scholarly journals The Treatment and Outcome of Patients With Soft Tissue Sarcomas and Synchronous Metastases

Sarcoma ◽  
2002 ◽  
Vol 6 (2) ◽  
pp. 69-73 ◽  
Author(s):  
John M. Kane ◽  
J. William Finley ◽  
Deborah Driscoll ◽  
William G. Kraybill ◽  
John F. Gibbs
Keyword(s):  
Overall Survival ◽  
Soft Tissue ◽  
Metastatic Disease ◽  
Primary Tumor ◽  
Strong Association ◽  
Soft Tissue Sarcomas ◽  
Poor Overall Survival ◽  
Primary Tumors ◽  
Synchronous Metastases ◽  
Metastatic Sites

Introduction: There is a strong association between poor overall survival and a short disease-free interval for patients with soft tissue sarcomas (STS) and metastatic disease. Patients with STS and synchronous metastases should have a very dismal prognosis.The role of surgery in this subgroup of patients with STS has not been defined.Patients and Methods: A single-institution retrospective review was performed of 48 patients with STS and synchronous metastases in regard to patient demographics, presentation, tumor characteristics, metastatic sites, treatment, follow-up, and survival over a 27-year period.Results: Most primary tumors were ≥10 cm (58%), high-grade histology (77%), and located on the extremity (60%).The most frequent site of metastatic disease was the lung (63%); 27% of patients had metastases to ≥2 organ sites. Surgery to the primary tumor was performed in 94% of patients (n = 45) and 68% had additional radiation therapy (n = 32). Thirty- five percent of patients underwent at least one metastastectomy (n = 17). Chemotherapy was administered to 90% of patients (n = 43); 31% received ≥3 different regimens (n = 15) and 25% were given intra-arterial or intracavitary therapy (n = 12). Median overall survival was 15 months with a 21% 2-year survival. Local control of the primary tumor was achieved in 54% (n = 26), and metastastectomy was performed in 35% (n = 17). No analyzed factors were associated with an improvement in overall survivalConclusions: Despite multiple poor prognostic factors, the survival of patients with STS and metastases is comparable to those who develop delayed metastatic disease. However, unlike patients who present with metachronous disease, there was no improved survival observed for patients treated with metastastectomy. Consequently, treatment for patients with STS and synchronous metastases should be approached with caution. Surgical management of STS with synchronous metastases must be considered palliative and should be reserved for patients requiring palliation of symptoms. Patients must also be well informed of the noncurative nature of the procedure.

Predicting biomarkers of hepatic metastasis in Chinese colorectal cancer patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e15545-e15545
Author(s):  
Honghua Peng ◽  
Tianhao Mu ◽  
Yaping Sheng ◽  
Yingmei Li ◽  
Peiguo Cao
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Hepatic Metastasis ◽  
Primary Tumor ◽  
Potential Candidate ◽  
Poor Overall Survival ◽  
Primary Tumors ◽  
Distant Spread ◽  
Colorectal Cancer Patients

e15545 Background: Hepatic metastasis is the most common site of distant spread from colorectal cancer. About 15-25% patients with colorectal cancer harbors hepatic metastasis. The molecular mechanism and predicting biomarkers in colorectal cancer are still not fully understood. Methods: 57 Chinese colorectal cancer patients were enrolled in a cohort study. Samples of primary tumor were collected in these patients and underwent whole exome sequencing. Mutation profiles of primary tumors between the patients with metastasis and those without metastasis were analyzed and compared. Results: In the cohort, 54.4% (31/57) patients presented hepatic metastasis at the time of diagnosis, while 45.6% (26/57) did not. The patients were divided into 2 groups—with hepatic metastasis and without hepatic metastasis. The mutation landscape of primary tumor indicated that the Top 3 most frequently mutated genes of both groups were the same and presented mutated TP53, APC, and KRAS. 2. Interestingly, compared with the patients without hepatic metastasis, the patients with hepatic metastasis presented a higher frequency of mutated TCF7L2 (35.5% vs 3.85%) and TRIM77 (16.1% vs 0%). Moreover, in the patients with hepatic metastasis, the patients with TRIM77 mutation in primary tumor showed a worse overall survival (p < 0.0001). Conclusions: TCF7L2 and TRIM77 may be identified as potential candidate predicting biomarkers for hepatic metastasis in colorectal patients. In addition, mutated TRIM 77 predicted a poor overall survival in hepatic metastasis from colorectal cancer.

