR = 1.01; CI95%: 1-1.02; p = 0.048). Tumor persistence at admission to the INC (HR = 2.34; CI95%: 1.25-4.35; p = 0.007) and histologic grade III (HR = 5.36; CI95%: 2.29-12.56; p = <0.001) showed statistical significance in the multivariate analysis for recurrence of any type, as did the PFs associated with a higher risk of local recurrence (HR = 2.85; CI95%: 1.23-6.57; p = 0.014 and HR = 6.09; CI95%: 2.03-18.2; p = 0.001), respectively. Tumor size (HR = 1.03; CI95%: 1-1.06; p = 0.015) and histologic grade III (HR = 4.53; CI95%: 1.42-14.49; p = 0.011) were associated with a higher risk of distant recurrence. Conclusions: This cohort showed that in addition to histologic grade and tumor size, tumor persistence at the time of admission has an impact on disease recurrence, so STS should be managed by a multidisciplinary team with experience in this pathology in high-volume reference centers.
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Affiliation(s)
- Sandra E. Díaz Casas
- Functional Unit for Breast and Soft Tissue Tumors, Instituto Nacional de Cancerología, Bogotá 111511, Colombia (J.Á.A.); (R.S.R.); (C.A.D.T.)
| | | | - Carlos Lehmann Mosquera
- Functional Unit for Breast and Soft Tissue Tumors, Instituto Nacional de Cancerología, Bogotá 111511, Colombia (J.Á.A.); (R.S.R.); (C.A.D.T.)
| | - Mauricio García Mora
- Functional Unit for Breast and Soft Tissue Tumors, Instituto Nacional de Cancerología, Bogotá 111511, Colombia (J.Á.A.); (R.S.R.); (C.A.D.T.)
| | - Iván Mariño Lozano
- Functional Unit for Breast and Soft Tissue Tumors, Instituto Nacional de Cancerología, Bogotá 111511, Colombia (J.Á.A.); (R.S.R.); (C.A.D.T.)
| | - Javier Ángel Aristizábal
- Functional Unit for Breast and Soft Tissue Tumors, Instituto Nacional de Cancerología, Bogotá 111511, Colombia (J.Á.A.); (R.S.R.); (C.A.D.T.)
| | - Raúl Suarez Rodríguez
- Functional Unit for Breast and Soft Tissue Tumors, Instituto Nacional de Cancerología, Bogotá 111511, Colombia (J.Á.A.); (R.S.R.); (C.A.D.T.)
| | - Carlos Alfonso Duarte Torres
- Functional Unit for Breast and Soft Tissue Tumors, Instituto Nacional de Cancerología, Bogotá 111511, Colombia (J.Á.A.); (R.S.R.); (C.A.D.T.)
| | - Ricardo Sánchez Pedraza
- Instituto Nacional de Cancerología (INC)—Empresa Social del Estado, Universidad Nacional de Colombia, Bogotá 111511, Colombia;
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Sanfilippo R, Hayward RL, Musoro J, Benson C, Leahy MG, Brunello A, Blay JY, Steeghs N, Desar IME, Ali N, Hervieu A, Thway K, Marreaud S, Litiere S, Kasper B. Activity of Cabazitaxel in Metastatic or Inoperable Locally Advanced Dedifferentiated Liposarcoma: A Phase 2 Study of the EORTC Soft Tissue and Bone Sarcoma Group (STBSG). JAMA Oncol 2022; 8:1420-1425. [PMID: 35980618 PMCID: PMC9389439 DOI: 10.1001/jamaoncol.2022.3218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/08/2022] [Indexed: 11/14/2022]
Abstract
Importance Treatment options for patients with unresectable and/or metastatic dedifferentiated liposarcoma (DDLPS) are limited. New drugs are required. Objective To assess whether cabazitaxel demonstrated sufficient antitumor activity in patients with metastatic or inoperable locally advanced DDLPS to justify further investigation in a phase 3 setting. Design, Setting, and Participants This international multicenter, open-label single-arm phase 2 trial was conducted at 10 institutions in 4 European countries from March 2015 to March 2019. Eligible patients had to have metastatic or locally advanced histologically proven DDLPS with evidence of disease progression within the past 6 months and had to have received no more than 1 previous line of chemotherapy. Interventions After mandatory central review of tumor blocks, if the DDLPS diagnosis was confirmed, patients started treatment within 72 hours after registration. Cabazitaxel was administered at a dose of 25 mg/m2 IV infusion over 1 hour every 21 days until intolerance, progression, or withdrawal of consent. Main Outcomes and Measures The primary end point was progression-free survival (PFS) rate at 12 weeks per RECIST 1.1. Based on a Simon 2-stage design, at least 4 of 17 (stage 1) and 11 of 37 (stage 2) eligible and evaluable patients who were progression free at 12 weeks were needed. The final analysis report was completed on November 17, 2021. Results Forty patients were registered, with 2 patients being ineligible. The number of cycles ranged from 1 to 30, with a median of 5; 26 patients (65%) received at least 4 cycles of cabazitaxel. Progression-free survival at 12 weeks was 55%, achieving the primary study end point. At a median follow-up of 21.6 months, median PFS was 6 months and median OS 21 months. Response rate (RR) was 8% with 1 clinical response (CR) and 2 partial responses (PR). Twenty-three (60.5%) patients had a stable disease (SD). Disease control (PR+SD) was achieved in 26 patients (68%). Conclusions and Relevance This nonrandomized phase 2 clinical trial met its primary end point, with 21 of 38 patients (55%) being progression free at 12 weeks. These results suggest important activity of cabazitaxel in patients with metastatic or inoperable locally advanced DDLPS. The drug is worth being further studied in these tumors in a phase 3 setting.
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Affiliation(s)
- Roberta Sanfilippo
- Medical Oncology Unit 2, Medical Oncology Dpt, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | | | | | | | - Antonella Brunello
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Jean-Yves Blay
- Centre Léon Bérard, & Univ Claude Bernard Lyon I, Unicancer, Lyon, France
| | | | | | - Nasim Ali
- Clatterbrige Cancer Centre, Wirral, United Kingdom
| | | | - Khin Thway
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - Bernd Kasper
- Mannheim Cancer Center (MCC), University of Heidelberg, Mannheim University Medical Center, Mannheim, Germany
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Braschi EL, Kharod SM, Morris CG, Spiguel AR, Gibbs CP, Scarborough MT, Zlotecki RA. Reirradiation in Conservative Salvage of Recurrent Soft-tissue Sarcoma: An Analysis of Treatment Efficacy and Toxicities. Am J Clin Oncol 2021; 44:624-628. [PMID: 34753882 DOI: 10.1097/coc.0000000000000874] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Compared with radical resection alone, perioperative radiation therapy (RT) combined with neurovascular preserving surgery is the standard for the management of virgin soft-tissue sarcomas. Yet, the optimal management of a local recurrence remains unclear. We report outcomes of patients with locally recurrent soft-tissue sarcoma treated with resection and reirradiation at the University of Florida. MATERIALS AND METHODS We reviewed the records of patients treated with primary conservative surgery and radiation for soft-tissue sarcoma followed by salvage resection and reirradiation for a local recurrence at our institution. RESULTS We analyzed 23 patients treated between 1976 and 2014 (median follow-up, 46 mo). Tumor sites included: proximal extremity, 11 patients; trunk, 6; distal extremity, 5; and head and neck, 1. All patients had conservative gross total resection of their recurrent tumor, without amputation. For reirradiation, 16 patients received external-beam RT alone, 6 received external-beam RT and brachytherapy, and 1 received brachytherapy alone. Two patients received chemotherapy. After retreatment, the 5-year overall survival, cause-specific survival, local control, and distant control rates were 39%, 42%, 46%, and 60%, respectively. Ten patients experienced local recurrences, 1 experienced regional recurrence, and 9 developed distant metastases. Retreatment-related complications ranged from delayed wound healing to limb amputation; 8 patients required amputation. Only 3 patients remained disease-free at last follow-up. No statistically significant associations were found between treatment factors (eg, RT dose) and local control. CONCLUSIONS Achieving local control of recurrent soft-tissue sarcoma is challenging. Treatment with reoperation and reirradiation can lead to debilitating complications affecting function and quality of life.
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Affiliation(s)
| | | | | | - Andre R Spiguel
- Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL
| | - Charles P Gibbs
- Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL
| | - Mark T Scarborough
- Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL
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Russi S, Sgambato A, Bochicchio AM, Zoppoli P, Aieta M, Capobianco AML, Ruggieri V, Zifarone E, Falco G, Laurino S. CHIR99021, trough GSK-3β Targeting, Reduces Epithelioid Sarcoma Cell Proliferation by Activating Mitotic Catastrophe and Autophagy. Int J Mol Sci 2021; 22:ijms222011147. [PMID: 34681807 PMCID: PMC8538073 DOI: 10.3390/ijms222011147] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 09/22/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 12/11/2022] Open
Abstract
Epithelioid sarcoma (ES) is a rare disease representing <1% of soft tissue sarcomas. Current therapies are based on anthracycline alone or in combination with ifosfamide or other cytotoxic drugs. ES is still characterized by a poor prognosis with high rates of recurrence. Indeed, for years, ES survival rates have remained stagnant, suggesting that conventional treatments should be revised and improved. New therapeutic approaches are focused to target the key regulators of signaling pathways, the causative markers of tumor pathophysiology. To this end, we selected, among the drugs to which an ES cell line is highly sensitive, those that target signaling pathways known to be dysregulated in ES. In particular, we found a key role for GSK-3β, which results in up-regulation in tumor versus normal tissue samples and associated to poor prognosis in sarcoma patients. Following this evidence, we evaluated CHIR99021, a GSK-3 inhibitor, as a potential drug for use in ES therapy. Our data highlight that, in ES cells, CHIR99021 induces cell cycle arrest, mitotic catastrophe (MC) and autophagic response, resulting in reduced cell proliferation. Our results support the potential efficacy of CHIR99021 in ES treatment and encourage further preclinical and clinical studies.
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Affiliation(s)
- Sabino Russi
- IRCCS CROB—Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy; (S.R.); (A.S.); (A.M.B.); (P.Z.); (M.A.); (A.M.L.C.); (V.R.); (E.Z.); (S.L.)
| | - Alessandro Sgambato
- IRCCS CROB—Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy; (S.R.); (A.S.); (A.M.B.); (P.Z.); (M.A.); (A.M.L.C.); (V.R.); (E.Z.); (S.L.)
| | - Anna Maria Bochicchio
- IRCCS CROB—Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy; (S.R.); (A.S.); (A.M.B.); (P.Z.); (M.A.); (A.M.L.C.); (V.R.); (E.Z.); (S.L.)
| | - Pietro Zoppoli
- IRCCS CROB—Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy; (S.R.); (A.S.); (A.M.B.); (P.Z.); (M.A.); (A.M.L.C.); (V.R.); (E.Z.); (S.L.)
| | - Michele Aieta
- IRCCS CROB—Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy; (S.R.); (A.S.); (A.M.B.); (P.Z.); (M.A.); (A.M.L.C.); (V.R.); (E.Z.); (S.L.)
| | - Alba Maria Lucia Capobianco
- IRCCS CROB—Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy; (S.R.); (A.S.); (A.M.B.); (P.Z.); (M.A.); (A.M.L.C.); (V.R.); (E.Z.); (S.L.)
| | - Vitalba Ruggieri
- IRCCS CROB—Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy; (S.R.); (A.S.); (A.M.B.); (P.Z.); (M.A.); (A.M.L.C.); (V.R.); (E.Z.); (S.L.)
- UOC Clinical Pathology, Altamura Hospital, 70022 Altamura, Italy
| | - Emanuela Zifarone
- IRCCS CROB—Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy; (S.R.); (A.S.); (A.M.B.); (P.Z.); (M.A.); (A.M.L.C.); (V.R.); (E.Z.); (S.L.)
| | - Geppino Falco
- Department of Biology, University of Naples Federico II, 80133 Naples, Italy
- Biogem—Istituto di Biologia e Genetica Molecolare, 83031 Ariano Irpino, Italy
- Correspondence:
| | - Simona Laurino
- IRCCS CROB—Referral Cancer Center of Basilicata, 85028 Rionero in Vulture, Italy; (S.R.); (A.S.); (A.M.B.); (P.Z.); (M.A.); (A.M.L.C.); (V.R.); (E.Z.); (S.L.)
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Eraslan E, Ilhan Gulesen A, Yildiz F, Tufan G, Yalcintas Arslan U, Alkis N. The effect of adjuvant chemotherapy on the survival of patients with high-risk soft tissue sarcomas: Single center experience. J BUON 2021; 26:2169-2175. [PMID: 34761631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE To evaluate the effect of adding adjuvant ifosfamide/doxorubicin combination chemotherapy (CTX) to adjuvant radiotherapy (RT) on the survival in patients with surgically treated high-risk soft tissue sarcomas (STSs). METHODS The study included 69 patients (group A) receiving adjuvant RT and 74 patients (group B) receiving adjuvant CTX after adjuvant RT. RESULTS The median relapse-free survival (RFS) was 18.2 months (95% CI, 11.9-43.4) in group A and 27.2 months (95% CI, 17.6-36.8) in group B (p = 0.004). The median overall survival (OS) was 45.6 months (95% CI, 26.4-64.8) in group A and 110.1 mo (95% CI, 44.3-175.8) in group B (p = 0.007). Receiving adjuvant CTX was an independent predictive factor for both RFS [HR: 0.482, (0.307-0.757), p = 0.002) and OS (HR: 0.549, [0.348-0.867], p = 0.010). CONCLUSION There are conflicting literature data regarding the survival benefit of adjuvant CTX for surgically treated STSs. However, appropriate patient selection may provide a significant survival benefit in RFS and OS with CTX in the adjuvant treatment of high-risk STSs.
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Affiliation(s)
- Ermrah Eraslan
- University of Health Sciences, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Department of Medical Oncology, Ankara, Turkey
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Patel RR, Lupo PJ, Bishop AJ, Lin PP, Delclos GL, Lazar AJ, Benjamin RS, Araujo DM. Synovial Sarcoma of the Hand and Foot: An Institutional Review. Am J Clin Oncol 2021; 44:361-368. [PMID: 33927134 DOI: 10.1097/coc.0000000000000822] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Synovial sarcomas (SS) arising in distal extremities are rare and have been studied using mostly case reports and small series. We aimed to evaluate clinical presentation and survival outcomes for patients with hand or foot SS. MATERIALS AND METHODS We conducted a retrospective review of 84 patients diagnosed with primary hand (n=20) and foot (n=64) SS between 1979 and 2019. Progression-free survival (PFS), overall survival (OS), local recurrence-free survival and metastasis-free survival were estimated using the Kaplan-Meier method and log-rank test. Cox-proportional hazards regression was used to estimate the hazard ratios. RESULTS Of 84 patients, 63 (75%) presented with localized disease with 36 years median age at diagnosis (range: 4 to 76) and 21 (25%) with metastasis with 30 years median age at diagnosis (range: 15 to 64). Among patients presenting with localized disease, (1) 5 years-PFS, OS, local recurrence-free survival, and metastasis-free survival rates were 82%, 88%, 100%, and 86%, respectively. (2) Tumor size <3.0 cm corresponded to 95% 5 years-PFS (vs. 84% for 3.0 to 4.9 cm, 53% for ≥5.0 cm; P=0.007) and 100% 5 years-OS (vs. 77% for ≥3.0 cm; P=0.04). (3) Patients with ≥5.0 cm (vs. <3.0 cm) tumor size had 7.99 (95% confidence interval: 1.68, 37.91) times higher hazard of progression. Remarkably, patients presenting with metastasis had 50% 5 years-OS rate. Also, younger age (15 to 39 vs. 40 y and above) predicted better OS among patients presenting with localized disease (P=0.04) and with metastasis (P=0.03). CONCLUSIONS Survival outcomes are favorable for younger patients with <3.0 cm hand or foot SS. Local control is excellent, but we observed larger tumor size to be associated with poorer outcomes. Therefore, we recommend consideration of systemic therapy for patients with ≥3.0 cm hand or foot SS.
