The Utility of Chest Imaging for Surveillance of Atypical Lipomatous Tumors

Synopsis. For ALTs, the utility of chest surveillance has not been well defined. This study suggests that chest imaging does not have a significant role in the surveillance of ALTs. Advanced local imaging and more intensive chest surveillance may be considered in cases of local recurrence. Background. Unlike other soft tissue sarcomas, atypical lipomatous tumors (ALTs) are thought to have a low propensity for metastasis. Despite this, a standard of care for pulmonary metastasis (PM) surveillance has not been established. This study aimed to evaluate the utility of chest imaging for PM surveillance following ALT excision. Methods. This was a multi-institution, retrospective review of all patients with primary ALTs of the extremities or superficial torso who underwent excision between 2006 and 2018. Minimum follow-up was two years. Long-term survival was evaluated using the Kaplan–Meier method. Results. 190 patients with ALT were included. Average age was 61.7 years and average follow-up was 58.6 months (24 to 180 months). MDM2 testing was positive in 88 patients (46.3%), and 102 (53.7%) did not receive MDM2 testing. 188 patients (98.9%) had marginal excision, and 127 (66.8%) had marginal or positive margins. Patients received an average of 0.9 CT scans and 1.3 chest radiographs over the surveillance period. 10-year metastasis-free survival was 100%, with no documented deaths from disease. Conclusions. This study suggests that chest imaging does not have a significant role in PM surveillance following ALT excision, but advanced local imaging and chest surveillance may be considered in cases of local recurrence or concern for dedifferentiation.

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Extended ray resection for sarcoma of the hand: long-term survival and functional results

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193419885039 ◽

2019 ◽

Vol 45 (2) ◽

pp. 160-166 ◽

Cited By ~ 1

Author(s):

Farhad Farzaliyev ◽

Hans-Ulrich Steinau ◽

Halil-Ibrahim Karadag ◽

Alexander Touma ◽

Lars Erik Podleska

Keyword(s):

Soft Tissue ◽

Survival Rates ◽

Soft Tissue Sarcomas ◽

Functional Results ◽

Contralateral Side ◽

Level Of Evidence ◽

Term Survival ◽

Kaplan Meier

In this retrospective study, we analysed the long-term oncological and functional results after extended ray resection for sarcoma of the hand. Recurrence-free and overall survivals were calculated using the Kaplan–Meier method. The function of the operated hand was assessed with the Michigan Hand Questionnaire and compared with the contralateral side. Extended ray resection was performed in 25 out of 168 consecutive patients with soft-tissue and bony sarcomas of the hand. The overall 5- and 10-year, disease-specific survival rates were 86% and 81%, respectively. Local recurrences were observed in two patients. The Michigan Hand Questionnaire score for the affected hand at follow-up in nine patients was 82 points versus 95 for the healthy contralateral hands. We conclude that extended ray resection of osseous sarcomas breaking through the bone into the soft tissue or for soft tissue sarcomas invading bone is a preferable alternative to hand ablation when excision can be achieved with tumour-free margins. Level of evidence: III

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Total Lymphoid Irradiation and High-Dose Chemotherapy with Autologous Blood Stem-Cell Transplantation for Relapsed and Refractory Hodgkin Lymphoma: Excellent Disease Control and Long-Term Survival Rates

Blood ◽

10.1182/blood.v120.21.2024.2024 ◽

2012 ◽

Vol 120 (21) ◽

pp. 2024-2024

Author(s):

Ryan D. Gentzler ◽

Andrew M. Evens ◽

Alfred W. Rademaker ◽

Bharat B Mittal ◽

Adam M. Petrich ◽

...

Keyword(s):

