scholarly journals Reliability of Margin Assessment after Surgery for Extremity Soft Tissue Sarcoma: The SSG Experience

Sarcoma ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Clement S. Trovik ◽  
Sigmund Skjeldal ◽  
Henrik Bauer ◽  
Anders Rydholm ◽  
Nina Jebsen
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Local Control ◽  
Adjuvant Radiotherapy ◽  
Surgical Margin ◽  
Primary Treatment ◽  
Margin Assessment ◽  
Treatment Characteristics ◽  
Extremity Soft Tissue Sarcoma ◽  
Original Classification

Surgery remains the mainstay of soft tissue sarcoma (STS) treatment and has been the primary treatment for the majority of patients in Scandinavia during the last 30 years although the use of adjuvant radiotherapy has increased. Patient and treatment characteristics have been recorded in the Scandinavian Sarcoma Group (SSG) Register since 1987. When the effect of new radiotherapy guidelines from 1998 was evaluated, the reliability of surgical margin assessments among different Scandinavian institutions was investigated. Margins were reevaluated by a panel of sarcoma surgeons, studying pathology and surgical reports from 117 patients, randomly selected among 470 recorded patients treated between 1998–2003. In 80% of cases, the panel agreed with the original classification. Disagreement was most frequent when addressing the distinction between marginal and wide margins. Considered the element of judgment inherent in all margin assessment, we find this reliability acceptable for using the Register for studies of local control of STS.

scholarly journals Intraoperative Radiotherapy in the Management of Locally Recurrent Extremity Soft Tissue Sarcoma

Sarcoma ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Christopher L. Tinkle ◽  
Vivian Weinberg ◽  
Steve E. Braunstein ◽  
Rosanna Wustrack ◽  
Andrew Horvai ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Disease Control ◽  
Local Control ◽  
Intraoperative Radiotherapy ◽  
Disease Free Survival ◽  
Median Dose ◽  
Extremity Soft Tissue Sarcoma ◽  
Locally Recurrent ◽  
Grade 3

Purpose. To investigate the efficacy and morbidity of limb-sparing surgery with intraoperative radiotherapy (IORT) for patients with locally recurrent extremity soft tissue sarcoma (ESTS).Methods and Materials. Twenty-six consecutively treated patients were identified in a single institution retrospective analysis of patients with locally recurrent ESTS treated with IORT following salvage limb-sparing resection from May 2000 to July 2011. Fifteen (58%) patients received external beam radiotherapy (EBRT) prior to recurrence (median dose 63 Gy), while 11 (42%) patients received EBRT following IORT (median dose 52 Gy). The Kaplan-Meier product limit method was used to estimate disease control and survival and subsets were compared using a log rank statistic, Cox’s regression model was used to determine independent predictors of disease outcome, and toxicity was reported according to CTCAE v4.0 guidelines.Results. With a median duration of follow-up from surgery and IORT of 34.9 months (range: 4 to 139 mos.), 10 patients developed a local recurrence with 4 subsequently undergoing amputation. The 5-year estimate for local control (LC) was 58% (95% CI: 36–75%), for amputation-free was 81% (95% CI: 57–93%), for metastasis-free control (MFC) was 56% (95% CI: 31–75%), for disease-free survival (DFS) was 35% (95% CI: 17–54%), and for overall survival (OS) was 50% (95% CI: 24–71%). Prior EBRT did not appear to influence disease control (LC,p=0.74; MFC,p=0.66) or survival (DFS,p=0.16; OS,p=0.58). Grade 3 or higher acute and late toxicities were reported for 6 (23%) and 8 (31%) patients, respectively. The frequency of both acute and late grade 3 or higher toxicities occurred equally between patients who received EBRT prior to or after IORT.Conclusions. IORT in combination with oncologic resection of recurrent ESTS yields good rates of local control and limb-salvage with acceptable morbidity. Within the limitations of small subsets, these data suggest that prior EBRT does not significantly influence disease control or toxicity.

scholarly journals Efficacy of adjuvant radiotherapy in non-extremity soft tissue sarcoma with moderate chemosensitivity

2018 ◽  
Vol 36 (4) ◽  
pp. 325-331
Author(s):  
Eun Mi Lee ◽  
Dong Hyun Kim ◽  
Do Young Kim ◽  
Young Mi Seol ◽  
Young Jin Choi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Adjuvant Radiotherapy ◽  
Extremity Soft Tissue Sarcoma

CT-guided Interstitial Brachytherapy Followed by External Bean Radiotherapy for a Patient With Relapsed Extremity Soft Tissue Sarcoma