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Affiliation(s)
- Riddhi R Patel
- Departments of Sarcoma Medical Oncology
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center
| | - Philip J Lupo
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | | | | | - George L Delclos
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center
| | - Alexander J Lazar
- Pathology
- Genomic Medicine, The University of Texas MD Anderson Cancer Center
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Kungwengwe G, Clancy R, Vass J, Slade R, Sandhar S, Dobbs TD, Bragg TWH. Preoperative versus Post-operative Radiotherapy for Extremity Soft tissue Sarcoma: a Systematic Review and Meta-analysis of Long-term Survival. J Plast Reconstr Aesthet Surg 2021; 74:2443-2457. [PMID: 34266806 DOI: 10.1016/j.bjps.2021.05.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/26/2021] [Accepted: 05/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of perioperative radiotherapy in the management of resectable extremity soft tissue sarcoma (ESTS) is widely recognised for local tumour control, wound complications (WC) and long-term function. However, debate continues regarding its implications on long-term survival. This study aimed to determine whether the timing of perioperative radiotherapy affects long-term survival outcomes in adults with ESTS. METHODS A systematic literature search of MEDLINE, EMBASE, Web of Science and Cochrane was performed. The primary outcome measure was the pooled hazard ratio (HR) at 95% confidence intervals. Secondary outcomes and subgroup analyses were presented as cumulative odds ratios (OR). A random-effects, generic inverse variance method and sensitivity analysis were performed to minimise heterogeneity. RESULTS Six studies (n = 4192 patients) were identified. Time-to-event analysis demonstrated a statistically significant advantage in post-operative radiotherapy for overall survival (HR 1.15 and p = 0.05). Combined HRs for disease-free (1.25 and p = 0.22) and disease-specific (1.06 and p = 0.43) survival also favoured post-operative radiotherapy but did not achieve statistical significance. Post-operative radiotherapy was shown to confer an overall (OR 1.19 and p = 0.01), disease-free (OR 1.19 and p = 0.01) and disease-specific (OR 1.19 and p = 0.01) survival advantage on subgroup analysis. This survival benefit was best observed at three years in the disease-free survival comparison (OR 1.55 and p = 0.003). Preoperative radiotherapy was associated with more WC (OR 2.74 and p<0.00001). CONCLUSIONS Pooled analysis of published literature suggests that post-operative radiotherapy confers a significant long-term survival advantage with fewer WC. Further large multicentre randomised controlled trials with long-term follow-up are required to determine the optimal perioperative radiotherapy regime in adult ESTS.
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Affiliation(s)
- Garikai Kungwengwe
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK.
| | | | - Johanne Vass
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | | | - Simarjit Sandhar
- Queen Charlotte's & Chelsea Hospital, Imperial College NHS Trust, London, UK
| | - Thomas D Dobbs
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK; Reconstructive Surgery & Regenerative Medicine Research Group, Swansea, UK
| | - Thomas W H Bragg
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
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Fujiwara T, Ogura K, Healey J. Greater travel distance to specialized facilities is associated with higher survival for patients with soft-tissue sarcoma: US nationwide patterns. PLoS One 2021; 16:e0252381. [PMID: 34086725 PMCID: PMC8177553 DOI: 10.1371/journal.pone.0252381] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/15/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose The survival impact of geographic access to specialized care remains unknown in patients with soft-tissue sarcomas (STS). This study aimed to clarify the association between the patient travel distance and survival outcome and investigate the factors lying behind it. Methods A total of 34 528 patients with STS registered in the National Cancer Data Base, diagnosed from 2004–2016, were investigated. Results Tumor stage correlated with travel distance: patients with metastatic disease stayed closer to home. However, the type of facility showed greatest variation: 37.0%, 51.0%, 73.5%, and 75.9% of patients with ≤10 miles, 10.1–50 miles, 50.1–100 miles, and >100 miles, respectively (P<0.001), had a sarcoma care at academic/research centers. On a multivariable analysis, reduced mortality risk was associated with longer (versus short) travel distance (>100 miles: HR = 0.877; P = 0.001) and management at academic/research (versus non-academic/research) centers (HR = 0.857; P<0.001). The greatest divergence was seen in patients traveling very long distance (>100 miles) to an academic/research center, with a 26.9% survival benefit (HR = 0.731; P<0.001), compared with those traveling short distance (≤10 miles; 95.4% living in metropolitan area) to a non-academic/research center. There was no significant correlation between travel distance and survival in patients who had care at academic/research centers, whereas a survival benefit of management at academic/research centers was observed in every group of travel distance, regardless of tumor stage. Conclusions This national study demonstrated that increased travel distance was associated with superior survival, attributable to a higher proportion of patients receiving sarcoma care at distant academic/research centers. These data support centralized care for STS. Overcoming referral and travel barriers may enable more patients to be treated at specialized centers and may further improve survival rates for patients with STS, even when it imposes an increased travel burden.
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Affiliation(s)
- Tomohiro Fujiwara
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Koichi Ogura
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - John Healey
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- * E-mail:
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Wang XW, Sun Q, Xu SB, Xu C, Xia CJ, Zhao QM, Zhang HH, Tan WQ, Zhang L, Yao SD. A 3-DNA methylation signature as a novel prognostic biomarker in patients with sarcoma by bioinformatics analysis. Medicine (Baltimore) 2021; 100:e26040. [PMID: 34011115 PMCID: PMC8137010 DOI: 10.1097/md.0000000000026040] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/04/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Tumor-specific DNA methylation can potentially be a useful indicator in cancer diagnostics and monitoring. Sarcomas comprise a heterogeneous group of mesenchymal neoplasms which cause life-threatening tumors occurring throughout the body. Therefore, potential molecular detection and prognostic evaluation is very important for early diagnosis and treatment. METHODS We performed a retrospective study analyzing DNA methylation of 261 patients with sarcoma from The Cancer Genome Atlas (TCGA) database. Cox regression analyses were conducted to identify a signature associated with the overall survival (OS) of patients with sarcoma, which was validated in a validation dataset. RESULTS Three DNA methylation signatures were identified to be significantly associated with OS. Kaplan-Meier analysis showed that the 3-DNA methylation signature could significantly distinguish the high- and low-risk patients in both training (first two-thirds) and validation datasets (remaining one-third). Receiver operating characteristic (ROC) analysis confirmed that the 3-DNA methylation signature exhibited high sensitivity and specificity in predicting OS of patients. Also, the Kaplan-Meier analysis and the area under curve (AUC) values indicated that the 3-DNA methylation signature was independent of clinical characteristics, including age at diagnosis, sex, anatomic location, tumor residual classification, and histological subtypes. CONCLUSIONS The current study showed that the 3-DNA methylation model could efficiently function as a novel and independent prognostic biomarker and therapeutic target for patients with sarcoma.
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Affiliation(s)
| | - Qi Sun
- Department of Orthopedic Surgery, Fuyang Orthopedics and Traumatology Hospital, Zhejiang Chinese Medical University
| | - Shi-Bin Xu
- Department of Orthopedic Surgery, The First People's Hospital of Xiaoshan District
| | - Chao Xu
- Department of Oncology, Zhejiang Cancer Hospital
| | - Chen-Jie Xia
- Department of Orthopedic Surgery, Li Hui-Li Hospital, Ningbo
| | - Qi-Ming Zhao
- Department of Plastic Surgery, Zhejiang Hospital
| | | | - Wei-Qiang Tan
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine
| | - Lei Zhang
- Department of Orthopedic Surgery, Xiaoshan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou
| | - Shu-Dong Yao
- Department of Nephrology, Huzhou Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Huzhou, Zhejiang, China
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Rajasekaran RB, Ashford RU, Cosker TDA, Stevenson JD, Jeys L, Pollock R, Rankin KS, Cool P, Patton JT, Whitwell D, Gibbons CLMH, Carr A. What Proportion of Patients with Bone and Soft Tissue Tumors Contracted Coronavirus-19 and Died From Surgical Procedures During the Initial Period of the COVID-19 Pandemic? Results From the Multicenter British Orthopaedic Oncology Society Observational Study. Clin Orthop Relat Res 2021; 479:1158-1166. [PMID: 33196585 PMCID: PMC8051862 DOI: 10.1097/corr.0000000000001568] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/13/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Delivering uninterrupted cancer treatment to patients with musculoskeletal tumors has been essential during the rapidly evolving coronavirus 2019 (COVID-19) pandemic, as delays in management can be detrimental. Currently, the risk of contracting COVID-19 in hospitals when admitted for surgery and the susceptibility due to adjuvant therapies and associated mortality due to COVID-19 is unknown, but knowledge of these potential risks would help treating clinicians provide appropriate cancer care. QUESTIONS/PURPOSES (1) What is the risk of hospital-acquired COVID-19 in patients with musculoskeletal tumors admitted for surgery during the initial period of the pandemic? (2) What is the associated mortality in patients with musculoskeletal tumors who have contracted COVID-19? (3) Are patients with musculoskeletal tumors who have had neoadjuvant therapy (chemotherapy or radiation) preoperatively at an increased risk of contracting COVID-19? (4) Is a higher American Society of Anesthesiologists (ASA) grade in patients with musculoskeletal tumors associated with an increased risk of contracting COVID-19 when admitted to the hospital for surgery? METHODS This retrospective, observational study analyzed patients with musculoskeletal tumors who underwent surgery in one of eight specialist centers in the United Kingdom, which included the five designated cancer centers in England, one specialist soft tissue sarcoma center, and two centers from Scotland between March 12, 2020 and May 20, 2020. A total of 347 patients were included, with a median (range) age of 53 years (10 to 94); 60% (207 of 347) were men, and the median ASA grade was II (I to IV). These patients had a median hospital stay of 8 days (0 to 53). Eighteen percent (61 of 347) of patients had received neoadjuvant therapy (8% [27] chemotherapy, 8% [28] radiation, 2% [6] chemotherapy and radiation) preoperatively. The decision to undergo surgery was made in adherence with United Kingdom National Health Service and national orthopaedic oncology guidelines, but specific data with regard to the number of patients within each category are not known. Fifty-nine percent (204 of 347) were negative in PCR testing done 48 hours before the surgical procedure; the remaining 41% (143 of 347) were treated before preoperative PCR testing was made mandatory, but these patients were asymptomatic. All patients were followed for 30 days postoperatively, and none were lost to follow-up during that period. The primary outcome of the study was contracting COVID-19 in the hospital after admission. The secondary outcome was associated mortality after contracting COVID-19 within 30 days of the surgical procedure. In addition, we assessed whether there is any association between ASA grade or neoadjuvant treatment and the chances of contracting COVID-19 in the hospital. Electronic patient record system and simple descriptive statistics were used to analyze both outcomes. RESULTS Four percent (12 of 347) of patients contracted COVID-19 in the hospital, and 1% (4 of 347) of patients died because of COVID-19-related complications. Patients with musculoskeletal tumors who contracted COVID-19 had increased mortality compared with patients who were asymptomatic or tested negative (odds ratio 55.33 [95% CI 10.60 to 289.01]; p < 0.001).With the numbers we had, we could not show that adjuvant therapy had any association with contracting COVID-19 while in the hospital (OR 0.94 [95% CI 0.20 to 4.38]; p = 0.93). Increased ASA grade was associated with an increased likelihood of contracting COVID-19 (OR 58 [95% CI 5 to 626]; p < 0.001). CONCLUSION Our results show that surgeons must be mindful and inform patients that those with musculoskeletal tumors are at risk of contracting COVID-19 while admitted to the hospital and some may succumb to it. Hospital administrators and governmental agencies should be aware that operations on patients with lower ASA grade appear to have lower risk and should consider restructuring service delivery to ensure that procedures are performed in designated COVID-19-restricted sites. These measures may reduce the likelihood of patients contracting the virus in the hospital, although we cannot confirm a benefit from this study. Future studies should seek to identify factors influencing these outcomes and also compare surgical complications in those patients with and without COVID-19. LEVEL OF EVIDENCE Level III, therapeutic study.
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Maduekwe UN, Herb JN, Esther RJ, Kim HJ, Spanheimer PM. Pathologic nodal staging for clinically node negative soft tissue sarcoma of the extremities. J Surg Oncol 2021; 123:1792-1800. [PMID: 33751586 PMCID: PMC11022073 DOI: 10.1002/jso.26465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/20/2021] [Revised: 02/15/2021] [Accepted: 03/09/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Synovial, clear cell, angiosarcoma, rhabdomyosarcoma, and epithelioid (SCARE) soft tissue sarcoma are at risk for nodal involvement, although the nodal positivity rates and impact on prognostication in clinically node negative patients are not well described. METHODS Patients with extremity SCARE sarcoma without clinical nodal involvement undergoing surgical resection in the National Cancer Database (2004-2017) were included. Logistic regression was used to evaluate the likelihood of nodal surgery and nodal positivity. Kaplan-Meier method and Cox regression were used to assess associations of nodal status to overall survival. RESULTS We included 4158 patients, and 669 patients (16%) underwent regional lymph node surgery (RLNS). On multivariable logistic analysis, patients with epithelioid (odds ratio [OR]: 3.77; p < .001) and clear cell (OR: 6.38; p < .001) were most likely to undergo RLNS. Forty-five patients (7%) had positive nodes. Clear cell sarcoma (14%) and angiosarcoma (13%) had the highest rates of nodal positivity. Patients with positive nodes had reduced 5-year overall survival, and the stratification was largest in clear cell and angiosarcoma. CONCLUSION Discordance exists between selection for pathologic nodal evaluation and factors associated with nodal positivity. Clinically node negative patients with clear cell and angiosarcoma should be considered for pathologic nodal evaluation.
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Affiliation(s)
- Ugwuji N. Maduekwe
- Department of Surgery, University of North Carolina, Chapel Hill, NC
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Joshua N. Herb
- Department of Surgery, University of North Carolina, Chapel Hill, NC
- Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC
| | - Robert J. Esther
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| | - Hong Jin Kim
- Department of Surgery, University of North Carolina, Chapel Hill, NC
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Philip M. Spanheimer
- Department of Surgery, University of North Carolina, Chapel Hill, NC
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Schliemann C, Hemmerle T, Berdel AF, Angenendt L, Kerkhoff A, Hering JP, Heindel W, Hartmann W, Wardelmann E, Chawla SP, de Braud F, Lenz G, Neri D, Kessler T, Berdel WE. Dose escalation and expansion phase I studies with the tumour-targeting antibody-tumour necrosis factor fusion protein L19TNF plus doxorubicin in patients with advanced tumours, including sarcomas. Eur J Cancer 2021; 150:143-154. [PMID: 33901793 DOI: 10.1016/j.ejca.2021.03.038] [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: 01/01/2021] [Revised: 02/23/2021] [Accepted: 03/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND L19TNF is a recombinant fusion protein composed of a human antibody fragment and human tumour necrosis factor. L19TNF targets the EDB domain of oncofetal fibronectin highly expressed in tumour vasculature and induces tumour remission in mouse tumours. We summarise two phase I trials testing a combination of L19TNF with doxorubicin in patients with solid tumours, particularly soft tissue sarcomas (STS). PATIENTS AND METHODS The first study, an open-label, dose-escalation and expansion phase I study of L19TNF plus doxorubicin, enrolled 27 patients. Three cohorts (10.4-17 μg/kg L19TNF) of patients received L19TNF intravenously at days 1, 3, and 5 and doxorubicin (75 mg/m2, then 60 mg/m2) on day 1 every 3 weeks. The expansion cohort enrolled patients with STS. The second study tried to re-escalate the doxorubicin dose to 75 mg/m2 with 13 μg/kg L19TNF. Among primary objectives was the establishment of a recommended dose (RD). RESULTS The combination was safely applicable. Dose-limiting toxicity occurred either at 17 μg/kg L19TNF or at 75 mg/m2 doxorubicin. RD is 13 μg/kg L19TNF plus 60 mg/m2 doxorubicin. In 15 STS patients of the extension cohort evaluable for efficacy, antitumour activity was observed with complete remission in 1, partial remission in 1 and minor tumour shrinkage in 7 patients. The median overall survival for this heavily pretreated cohort was 14.9 months. CONCLUSION L19TNF can be safely applied in combination with doxorubicin and induces encouraging tumour remissions in patients with soft tissue sarcomas.