Clinical Trial ◽

Phase I ◽

Survival Rates ◽

Standard Of Care ◽

High Dose Chemotherapy ◽

Salvage Chemotherapy ◽

High Dose ◽

Term Survival

Abstract Abstract 2024 Background: For patients with relapsed or refractory HL, salvage chemotherapy followed by aHSCT is the standard of care. Our group previously reported excellent clinical outcomes with accelerated hyperfractionated TLI followed by high-dose chemotherapy and aHSCT (Ann of Oncol. 16:679, 2007). This strategy has been adopted as the standard at our institution for eligible individuals and we now report long-term outcomes of patients previously reported on the phase I/II clinical trial in addition to those who were subsequently treated as standard of care. Patients and methods: Patients with biopsy confirmed relapsed/refractory classical HL who previously received no more than 20 Gy were eligible. Salvage chemotherapy was chosen by the patient's treating physician. All patients received accelerated hyperfractionated TLI prior to transplantation administered twice daily at 150 cGy, five days/week for 10 days. The morning dose was delivered to all nodal sites including the spleen, and the afternoon dose was delivered to all sites of previous and current disease. The goal was to treat uninvolved nodal sites and spleen to 1500 cGy and sites of current and previous disease to 3000 cGy. Conditioning chemotherapy consisted of high-dose carboplatin, cyclophosphamide, and etoposide. All patients received carboplatin 450 mg/m2 by continuous intravenous infusion (CIV) on days –6 to –4 (total dose = 1350 mg/m2) and cyclophosphamide 60 mg/kg/day over 1 h on days –3 and –2 (total dose = 120 mg/kg). Patients on the phase I portion of the trial received escalating doses of etoposide by CIV from days –6 to –4. Initial dosing levels were 400 mg/m2/day, 450 mg/m2/day, 500 mg/m2/day, 600 mg/m2/day and 700 mg/m2/day. Those treated on the phase II portion of the clinical trial or subsequent to the closing of the trial were treated with etoposide 700 mg/m2/day for a total of 2100 mg/m2. Results: 52 patients with relapsed/refractory HL at Northwestern University were treated with TLI and aHSCT from 1993 to January 2011. One patient was lost to follow-up immediately post-transplant. 51 patients were included in this analysis and had a median follow-up of 47 months (range: 0.07–204 months). Thirty patients were treated on a previously reported prospective phase I/II clinical trial. Most patients had nodular sclerosis histology (n=39, 76%) and more than half had primary induction failure (PIF; n=29). Among patients who achieved a CR with induction, 62% relapsed within one year. The most common salvage regimens were ESHAP and ICE chemotherapy and most had received two lines of chemotherapy prior to aHSCT. Only 21 patients (41%) achieved a complete response (CR) with salvage therapy and in most cases (n=31, 61%), response was determined by functional imaging prior to aHSCT. The 10-year PFS and OS for all patients were 56% and 54%, respectively. Ten-year PFS and OS for patients with PIF was 53%, compared with 63% and 59%, respectively, for those with relapsed disease (p=0.13 and p=0.20, respectively). Patients who had incomplete responses to salvage therapy had a 10-year PFS and OS of 41% and 39%, respectively, compared to 76% and 81%, respectively, for those who achieved a CR (p=0.1 and p=0.056, respectively). Treatment-related mortality within the first 100 days was observed in one patient. Five patients (10%) developed secondary malignancies; three developed MDS (one who had received MOPP induction died with MDS; one had relapsed HL post-aHSCT and died of AML and one is alive with MDS 3+ yrs post-diagnosis). There was one case each of T-cell lymphoma (7 months post-aHSCT) and melanoma. Conclusions: Sequential TLI/chemotherapy conditioning for relapsed/refractory HL for patients with limited or no prior radiotherapy continues to be associated with excellent disease control and long-term survival rates including high-risk populations such as PIF and chemotherapy-resistant disease. Disclosures: No relevant conflicts of interest to declare.

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Sarcomas of the extremities and the pelvis: comparing local recurrence after incisional and after core-needle biopsy

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02481-2 ◽

2022 ◽

Vol 20 (1) ◽

Author(s):

Alexander Klein ◽

Christof Birkenmaier ◽

Julian Fromm ◽

Thomas Knösel ◽

Dorit Di Gioia ◽

...

Keyword(s):

