Is local recurrence in bone and soft tissue sarcomas just a local recurrence or does it impact the overall survival, retrospective cohort from a sarcoma referral center

PURPOSE: To determine whether treatment-induced pathologic necrosis correlates with local recurrence and overall survival in patients who receive neoadjuvant therapy for high-grade extremity soft tissue sarcomas. PATIENTS AND METHODS: Four hundred ninety-six patients with intermediate- to high-grade extremity soft tissue sarcomas received protocol neoadjuvant therapy. All patients underwent surgical resection after neoadjuvant therapy and had pathologic assessment of tumor necrosis in the resected specimens. RESULTS: The 5- and 10-year local recurrence rates for patients with ≥ 95% pathologic necrosis were significantly lower (6% and 11%, respectively) than the local recurrence rates for patients with less than 95% pathologic necrosis (17% and 23%, respectively). The 5- and 10-year survival rates for the patients with ≥ 95% pathologic necrosis were significantly higher (80% and 71%, respectively) than the survival rates for the patients with less than 95% pathologic necrosis (62% and 55%, respectively). Patients with less than 95% pathologic necrosis were 2.51 times more likely to develop a local recurrence and 1.86 times more likely to die of their disease as compared with patients with ≥ 95% pathologic necrosis. The percentage of patients who achieved ≥ 95% pathologic necrosis increased to 48% with the addition of ifosfamide as compared with 13% of the patients in all the other protocols combined. CONCLUSION: Treatment-induced pathologic necrosis is an independent predictor of both local recurrence and overall survival in patients who receive neoadjuvant therapy for high-grade extremity soft tissue sarcomas. A complete pathologic response (≥ 95% pathologic necrosis) correlated with a significantly lower rate of local recurrence and improved overall survival.

Download Full-text

High-grade soft tissue sarcomas of the extremities: surgical margins influence only local recurrence not overall survival

International Orthopaedics ◽

10.1007/s00264-015-2694-x ◽

2015 ◽

Vol 39 (5) ◽

pp. 935-941 ◽

Cited By ~ 16

Author(s):

Julie Willeumier ◽

Marta Fiocco ◽

Remi Nout ◽

Sander Dijkstra ◽

William Aston ◽

...

Keyword(s):

Overall Survival ◽

Soft Tissue ◽

Local Recurrence ◽

Soft Tissue Sarcomas ◽

Surgical Margins ◽

High Grade

Download Full-text

Adjuvant CYVADIC chemotherapy for adult soft tissue sarcoma--reduced local recurrence but no improvement in survival: a study of the European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group.

Journal of Clinical Oncology ◽

10.1200/jco.1994.12.6.1137 ◽

1994 ◽

Vol 12 (6) ◽

pp. 1137-1149 ◽

Cited By ~ 166

Author(s):

V Bramwell ◽

J Rouesse ◽

W Steward ◽

A Santoro ◽

H Schraffordt-Koops ◽

...

Keyword(s):