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Affiliation(s)
- Christoph Schliemann
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Albert Schweitzer Campus 1, 48149 Muenster, Germany.
| | | | - Andrew F Berdel
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Albert Schweitzer Campus 1, 48149 Muenster, Germany
| | - Linus Angenendt
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Albert Schweitzer Campus 1, 48149 Muenster, Germany
| | - Andrea Kerkhoff
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Albert Schweitzer Campus 1, 48149 Muenster, Germany
| | - Jan P Hering
- Institute for Clinical Radiology, University Hospital Muenster, Albert Schweitzer Campus 1, Muenster, 48149, Germany
| | - Walter Heindel
- Institute for Clinical Radiology, University Hospital Muenster, Albert Schweitzer Campus 1, Muenster, 48149, Germany
| | - Wolfgang Hartmann
- Gerhard-Domagk-Institute for Pathology, University Hospital of Muenster, Albert Schweitzer Campus 1, Muenster, 48149, Germany
| | - Eva Wardelmann
- Gerhard-Domagk-Institute for Pathology, University Hospital of Muenster, Albert Schweitzer Campus 1, Muenster, 48149, Germany
| | - Sant P Chawla
- Sarcoma Oncology Center, 2811 Wilshire Blvd, Santa Monica, CA, 90403, USA
| | - Filippo de Braud
- Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, Milano MI, 20133, Italy
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Albert Schweitzer Campus 1, 48149 Muenster, Germany
| | | | - Torsten Kessler
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Albert Schweitzer Campus 1, 48149 Muenster, Germany
| | - Wolfgang E Berdel
- Department of Medicine A, Hematology, Oncology, University Hospital Muenster, Albert Schweitzer Campus 1, 48149 Muenster, Germany.
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Li Z, Zhao R, Yang W, Li C, Huang J, Wen Z, Du G, Jiang L. PLCG2 as a potential indicator of tumor microenvironment remodeling in soft tissue sarcoma. Medicine (Baltimore) 2021; 100:e25008. [PMID: 33725976 PMCID: PMC7982206 DOI: 10.1097/md.0000000000025008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/11/2021] [Indexed: 01/05/2023] Open
Abstract
The tumor microenvironment (TME) plays an important role in the occurrence and development of soft tissue sarcoma (STS). A number of studies have shown that to inhibit tumor growth, the TME can be remodeled into an environment unsuitable for tumor proliferation. However, a lack of understanding exists regarding the dynamic regulation of TME.In this study, we used CIBERSORT and ESTIMATE calculation methods from the Cancer Genome Atlas (TCGA) database to calculate the proportion of tumor infiltrating immune cells (TICs) and the number of immune and stromal components in 263 STS samples. Differential expression genes (DEGs) shared by Immune Score and Stromal Score were obtained via difference analysis. Univariate Cox regression analysis and construction of protein-protein interaction (PPI) networks were applied to the DEGs.Through intersection analysis of univariate COX and PPI, PLCG2 was determined as the indicator. Further analysis showed that PLCG2 expression was positively correlated with the survival of STS patients. Gene set enrichment analysis (GSEA) showed that genes in the highly expressed PLCG2 group were enriched in immune-related activities. In the low-expression PLCG2 group, genes were enriched in the E2F, G2M, and MYC pathways. Difference analysis and correlation analysis showed that CD8+ T cells, gamma delta T cells, monocytes, and M1 macrophages were positively correlated with PLCG2 expression, indicating that PLCG2 may represent the immune status of TME.Therefore, the level of PLCG2 may aid in determining the prognosis of STS patients, especially the status of TME. These data provide additional insights into the remodeling of TME.
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Affiliation(s)
| | | | | | | | | | | | - Gang Du
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning
| | - Lingling Jiang
- Department of Anesthesiology, The second Hospital of Anhui Medical University, Hefei, China
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15
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Brewster R, Purington N, Henry S, Wood D, Ganjoo K, Bui N. Evaluation of Absolute Lymphocyte Count at Diagnosis and Mortality Among Patients With Localized Bone or Soft Tissue Sarcoma. JAMA Netw Open 2021; 4:e210845. [PMID: 33666664 PMCID: PMC7936255 DOI: 10.1001/jamanetworkopen.2021.0845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Host-related immune factors have been implicated in the development and progression of diverse malignant neoplasms. Identifying associations between immunologic laboratory parameters and overall survival may inform novel prognostic biomarkers and mechanisms of antitumor immunity in localized bone and soft tissue sarcoma. OBJECTIVE To assess whether lymphopenia at diagnosis is associated with overall survival among patients with localized bone and soft tissue sarcoma. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study analyzed patients from the Stanford Cancer Institute with localized bone and soft tissue sarcoma between September 1, 1998, and November 1, 2018. Patients were included if laboratory values were available within 60 days of diagnosis and, if applicable, prior to the initiation of chemotherapy and/or radiotherapy. Statistical analysis was performed from January 1, 2019, to November 1, 2020. EXPOSURES Absolute lymphocyte count within 60 days of diagnosis and antimicrobial exposure, defined by the number of antimicrobial agent prescriptions and the cumulative duration of antimicrobial administration within 60 days of diagnosis. MAIN OUTCOMES AND MEASURES The association between minimum absolute lymphocyte count at diagnosis and 5-year overall survival probability was characterized with the Kaplan-Meier method and multivariate Cox proportional hazards regression models. Multivariable logistic regressions were fitted to evaluate whether patients with lymphopenia were at greater risk of increased antimicrobial exposure. RESULTS Among 634 patients, the median age at diagnosis was 53.7 years (interquartile range, 37.5-66.8 years), and 290 patients (45.7%) were women, with a 5-year survival probability of 67.9%. There was a significant inverse association between lymphopenia at diagnosis and overall survival (hazard ratio [HR], 1.82; 95% CI, 1.39-1.40), resulting in a 13.5% 5-year survival probability difference compared with patients who did not have lymphopenia at diagnosis (60.2% vs 73.7% for those who never had lymphopenia). In addition, poorer survival was observed with higher-grade lymphopenia (grades 3 and 4: HR, 2.44; 95% CI, 1.68-3.55; grades 1 and 2: HR, 1.60; 95% CI, 1.18-2.18). In an exploratory analysis, patients with increased antibiotic exposure were more likely to have lymphopenia (odds ratio, 1.96; 95% CI, 1.26-3.07 for total number of antimicrobial agents; odds ratio, 1.70; 95% CI, 1.10-2.57 for antimicrobial duration) than antimicrobial-naive patients. CONCLUSIONS AND RELEVANCE This study suggests that an abnormally low absolute lymphocyte count at diagnosis is associated with higher mortality among patients with localized bone and soft tissue sarcoma; therefore, lymphopenia may serve as a reliable prognostic biomarker. Potential mechanisms associated with host immunity and overall survival include a suppressed antitumor response and increased infectious complications, which merit future investigation.
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Affiliation(s)
- Ryan Brewster
- Stanford University School of Medicine, Stanford, California
| | - Natasha Purington
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | - Solomon Henry
- Deprtment of Biomedical Data Science, Stanford University, Stanford, California
| | - Douglas Wood
- Deprtment of Biomedical Data Science, Stanford University, Stanford, California
| | - Kristen Ganjoo
- Department of Medicine (Oncology), Stanford University School of Medicine, Stanford, California
| | - Nam Bui
- Department of Medicine (Oncology), Stanford University School of Medicine, Stanford, California
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Collier CD, Kim CY, Liu RW, Getty PJ. The Interval Between Preoperative Radiation and Surgery Is Not Associated with Overall Survival for Soft-tissue Sarcomas: An Analysis of the National Cancer Database. Clin Orthop Relat Res 2021; 479:506-517. [PMID: 32401002 PMCID: PMC7899587 DOI: 10.1097/corr.0000000000001287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/14/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Most cancer centers prefer preoperative radiation therapy (preRT) over postoperative therapy to treat soft-tissue sarcoma (STS) to limit long-term fibrosis, joint stiffness, and edema. Surgery is often delayed after preRT to allow for tissue recovery and to reduce wound complications. However, the association between the time interval between preRT and surgery and survival is unknown. QUESTIONS/PURPOSES (1) What factors are associated with the preRT-surgery interval in patients with STS? (2) Is the preRT-surgery interval associated with overall survival? METHODS The National Cancer Database, a nationwide registry that includes 70% of all new cancers in the United States with 90% follow-up, was reviewed to identify 6378 patients who underwent preRT and surgical resection for a localized extremity or pelvic STS from 2004 to 2014. Patients were excluded if they had lymphatic or metastatic disease at diagnosis (23%; n = 1438), underwent neoadjuvant chemotherapy (24%; 1531), were missing vital status (8%; 487), had chemosensitive histologies (9%; 603), underwent radiation other than external beam (1%; 92), were missing preRT-surgery interval (1%; 45), or had a preRT-surgery interval greater than 120 days (< 1%; 6). A total of 2176 patients were included for analysis, with a mean preRT-surgery interval of 35 ± 16 days. A multiple linear regression model was generated to assess demographic, clinicopathologic, and treatment characteristics associated with the preRT-surgery interval. A Kaplan-Meier survival analysis was then conducted, stratified by the preRT-surgery interval, to assess survival over 10 years. Finally, a multivariate Cox regression analysis model was constructed to further evaluate the association between the preRT-surgery interval and overall survival, adjusted for demographic, clinicopathologic, and treatment characteristics. RESULTS A longer preRT-surgery interval was associated with higher age (β = 0.002 per year [95% CI 0.0 to 0.004]; p = 0.026), tumor location in the pelvis (compared with the lower extremity; β = 0.15 [95% CI 0.082 to 0.22]; p < 0.001), and malignant peripheral nerve sheath tumor subtype (compared with undifferentiated pleomorphic sarcoma; β = 0.17 [95% CI 0.044 to 0.29]; p = 0.008). A shorter preRT-surgery interval was associated with higher facility volume (β = -0.002 per case [95% CI -0.003 to -0.002]; p = 0.026) and higher tumor stage (compared with Stage I; β = -0.066 [95% CI -0.13 to -0.006]; p = 0.03 for Stage II; β = -0.12 [95% CI -0.17 to -0.065]; p < 0.001 for Stage III). The 5-year overall survival rates were similar across all preRT-surgery interval groups: less than 3 weeks (66% [95% CI 60 to 72]), 3 to 4 weeks (65% [95% CI 60 to 71]), 4 to 5 weeks (65% [95% CI 60 to 71]), 5 to 6 weeks (66% [95% CI 60 to 72]), 6 to 7 weeks (63% [95% CI 54 to 72]), 7 to 9 weeks (66% [95% CI 58 to 74]), and more than 9 weeks (59% [95% CI 48 to 69]). Over 10 years, no difference in overall survival was observed when stratified by the preRT-surgery interval (p = 0.74). After controlling for potentially confounding variables, including age, sex, Charlson/Deyo comorbidity score, histology, tumor size, stage and surgery type, the preRT-surgery interval was not associated with survival (hazard ratio = 1 per day [95% CI 1 to 1]; p = 0.88). CONCLUSION With the numbers available, this study demonstrates that a delay in surgery up to 120 days after radiation is not associated with poorer survival. Therefore, clinicians may be able to delay surgery to minimize the risks of wound complications and modifiable comorbidities without affecting overall survival.Level of Evidence Level III, therapeutic study.
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Affiliation(s)
- Christopher D Collier
- C. D. Collier, C.-Y. Kim, R. W. Liu, P. J. Getty, Department of Orthopaedics, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Li K, Wu Z, Yao J, Fan J, Wei Q. DNA methylation patterns-based subtype distinction and identification of soft tissue sarcoma prognosis. Medicine (Baltimore) 2021; 100:e23787. [PMID: 33592836 PMCID: PMC7870194 DOI: 10.1097/md.0000000000023787] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/13/2020] [Indexed: 01/05/2023] Open
Abstract
Soft tissue sarcomas (STSs) are heterogeneous at the clinical with a variable tendency of aggressive behavior. In this study, we constructed a specific DNA methylation-based classification to identify the distinct prognosis-subtypes of STSs based on the DNA methylation spectrum from the TCGA database. Eventually, samples were clustered into 4 subgroups, and their survival curves were distinct from each other. Meanwhile, the samples in each subgroup reflected differentially in several clinical features. Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis was also conducted on the genes of the corresponding promoter regions of the above-described specific methylation sites, revealing that these genes were mainly concentrated in certain cancer-associated biological functions and pathways. In addition, we calculated the differences among clustered methylation sites and performed the specific methylation sites with LASSO algorithm. The selection operator algorithm was employed to derive a risk signature model, and a prognostic signature based on these methylation sites performed well for risk stratification in STSs patients. At last, a nomogram consisted of clinical features and risk score was developed for the survival prediction. This study declares that DNA methylation-based STSs subtype classification is highly relevant for future development of personalized therapy as it identifies the prediction value of patient prognosis.
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Affiliation(s)
- Kai Li
- Department of Orthopedics Trauma and Hand Surgery
| | - Zhengyuan Wu
- Department of Orthopedics Trauma and Hand Surgery
| | - Jun Yao
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University
- Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Medical University, Nanning, China
| | - Jingyuan Fan
- Department of Orthopedics Trauma and Hand Surgery
| | - Qingjun Wei
- Department of Orthopedics Trauma and Hand Surgery
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Jang WY, Kim HS, Han I. Impact of surgical margin on survival in extremity soft tissue sarcoma: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24124. [PMID: 33546021 PMCID: PMC7837970 DOI: 10.1097/md.0000000000024124] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/08/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The impact of surgical margin status on the survival of patients with extremity soft tissue sarcoma (STS) remains to be clearly defined. The evidence regarding the impact of surgical margins on survival is limited by retrospective single-institution cohort studies. We conducted a systematic review and meta-analysis to examine the impact of surgical margin status on patient survival in extremity STS. METHODS A literature search in the PubMed, EMBASE, and Cochrane Controlled Trials Register electronic databases, and a manual search of reference lists of original studies was performed. The following text words and/or Medical Subject Heading terms were searched: (neoplasm) or/and (sarcoma) and/or (connective tissue) and/or (soft tissue) and/or (extremity) and/or (extremity) and/or (surgical margin). RESULTS Six selected studies that reported a total of 2917 cases of extremity STS were published between 1994 and 2013. All the eligible studies were observational cohort studies, and the sample size ranged from 95 to 1261 patients. A meta-analysis of 6 studies showed that a positive surgical margin predicted poor 5-year OS in a random-effects model (summary hazard ratio, 1.56; 95% confidence interval, 1.12-2.17). Moderate heterogeneity was observed among the studies (P < .075; heterogeneity, 45.6%). CONCLUSIONS This meta-analysis supports the hypothesis that adequate surgical margins are associated with improved survival in extremity STS.