Soft Tissue ◽

Local Recurrence ◽

Core Needle Biopsy ◽

Needle Biopsy ◽

Tumor Resection ◽

Soft Tissue Sarcomas ◽

Wide Resection ◽

Incisional Biopsy ◽

Core Needle

Abstract Background The degree of contamination of healthy tissue with tumor cells during a biopsy in bone or soft tissue sarcomas is clearly dependant on the type of biopsy. Some studies have confirmed a clinically relevant contamination of the biopsy tract after incisional biopsies, as opposed to core-needle biopsies. The aim of our prospective study was to evaluate the risk of local recurrence depending on the biopsy type in extremity and pelvis sarcomas. Methods We included 162 patients with a minimum follow-up of 6 months after wide resection of extremity sarcomas. All diagnostic and therapeutic procedures were performed at a single, dedicated sarcoma center. The excision of the biopsy tract after an incisional biopsy was performed as a standard with all tumor resections. All patients received their follow-up after the conclusion of therapy at our center by means of regional MRI studies and, at a minimum, CT of the thorax to rule out pulmonary metastatic disease. The aim of the study was the evaluation of the influence of the biopsy type and of several other clinical factors on the rate of local recurrence and on the time of local recurrence-free survival. Results One hundred sixty-two patients with bone or soft tissue tumors of the extremities and the pelvis underwent either an incisional or a core-needle biopsy of their tumor, with 70 sarcomas (43.2%) being located in the bone. 84.6% of all biopsies were performed as core-needle biopsies. The median follow-up time was 55.6 months, and 22 patients (13.6%) developed a local recurrence after a median time of 22.4 months. There were no significant differences between incisional and core-needle biopsy regarding the risk of local recurrence in our subgroup analysis with differentiation by kind of tissue, grading of the sarcoma, and perioperative multimodal therapy. Conclusions In a large and homogenous cohort of extremity and pelvic sarcomas, we did not find significant differences between the groups of incisional and core-needle biopsy regarding the risk of local recurrence. The excision of the biopsy tract after incisional biopsy in the context of the definitive tumor resection seems to be the decisive factor for this result.

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Inotuzumab ozogamicin versus standard of care in relapsed or refractory acute lymphoblastic leukemia: Final report and long‐term survival follow‐up from the randomized, phase 3 INO‐VATE study

Cancer ◽

10.1002/cncr.32116 ◽

2019 ◽

Vol 125 (14) ◽

pp. 2474-2487 ◽

Cited By ~ 57

Author(s):

Hagop M. Kantarjian ◽

Daniel J. DeAngelo ◽

Matthias Stelljes ◽

Michaela Liedtke ◽

Wendy Stock ◽

...

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Lymphoblastic Leukemia ◽

Standard Of Care ◽

Final Report ◽

Inotuzumab Ozogamicin ◽

Phase 3 ◽

Term Survival ◽

Long Term Survival

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Popliteal Fossa Sarcomas

10.21203/rs.3.rs-721063/v1 ◽

2021 ◽

Author(s):

Ozgur Erdogan ◽

Aykut Çelik ◽

Ertuğrul Tekçe ◽

Güray Altun ◽

Korhan Ozkan ◽

...

Keyword(s):

Soft Tissue ◽

Local Recurrence ◽

Soft Tissue Sarcomas ◽

Popliteal Fossa ◽

Tumor Type ◽

Fusiform Cell ◽

Positive Margins ◽

Large Patient ◽

The Mean

Abstract Background and Aim: Soft tissue sarcomas of the popliteal fossa are extremely rare tumors of mesenchymal origin accounting for 3%–5% of all extremity sarcomas. However, data regarding the tumor type, neurovascular involvement, and administration of radiation therapy before or after resection are limited. This study aimed to report on popliteal fossa sarcomas analyzing data from two institutions based on a relatively large patient sample.Materials and Method: Twenty-four patients (80%; 9 men and 15 women) with a popliteal fossa soft tissue sarcoma were included in this study. The reviewed patient data included sex, age, duration of complaints, interval to diagnosis, radiology, pre- and postoperative biopsy, tumor histology, surgery type, complications, and pre- and postoperative oncologic and functional outcomes.Results: The mean age of the patients was 48 ± 21.23 (range 3–72) years at the time of diagnosis. The most common histological diagnoses were synovial sarcoma (6 patients), hemangiopericytoma (2 patients), soft tissue osteosarcoma (2 patients), fusiform cell sarcoma (2 patients), and myxofibrosarcoma (2 patients). Local recurrence after limb salvage was observed in six patients (25%). At the latest follow-up, 2 patients died of the disease, 2 patients were still alive with progressive lung disease and soft tissue metastasis, and the remaining 20 patients were free from the disease.Conclusions: Microscopically positive margins may not be an absolute indication for amputation. Also, negative margins do not provide a guarantee that local recurrence will not occur. Lymph node or distant metastasis may be predictive factors for local recurrence rather than positive margins.