Treatment patterns should be carefully chosen in different primary sites of GI-NECs.

2021 ◽  
Vol 01 ◽  
Author(s):  
Hanguang Hu ◽  
Wen Cai ◽  
Jiawei Zhang ◽  
Jianshan Mao ◽  
Weiting Ge
Keyword(s):  
Overall Survival ◽  
Metastatic Disease ◽  
Primary Tumor ◽  
Reference Group ◽  
Tumor Resection ◽  
Treatment Patterns ◽  
Primary Tumor Resection ◽  
Primary Surgery ◽  
Small Intestinal ◽  
Metastatic Sites

Background: Neuroendocrine carcinomas (NECs) are heterogeneous and aggressive in gastrointestinal tract (GI). However, treatment patterns and related outcomes in different primary sites have not been well described. Methods: The SEER data was selected from 2010 to 2016 and 5-year survival was set as the end-point. Coarsened exact matching (CEM) was performed to match comparable patients. Patients were separated by treatment groups and then comparing survivals for treatment patterns used multivariate analysis in different primary sites. Results: 3975 patients with GI-NECs including stomach (13.41%), small intestinal (38.82%), colon (25.31%) and rectum (22.47%) were identified. In stomach, primary tumor resection benefits patients (HR=0.492; P= 0.011) in non-metastatic disease and primary surgery combine with systematic chemotherapy (HR=0.401; P= 0.041) benefit patients in metastatic disease comparing with only chemotherapy. In small intestinal, patients’ diagnosis age and tumor size were important factors affecting patients’ overall survival. Primary tumor resection benefits both non-metastatic and metastatic patients (HR=0.246; P= 0.002 vs HR= 0.551; P= 0.005). In colon, primary surgery with systematic chemotherapy benefit patients (HR= 0.633; P= 0.005). In rectum, primary tumor resection benefits non-metastatic patients (HR=0.398; P<0.001), while neither chemotherapy or primary tumor resection showed priority in prolong overall survival in metastatic disease. Pooling all patients received metastatic sites resection and comparing with reference group, metastatic sites resection in GI-NEC will bring survival benefits (HR=0.42; P=0.033). Conclusions: GI-NECs have different treatment patterns in different primary sites. Primary sites resection should be the basic treatment choices for GI-NECs. Chemotherapy should be cautious especially in non-metastatic patients and considered more clinical and biological characteristics. Patients with distant metastasis can benefit from metastatic site resection.

Detection of MSC-like cells in soft tissue sarcoma cell lines and primary tumors

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 11000-11000
Author(s):  
S. Wirths ◽  
E. Malenke ◽  
T. Wiesner ◽  
H. Buehring ◽  
J. Hartmann ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Cell Lines ◽  
Primary Tumor ◽  
Growth Factor Receptor ◽  
Soft Tissue Sarcomas ◽  
Proliferative Capacity ◽  
Differentiation Potential ◽  
Primary Tumors