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Affiliation(s)
- Woo Young Jang
- Department of Orthopaedic Surgery, Seoul National University Hospital
- Department of Orthopaedic Surgery, Korea University Anam Hospital
| | - Han-Soo Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ilkyu Han
- Department of Orthopaedic Surgery, Seoul National University Hospital
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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19
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Abstract
Despite the release of anatomic site-specific staging systems for soft tissue sarcomas in the eighth edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, the algorithms for sarcomas arising in the extremities/trunk and retroperitoneum differ only in the staging of lymph node metastasis. The retroperitoneum not only provides a larger potential space for tumor growth before the clinical presentation, but its anatomic complexities complicate surgical resection and adversely affect disease-free survival. Here, we propose a new staging system for MDM2-amplified liposarcomas (well-differentiated and dedifferentiated subtypes) that properly emphasizes retroperitoneal localization, degree of differentiation (histologic subtype), and presence of distant metastasis. A retrospective cohort of 4146 adult patients with surgically resected liposarcoma was extracted from the SEER database to compare the natural history of MDM2-amplified liposarcomas arising in the extremities/trunk or retroperitoneum. Separate training and validation datasets were created, and Cox proportional hazard regression, multivariable nonlinear regression, and nomographic analyses determined the most significant parameters in predicting sarcoma-specific death. A new staging system was derived and its predictive accuracy was compared with the AJCC, eighth edition system using areas under receiver operating characteristic curves and multiple concordance indices. Multivariable analysis showed that dedifferentiation (hazard ratio [HR]=3.7±0.5; P<0.0005), retroperitoneal location (HR=3.2±0.5; P<0.0005), and distant metastasis (HR=2.4±0.6; P=0.002), but not categorized tumor size (pT category), had the largest effects on sarcoma-specific survival. A new staging system based on these predictive factors demonstrated better discrimination between tumor stages, higher concordance with clinical outcomes, and greater predictive accuracy than the AJCC eighth edition staging system (86±1% vs. 83±2%; P=0.005). Statistical analysis of a large national cohort failed to confirm that categorized tumor size is a useful criterion by which to stage MDM2-amplified liposarcoma. A simplified staging system based on anatomic location and dedifferentiation outperforms the current AJCC staging system. Anatomic localization and histologic grade, and not tumor size, should be included in any future liposarcoma-specific staging system.
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Affiliation(s)
- Jonathan J Tucci
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
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20
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Abstract
Several preoperative blood and biochemical parameters are associated with postoperative survival in many kinds of tumors. The aim of this study is to study the predictive value of several routine preoperative blood and biochemical parameters on the prognosis patients with rhabdomyosarcoma (RMS).We retrospectively recruited 55 patients diagnosed with RMS and had surgery at West China Hospital, Sichuan University between January 2010 and December 2018. Baseline characteristics of the patients, tumor features, surgery details, and values of several examinations were extracted. A long-term follow-up was conducted by phone call. A novel statistical analysis was subsequently carried out to look for the relationship of preoperative parameters and patients' prognosis.The ROC analysis showed an area under curve (AUC) of 0.608, 0.620, 0.626, 0.591, and 0.518 for neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), lactic dehydrogenase (LDH), and alkaline phosphatase (ALP) respectively, and the cut-off value of 2.843, 162.961, and 0.239 for NLR, PLR, and MLR respectively. The survival analysis showed that certain blood and biochemical parameters could cause differences in overall survival (OS) (P = .005 for NLR, P = .005 for PLR, and P = .007 for MLR) and progression free survival (PFS) (P = .029 for NLR, P = .008 for PLR, and P = .013 for MLR).Several preoperative blood and biochemical parameters are novel prognostic factors in RMS patients. Specifically, a higher NLR, PLR, and MLR value will predict a statistically shorter OS and PFS.In the future, surgeons should care more about NLR, PLR, and MLR values and several other parameters in patients' preoperative normal blood and biochemical tests to predict the postoperative conditions.
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Affiliation(s)
- Hongyu Jin
- Department of Liver Surgery, Liver Transplantation Center
| | | | - Hui Zhou
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology
| | | | - Chenggong Hu
- Department of Critical Care Unit, West China Hospital, Sichuan University, Chengdu, China
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21
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Filleron T, Le Guellec S, Chevreau C, Cabarrou B, Lesluyes T, Lodin S, Massoubre A, Mounier M, Poublanc M, Chibon F, Valentin T. Value of peri-operative chemotherapy in patients with CINSARC high-risk localized grade 1 or 2 soft tissue sarcoma: study protocol of the target selection phase III CHIC-STS trial. BMC Cancer 2020; 20:716. [PMID: 32736540 PMCID: PMC7395339 DOI: 10.1186/s12885-020-07207-3] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The value of chemotherapy in soft tissue sarcoma (STS) remains controversial. Several expert teams consider that chemotherapy provides a survival advantage and should be proposed in high-risk (HR) patients. However, the lack of accuracy in identifying HR patients with conventional risk factors (large, deep, FNCLCC grade 3, extremity STS) is an issue that cannot be neglected. For example, while the FNCLCC grading system is a powerful tool, it has several limitations. CINSARC, a 67-gene signature, has proved to be an additional independent factor for predicting metastatic spread and outperforms histological grade. Regardless of FNCLCC grade, CINSARC stratifies patients into two separate prognostic groups: one with an excellent prognosis (low-risk (LR) CINSARC) and the other with a worse outcome (HR-CINSARC) in terms of metastatic relapse. Here we evaluate the role of chemotherapy in grade 1-2 STS patients with HR-CINSARC and assess the prognostic value of CINSARC in patients treated with standard of care. METHODS CHIC is a parallel, randomized, open-label, multicenter study evaluating the effect on metastasis-free survival of adding perioperative chemotherapy to standard of care in patients with grade ½ STS sarcoma defined as HR by CINSARC. In this target selection design, 600 patients will be screened with CINSARC to randomize 250 HR-CINSARC patients between standard of care and standard of care plus chemotherapy (4 cycles of 3 weeks of intravenous chemotherapy with doxorubicin in combination with dacarbazine or ifosfamide according to histologic subtype). LR-CINSARC patients will be treated by standard of care according to the investigator. The primary endpoint is metastasis-free survival. Secondary endpoints include overall survival, disease-free survival and safety. Furthermore, the prognostic value of CINSARC will be evaluated by comparing LR-CINSARC patients to HR-CINSARC patients randomized in standard of care. DISCUSSION CHIC is a prospective randomized phase III trial designed to comprehensively evaluate the benefit of chemotherapy in HR-CINSARC patients and to prospectively validate the prognostic value of CINSARC in grade ½ STS sarcoma patients. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04307277 Date of registration: 13 March 2020.
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Affiliation(s)
- Thomas Filleron
- Biostatistics Unit, Institut Claudius Regaud, IUCT-O, 1 Avenue Irène Joliot Curie, 31059 Toulouse Cedex, France
| | - Sophie Le Guellec
- Department of Pathology, Institut Claudius Regaud, IUCT-O, 1 Avenue Irène Joliot Curie, 31059 Toulouse, France
- INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
| | - Christine Chevreau
- Department of Medical Oncology, Institut Claudius Regaud IUCT-O, 1 Avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Bastien Cabarrou
- Biostatistics Unit, Institut Claudius Regaud, IUCT-O, 1 Avenue Irène Joliot Curie, 31059 Toulouse Cedex, France
| | - Tom Lesluyes
- INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
| | - Sabrina Lodin
- Clinical Trials Office, Institut Claudius Regaud, IUCT-O, 1 Avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Angélique Massoubre
- Clinical Trials Office, Institut Claudius Regaud, IUCT-O, 1 Avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Muriel Mounier
- Clinical Trials Office, Institut Claudius Regaud, IUCT-O, 1 Avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Muriel Poublanc
- Clinical Trials Office, Institut Claudius Regaud, IUCT-O, 1 Avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Frédéric Chibon
- Department of Pathology, Institut Claudius Regaud, IUCT-O, 1 Avenue Irène Joliot Curie, 31059 Toulouse, France
- INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
| | - Thibaud Valentin
- INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France
- Department of Medical Oncology, Institut Claudius Regaud IUCT-O, 1 Avenue Irène Joliot Curie, 31059 Toulouse, France
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22
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Abstract
Limb synovial sarcoma (LSS) patients with metastasis at presentation usually have a very poor prognosis. Little is known about survival prediction and risk factors in these patients owing to the condition's rarity. Thus, this study examined the survival and prognostic variables of metastatic LSS.Clinical data for LSS patients with metastasis at presentation from 1975 to 2016 were obtained from the surveillance, epidemiology, and end results database. The Kaplan-Meier method was used to determine the survival curves. Univariate and multivariate Cox regression analysis were conducted to identify the prognostic predictors.The study enrolled 217 patients. Male predominance was observed in the metastatic LSS group. The median age at diagnosis of this population was 40 years. The subtypes were "not otherwise specified" (49.8%), spindle cell (32.7%), biphasic (17.1%), and epithelioid cell (0.5%). The 3-year overall and cancer-specific survival rates of the entire group were 27.2% and 28.3%, respectively. Tumor size <10 cm, surgery, radiotherapy, and chemotherapy were independent predictors of improved overall and cancer-specific survival in the multivariate analyses.Comprehensive treatment for LSS patients with metastasis at diagnosis is necessary and effective and can prolong survival.
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Affiliation(s)
- Pan Guo
- Department of Orthopaedics, First People's Hospital of Huzhou, First Affiliated Hospital of Huzhou University, Huzhou
| | - Renbo Zhao
- Department of Orthopaedics, Taizhou Tumor Hospital, Wenling
| | - Yuanxi Zhou
- Department of Orthopaedics, Health Community Group of Yuhuan Second People's Hospital, Yuhuan, Zhejiang, China
| | - Yuxin Shen
- Department of Orthopaedics, First People's Hospital of Huzhou, First Affiliated Hospital of Huzhou University, Huzhou
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23
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Salah S, Abuhijla F, Ismail T, Yaser S, Sultan I, Halalsheh H, Shehadeh A, Abdelal S, Almousa A, Jaber O, Abu-Hijlih R. Outcomes of extraskeletal vs. skeletal Ewing sarcoma patients treated with standard chemotherapy protocol. Clin Transl Oncol 2020; 22:878-883. [PMID: 31429039 DOI: 10.1007/s12094-019-02202-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 07/11/2019] [Accepted: 08/09/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare the outcomes of extraskeletal and skeletal Ewing sarcomas treated with standard chemotherapy protocol. METHODS We retrospectively collected data on primary localized skeletal and extraskeletal ES patients. Demographics and disease characteristics were compared between the two groups. The influence of presentation (skeletal vs. extraskeletal) on overall survival (OS) and local recurrence-free survival (LRFS) was assessed and compared by the log-rank test. RESULTS A total of 120 patients were included; 29 (24%) had extraskeletal and 91 (76%) had skeletal ES. All patients received vincristine, doxorubicin, and cyclophosphamide alternating with ifosfamide and etoposide (VDC-IE) chemotherapy, with a plan for local control at week 12. At a median follow-up of 38 months, there was no difference in OS between skeletal and extraskeletal ES; 5-year OS 70% and 67% respectively, p = 0.96. Patients with extraskeletal ES had inferior 5-year LRFS compared to skeletal ES; 74% vs. 83%; p = 0.042. Local recurrence occurred at a higher frequency in the extraskeletal group; 28% vs. 11%, p = 0.034, although more extraskeletal patients received adjuvant radiotherapy; 73% vs. 36%, p = 0.01. Among patients who underwent surgery (n = 76), there was no difference in R0 resection rate (skeletal: 89%, extraskeletal: 86%, p = 0.52, or good ( ≥ 90%) tumor necrosis; skeletal: 54%, extraskeletal: 38%, p = 0.31. CONCLUSION Patients with localized extraskeletal ES have comparable OS outcomes to patients with skeletal ES utilizing the standard VDC-IE chemotherapy. However, extraskeletal patients are at significantly higher risk for local recurrence.
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Affiliation(s)
- S Salah
- Medical Oncology Department, King Hussein Cancer Center, Queen Rania Al Abdullah St 202, Amman, 11941, Jordan.
| | - F Abuhijla
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - T Ismail
- Department of Pediatric Oncology and Hematology, King Hussein Cancer Center, Amman, Jordan
| | - S Yaser
- Medical Oncology Department, King Hussein Cancer Center, Queen Rania Al Abdullah St 202, Amman, 11941, Jordan
| | - I Sultan
- Department of Pediatric Oncology and Hematology, King Hussein Cancer Center, Amman, Jordan
| | - H Halalsheh
- Department of Pediatric Oncology and Hematology, King Hussein Cancer Center, Amman, Jordan
| | - A Shehadeh
- Department of Orthopedic Surgery, King Hussein Cancer Center, Amman, Jordan
| | - S Abdelal
- Department of Orthopedic Surgery, King Hussein Cancer Center, Amman, Jordan
| | - A Almousa
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - O Jaber
- Department of Pathology, King Hussein Cancer Center, Amman, Jordan
| | - R Abu-Hijlih
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
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24
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Shelby RD, Suarez-Kelly LP, Yu PY, Hughes TM, Ethun CG, Tran TB, Poultsides G, King DM, Bedi M, Mogal H, Clarke C, Tseng J, Roggin KK, Chouliaras K, Votanopoulos K, Krasnick BA, Fields RC, Pollock RE, Howard JH, Cardona K, Grignol V. Neoadjuvant radiation improves margin-negative resection rates in extremity sarcoma but not survival. J Surg Oncol 2020; 121:1249-1258. [PMID: 32232871 DOI: 10.1002/jso.25905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/13/2020] [Accepted: 02/16/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Radiation improves limb salvage in extremity sarcomas. Timing of radiation therapy remains under investigation. We sought to evaluate the effects of neoadjuvant radiation (NAR) on surgery and survival of patients with extremity sarcomas. MATERIALS AND METHODS A multi-institutional database was used to identify patients with extremity sarcomas undergoing surgical resection from 2000-2016. Patients were categorized by treatment strategy: surgery alone, adjuvant radiation (AR), or NAR. Survival, recurrence, limb salvage, and surgical margin status was analyzed. RESULTS A total of 1483 patients were identified. Most patients receiving radiotherapy had high-grade tumors (82% NAR vs 81% AR vs 60% surgery; P < .001). The radiotherapy groups had more limb-sparing operations (98% AR vs 94% NAR vs 87% surgery; P < .001). NAR resulted in negative margin resections (90% NAR vs 79% surgery vs 75% AR; P < .0001). There were fewer local recurrences in the radiation groups (14% NAR vs 17% AR vs 27% surgery; P = .001). There was no difference in overall or recurrence-free survival between the three groups (OS, P = .132; RFS, P = .227). CONCLUSION In this large study, radiotherapy improved limb salvage rates and decreased local recurrences. Receipt of NAR achieves more margin-negative resections however this did not improve local recurrence or survival rates over.