Overall Survival ◽

Adjuvant Chemotherapy ◽

Soft Tissue ◽

Local Recurrence ◽

Randomized Study ◽

Survival Rates ◽

Soft Tissue Sarcomas ◽

European Organization ◽

Similar Frequency ◽

Percentage Survival

PURPOSE To evaluate the benefit of adjuvant chemotherapy in adult patients with soft tissue sarcomas. The principal end points were freedom from local recurrence and/or metastases and overall survival. PATIENTS AND METHODS Between January 1977 and June 1988, 468 patients entered this randomized study and 317 were considered eligible. Following complete surgical resection with or without radiotherapy, outcome in 145 eligible patients receiving cyclophosphamide 500 mg/m2 intravenously (IV) bolus on day 1, vincristine 1.4 mg/m2 IV bolus on day 1, doxorubicin (Adriamycin; Adria Laboratories, Columbus, OH) 50 mg/m2 IV bolus on day 1, and dacarbazine (DTIC) 400 mg/m2 by 1-hour infusion on days 1 to 3 (CYVADIC) cycles repeated every 28 days for eight courses was compared with that in 172 control patients. RESULTS With a median follow-up duration of 80 months (range, 39 to 165), actuarial percentage survival figures at 7 years were compared. Relapse-free survival rates were higher for CYVADIC, 56% versus 43% (P = .007), and local recurrence was significantly reduced in the CYVADIC arm at 17% versus 31% (P = .004). In contrast, distant metastases occurred with similar frequency in both arms, 32% for CYVADIC versus 36% for control patients (P = .42), and overall survival rates were not significantly different at 63% versus 56% (P = .64). A reduction in local recurrence was only apparent in the group of head, neck, and trunk sarcomas (P = .002), but not in limb tumors (P = .31). CONCLUSION Adjuvant chemotherapy with CYVADIC cannot be recommended outside the context of a clinical trial. Experience from this study has been used to plan a trial of neoadjuvant chemotherapy with doxorubicin/ifosfamide, which is currently in progress.

Download Full-text

Adult Head and Neck Soft Tissue Sarcomas: Treatment and Outcome

Sarcoma ◽

10.1155/2008/654987 ◽

2008 ◽

Vol 2008 ◽

pp. 1-5 ◽

Cited By ~ 18

Author(s):

Rabindra P. Singh ◽

Robert J. Grimer ◽

Nabina Bhujel ◽

Simon R. Carter ◽

Roger M. Tillman ◽

...

Keyword(s):

Overall Survival ◽

Soft Tissue ◽

Local Recurrence ◽

Head And Neck ◽

Metastatic Disease ◽

Tumour Size ◽

Soft Tissue Sarcomas ◽

Histological Subtypes ◽

Median Size ◽

Adult Head

We have retrospectively analysed the experience of a musculoskeletal oncological unit in the management of adult head and neck soft tissue sarcomas from 1990 to 2005. Thirty-six patients were seen, of whom 24 were treated at this unit, the remainder only receiving advice. The median age of the patients was 46 years. Most of the sarcomas were deep and of high or intermediate grade with a median size of 5.5 cm. Eleven different histological subtypes were identified. Wide excision was possible only in 21% of the cases. 42% of the patients developed local recurrence and 42% developed metastatic disease usually in the lungs. Overall survival was 49% at 5 years. Tumour size was the most important prognostic factor. Adult head and neck soft tissue sarcomas have a high mortality rate with a high risk of local recurrence and metastatic disease. The rarity of the disease would suggest that centralisation of care could lead to increased expertise and better outcomes.

Download Full-text

What Factors Influence the Outcome of Surgically Treated Soft Tissue Sarcomas of the Hand and Wrist?

Hand ◽

10.1177/1558944716672197 ◽

2016 ◽

Vol 12 (5) ◽

pp. 493-500 ◽

Cited By ~ 4

Author(s):

Matthew T. Houdek ◽

Brian E. Walczak ◽

Benjamin K. Wilke ◽

Sanjeev Kakar ◽

Peter S. Rose ◽

...

Keyword(s):

Overall Survival ◽

Soft Tissue ◽

Local Recurrence ◽

Soft Tissue Sarcomas ◽

Disease Free Survival ◽

Disease Status ◽

Distant Metastases ◽

Factors Affecting ◽

Disease Free

Background: Soft tissue sarcomas (STS) of the hand are exceedingly rare. The aim of this study was to review our institution’s experience with STS of the hand to identify factors affecting outcomes and survivorship. Methods: We retrospectively reviewed the records of 46 hand STS treated with definitive surgery at our institution between 1992 and 2013. Pertinent demographics as well as information regarding the surgical procedure, and disease status at latest follow-up were reviewed. Mean age at diagnosis was 38 years with a mean follow-up of 5 years. Results: The most common tumor subtypes were epithelioid (n = 10) and synovial sarcoma (n = 8). Sixty-one percent were superficial in location. Thirty-three patients had had a nononcologic resection prior to definitive surgical treatment at our institution. Ultimately, negative margins were obtained in all cases. Local recurrence was observed in 5 patients and distant metastases in 14 patients. Tumor sizes ≥2 cm, American Joint Committee on Cancer (AJCC) grade, and depth of the tumor were found to adversely affect the outcome in terms of disease-free and overall survival. Reexcision of an inadvertently excised tumor at an outside institution did not adversely affect the outcome. The 10-year overall and disease-free survival was 72% and 63%. Conclusions: Local recurrence after a wide excision was observed infrequently; however, distant disease was relatively common. Tumors with a size ≥2 cm were associated with a worse disease-free and overall survival, highlighting the aggressive nature of these tumors.