11000 Background: Soft tissue sarcomas (STS) are a heterogeneous group of mesodermal tumors hypothetically originating from mesenchymal stem cells (MSC). While the expression profile of bone marrow derived MSCs and their in vitro differentiation potential have been examined extensively, knowledge regarding the in vivo counterparts of MSC is still evolving. We hypothesized that MSC-like cells within STS could represent sarcoma initiating cells. Methods: To target rare human cell populations including MSCs, an exclusive antibody panel was developed. The target antigens include platelet-derived growth factor receptor-β (CD140b), HER-2/erbB2 (CD340), TNFRSF16 (CD217), frizzled-4 (CD344), the recently described W8B2 antigen, as well as several surface antigens identified by novel antibodies. To define the expression pattern of MSC-markers in STS, both cell lines and primary tumor samples in suspension and in snap frozen sections were investigated. To reveal functional differences between identified rare tumor populations single cell proliferation kinetics were investigated after FACS-sorting. Results: All cell lines und primary tumor samples revealed expression of selected markers. Antigens identifying subpopulations within all sarcoma samples investigated, were selected for functional studies. These included frizzled-4, TNFRSF16, W5C5 and W8B2. Liposarcoma (SW872), leiomyosarcoma (SK-LMS) and fibrosarcoma (HT1080) cell lines enclosed subpopulations with differential expression of above markers and by FACS based limiting dilution it was demonstrated that only fractions of viable cells contained proliferative capacity. Cells lacking expression of CD271 had lower proliferative capacity compared to mock sorted HT1080 or SK-LMS, while CD271+ SW872 had significantly higher proliferation. The antigen defined by W5C5 identified cells with high proliferative capacity compared to control in SW872 and SK-LMS and its lack in HT1080 identified a subpopulation with largely reduced proliferation. Conclusions: Subpopulations within STS cell lines and primary sarcoma tissue express novel MSC-markers and display increased proliferative capacity, potentially reflecting the existence of sarcoma initiating cells. No significant financial relationships to disclose.

Impact of low-income public insurance on survival for children and young adults with bone and soft tissue sarcomas.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 10037-10037
Author(s):  
Neela Lakshmi Penumarthy ◽  
Robert Goldsby ◽  
Lena Penumarthy
Keyword(s):  
Public Health ◽  
Overall Survival ◽  
Young Adults ◽  
Health Insurance ◽  
Soft Tissue ◽  
Metastatic Disease ◽  
Low Income ◽  
Soft Tissue Sarcomas ◽  
Public Health Insurance ◽  
Public Insurance

10037 Background: Racial and ethnic survival disparities have been described for many pediatric malignancies, but the impact of income has not been extensively explored. To assess whether socioeconomic status affects outcomes, we evaluated low-income public health insurance as a proxy. We analyzed how low-income public health insurance influences overall survival in children, adolescents, and young adults diagnosed with bone and soft tissue sarcomas. Methods: The University of California San Francisco Cancer Registry was used to identify patients age 0-39 diagnosed with bone or soft tissue sarcomas between 2000-2015. Low-income patients were defined as those with Medicaid, which is only available under state law to eligible low-income individuals or families, or those with no insurance. The comparison group included all other patients with private insurance, Medicare, or Tricare. Survival curves were computed using the Kaplan-Meier method and compared using log-rank tests and Cox models. Logistic regression was used to investigate the association of low-income public insurance and presence of metastatic disease at diagnosis. Results: A total of 1,106 patients were included in the analysis. 444 (40%) were considered low-income; of these, 428 (39%) had public insurance and 16 (1%) had no insurance. Low-income patients were more likely to both be racial/ethnic minorities and present with metastatic disease on multivariable analysis. Low-income patients had significantly worse 5-year OS (61% vs 71%, p = 0.0003). When stratified by localized, regional, or metastatic disease, low-income patients consistently had significantly worse 5-year OS (localized: 78% vs 84%, regional: 64% vs 73%, metastatic: 23% vs 30% respectively, p < 0.0001). Age and race/ethnicity did not significantly impact OS in this study population. Conclusions: Low-income patients with bone and soft tissue sarcomas had decreased overall survival. While these patients were more likely to have metastatic disease, disparities in survival were noted even within the localized and regional disease groups. The means by which insurance status impacts survival requires additional investigation, but may be through reduced access to care.

scholarly journals Adult Head and Neck Soft Tissue Sarcomas: Treatment and Outcome