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Affiliation(s)
- Rita D Shelby
- Department of Surgery, The Ohio State University, Columbus, Ohio
| | | | - Peter Y Yu
- Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Tasha M Hughes
- Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Cecilia G Ethun
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Thuy B Tran
- Department of Surgery, Stanford University, Palo Alto, California
| | | | - David M King
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Meena Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Harveshp Mogal
- Department of Surgery, Wake Forest University, Winston-Salem, North Carolina
| | - Callisia Clarke
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jennifer Tseng
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Kevin K Roggin
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | | | | | - Bradley A Krasnick
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Ryan C Fields
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Kenneth Cardona
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Valerie Grignol
- Department of Surgery, The Ohio State University, Columbus, Ohio
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25
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Tian Z, Liu H, Zhang F, Li L, Du X, Li C, Yang J, Wang J. Retrospective review of the activity and safety of apatinib and anlotinib in patients with advanced osteosarcoma and soft tissue sarcoma. Invest New Drugs 2020; 38:1559-1569. [PMID: 32100146 PMCID: PMC7497688 DOI: 10.1007/s10637-020-00912-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 12/04/2019] [Accepted: 02/12/2020] [Indexed: 11/29/2022]
Abstract
Background Previous studies have demonstrated the efficacy of apatinib and anlotinib for the treatment of sarcomas. However, more clinical data and evidence are needed to support clinical treatment selection and study design. Here, we evaluated the effectiveness and safety of these two drugs for the treatment of sarcomas. Methods We retrospectively reviewed the data of 110 patients with advanced osteosarcoma (n = 32) or soft tissue sarcoma (STS, n = 78) who received oral apatinib or anlotinib therapy during May 2016–February 2019 at two centers. Patients were divided into the apatinib and anlotinib groups. Results Among osteosarcoma patients, the objective response rates (ORRs) for the apatinib and anlotinib groups were 15.79% (3/19) and 7.69% (1/13), respectively. The disease control rates (DCRs) were 63.16% (12/19) and 30.77% (4/13), and the median progression-free survival (m-PFS) was 4.67 ± 3.01 and 2.67 ± 1.60 months, respectively. Among STS patients, ORRs for the apatinib and anlotinib groups were 12.24% (6/49) and 13.79% (4/29), respectively. The DCRs were 59.18% (29/49) and 55.17% (16/29), and m-PFS was 7.82 ± 6.90 and 6.03 ± 4.50 months, respectively. Regarding adverse events (AEs), apatinib was associated with a higher incidence of hair hypopigmentation and pneumothorax, while anlotinib was associated with a higher incidence of pharyngalgia or hoarseness. Conclusion Both apatinib and anlotinib were effective for the treatment of sarcomas. However, the effectiveness of the two drugs and associated AEs varied based on the histological type of sarcoma. These differences may be due to their different sensitivities to targets such as RET, warranting further study.
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Affiliation(s)
- Zhichao Tian
- Department of Orthopedics, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450008, Henan Province, China
| | - Huimin Liu
- Department of Medical Oncology, The Affiliated People's Hospital of Zhengzhou University, Zhengzhou, 450003, Henan Province, China
| | - Fan Zhang
- Department of Orthopedics, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450008, Henan Province, China
| | - Liangyu Li
- Department of Orthopedics, the People's Hospital of Jiyuan, Jiyuan, 459000, Henan Province, China
| | - Xinhui Du
- Department of Orthopedics, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450008, Henan Province, China
| | - Chao Li
- Department of Orthopedics, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450008, Henan Province, China
| | - Jinpo Yang
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450008, Henan Province, China
| | - Jiaqiang Wang
- Department of Orthopedics, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450008, Henan Province, China.
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26
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Tsuchie H, Emori M, Miyakoshi N, Okada K, Nagasawa H, Murahashi Y, Mizushima E, Shimizu J, Yamashita T, Shimada Y. Prognostic Factors in Patients with Distant Soft Tissue Metastasis of Carcinoma: A Clinicopathological Study of 16 Cases. Med Princ Pract 2020; 29:538-543. [PMID: 32380496 PMCID: PMC7768164 DOI: 10.1159/000508463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 09/25/2019] [Accepted: 04/21/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Soft tissue metastasis (STM) is an uncommon condition in carcinoma. Although various case series related to STM have been reported, few reports have examined prognostic factors. This study aimed to evaluate the characteristics of STM and the factors affecting its prognosis. MATERIALS AND METHODS Patients with STM from carcinoma were retrospectively studied. The patients' information, including age, sex, primary tumor, metastasis location, size of the metastatic tumor, presence of pain, histological classification, history of primary tumor treatment, and other metastasis at diagnosis of STM were collected and associated with prognosis. RESULTS Overall, 16 patients with a mean age of 68.7 years were evaluated. The overall survival rate was not significantly different between lung cancer and non-lung cancer patients. The overall survival rate was significantly better in patients undergoing definitive treatment for the primary tumor than in those without history of treatment (p = 0.046). The overall survival rate of STM patients with no metastasis was significantly better than those with other metastasis at the diagnosis of STM (p = 0.041). On multivariate analysis, no history of primary tumor treatment and STM without pain were risk factors for prognosis (p = 0.0340 and 0.0474, respectively). None of the patients who developed STM under the skin experienced pain, while 92.3% of the patients who developed STM in the deep layer had pain. CONCLUSION The risk factors for poor diagnosis of STM were no past treatment of the primary tumor and absence of pain. STM in the deep layer is prone to pain.
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Affiliation(s)
- Hiroyuki Tsuchie
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan,
| | - Makoto Emori
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kyoji Okada
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Hiroyuki Nagasawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yasutaka Murahashi
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Emi Mizushima
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Junya Shimizu
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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27
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Tanaka K, Mizusawa J, Naka N, Kawai A, Katagiri H, Hiruma T, Matsumoto Y, Tsuchiya H, Nakayama R, Hatano H, Emori M, Watanuki M, Yoshida Y, Okamoto T, Abe S, Asanuma K, Yokoyama R, Hiraga H, Yonemoto T, Morii T, Ae K, Nagano A, Yoshikawa H, Fukuda H, Ozaki T, Iwamoto Y. Ten-year follow-up results of perioperative chemotherapy with doxorubicin and ifosfamide for high-grade soft-tissue sarcoma of the extremities: Japan Clinical Oncology Group study JCOG0304. BMC Cancer 2019; 19:890. [PMID: 31492159 PMCID: PMC6728960 DOI: 10.1186/s12885-019-6114-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/30/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Soft-tissue sarcomas (STS) are rare malignant tumors those are resistant to chemotherapy. We have previously reported the 3-year follow-up result on the efficacy of perioperative chemotherapy with doxorubicin (DXR) and ifosfamide (IFM) for high-risk STS of the extremities (JCOG0304). In the present study, we analyzed the 10-year follow-up results of JCOG0304. METHODS Patients with operable, high-risk STS (T2bN0M0, AJCC 6th edition) of the extremities were treated with 3 courses of preoperative and 2 courses of postoperative chemotherapy, which consisted of 60 mg/m2 of DXR plus 10 g/m2 of IFM over a 3-week interval. The primary study endpoint was progression-free survival (PFS) estimated by Kaplan-Meier methods. Prognostic factors were evaluated by univariable and multivariable Cox proportional hazards model. RESULTS A total of 72 patients were enrolled between March 2004 and September 2008, with 70 of these patients being eligible. The median follow-up period was 10.0 years for all eligible patients. Local recurrence and distant metastasis were observed in 5 and 19 patients, respectively. The 10-year PFS was 65.7% (95% CI: 53.4-75.5%) with no PFS events being detected during the last 5 years of follow-up. The 10-year overall survival was 78.1% (95% CI: 66.3-86.2%). Secondary malignancy was detected in 6 patients. The subgroup analysis demonstrated that there was significant difference in survival with regard to primary tumor size. CONCLUSIONS Only a few long-term results of clinical trials for perioperative chemotherapy treatment of STS have been reported. Our results demonstrate that the 10-year outcome of JCOG0304 for patients with operable, high-risk STS of the extremities was stable and remained favorable during the last 5 years of follow-up. TRIAL REGISTRATION This trial was registered at the UMIN Clinical Trials Registry as C000000096 on August 30, 2005.
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Affiliation(s)
- Kazuhiro Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Idaigaoka 1-1, Hasama, Yufu City, Oita 879-5593 Japan
| | - Junki Mizusawa
- JCOG Data Center, National Cancer Center Hospital, Tokyo, 104-0045 Japan
| | - Norifumi Naka
- Musculoskeletal Oncology Service, Osaka International Cancer Institute, Osaka, 541-8567 Japan
| | - Akira Kawai
- Department of Orthopaedic Surgery, National Cancer Center, Tokyo, 104-0045 Japan
| | - Hirohisa Katagiri
- Department of Orthopaedic Surgery, Shizuoka Cancer Center, Shizuoka, 411-0934 Japan
| | - Toru Hiruma
- Department of Orthopaedic Surgery, Kanagawa Cancer Center, Kanagawa, 241-0815 Japan
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, 812-8582 Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University, Ishikawa, 920-8641 Japan
| | - Robert Nakayama
- Department of Orthopaedic Surgery, Keio University, Tokyo, 160-0016 Japan
| | - Hiroshi Hatano
- Department of Orthopaedic Surgery, Niigata Cancer Center Hospital, Niigata, 951-8133 Japan
| | - Makoto Emori
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, 060-8556 Japan
| | - Munenori Watanuki
- Department of Orthopaedic Surgery, Tohoku University, Sendai, 980-8575 Japan
| | - Yukihiro Yoshida
- Department of Orthopaedic Surgery, Nihon University, Tokyo, 173-8610 Japan
| | - Takeshi Okamoto
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, 606-8501 Japan
| | - Satoshi Abe
- Department of Orthopaedic Surgery, Teikyo University, Tokyo, 173-8606 Japan
| | - Kunihiro Asanuma
- Department of Orthopaedic Surgery, Mie University, Mie, 514-8507 Japan
| | - Ryohei Yokoyama
- Department of Orthopaedic Surgery, National Kyushu Cancer Center, Fukuoka, 811-1395 Japan
| | - Hiroaki Hiraga
- Department of Orthopaedic Surgery, Hokkaido Cancer Center, Sapporo, 003-0804 Japan
| | - Tsukasa Yonemoto
- Department of Orthopaedic Surgery, Chiba Cancer Center, Chiba, 260-8717 Japan
| | - Takeshi Morii
- Department of Orthopaedic Surgery, Kyorin University, Tokyo, 181-8611 Japan
| | - Keisuke Ae
- Department of Orthopaedic Surgery, Cancer Institute Hospital, Tokyo, 135-8550 Japan
| | - Akihito Nagano
- Department of Orthopaedic Surgery, Gifu University, Gifu, 501-1194 Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University, Osaka, 565-0871 Japan
| | - Haruhiko Fukuda
- JCOG Data Center, National Cancer Center Hospital, Tokyo, 104-0045 Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University, Okayama, 700-0914 Japan
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Abstract
Approximately half of all cancer patients receive radiation therapy as part of their oncologic treatment. Radiation-associated sarcomas occur in fewer than 1% of patients who receive radiation therapy but account for up to 5% of all sarcomas. As the use of radiation has increased in the past few decades and overall oncologic outcomes are improving, the incidence of radiation-associated sarcomas is also expected to increase. Historically, radiation-associated sarcomas have been associated with poor outcomes but recent data suggest the prognosis is improving. Distinguishing the sarcoma from the primary malignancy is a major diagnostic criterion.
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Affiliation(s)
- Jeffrey K Mito
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Devarati Mitra
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Leona A Doyle
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Bots B, Eipel O, Terkovics L, Felkai L, Csóka M. [Treatment results of pediatric soft tissue sarcomas at the 2nd Department of Pediatrics, Semmelweis University]. Magy Onkol 2018; 62:222-229. [PMID: 30540864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/25/2018] [Indexed: 06/09/2023]
Abstract
Malignant tumors found in children are different from the ones that occur in adults. Compared to the malignancies in adults, the histological entities in pediatric patients are different and survival rates are higher among the children. Though pediatric soft tissue sarcomas are less common than leukemia and central nervous system malignancies, recognition of them is necessary to start the therapy as soon as possible. The delay of an appropriate treatment - chemotherapy, radiotherapy, surgery, in some cases targeted therapy - is unfavorable because somatic damages and functional loss can occur. In our study at the oncology department of the 2nd Department of Pediatrics of Semmelweis University, we collected and analyzed the data of 90 children who were diagnosed with soft tissue sarcomas between January of 2000 and November of 2016. Our results correlate with the data collected worldwide.
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Affiliation(s)
- Bianka Bots
- II. Sz. Gyermekgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
| | - Olivér Eipel
- II. Sz. Gyermekgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
| | - Lotte Terkovics
- II. Sz. Gyermekgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
| | - Luca Felkai
- II. Sz. Gyermekgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
| | - Monika Csóka
- II. Sz. Gyermekgyógyászati Klinika, Semmelweis Egyetem, Budapest, Hungary.
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30
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Muratori F, Frenos F, Bettini L, Matera D, Mondanelli N, Scorianz M, Cuomo P, Scoccianti G, Beltrami G, Greto D, Livi L, Baldi G, Roselli G, Capanna R, Campanacci DA. Liposarcoma: Clinico-pathological analysis, prognostic factors and survival in a series of 307 patients treated at a single institution. J Orthop Sci 2018; 23:1038-1044. [PMID: 30007495 DOI: 10.1016/j.jos.2018.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 05/13/2018] [Accepted: 06/03/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Liposarcoma (LPS) is a malignant mesenchymal tumor and the most common soft tissue sarcoma. Four different subtypes are described: well differentiated (WD) LPS or atypical lipomatous tumor (ALT), dedifferentiated (DD) LPS, myxoid LPS, and pleomorphic LPS (PLS). The objective of the study was to investigate prognostic factors and clinical outcome of liposarcoma. METHODS We retrospectively examined the clinico-pathological features of a series of 307 patients affected by Liposarcoma at a mean follow-up of 69 months (range 6-257). ALT/WD LPS were analyzed separately. The influence of site, size, type of presentation, grading, histotype and local recurrence on local and systemic control and survival was assessed. RESULTS The statistical analysis indicated that only surgical margins represented a significant prognostic factor for local recurrence in ALT/WD LPS (P = 0.0007) and other subtypes of LPS (P = 0.0055). In myxoid, PLS and DD LPS, significant prognostic factors for metastasis free survival (MFS) were surgical margins (P = 0.0009), size of the tumor (P = 0.0358), histology (P = 0.0117) and local recurrence (P = 0.0015). In multivariate analysis, surgical margins (0.0180), size (0.0432) and local recurrence (0.0288) correlated independently with MFS. Margins (P = 0.0315), local recurrence (P = 0.0482) and metastases (P < 0.0001) were prognostic factors for overall survival (OS). CONCLUSION Marginal surgery can be an accepted treatment for ALT/WD LPS. In other liposarcoma subtypes (Myxoid, DD, PLS) wide or radical surgery is recommended as the margins significantly influence local recurrence-free survival (LRFS), metastasis-free survival (MFS) and overall survival (OS). Local recurrence and metastases were significant prognostic factors for OS.