Download Full-text

What Factors Are Predictive of Outcome in the Treatment of Soft Tissue Sarcomas of the Foot and Ankle?

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000113 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Taylor Beahrs ◽

Norman Turner ◽

Cody Wyles

Keyword(s):

Overall Survival ◽

Soft Tissue ◽

Local Recurrence ◽

Tumor Size ◽

Soft Tissue Sarcomas ◽

Published Data ◽

Maximal Dimension ◽

Foot And Ankle ◽

Increased Risk

Category: Tumor Introduction/Purpose: Soft tissue sarcomas (STS) of the foot and ankle are common, accounting for 10% of sarcomas; however, there exists little published data on the outcome of treatment. Because of the unique anatomy of the foot and ankle, and the fact that benign lesions in this area are 200-fold more common than malignant lesions, these tumors can be frequently misdiagnosed, leading to unplanned excision and poor outcomes. The purpose of this study was to describe outcomes of the surgical treatment of STS of the foot and ankle at our institution, with an analysis on risk factors for local and distant recurrence, as well as overall survival. Methods: We reviewed the records of 62 foot and ankle soft tissue sarcomas treated with definitive surgery at our institution between 1992 and 2013. The cohort consisted of 35 males and 27 females with a mean age at diagnosis of 45 years and a mean follow-up of 7 years. Age, gender, anatomic location, tumor size, subtype, stage, neoadjuvant and adjuvant treatments, previous surgery, surgical procedure, and disease status at latest follow-up was recorded. Results: The most common tumor subtype was synovial sarcoma (n = 16). The overall limb salvage rate was 53%. Local recurrence was observed in 9 patients and distant metastases in 15 patients. Tumor size >=3 cm in maximal dimension was the greatest risk factor in mortality. Post treatment complications occurred in 15 patients. Local recurrence and development of distant disease was relatively common following wide excision of a soft tissue sarcoma of the foot and ankle. Tumors that were >=3 cm in maximal dimension were associated with a worse overall survival and patients with neoadjuvant radiation were at increased risk of complications. Conclusion: The results of our study highlight the aggressive nature of soft tissue sarcomas of the foot and ankle, with smaller tumors than previously reported (<5 cm) behaving like high-grade advanced disease.

Download Full-text

The Effect of Resection Margin on Local Recurrence and Survival in High Grade Soft Tissue Sarcoma of the Extremities: How Far Is Far Enough?

Cancers ◽

10.3390/cancers12092560 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2560

Author(s):

Annika Bilgeri ◽

Alexander Klein ◽

Lars H. Lindner ◽

Silke Nachbichler ◽

Thomas Knösel ◽

...

Keyword(s):

Overall Survival ◽

Soft Tissue ◽

Local Recurrence ◽

Resection Margin ◽

Soft Tissue Sarcomas ◽

High Grade ◽

Recurrence Free Survival ◽

Free Survival ◽

Positive Margins ◽

Local Recurrence Free Survival

Background: The significance of surgical margins after resection of soft tissue sarcomas in respect to local-recurrence-free survival and overall survival is evaluated. Methods: A total of 305 patients with deep-seated, G2/3 soft tissue sarcomas (STS) of the extremity, the trunk wall, or the pelvis were reviewed. The margin was defined according to the Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) classification system (R0-2), the Union Internationale Contre le Cancer (UICC) classification (R + 1 mm) for which a margin <1 mm is included into the R1 group, and in groups of <1 mm, 1–5 mm, >5 mm, or >10 mm. Results: Of these patients, 31 (10.2%) had a contaminated margin, 64 (21%) a margin of <1 mm, 123 (40.3%) a margin of 1–5 mm, 47 (15.4%) a margin of >5 mm, and 40 (13.1%) a margin of >10 mm. The 5-year local recurrence-free survival (LRFS) was 81.6%. Overall survival (OS) at 5 years was 65.9%. Positive margins worsened LRFS and OS. A margin of >10 mm did not improve LRFS and OS as compared to one of >5 mm. Conclusions: A resection margin of <1 mm showed a trend but not significantly better LRFS or OS compared to a contaminated margin. This finding supports use of the UICC classification. A margin of more than 10 mm did not improve LRFS or OS.