2021 ◽  
Author(s):  
Zhongshan Liu ◽  
Yangzhi Zhao ◽  
Yunfeng Li ◽  
Xia Lin ◽  
Dongzhou Wang ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Lower Extremity ◽  
Local Control ◽  
Conservative Surgery ◽  
Local Control Rate ◽  
Left Thigh ◽  
Ct Guided ◽  
Extremity Soft Tissue Sarcoma ◽  
Locally Recurrent

Abstract Purpose: Locally recurrent extremity soft tissue sarcoma remains a therapeutic challenge; conservative surgery alone results in an inferior local control rate. This study demonstrates a new interstitial (IS) brachytherapy (BT) technique in a patient with recurrent extremity soft tissue sarcoma. Patients and methods: A 53-year-old man with recurrent left thigh malignant fibrous histiocytoma underwent conservative surgery and adjuvant intensity-modulated radiotherapy (IMRT) after two surgical excisions. A magnetic resonance imaging (MRI) of the lower extremity after the conservative surgery and IMRT revealed a left thigh mass measuring 12 cm × 8 cm × 7 cm. An IS BT with 3 fractions of 8 Gy each and guided with three-dimensional (3D) computed tomography (CT) was administered. For this procedure, IS metal needles were inserted at a depth of 1 cm into the tumor as a preliminary implantation, and their direction and depth were adjusted repeatedly until a satisfactory distribution was achieved through multiple CT scans. Results: The course of the IS BT procedure was uneventful. No severe bleeding, infection, or other complications were observed. At 3, 12, and 24 months after the IS BT, lower extremity MRI scans showed a left thigh mass measuring 10 cm × 5 cm × 4, 8 cm × 3 cm × 2 cm, and 6 cm × 2 cm × 2 cm, respectively. Minimal fibrosis, local numbness, and edema in the treatment area were noted. The patient had an excellent quality of life. Conclusion: Favorable oncologic outcomes for locally recurrent extremity soft tissue sarcoma were achieved using 3D CT-guided IS BT. This BT technique may contribute to an excellent local control rate and offer an effective and safe therapeutic option in selected cases.

Amputations for extremity soft tissue sarcoma in an era of limb salvage treatment: Local control and survival

2017 ◽  
Vol 117 (3) ◽  
pp. 434-442 ◽  
Author(s):  
Marc G. Stevenson ◽  
Annelie H. Musters ◽  
Jan H.B. Geertzen ◽  
Barbara L. van Leeuwen ◽  
Harald J. Hoekstra ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Limb Salvage ◽  
Local Control ◽  
Salvage Treatment ◽  
Extremity Soft Tissue Sarcoma

scholarly journals Late Local Recurrence and Metastasis in Soft Tissue Sarcoma of the Extremities and Trunk Wall: Better Outcome After Treatment of Late Events Compared with Early

2021 ◽  
Author(s):  
Arvid von Konow ◽  
Iman Ghanei ◽  
Emelie Styring ◽  
Fredrik Vult von Steyern
Keyword(s):  
Risk Factors ◽  
Soft Tissue ◽  
Local Recurrence ◽  
Soft Tissue Sarcoma ◽  
Surgical Margin ◽  
Late Recurrence ◽  
Primary Treatment ◽  
Population Based ◽  
Primary Diagnosis ◽  
Late Metastasis

Abstract Background Approximately 80% of soft tissue sarcoma (STS) recurrences, local and metastatic disease, are diagnosed within the first 3 years after primary diagnosis and treatment. Recurrences, however, can present after a longer period of remission. Our goal was to identify factors that may predict the risk of late recurrence. Methods We identified 677 patients with STS of the extremities and trunk wall from a population-based sarcoma register. Of these, 377 patients were alive and event-free at 3 years and were included for analysis of possible risk factors for late recurrence. Results Fifty-five of 377 (15%) patients developed late recurrence: 23 local recurrence, 21 metastasis, and 11 both manifestations. With R0 wide surgical margin as reference, R0 marginal (hazard ratio [HR] 2.6; p = 0.02) and R1 (HR 5.0; p = 0.005) margins were risk factors for late local recurrence. Malignancy grade (HR 8.3; p = 0.04) and R0 marginal surgical margin (HR 2.3; p = 0.04) were risk factors for late metastasis. We could not find a statistically significant correlation of late recurrence with many of the generally known risk factors for local recurrence and metastasis in STS. Outcome after treatment of late recurrences was better compared with outcome after treatment of early events. Conclusions Late recurrences, albeit relatively rare, do occur. Outcome after treatment was good compared with outcome after early events. Long surveillance of all patients with high-grade STS, especially if R0 wide surgical margin is not achieved in the primary treatment, appear to be well justified.

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