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Affiliation(s)
- Francesco Muratori
- Azienda Ospedaliera Universitaria Careggi Firenze, Ortopedia Oncologica e Ricostruttiva, Firenze, Italy.
| | - Filippo Frenos
- Azienda Ospedaliera Universitaria Careggi Firenze, Ortopedia Oncologica e Ricostruttiva, Firenze, Italy
| | - Leonardo Bettini
- Azienda Ospedaliera Universitaria Careggi Firenze, Ortopedia Oncologica e Ricostruttiva, Firenze, Italy
| | - Davide Matera
- Azienda Ospedaliera Universitaria Careggi Firenze, Ortopedia Oncologica e Ricostruttiva, Firenze, Italy
| | - Nicola Mondanelli
- Azienda Ospedaliera Universitaria Careggi Firenze, Ortopedia Oncologica e Ricostruttiva, Firenze, Italy
| | - Maurizio Scorianz
- Azienda Ospedaliera Universitaria Careggi Firenze, Ortopedia Oncologica e Ricostruttiva, Firenze, Italy
| | - Pierluigi Cuomo
- Azienda Ospedaliera Universitaria Careggi Firenze, Ortopedia Oncologica e Ricostruttiva, Firenze, Italy
| | - Guido Scoccianti
- Azienda Ospedaliera Universitaria Careggi Firenze, Ortopedia Oncologica e Ricostruttiva, Firenze, Italy
| | - Giovanni Beltrami
- Azienda Ospedaliera Universitaria Careggi Firenze, Ortopedia Oncologica e Ricostruttiva, Firenze, Italy
| | - Daniela Greto
- Azienda Ospedaliera Universitaria Careggi Firenze, Radioterapia, Firenze Italy
| | - Lorenzo Livi
- Azienda Ospedaliera Universitaria Careggi Firenze, Radioterapia, Firenze Italy
| | - Giacomo Baldi
- Azienda Ospedaliera di Prato, Oncologia, Prato Italy
| | - Giuliana Roselli
- Azienda Ospedaliera Universitaria Careggi Firenze, Radiologia, Firenze Italy
| | - Rodolfo Capanna
- Azienda Ospedaliero Universitaria Pisana, Dipartimento di Ortopedia, Pisa, Italy
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31
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Chi Y, Fang Z, Hong X, Yao Y, Sun P, Wang G, Du F, Sun Y, Wu Q, Qu G, Wang S, Song J, Yu J, Lu Y, Zhu X, Niu X, He Z, Wang J, Yu H, Cai J. Safety and Efficacy of Anlotinib, a Multikinase Angiogenesis Inhibitor, in Patients with Refractory Metastatic Soft-Tissue Sarcoma. Clin Cancer Res 2018; 24:5233-5238. [PMID: 29895706 DOI: 10.1158/1078-0432.ccr-17-3766] [Citation(s) in RCA: 192] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/22/2018] [Accepted: 06/07/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Yihebali Chi
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiwei Fang
- Peking University Cancer Hospital, Beijing, China
| | - Xiaonan Hong
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yang Yao
- Sixth People's Hospital, Shanghai, China
| | - Ping Sun
- Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Guowen Wang
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Feng Du
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), the VIPII Gastrointestinal Cancer Division of Medical Department, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yongkun Sun
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiong Wu
- The first Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Guofan Qu
- Harbin Medical University Cancer Hospital, Harbin, China
| | - Shusen Wang
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jianmin Song
- Gansu Provincial Cancer Hospital, Lanzhou, China
| | - Jianchun Yu
- Peking Union Medical College Hospital, Beijing, China
| | - Yongkui Lu
- Affiliated Cancer Hospital of Guangxi Medical University, Nanning, China
| | - Xia Zhu
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | | | - Zhiyong He
- Fujian Provincial Cancer Hospital, Fuzhou, China
| | - Jinwan Wang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Yu
- School of Public Health Nanjing Medical University, Nanjing, China
| | - Jianqiang Cai
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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32
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Frustaci S, Lo Re G, Crivellari D, De Paoli A, Galligioni E, Franchin G, Tumolo S, Monfardini S. Retrospective Analysis of the Cyvadic Regimen in Advanced Soft Tissue Sarcomas. Tumori 2018; 75:152-5. [PMID: 2741222 DOI: 10.1177/030089168907500215] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We performed a retrospective review of our data obtained with the original CYVADIC regimen in 31 consecutive patients with advanced soft tissue sarcomas. The treatment consisted of cyclophosphamide 500 mg/m2 i.v. on day 1, vincristine 1.5 mg/m2 in days 1 and 5, doxorubicin 50 mg/m2 i.v. on day 1, and dacarbazine 250 mg/m2 i.v. from days 1 to 5, repeated every 3 weeks. An objective response was observed in 11/31 patients (35.5%). There were 2 complete remissions (6.5%) lasting 23 and 2 months respectively and 9 partial responses (median duration 7 months, range 1–23). No change was observed in 14 patients, and 6 patients showed progression after a median of 2 cycles of chemotherapy. Toxicity was similar to that already described with this regimen, with alopecia, nausea, vomiting and myelosuppression being the most important side effects. In particular, the median WBC nadir was 1,900/mm3 (range 400–3,600/mm3) whereas the platelet nadir was 181,000/mm3 (range 80,000–358,000/mm3); no patient developed congestive heart failure, and no treatment related death was observed. Still today, after 10 years of use, the CYVADIC regimen is very widely employed as a standard treatment for recurrent or metastatic soft tissue sarcomas, although the original positive results have been confirmed only by a few authors. In our retrospective analysis of a totally unselected population of patients, we too observed a lower activity which is, however, according to a recent review, similar to the mean value of responses obtained in the whole population of treated patients reported in the literature.
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Affiliation(s)
- S Frustaci
- Division of Medical Oncology, Centro di Riferimento Oncologico, Aviano, Pordenone, Italy
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Blay JY, Soibinet P, Penel N, Bompas E, Duffaud F, Stoeckle E, Mir O, Adam J, Chevreau C, Bonvalot S, Rios M, Kerbrat P, Cupissol D, Anract P, Gouin F, Kurtz JE, Lebbe C, Isambert N, Bertucci F, Toumonde M, Thyss A, Piperno-Neumann S, Dubray-Longeras P, Meeus P, Ducimetière F, Giraud A, Coindre JM, Ray-Coquard I, Italiano A, Le Cesne A. Improved survival using specialized multidisciplinary board in sarcoma patients. Ann Oncol 2017; 28:2852-2859. [PMID: 29117335 PMCID: PMC5834019 DOI: 10.1093/annonc/mdx484] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [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] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Sarcomas are rare but aggressive diseases. Specialized multidisciplinary management is not implemented for all patients in most countries. We investigated the impact of a multidisciplinary tumor board (MDTB) presentation before treatment in a nationwide study over 5 years. PATIENTS AND METHODS NETSARC (netsarc.org) is a network of 26 reference sarcoma centers with specialized MDTB, funded by the French National Cancer Institute to improve the outcome of sarcoma patients. Since 2010, presentation to an MDTB and second pathological review are mandatory for sarcoma patients in France. Patients' characteristics and follow-up are collected in a database regularly monitored and updated. The management and survival of patients presented to these MDTB before versus after initial treatment were analyzed. RESULTS Out of the 12 528 patients aged ≥15 years, with a first diagnosis of soft tissue and visceral sarcoma obtained between 1 January 2010 and 31 December 2014, 5281 (42.2%) and 7247 (57.8%) were presented to the MDTB before and after the initiation of treatment, respectively. The former group had generally worse prognostic characteristics. Presentation to a MDTB before treatment was associated with a better compliance to clinical practice guidelines, for example, biopsy before surgery, imaging, quality of initial surgery, and less reoperations (all P < 0.001). Local relapse-free survival and relapse-free survival were significantly better in patients presented to a MDTB before initiation of treatment, both in univariate and multivariate analysis. CONCLUSION The compliance to clinical practice guidelines and relapse-free survival of sarcoma patients are significantly better when the initial treatment is guided by a pre-therapeutic specialized MDTB.
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Affiliation(s)
- J-Y Blay
- Department of Medical and Surgical Oncology, Centre Léon Bérard, Lyon; Department of Université Claude Bernard, Lyon.
| | - P Soibinet
- Department of Medical Oncology, Centre J Godinot, Reims
| | - N Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille
| | - E Bompas
- Department of Medical Oncology, Centre René Gauducheau Nantes, St. Herblain
| | - F Duffaud
- Department of Medical Oncology, La Timone University Hospital, Marseille
| | - E Stoeckle
- Departments of Medical and Surgical Oncology, Institut BergoniéBordeaux
| | - O Mir
- Departments of Medicine and Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - J Adam
- Departments of Medicine and Surgery, Gustave Roussy Cancer Campus, Villejuif
| | - C Chevreau
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse
| | - S Bonvalot
- Departments of Medicine and Surgery, Gustave Roussy Cancer Campus, Villejuif; Departments of Medical and Surgical Oncology, Institut Curie, Paris
| | - M Rios
- Department of Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-lès-Nancy
| | - P Kerbrat
- Department of Medical Oncology, Eugene Marquis Comprehensive Cancer Center, Rennes
| | - D Cupissol
- Department of Medical Oncology, Centre Val d'Aurelle, Montpellier
| | - P Anract
- Department of Orthopedics, Hopital Cochin Saint Vincent de Paul, Paris
| | - F Gouin
- Department of Orthopedics, Centre Hospitalier et Universitaire, Nantes
| | - J-E Kurtz
- Department of Medical Oncology, Hôpitaux Universitaires de Strasbourg, Strasbourg
| | - C Lebbe
- Department of Dermatology and CIC Department, INSERM U976 University Paris Diderot Saint Louis Hospital, Paris
| | - N Isambert
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon
| | - F Bertucci
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille
| | - M Toumonde
- Departments of Medical and Surgical Oncology, Institut BergoniéBordeaux
| | - A Thyss
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice
| | | | - P Dubray-Longeras
- Department of Medical Oncology, Centre Jean Perrin, Clermont-Ferrand, France
| | - P Meeus
- Department of Medical and Surgical Oncology, Centre Léon Bérard, Lyon; Department of Université Claude Bernard, Lyon
| | - F Ducimetière
- Department of Medical and Surgical Oncology, Centre Léon Bérard, Lyon; Department of Université Claude Bernard, Lyon
| | - A Giraud
- Departments of Medical and Surgical Oncology, Institut BergoniéBordeaux
| | - J-M Coindre
- Departments of Medical and Surgical Oncology, Institut BergoniéBordeaux
| | - I Ray-Coquard
- Department of Medical and Surgical Oncology, Centre Léon Bérard, Lyon; Department of Université Claude Bernard, Lyon
| | - A Italiano
- Departments of Medical and Surgical Oncology, Institut BergoniéBordeaux
| | - A Le Cesne
- Departments of Medicine and Surgery, Gustave Roussy Cancer Campus, Villejuif
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Tawbi HA, Burgess M, Bolejack V, Van Tine BA, Schuetze SM, Hu J, D'Angelo S, Attia S, Riedel RF, Priebat DA, Movva S, Davis LE, Okuno SH, Reed DR, Crowley J, Butterfield LH, Salazar R, Rodriguez-Canales J, Lazar AJ, Wistuba II, Baker LH, Maki RG, Reinke D, Patel S. Pembrolizumab in advanced soft-tissue sarcoma and bone sarcoma (SARC028): a multicentre, two-cohort, single-arm, open-label, phase 2 trial. Lancet Oncol 2017; 18:1493-1501. [PMID: 28988646 DOI: 10.1016/s1470-2045(17)30624-1] [Citation(s) in RCA: 811] [Impact Index Per Article: 115.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/05/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with advanced sarcomas have a poor prognosis and few treatment options that improve overall survival. Chemotherapy and targeted therapies offer short-lived disease control. We assessed pembrolizumab, an anti-PD-1 antibody, for safety and activity in patients with advanced soft-tissue sarcoma or bone sarcoma. METHODS In this two-cohort, single-arm, open-label, phase 2 study, we enrolled patients with soft-tissue sarcoma or bone sarcoma from 12 academic centres in the USA that were members of the Sarcoma Alliance for Research through Collaboration (SARC). Patients with soft-tissue sarcoma had to be aged 18 years or older to enrol; patients with bone sarcoma could enrol if they were aged 12 years or older. Patients had histological evidence of metastatic or surgically unresectable locally advanced sarcoma, had received up to three previous lines of systemic anticancer therapy, had at least one measurable lesion according to the Response Evaluation Criteria In Solid Tumors version 1.1, and had at least one lesion accessible for biopsy. All patients were treated with 200 mg intravenous pembrolizumab every 3 weeks. The primary endpoint was investigator-assessed objective response. Patients who received at least one dose of pembrolizumab were included in the safety analysis and patients who progressed or reached at least one scan assessment were included in the activity analysis. Accrual is ongoing in some disease cohorts. This trial is registered with ClinicalTrials.gov, number NCT02301039. FINDINGS Between March 13, 2015, and Feb 18, 2016, we enrolled 86 patients, 84 of whom received pembrolizumab (42 in each disease cohort) and 80 of whom were evaluable for response (40 in each disease cohort). Median follow-up was 17·8 months (IQR 12·3-19·3). Seven (18%) of 40 patients with soft-tissue sarcoma had an objective response, including four (40%) of ten patients with undifferentiated pleomorphic sarcoma, two (20%) of ten patients with liposarcoma, and one (10%) of ten patients with synovial sarcoma. No patients with leiomyosarcoma (n=10) had an objective response. Two (5%) of 40 patients with bone sarcoma had an objective response, including one (5%) of 22 patients with osteosarcoma and one (20%) of five patients with chondrosarcoma. None of the 13 patients with Ewing's sarcoma had an objective response. The most frequent grade 3 or worse adverse events were anaemia (six [14%]), decreased lymphocyte count (five [12%]), prolonged activated partial thromboplastin time (four [10%]), and decreased platelet count (three [7%]) in the bone sarcoma group, and anaemia, decreased lymphocyte count, and prolonged activated partial thromboplastin time in the soft-tissue sarcoma group (three [7%] each). Nine (11%) patients (five [12%] in the bone sarcoma group and four [10%] in the soft-tissue sarcoma group) had treatment-emergent serious adverse events (SAEs), five of whom had immune-related SAEs, including two with adrenal insufficiency, two with pneumonitis, and one with nephritis. INTERPRETATION The primary endpoint of overall response was not met for either cohort. However, pembrolizumab showed encouraging activity in patients with undifferentiated pleomorphic sarcoma or dedifferentiated liposarcoma. Enrolment to expanded cohorts of those subtypes is ongoing to confirm and characterise the activity of pembrolizumab. FUNDING Merck, SARC, Sarcoma Foundation of America, QuadW Foundation, Pittsburgh Cure Sarcoma, and Ewan McGregor.
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Affiliation(s)
- Hussein A Tawbi
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | | | | | | | | | - James Hu
- University of Southern California, Los Angeles, CA, USA
| | | | | | | | - Dennis A Priebat
- Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Lara E Davis
- Oregon Health & Science University, Portland, OR, USA
| | | | | | - John Crowley
- Cancer Research and Biostatistics, Seattle, WA, USA
| | | | - Ruth Salazar
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | | - Robert G Maki
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Denise Reinke
- Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI, USA
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Seddon B, Strauss SJ, Whelan J, Leahy M, Woll PJ, Cowie F, Rothermundt C, Wood Z, Benson C, Ali N, Marples M, Veal GJ, Jamieson D, Küver K, Tirabosco R, Forsyth S, Nash S, Dehbi HM, Beare S. Gemcitabine and docetaxel versus doxorubicin as first-line treatment in previously untreated advanced unresectable or metastatic soft-tissue sarcomas (GeDDiS): a randomised controlled phase 3 trial. Lancet Oncol 2017; 18:1397-1410. [PMID: 28882536 PMCID: PMC5622179 DOI: 10.1016/s1470-2045(17)30622-8] [Citation(s) in RCA: 307] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/06/2017] [Accepted: 07/12/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND For many years, first-line treatment for locally advanced or metastatic soft-tissue sarcoma has been doxorubicin. This study compared gemcitabine and docetaxel versus doxorubicin as first-line treatment for advanced or metastatic soft-tissue sarcoma. METHODS The GeDDiS trial was a randomised controlled phase 3 trial done in 24 UK hospitals and one Swiss Group for Clinical Cancer Research (SAKK) hospital. Eligible patients had histologically confirmed locally advanced or metastatic soft-tissue sarcoma of Trojani grade 2 or 3, disease progression before enrolment, and no previous chemotherapy for sarcoma or previous doxorubicin for any cancer. Patients were randomly assigned 1:1 to receive six cycles of intravenous doxorubicin 75 mg/m2 on day 1 every 3 weeks, or intravenous gemcitabine 675 mg/m2 on days 1 and 8 and intravenous docetaxel 75 mg/m2 on day 8 every 3 weeks. Treatment was assigned using a minimisation algorithm incorporating a random element. Randomisation was stratified by age (≤18 years vs >18 years) and histological subtype. The primary endpoint was the proportion of patients alive and progression free at 24 weeks in the intention-to-treat population. Adherence to treatment and toxicity were analysed in the safety population, consisting of all patients who received at least one dose of their randomised treatment. The trial was registered with the European Clinical Trials (EudraCT) database (no 2009-014907-29) and with the International Standard Randomised Controlled Trial registry (ISRCTN07742377), and is now closed to patient entry. FINDINGS Between Dec 3, 2010, and Jan 20, 2014, 257 patients were enrolled and randomly assigned to the two treatment groups (129 to doxorubicin and 128 to gemcitabine and docetaxel). Median follow-up was 22 months (IQR 15·7-29·3). The proportion of patients alive and progression free at 24 weeks did not differ between those who received doxorubicin versus those who received gemcitabine and docetaxel (46·3% [95% CI 37·5-54·6] vs 46·4% [37·5-54·8]); median progression-free survival (23·3 weeks [95% CI 19·6-30·4] vs 23·7 weeks [18·1-20·0]; hazard ratio [HR] for progression-free survival 1·28, 95% CI 0·99-1·65, p=0·06). The most common grade 3 and 4 adverse events were neutropenia (32 [25%] of 128 patients who received doxorubicin and 25 [20%] of 126 patients who received gemcitabine and docetaxel), febrile neutropenia (26 [20%] and 15 [12%]), fatigue (eight [6%] and 17 [14%]), oral mucositis (18 [14%] and two [2%]), and pain (ten [8%] and 13 [10%]). The three most common serious adverse events, representing 111 (39%) of all 285 serious adverse events recorded, were febrile neutropenia (27 [17%] of 155 serious adverse events in patients who received doxorubicin and 15 [12%] of 130 serious adverse events in patients who received gemcitabine and docetaxel, fever (18 [12%] and 19 [15%]), and neutropenia (22 [14%] and ten [8%]). 154 (60%) of 257 patients died in the intention-to-treat population: 74 (57%) of 129 patients in the doxorubicin group and 80 (63%) of 128 in the gemcitabine and docetaxel group. No deaths were related to the treatment, but two deaths were due to a combination of disease progression and treatment. INTERPRETATION Doxorubicin should remain the standard first-line treatment for most patients with advanced soft-tissue sarcoma. These results provide evidence for clinicians to consider with their patients when selecting first-line treatment for locally advanced or metastatic soft-tissue sarcoma. FUNDING Cancer Research UK, Sarcoma UK, and Clinical Trial Unit Kantonsspital St Gallen.