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Outcomes after surgical resection of primary cardiac sarcomas

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2021-2-69-79 ◽

2021 ◽

Vol 25 (2) ◽

pp. 69

Author(s):

S. S. Babeshko ◽

Yu. P. Samurganov ◽

K. O. Barbukhatti ◽

V. A. Porkhanov

Keyword(s):

Local Recurrence ◽

Surgical Resection ◽

Conflict Of Interest ◽

Right Atrium ◽

Radical Resection ◽

Long Term Results ◽

Survival Duration ◽

Term Survival

Aim. To assess the immediate and long-term results of surgical treatment of patients with primary cardiac sarcomas.Methods. In the period from 2013 to 2020, five patients (two men and three women) of different age groups (from 10 to 54 years old) with primary cardiac sarcomas various localisations had been operated at our hospital. In all the patients, the operation was performed from the median sternotomy with cardiopulmonary bypass, normothermia and crystalloid cardioplegia.Results. The average age of the patients was 32 ± 12 years. Two patients had leiomyosarcoma (of right atrium and pulmonary artery), two had angiosarcoma of the right atrium and one was diagnosed with pleomorphic left atrial sarcoma. Only in two patients, the lesion was limited to one chamber; in other cases, the tumour exhibited aggressive infiltrative growth and invasion into the inferior vena cava, myocardium of the left ventricle, contralateral cardiac chambers, pericardium and parietal pleura. Three patients underwent radical surgery with R0 resection, two others underwent cytoreductive surgery with R2 resection owing to the prevalence of the process and the technical impossibility of radical resection. We did not record any in-hospital mortality. Postoperative chemotherapy was administered to four patients. At follow up, (median 18.8 ± 11.7 month), one patient was alive (follow-up 35 months) and was undergoing chemotherapy owing to local recurrence of the disease. One patient with pulmonary leiomyosarcoma underwent re-operation because of local recurrence 1 year after the primary surgery. All the patients died because of disease progression. The average postoperative survival duration in those who died was 14.8 ± 8.1 month.Conclusion. Despite effective early results, long-term survival and tumour-free course were disappointing owing to the initial prevalence of the disease course, the complexity of surgical procedures and the impossibility of radical resection in two cases. However, a multimodality treatment of this pathology, including radical surgical resection of the tumour (R0) along with the modern neoadjuvant and adjuvant chemotherapy, and in some cases, radiotherapy, can improve the survival duration.Received 18 December 2020. Revised 4 March 2021. Accepted 10 March 2021.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.

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Meningeal hemangiopericitoma (HPC): Treatment outcome in a retrospective series in a single institution.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e12511 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e12511-e12511

Author(s):

Alejandro Daniel Muggeri ◽

BERNADETTE CALABRESE ◽

Sebastian Cerrato ◽

Andres Cervio ◽

Blanca D. Diez

Keyword(s):

Survival Rates ◽

Progression Free Survival ◽

Standard Of Care ◽

Rank Test ◽

Subtotal Resection ◽

Term Survival ◽

Local Progression ◽

Alive With Disease

e12511 Background: HPC is a rare malignant tumor with a high proclivity toward recurrence and metastasis. Methods: The purpose of this study was to analyse retrospectively a series of eighteen patients with HPC treated between January 1992 and Oct 2011 with respect to clinical presentation, treatment results and long-term follow-up outcomes.Survival rate and PFS were analyzed by Kaplan-Meier method, with the use of two-sided log-rank test statistics Results: Twelve were females with a median age of 44.5 years (21-62). In 17 the tumor was intracranial, in one in the spinal cord. Median follow-up was 75,5 months (4 -314). Eight underwent gross total resection (GTR) and 2 of them received adjuvant radiotherapy. Ten had subtotal resection (STR) and 2 of them received RT. Three of 6 with GTR without RT relapsed. All patients with STR suffered local progression (2 after RT). Five developed systemic metastases after reiterate surgical resection (more than 3); three of them are alive with disease after further treatment at 11, 18 and 28 month. The median progression free survival (PFS) was 42,5 months (4-264), with 2 and 5-year PFS rates of 88% and 27% respectively. The 2, 5 and 10-year survival rates was 100, 93 and 81% respectively. All patients with GTR are alive (median follow-up: 60,5 months, range 30-125) and 3 of 10 patients with STR died (median follow-up: 81,5 months, range 4-314). Conclusions: When safe and feasible, GTR should be pursued as an initial surgical strategy to maximize overall survival. Adjuvant RT may show promise in preventing tumor progression in GTR patients. In metastatic disease long term survival could be achieved. The lack of a standard of care for HPC patients makes it especially important to do a complete workup, especially among patients presenting with recurrent HPC.

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Nonreferral of Possible Soft Tissue Sarcomas in Adults: A Dangerous Omission in Policy

Sarcoma ◽

10.1155/2009/827912 ◽

2009 ◽

Vol 2009 ◽

pp. 1-7 ◽

Cited By ~ 18

Author(s):

Juan F. Abellan ◽

José M. Lamo de Espinosa ◽

Julio Duart ◽

Ana Patiño-García ◽

Salvador Martin-Algarra ◽

...