Sarcoma ◽  
2008 ◽  
Vol 2008 ◽  
pp. 1-5 ◽  
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.

scholarly journals Clinical Outcomes and Efficacy of Stereotactic Body Radiation Therapy in Children, Adolescents, and Young Adults with Metastatic Solid Tumors

2021 ◽  
Author(s):  
Sujith Baliga ◽  
Jennifer Matsui ◽  
Brett Klamer ◽  
Ashley Cetnar ◽  
Ashlee Ewing ◽  
...  
Keyword(s):  
Overall Survival ◽  
Solid Tumors ◽  
Metastatic Disease ◽  
Cumulative Incidence ◽  
Pediatric Patients ◽  
Local Therapy ◽  
Progression Free Survival ◽  
Local Failure ◽  
Poor Overall Survival ◽  
Metastatic Sites

Purpose Pediatric patients with metastatic solid tumors historically have a poor overall survival. Some pediatric patients may still be potentially curable with aggressive local therapy to metastatic disease. The purpose of this study is to report results of the use of SBRT in the treatment of pediatric metastatic disease. Materials and Methods Pediatric patients who received SBRT between the years 2000-2020. Study endpoints included local control (LC), progression free survival (PFS), overall survival (OS), cumulative incidence (CI) of death or local failure and toxicity. The endpoints with respect to survival and LC were calculated using the Kaplan-Meier estimate. The cumulative incidence of local failure was calculated using death as a competing risk. Results 16 patients with 36 lesions irradiated met inclusion criteria. The median OS and PFS was 17 months and 15.7 months, respectively. The 1-year OS was 75%. The 6- and 12-month LC was 85% and 78%, respectively. There were no local failures in lesions receving a BED10≥100 Gy. Patients who had ≤5 metastatic lesions at first recurrence had a superior 1-year OS of 100% versus 50% with >5 lesions. One patient (6.3%) experienced a grade 3 CNS toxicity. Conclusions LC was excellent with SBRT delivered to metastatic disease, particularly for lesions receiving a BED10≥100 Gy. High-grade toxicity was rare in our patient population. Patients with ≤5 metastatic sites have a significantly better OS compared to >5 sites. Future prospective trials with multi-institutional collaboration will be necessary to evaluate appropriate patient selection and the optimal radiation dose regimen.

Treatment-Induced Pathologic Necrosis: A Predictor of Local Recurrence and Survival in Patients Receiving Neoadjuvant Therapy for High-Grade Extremity Soft Tissue Sarcomas

2001 ◽  
Vol 19 (13) ◽  
pp. 3203-3209 ◽  
Author(s):  
Fritz C. Eilber ◽  
Gerald Rosen ◽  
Jeffery Eckardt ◽  
Charles Forscher ◽  
Scott D. Nelson ◽  
...  
Keyword(s):  
Overall Survival ◽  
Soft Tissue ◽  
Local Recurrence ◽  
Neoadjuvant Therapy ◽  
Independent Predictor ◽  
Survival Rates ◽  
Soft Tissue Sarcomas ◽  
High Grade ◽  
Recurrence Rates ◽  
Pathologic Assessment

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.

Impact of M1a and M1b staging in patients (pts) with metastatic colorectal cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 3590-3590 ◽  
Author(s):  
Hagen F. Kennecke ◽  
Jason Yu ◽  
Sharlene Gill ◽  
Winson Y. Cheung ◽  
Charles Davic Blanke ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Primary Tumor ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
Prognostic Impact ◽  
Primary Tumors ◽  
7Th Edition ◽  
The Impact