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Affiliation(s)
- Beatrice Seddon
- University College London Hospitals NHS Foundation Trust, London, UK.
| | - Sandra J Strauss
- University College London Hospitals NHS Foundation Trust, London, UK; UCL Cancer Institute, London, UK
| | - Jeremy Whelan
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Fiona Cowie
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Christian Rothermundt
- Kantonsspital, St Gallen, Switzerland; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Zoe Wood
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Nasim Ali
- The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
| | | | - Gareth J Veal
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - David Jamieson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Katja Küver
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | | | - Sharon Forsyth
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
| | - Stephen Nash
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
| | | | - Sandy Beare
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
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Olaratumab (Lartruvo) for soft-tissue sarcoma. Med Lett Drugs Ther 2017; 59:e138-9. [PMID: 28787747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Takahashi M, Komine K, Imai H, Okada Y, Saijo K, Takahashi M, Shirota H, Ohori H, Takahashi S, Chiba N, Mori T, Shimodaira H, Ishioka C. Efficacy and safety of gemcitabine plus docetaxel in Japanese patients with unresectable or recurrent bone and soft tissue sarcoma: Results from a single-institutional analysis. PLoS One 2017; 12:e0176972. [PMID: 28489919 PMCID: PMC5425189 DOI: 10.1371/journal.pone.0176972] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 04/20/2017] [Indexed: 01/06/2023] Open
Abstract
Background Combination therapy with gemcitabine and docetaxel has been reported to be a good therapeutic strategy for patients with soft tissue sarcoma. The aim of the present study was to analyze the efficacy and toxicity of gemcitabine with docetaxel in Japanese patients with advanced bone and soft tissue sarcoma. Patients and methods We retrospectively analyzed the effect of gemcitabine and docetaxel therapy on overall response, progression-free survival, overall survival, and toxicity in 42 patients with bone or soft tissue sarcoma who had received the therapy between October 2006 and September 2015, at Tohoku University Hospital. Results The median age was 55 years; 23 patients were men, and 19 were women. Eight had bone sarcoma and 34 had soft tissue sarcoma. Forty patients (95%) had previously been treated with one or more chemotherapeutic regimens. The overall response rate was 6.9% and the disease control rate was 55%. The median progression-free survival was 2.3 months and the median overall survival was 14.3 months. Grade 3 or more neutropenia and febrile neutropenia were observed in 74% and 4.8% of all patients, respectively. Conclusion The response rate was lower and myelosuppression was more frequently observed than in other previous reports. On the other hand, most of toxicities were enough manageable. In addition, some patients had long survival with a good response. Our study supports the notion that gemcitabine and docetaxel therapy is a good therapeutic option for treating patients with advanced soft tissue sarcoma as well as bone sarcoma, also in Asian populations.
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Affiliation(s)
- Masanobu Takahashi
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Keigo Komine
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Hiroo Imai
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Yoshinari Okada
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Ken Saijo
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Masahiro Takahashi
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Hidekazu Shirota
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Hisatsugu Ohori
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
| | - Shin Takahashi
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Natsuko Chiba
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Cancer Biology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Takahiro Mori
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Hideki Shimodaira
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
| | - Chikashi Ishioka
- Department of Medical Oncology, Tohoku University Hospital, Aoba-ku, Sendai, Miyagi, Japan
- Department of Clinical Oncology, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, Miyagi, Japan
- * E-mail:
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Siracuse BL, Gorgy G, Ruskin J, Beebe KS. What is the Incidence of Suicide in Patients with Bone and Soft Tissue Cancer? : Suicide and Sarcoma. Clin Orthop Relat Res 2017; 475:1439-1445. [PMID: 27896676 PMCID: PMC5384914 DOI: 10.1007/s11999-016-5171-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 08/31/2016] [Accepted: 11/14/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with cancer in the United States are estimated to have a suicide incidence that is approximately twice that of the general population. Patients with bone and soft tissue cancer often have physical impairments and activity limitations develop that reduce their quality of life, which may put them at high risk for depression, anxiety, and suicidal ideation. To our knowledge, there have been no large studies determining incidence of suicide among patients with bone and soft tissue cancer; this information might allow screening of certain high-risk groups. QUESTIONS/PURPOSES To determine (1) the incidence of suicide in patients with bone and soft tissue cancer, (2) whether the incidence of suicide is greater in patients with bone and soft tissue cancer than it is in the general US population, and (3) any demographic and tumor characteristics associated with increased suicide incidence. METHODS A retrospective analysis of the Surveillance, Epidemiology, and End Results (SEER) program was performed. A total of 23,620 patients with primary bone and soft tissue cancer were identified in this database from 1973 and 2013. Patients with a cause of death listed as "suicide and self-inflicted injury" were considered to have committed suicide and suicide incidences were determined for different demographic and tumor characteristics in this subset of patients. Patient data for age, gender, race, marital status, year of diagnosis, primary cancer site, cancer stage, course of treatment, and survival time were collected and analyzed. The incidence of suicide in patients with bone and soft tissue sarcoma was compared with the age-, gender-, and race-adjusted incidence of suicide in the general US population from 1970 to 2013 available from the National Center for Health Statistics through the SEER Program. RESULTS The overall suicide incidence in this population was 32 per 100,000 person-years, which was higher than the age-, race-, and gender-adjusted US general population suicide incidence of 13 per 100,000 person-years. When compared with the incidence of suicide in matched subgroups of the general US population, a higher suicide incidence was observed in men (standardized mortality ratio [SMR], 2.49; 95% CI, 1.92-3.22; p < 0.001), patients of white race (SMR, 2.68; 95% CI, 1.94-3.56; p < 0.001), patients 21 to 30 years old (SMR, 4.40; 95% CI, 3.44-5.54; p < 0.001) and 61 to 70 years old (SMR, 3.27; 95% CI, 2.54-4.18; p < 0.001), patients with cancer of the vertebral column (SMR, 2.88; 95% CI, 2.13-3.83; p < 0.001) and pelvic bones (SMR, 2.75; 95% CI, 2.00-3.65; p < 0.001), and patients within the first 5 years of cancer diagnosis (SMR, 10.8; 95% CI, 9.19-12.61; p < 0.001). CONCLUSIONS With identification of these characteristics that are associated with higher incidence of suicide, physicians should consider screening patients possessing these traits. By identifying at-risk patients, we can hope to reduce the incidence of suicide in this population by providing the treatment that these patients need. Further research must be done to determine how best to screen these patients and to identify the best interventions to reduce suicide incidence. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Brianna L Siracuse
- Department of Orthopaedics, Rutgers-New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D1610, Newark, NJ, USA.
| | - George Gorgy
- Department of Orthopaedics, Rutgers-New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D1610, Newark, NJ, USA
| | - Jeremy Ruskin
- Department of Orthopaedics, Rutgers-New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D1610, Newark, NJ, USA
| | - Kathleen S Beebe
- Department of Orthopaedics, Rutgers-New Jersey Medical School, 140 Bergen Street, ACC Building, Suite D1610, Newark, NJ, USA
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Abstract
OBJECTIVES Previously we have shown that 20 days after the tumor cells injection smaller melanomas have been developed in chemically sympathectomized mice in comparison with animals having intact sympathetic nervous system. However, it is known that chemical sympathectomy reduces the sympathetic neurotransmission only temporarily. In the present study, we monitored the survival of the sympathectomized mice with melanoma with an attempt to find out how long the suppressing effect of sympathectomy on the melanoma growth may endure. METHODS The chemical sympathectomy was performed by intraperitoneal injection of neurotoxin 6-hydroxydopamine in male C57BL/6J mice. Seven days later, the animals were injected subcutaneously with B16-F10 melanoma cells. Then, melanoma development, survival of the tumor-bearing mice and weight of the developed tumor mass were analyzed. RESULTS Sympathectomy delayed the development of the palpable tumors (18th day vs.14th day) and significantly prolonged the survival of the tumor-bearing mice (median 34 days vs. 29 days). However, the weight of the developed melanoma was significantly increased in the sympathectomized mice in comparison with the animals having intact sympathetic nervous system. CONCLUSIONS The data of the present study showed that effect of the chemical sympathectomy, performed before the tumor growth induction, persisted even at the time when sympathetic nerves started to regenerate that resulted in a prolonged survival of the mice with melanoma. However, comparing to our previous study, in which we have shown a reduced tumor mass in earlier stages of the tumor growth, specifically 20 days after melanoma cells injection, now we indicate that in later stages of the melanoma progression, the tumor mass was significantly increased in sympathectomized animals. These contra-intuitive findings may indicate that interventions affecting the sympathetic nervous system may exert complex effect on the tumor progression. Based on these data we may suggest that the potential therapeutic interventions affecting the sympathetic signaling in the tumor tissue and its microenvironment should attenuate the sympathetic neurotransmission not only temporarily but till the complete regression of the tumor tissue.
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Abstract
BACKGROUND Considering the clinical importance of high 5-year mortality, we performed a meta-analysis of maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) from F-FDG PET-CT for overall survival (OS) and progression-free survival (PFS) in patients with soft tissue sarcoma. METHODS The search and selection of eligible articles was conducted on PubMed and EMBASE. We applied hazard ratio (HR) and odd ratio (OR) to measure the correlation between SUVmax, MTV, and TLG with PFS and OS. The SUVmax was analyzed through subgroup in terms of histological grade and HR of posttreatment SUVmax was also assessed. RESULTS Eleven studies with 582 patients were included. The pooled HRs of pretreatment SUVmax were 2.40 (95% CI: 1.38-4.17) for OS and 2.20 (95% CI: 1.47-3.30) for PFS. The HRs in terms of OS were 3.20 (95% CI: 1.71-5.98) based on MTV and 5.20 (95% CI: 2.34-11.56) based on TLG. Meanwhile, the predict results of pretreatment SUVmax on OR remained significant and the HRs of posttreatment SUVmax were 2.25 (95% CI: 1.33-3.80) for OS and 2.87 (95% CI: 1.81-4.55) for PFS. CONCLUSIONS The pretreatment SUVmax, MTV, and TLG of F-FDG PET-CT showed significant prognostic value for OS and the PET-CT can be used in identifying high-risk patients about progression and survival. The analysis for posttreatment SUVmax suggested PET-CT as a promising equipment in monitoring therapy response.
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Affiliation(s)
- Linyan Chen
- State Key Laboratory of Biotherapy and Cancer Center
| | - Xin Wu
- Department of Head and Neck Cancer, Cancer Center, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xuelei Ma
- State Key Laboratory of Biotherapy and Cancer Center
| | - Linghong Guo
- State Key Laboratory of Biotherapy and Cancer Center
| | - Chenjing Zhu
- State Key Laboratory of Biotherapy and Cancer Center
| | - Qingfang Li
- State Key Laboratory of Biotherapy and Cancer Center
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Karch A, Koch A, Grünwald V. A phase II trial comparing pazopanib with doxorubicin as first-line treatment in elderly patients with metastatic or advanced soft tissue sarcoma (EPAZ): study protocol for a randomized controlled trial. Trials 2016; 17:312. [PMID: 27387325 PMCID: PMC4936293 DOI: 10.1186/s13063-016-1434-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 10/28/2015] [Accepted: 06/07/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Anthracycline-based treatment remains the backbone of chemotherapy for nonresectable soft tissue sarcomas (STS). More than 30 % of patients with STS are aged 60 years or older, limiting the choice of treatment to single-agent approaches for this elderly population. Hematological toxicity is frequent during doxorubicin monotherapy, grade 4 neutropenia is reported in 34 %, with a febrile neutropenia rate of 9 % in STS. We assume that comorbidities in the elderly population may limit tolerability of doxorubicin, and novel agents may improve tolerability and health-related quality of life while maintaining efficacy. We therefore investigated whether the tyrosine kinase inhibitor pazopanib exerts such a clinical benefit in elderly patients with STS (pazopanib for elderly [the EPAZ study]). METHODS/DESIGN This study is a randomized, controlled, open-label, multicenter, phase II noninferiority trial in which pazopanib 800 mg once daily is being compared six cycles of intravenous doxorubicin 75 mg/m(2) as first-line treatment in elderly patients (≥60 years) with metastatic or advanced STS. A total of 120 patients will be randomized 1:2 to receive doxorubicin or pazopanib, stratified by Eastern Cooperative Oncology Group performance status (0-1 vs. 2) and liposarcoma histology (yes vs. no). The primary endpoint is progression-free survival based on local tumor assessment according to Response Evaluation Criteria in Solid Tumors criteria. Secondary endpoints include grade 4 neutropenia and febrile neutropenia in hierarchical order, as well as overall survival, objective response rate, health-related quality of life, and geriatric assessments. DISCUSSION Pazopanib is associated with promising tolerability according to previous studies and may offer a significant clinical advantage in first-line treatment of STS compared with doxorubicin. The elderly population seems especially appealing for such an approach, since these patients are not suitable for aggressive combination therapy. The EPAZ study will confirm whether pazopanib may be an alternative to toxic chemotherapy for elderly patients with STS. TRIAL REGISTRATION ClinicalTrials.gov NCT01861951 ; registered on 11 April 2013. EudraCT 2011-004168-30; registered on 4 June 2012.