Keyword(s):

Local Recurrence ◽

Tumour Size ◽

Soft Tissue Sarcomas ◽

Disease Free Survival ◽

Histologic Grade ◽

Specialist Centre ◽

Group A ◽

Patient Groups ◽

Group B

Introduction. The aim of this study is to compare outcomes in three groups of STS patients treated in our specialist centre: patients referred immediately after an inadequate initial treatment, patients referred after a local recurrence, and patients referred directly, prior to any treatment.Patients and methods. We reviewed all our nonmetastatic extremity-STS patients with a minimum follow-up of 2 years. We compared three patient groups: those referred directly to our centre (group A), those referred after an inadequate initial excision (group B), and patients with local recurrence (group C).Results. The study included 174 patients. Disease-free survival was 73%, 76%, and 28% in groups A, B, and C, respectively (P<.001). Depth, size, and histologic grade influenced the outcome in groups A and B, but not in C.Conclusion. Initial wide surgical treatment is the main factor that determines local control, being even more important than the known intrinsic prognostic factors of tumour size, depth, and histologic grade. The influence on outcome of initial wide local excision (WLE), which is made possible by referral to a specialist centre, is paramount.

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A single institutional experience treating adipocytic tumors: incidence, disease-related outcomes, and the clinical significance of MDM2 analysis

Orthopedic Reviews ◽

10.4081/or.2020.8818 ◽

2020 ◽

Vol 12 (3) ◽

Author(s):

Saule Tamkus ◽

Charles A. Gusho ◽

Matthew Colman ◽

Ira Miller ◽

Steven Gitelis ◽

...

Keyword(s):

Local Recurrence ◽

High Rate ◽

World Health ◽

Low Grade ◽

Adipocytic Tumors ◽

Imaging Characteristics ◽

Institutional Experience ◽

Atypical Lipomatous Tumors ◽

Mdm2 Amplification ◽

Lipomatous Tumors

Adipocytic tumors exist either as a benign or malignant form. The benign variant, lipoma, is composed of normal fat tissue. Lipomas typically develop from superficial fat cells beneath the skin or mucous membranes. Liposarcoma, the malignant counterpart, often develops in deeper tissues and is the most commonly diagnosed Soft Tissue Sarcoma (STS), comprising at least 20% of adult STS. However, malignant tumors of fatty origin exist as a spectrum of diagnoses, each carrying a unique risk of recurrence, metastasis, and longterm survival. The World Health Organization classifies liposarcomas into five categories: i) Atypical Lipomatous Tumors/Well Differentiated (ALT/WD); Ii) Dedifferentiated (ALT/DD); Iii) Myxoid; Iv) Round cell; and v) Pleomorphic. Lipomatous tumors often exhibit different immunohistochemical patterns. Benign lipomas are distinguished by the absence of Murine Double-Minute 2 (MDM2) amplification. Similarly, ALT/WD, classically defined as a low-grade and locally aggressive tumor, demonstrates consistent patterns of MDM2 amplification. Some studies suggest 10% of ALT/WD progress to the highgrade DD form, with others report a dedifferentiation rate of as high as 20% for primary ALT/WD based on location. The ALT/DD subtype is aggressive and has a high capacity to metastasize. While the mechanism of pathogenesis of ALT/DD metastasis is unknown, previous studies suggest that increased MDM2 amplification may play a role. This study sought to evaluate a single institutional experience treating the entire spectrum of lipomatous tumors and describe utilization patterns of MDM2 testing. The group hypothesized: i) Atypical Lipomatous Tumors (ALT), which include ALT/DD and ALT/WD, would exhibit a higher rate of local recurrence than lipomas with no significantly increased incidence of metastases; and ii) at least 50% of our MDM2 testing of ALT would prove positive for the MDM2 overamplification. This study retrospectively reviewed 105 cases (66 lipomas, 27 ALTs, 12 liposarcomas) of patients who underwent lipomatous tumor excision at our institution from 2013 to 2017. Twenty-five tumors (6 lipomas, 18 ALT, 1 liposarcoma) were tested for MDM2 amplification. Three of the tested tumors recurred (2 ALT, 1 liposarcoma), and each exhibited MDM2 overamplification. Five tumors (5 liposarcoma) developed late metastases. These data suggest that although ALT is associated with a higher rate of local recurrence, metastases are quite rare. Additionally, the data demonstrate a high rate of positive MDM2 testing (76%) based on clinical and imaging characteristics of the tumors.

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