3590 Background: In 2009, pts with M1 colorectal cancer were divided into two subsets for the American Joint Committee on Cancer (AJCC) 7th edition. Pts with metastases (mets) confined to one organ or site at initial diagnosis became stage M1a while multiple sites or peritoneal mets became M1b. The objectives of the study are to evaluate the impact of site of mets and M1a/b staging among pts with M1 colorectal cancer. Methods: All pts referred to the BC Cancer Agency from 1999-2007 with newly diagnosed M1 colon or rectal cancer were included. Demographic, treatment, and outcome data were prospectively collected. The prognostic impact of individual sites of mets was assessed by hazard ratio estimates from univariate Cox models. Multivariable Cox proportional-hazards models were used to determine variables associated with overall survival in the entire cohort and in those undergoing resection of their primary tumor. Results: 2,049 pts with M1 disease were included. Median age was 66 years; 71% had colonic origin; 70% had their primary tumor resected; and 69% received chemotherapy. In univariate analysis, solitary mets were associated with improved survival. In multivariable analysis, M1a/b status still had significant prognostic effect. The effect remained significant in the subgroup analysis of pts with resected primary tumors when histology, T and N stage were included. Conclusions: Pts with solitary mets, including peritoneum, have superior overall survival as compared to those with multiple sites of mets. AJCC 7th edition staging that includes M1a/b provides significant prognostic information and should be considered in clinical practice and trials of pts with M1 disease who otherwise have few prognostic factors. [Table: see text]

A randomized phase II study of durvalumab and tremelimumab compared to doxorubicin in patients with advanced or metastatic soft tissue sarcoma (MEDISARC, AIO-STS 0415).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. TPS11075-TPS11075
Author(s):  
Viktor Grünwald ◽  
Sebastian Bauer ◽  
Barbara Hermes ◽  
Philipp Ivanyi ◽  
Lars H Lindner ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Overall Survival ◽  
Soft Tissue ◽  
Phase Ii ◽  
Checkpoint Inhibitors ◽  
Performance Status ◽  
Soft Tissue Sarcomas ◽  
Predictive Biomarkers ◽  
Ecog Performance Status ◽  
Curative Intent

TPS11075 Background: Soft tissue sarcomas (STS) are rare tumors and exhibit substantial histological diversity. Efficacious targeted 1st line treatment for advanced or metastatic STS is not available, and the standard therapy has been anthracycline-based for decades. This strategy shows poor efficacy, as demonstrated by a median Overall Survival (OS) of 12-20 months. Several STS subtypes, however, have been shown to express PD-L1, and immune checkpoint inhibitors (ICI) have demonstrated principle anti-tumor activity in pretreated STS. Our ongoing clinical trial tests the activity and safety of ICI combination therapy in the first-line setting. We hypothesize that the dual checkpoint blockade with Durvalumab (PD-L1) and Tremelimumab (CTLA-4) improves overall survival in STS when compared to the standard of care doxorubicin. Methods: MEDISARC is a multi-center phase II trial that is enrolling adult treatment-naïve patients with histologically confirmed STS of intermediate or high grade (FNCLCC grade 2 or 3) not amenable to surgery with curative intent and ECOG performance status 0-2. Chemosensitive histologic STS are eligible. 100 patients will be randomized 1:1, stratified by ECOG status (0 vs. 1/2). Patients in the experimental arm are treated with fixed doses of durvalumab (1.5 g Q4W) and tremelimumab (75 mg Q4W for 3 cycles, then Q12W) until Progressive Disease (PD) or for a maximum of 12 months. Doxorubicin treatment in the standard arm is at 75 mg/m2 Q3W and limited to 6 cycles. OS is the primary endpoint. Secondary endpoints include 2-year OS rate, PFS, ORR according to conventional and modified RECIST 1.1, safety and tolerability and health-related quality of life (EORTC QLQ-C30). OS analysis may be performed when the required number of events (E=70) has been observed. All randomized and treated subjects will be included in the efficacy and safety analysis. The accompanying translational research aims to identify prognostic and predictive biomarkers in blood and tumor tissue. Enrollment of patients started in April 2018 and is ongoing. As of February 2019, 32 patients have been enrolled. The study is sponsored by AIO-Studien-gGmbH, Berlin, Germany. Clinical trial information: 2016-004750-15.

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