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Affiliation(s)
- Annika Karch
- />Institute for Biostatistics, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Armin Koch
- />Institute for Biostatistics, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Viktor Grünwald
- />Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
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Choi YB, Yi ES, Lee JW, Yoo KH, Sung KW, Koo HH. High-Dose Chemotherapy and Autologous Stem Cell Transplantation in Children with High-Risk or Recurrent Bone and Soft Tissue Sarcomas. J Korean Med Sci 2016; 31:1055-62. [PMID: 27366002 PMCID: PMC4900996 DOI: 10.3346/jkms.2016.31.7.1055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 04/09/2016] [Indexed: 01/09/2023] Open
Abstract
Despite increasing evidence that high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT) might improve the survival of patients with high-risk or recurrent solid tumors, therapy effectiveness for bone and soft tissue sarcoma treatment remains unclear. This study retrospectively investigated the feasibility and effectiveness of HDCT/auto-SCT for high-risk or recurrent bone and soft tissue sarcoma. A total of 28 patients (18 high-risk and 10 recurrent) underwent single or tandem HDCT/auto-SCT between October 2004 and September 2014. During follow-up of a median 15.3 months, 18 patients exhibited disease progression and 2 died of treatment-related toxicities (1 veno-occlusive disease and 1 sepsis). Overall, 8 patients remained alive and progression-free. The 3-year overall survival (OS) and event-free survival (EFS) rates for all 28 patients were 28.7% and 26.3%, respectively. In the subgroup analysis, OS and EFS rates were higher in patients with complete or partial remission prior to HDCT/auto-SCT than in those with worse responses (OS, 39.1% vs. 0.0%, P = 0.002; EFS, 36.8% vs. 0.0%, P < 0.001). Therefore, careful selection of patients who can benefit from HDCT/auto-SCT and maximal effort to reduce tumor burden prior to treatment will be important to achieve favorable outcomes in patients with high-risk or recurrent bone and soft tissue sarcomas.
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Affiliation(s)
- Young Bae Choi
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea
| | - Eun Sang Yi
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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In brief: Two Drugs for soft-tissue sarcoma. Med Lett Drugs Ther 2016; 58:e62. [PMID: 27148925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Murphy JM, Lim IIP, Farber BA, Heaton TE, Basu EM, Roberts SS, Modak S, Kushner BH, LaQuaglia MP. Salvage rates after progression of high-risk neuroblastoma with a soft tissue mass. J Pediatr Surg 2016; 51:285-8. [PMID: 26651282 PMCID: PMC4769938 DOI: 10.1016/j.jpedsurg.2015.10.075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 10/30/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Treatment of progression in high-risk neuroblastoma remains challenging despite improved survival. We retrospectively evaluated outcomes in children with a first progression that included soft-tissue masses. METHODS We reviewed records of 903 consecutive children with high-risk neuroblastoma diagnosed between 2004 and 2014, and identified 42 whose first progression included soft-tissue masses. Data on demographics, disease characteristics, treatment, and survival were collected. Primary outcome was 5-year overall survival (OS) from time of first progression. Secondary outcomes were local disease-free progression (LDFR) and progression-free survival (PFS) postprogression. We evaluated the prognostic significance of concomitant bone/bone marrow involvement, MYCN status, and multifocality of soft tissue relapse. RESULTS Median age at diagnosis was 3.0 (range: 1-10.7) years. Median time to first relapse or progression was 1.2 (range: 0.1-4.5) years after complete remission or minimal stable residual disease. Twelve (29%) patients had concomitant bone or marrow involvement at progression/relapse. There were 11 (26%) patients with International Neuroblastoma Staging System stage 3 disease (all with MYCN amplification), and 31 (74%) with stage 4 disease (12 with MYCN amplification). Nine (21%) patients had multifocal soft tissue progression. R1 resection was achieved in 41 children (95%), 38 (95%) of whom also received salvage radiation therapy. Five-year OS postprogression was 35% (95% CI: 19-51%), 5-year LDFS was 52% (95% CI: 32-72%), and 5-year PFS postprogression was 20% (95% CI: 6-34%). CONCLUSION Among children with high-risk neuroblastoma who underwent aggressive treatment of a first soft-tissue recurrence, 5-year postprogression overall survival was 34%. Multifocality and MYCN amplification were the predominant prognostic correlates for worse survival.
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Affiliation(s)
- Jennifer M Murphy
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Irene-Isabel P Lim
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Benjamin A Farber
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Todd E Heaton
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ellen M Basu
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen S Roberts
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shakeel Modak
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian H Kushner
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael P LaQuaglia
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Nystrom LM, Reimer NB, Reith JD, Scarborough MT, Gibbs CP. The Treatment and Outcomes of Extraskeletal Osteosarcoma: Institutional Experience and Review of The Literature. Iowa Orthop J 2016; 36:98-103. [PMID: 27528844 PMCID: PMC4910786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Extraskeletal osteosarcoma is a rare tumor with a poor prognosis. The purpose of this study is to examine the oncologic outcomes of this disease as they relate to surgical treatment and use of adjuvant therapies. METHODS We retrospectively analyzed all patients treated at our institution for high-grade extraskeletal osteosarcoma of the limb or chest wall. We recorded demographic data, presenting stage, surgical margin, use of adjuvant chemotherapy or radiation, incidence of local recurrence, metastases, and death. Overall and event-free survival were calculated using Kaplan-Meier survival methods. RESULTS There were 12 patients treated with primary wide resection or re-excision of a previously operated tumor bed. Four patients presented with metastases. Seven patients received chemotherapy and four patients received radiation therapy. There were two local recurrences, six patients developed new metastases, and nine patients died. There was no difference in overall survival in patients who received chemotherapy. There was, however, a trend towards increased length of survival in patients who received chemotherapy compared to those who did not (16.4 months vs. 9.3 months, p=0.16). CONCLUSIONS Despite no difference in overall survival, patients treated with adjuvant chemotherapy have a trend towards increased length of survival. We suggest that extraskeletal osteosarcoma be treated with standard osteosarcoma chemotherapy regimens in addition to wide resection.
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Affiliation(s)
| | | | - John D Reith
- Investigation Performed at the University of Florida
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Rhu J, Lee SK, Kil WH, Lee JE, Nam SJ. Surgery of primary tumour has survival benefit in metastatic breast cancer with single-organ metastasis, especially bone. ANZ J Surg 2015; 85:240-4. [PMID: 25996008 DOI: 10.1111/ans.12548] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Surgery for the primary breast tumour is usually not recommended in metastatic breast cancer (MBC); however, some reports have suggested a benefit of locoregional treatment. We designed this study to evaluate the efficacy of locoregional surgery in MBC. METHODS Data for patients diagnosed with MBC at Samsung Medical Center between 1995 and 2011 were retrospectively collected. We compared the survival benefit of all treatment modalities using Cox regression analysis. Subgroup analyses based on number of metastases were performed to delineate the indication for each treatment. RESULTS Among 262 patients, 40 (15.3%) underwent surgery. Other treatments included chemotherapy (n = 213, 81.3%), radiotherapy (n = 138, 52.7%), hormone therapy (n = 118, 45.0%) and HER2/neu receptor (HER2)-targeted therapy (n = 37, 14.1%). Cox regression analysis showed that surgery (hazard ratios (HR) = 0.51, P < 0.01), hormone therapy (HR = 0.31, P < 0.01) and HER2-targeted therapy (HR = 0.33, P < 0.01) were associated with improved survival, whereas presence of three or more metastatic organs (HR = 1.62, P = 0.03) was associated with poor survival. In patients with metastasis to a single organ, surgery (HR = 0.43, P < 0.01), chemotherapy (HR = 0.62, P = 0.05), hormone therapy (HR = 0.39, P < 0.01) and HER2-targeted therapy (HR = 0.39, P = 0.02) had a survival benefit. Furthermore, for patients with bone-only metastasis, surgery (HR = 0.37, P = 0.02), chemotherapy (HR = 0.42, P < 0.01), hormone therapy (HR = 0.22, P < 0.01) and HER2-targeted therapy (HR = 0.09, P = 0.02) showed a survival benefit. However, only hormone therapy and HER2-targeted therapy had a survival benefit in MBC with metastasis to multiple organs. CONCLUSION Surgical control of the primary breast tumour should be considered as a locoregional therapy in combination with systemic therapy in MBC with metastasis to a single organ, especially bone-only metastasis.
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Andersen KF, Fuglo HM, Rasmussen SH, Petersen MM, Loft A. Volume-Based F-18 FDG PET/CT Imaging Markers Provide Supplemental Prognostic Information to Histologic Grading in Patients With High-Grade Bone or Soft Tissue Sarcoma. Medicine (Baltimore) 2015; 94:e2319. [PMID: 26705220 PMCID: PMC4697986 DOI: 10.1097/md.0000000000002319] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the study is to assess the prognostic value of different volume-based calculations of tumor metabolic activity in the initial assessment of patients with high-grade bone sarcomas (BS) and soft tissue sarcomas (STS) using F-18 FDG PET/CT.A single-site, retrospective study from 2002 to 2012 including 92 patients with histologically verified high-grade BS (N = 37) or STS (N = 55). All patients underwent a pretreatment F-18 FDG PET/CT scan. Clinical data were registered. Measurements of the accuracy of metabolic tumor volume with a preset threshold of 40% of the maximum standardized uptake value of primary tumor (MTV40%) and total lesion glycolysis (TLG) as prognostic variables and identification of optimal discriminating cut-off values were performed through ROC curve analysis. Patients were grouped according to the cut-off values. All deaths were considered an event in survival analysis. Kaplan-Meier survival estimates and log-rank test were used to compare the degree of equality of survival distributions. Prognostic variables with related hazard ratios (HR) were assessed using Cox proportional hazards regression analysis.Forty-one of 92 patients died during follow-up (45%; 12 BS and 29 STS). Average survival for included patients was 6.5 years (95% CI 5.8-7.3 years) and probability of 5-year survival was 52%. There was a high-significant accuracy of TLG and MTV40% as prognostic variables when looking on all patients and during subgroup analysis. AUCs were higher for TLG than for MTV40%. TLG above optimal cut-off value was the only variable which was independently prognostic for survival throughout multivariate regression analysis of all included patients (P = 0.01, HR 4.78 [95% CI 1.45-15.87]) and subgroup analysis (BS: P = 0.04, HR 11.11 [95% CI 1.09-111.11]; STS: P < 0.05, HR 3.37 [95% CI 1.02-11.11]). No significant results were demonstrated for MTV40%.Volume-based F-18 FDG PET/CT imaging markers in terms of pretreatment estimation of TLG provide supplemental prognostic information to histologic grading, with significant independent properties for prediction of overall survival in patients with high-grade BS or STS.
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Affiliation(s)
- Kim Francis Andersen
- From the Department of Clinical Physiology, Nuclear Medicine & PET (KFA, SHR, AL); and Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (HMF, MMP)
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Abstract
BACKGROUND Extraosseous osteosarcoma is rare, and the most appropriate therapy is unclear because there are few studies regarding its treatment. The effectiveness of radiation and chemotherapy remains uncertain owing to conflicting results in previous reports. QUESTIONS/PURPOSES To review our experience with contemporary multimodality treatment, we asked: (1) What is the disease-specific survival and local relapse-free survival? (2) Does American Joint Commission on Cancer (AJCC) stage, tumor size, or location relate to disease outcome? (3) Does radiation therapy improve local control or survival? (4) Do doxorubicin and ifosfamide improve local control or survival? METHODS Between 1990 and 2012, we treated 40 patients for localized, high-grade extraosseous osteosarcoma. In this retrospective study, we could determine the status of 36 patients (90%) either to death or for a minimum of 24 months of followup; four (10%) were lost to followup before 24 months. There were 11 patients with AJCC Stage IIA and 25 with Stage III disease. All patients underwent wide surgical excision. Of the patients with Stage IIA disease, four received radiation and none received chemotherapy. Of the patients with Stage III disease, six received radiation, seven were treated with chemotherapy, and six received radiation and chemotherapy. During the study period, high-dose doxorubicin and ifosfamide was the preferred chemotherapy regimen for patients younger than 60 years with normal cardiac and renal function. Local relapse-free survival and disease-specific survival were determined by Kaplan-Meier analysis using a prospectively maintained institutional database supplemented by information from the institutional tumor registry. The Cox proportional hazard model was used to determine the effect of various factors on local recurrence and patient survival. RESULTS At 5 years, local relapse-free survival was 47% (95% CI, 27%-64%), and disease-specific survival was 53% (95% CI, 35%-68%). In multivariate analysis, AJCC stage, which depends on tumor size, was the strongest predictor of local relapse-free survival (hazard ratio [HR] = 0.17, p = 0.02), while tumor depth was the best predictor of disease-specific survival (HR = 5.6, p = 0.02). Radiation improved local relapse-free survival (HR = 0.30, p = 0.03) but not disease-specific survival in multivariate analysis. A regimen of doxorubicin and ifosfamide was associated with better local relapse-free survival for patients with Stage III disease (HR = 0.16, p = 0.04) but not disease-specific survival (HR = 0.32, p = 0.08). CONCLUSIONS With the limited number of patients in our study, it appears that extraosseous osteosarcoma behaves differently than osteosarcoma of bone. Multimodality treatment that includes doxorubicin and ifosfamide-based chemotherapy, radiation, and surgery may be a valid therapeutic strategy for Stage III disease, but larger, prospective studies will be needed to verify our preliminary observations. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Zhengfu Fan
- Department of Orthopaedic Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Shreyaskumar Patel
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Valerae O Lewis
- Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1448, Houston, TX, 77030, USA
| | - B Ashleigh Guadagnolo
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patrick P Lin
- Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1448, Houston, TX, 77030, USA.
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Nandra R, Hwang N, Matharu GS, Reddy K, Grimer R. One-year mortality in patients with bone and soft tissue sarcomas as an indicator of delay in presentation. Ann R Coll Surg Engl 2015; 97:425-33. [PMID: 26274756 PMCID: PMC5126236 DOI: 10.1308/003588415x14181254790284] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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] [Accepted: 02/07/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION For many cancers, one-year mortality following diagnosis is a reflection of either advanced stage at diagnosis, multiple co-morbidities and/or complications of treatment. One-year mortality has not been reported for soft tissue or bone sarcomas. This study reports 1-year sarcoma mortality data over a 25-year period, investigates prognostic factors and considers whether a delay in presentation affects 1-year mortality. METHODS A total of 4,945 newly diagnosed bone sarcoma and soft tissue sarcoma patients were identified from a prospectively maintained, single institution oncology database. Of these, 595 (12%) died within 1 year of diagnosis. Both patient factors and tumour characteristics available at diagnosis were analysed for effect. RESULTS There was significant variation in one-year mortality between different histological subtypes. There has been no significant change in mortality rate during the last 25 years (mean: 11.7%, standard deviation: 2.8 percentage points). Soft tissue sarcoma patients who survived over one year reported a longer duration of symptoms preceding diagnosis than those who died (median: 26 vs 20 weeks, p<0.001). Prognostic factors identified in both bone and soft tissue sarcomas mirrored those for mid to long-term survival, with high tumour stage, large tumour size, metastases at diagnosis and increasing age having the greatest predictive effect. CONCLUSIONS One-year mortality in bone and soft tissue sarcoma patients is easy to measure, and could be a proxy for late presentation and therefore a potential performance indicator, similar to other cancers. It is possible to predict the risk of one-year mortality using factors available at diagnosis. Death within one year does not correlate with a long history but is associated with advanced disease at diagnosis.
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Affiliation(s)
- R Nandra
- Royal Orthopaedic Hospital NHS Foundation Trust, UK
| | - N Hwang
- Royal Orthopaedic Hospital NHS Foundation Trust, UK
| | - G S Matharu
- Royal Orthopaedic Hospital NHS Foundation Trust, UK
| | - K Reddy
- Royal Orthopaedic Hospital NHS Foundation Trust, UK
| | - R Grimer
- Royal Orthopaedic Hospital NHS Foundation Trust, UK
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Abstract
Soft tissue sarcomas are a rare, heterogeneous group of malignancies that should be included in the differential diagnosis for any patient presenting with a soft tissue mass. This article reviews strategies for differentiating between benign and malignant soft tissue masses. Epidemiology, appropriate workup, and treatment of soft tissue sarcomas are reviewed.
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Affiliation(s)
- Edward W Jernigan
- Department of Orthopaedics, UNC School of Medicine, University of North Carolina, 3147 Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC 27599-7055, USA
| | - Robert J Esther
- Department of Orthopaedics, University of North Carolina, Campus Box 7055, 3155 Bioinformatics Building, Chapel Hill, NC 27599, USA.
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