Download Full-text

The Correlation of Surgical Margins and Outcome Of Soft Tissue Sarcomas of The Extremities and Trunk in Hospital Sultan Ismail, Johor Bahru

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v17i1.918 ◽

2018 ◽

Vol 17 (1) ◽

Author(s):

Muhamad Firdaus bin Zainudin

Keyword(s):

Overall Survival ◽

Soft Tissue ◽

Local Recurrence ◽

Survival Rates ◽

Soft Tissue Sarcomas ◽

Surgical Margin ◽

Study Patient ◽

P Value ◽

Limb Salvage Surgery

Introduction: Patients with soft tissue sarcoma are treated following the standardized guidelines, however it is not guaranteed patient will remain free from local recurrence (LR) and metastasis. This study was conducted to determine the association between microscopic marginal status with local recurrence, metastasis and the survival of the patient. Materials and Methods: This retrospective study was conducted from January 2015 to December 2017 in Hospital Sultan Ismail, Johor Bahru. All patients underwent complete standadized resection of the tumour and had been follow up for 5 years. An operating and follow-up records of 70 cases who fulfill the inclusion and exclusion criteria were collected and analysed using Pearson chi square test and Kaplan-Meier curves. Results: Of the 70 patients, 52 were males and 18 were females. The age of the patients were between 16 and 73 years with the means age of 48.8 years old. Sixty eight patients underwent limb salvage surgery and 2 had amputation. 42 of them had positive post-operative microscopic surgical margin (PMSM) while 28 were negative. Local recurrence was noted in 28 and metastasis in 30 patients. Patient who had PMSM has higher risk to get local recurrence and metastasis compared to patient with negative margin (p-value <0.001). The overall median survival was 23 months. Overall survival rates for 3 years was 80% and for 5 years was 65%. Conclusion: In our study, patient with positive post-operative microscopic surgical margin had higher possibility to develop local recurrence, metastases and decrease overall survival rate.

Download Full-text

Myxofibrosarcoma: clinical and prognostic value of MRI features

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405616999200729152135 ◽

2020 ◽

Vol 16 ◽

Cited By ~ 1

Author(s):

Paolo Spinnato ◽

Andrea Sambri ◽

Tomohiro Fujiwara ◽

Luca Ceccarelli ◽

Roberta Clinca ◽

...

Keyword(s):

Soft Tissue ◽

Local Recurrence ◽

Contrast Enhancement ◽

Imaging Modality ◽

Soft Tissue Sarcomas ◽

The Elderly ◽

High Rate ◽

Imaging Features ◽

High Grade ◽

Mri Features

: Myxofibrosarcoma is one of the most common soft tissue sarcomas in the elderly. It is characterized by an extremely high rate of local recurrence, higher than other soft tissue tumors, and a relatively low risk of distant metastases.Magnetic resonance imaging (MRI) is the imaging modality of choice for the assessment of myxofibrosarcoma and plays a key role in the preoperative setting of these patients.MRI features associated with high risk of local recurrence are: high myxoid matrix content (water-like appearance of the lesions), high grade of contrast enhancement, presence of an infiltrative pattern (“tail sign”). On the other hand, MRI features associated with worse sarcoma specific survival are: large size of the lesion, deep location, high grade of contrast enhancement. Recognizing the above-mentioned imaging features of myxofibrosarcoma may be helpful to stratify the risk for local recurrence and disease-specific survival. Moreover, the surgical planning should be adjusted according to the MRI features

Download Full-text