Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma.

1996 ◽  
Vol 14 (3) ◽  
pp. 859-868 ◽  
Author(s):  
P W Pisters ◽  
L B Harrison ◽  
D H Leung ◽  
J M Woodruff ◽  
E S Casper ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Local Control ◽  
Distant Metastasis ◽  
Soft Tissue Sarcomas ◽  
Complete Resection ◽  
High Grade ◽  
Disease Specific Survival ◽  
Recurrence Rates ◽  
Disease Specific

PURPOSE This trial was performed to evaluate the impact of adjuvant brachytherapy on local and systemic recurrence rates in patients with soft tissue sarcoma. PATIENTS AND METHODS In a single-institution prospective randomized trial, 164 patients were randomized intraoperatively to receive either adjuvant brachytherapy (BRT) or no further therapy (no BRT) after complete resection of soft tissue sarcomas of the extremity or superficial trunk. The adjuvant radiation was administered by iridium-192 implant, which delivered 42 to 45 Gy over 4 to 6 days. The two study groups had comparable distributions of patient and tumor factors, including age, sex, tumor site, tumor size, and histologic type and grade. RESULTS With a median follow-up time of 76 months, the 5-year actuarial local control rates were 82% and 69% in the BRT and no BRT groups (P = .04), respectively. Patients with high-grade lesions had local control rates of 89% (BRT) and 66% (no BRT) (P = .0025). BRT had no impact on local control in patients with low-grade lesions (P = .49). The 5-year freedom-from-distant-recurrence rates were 83% and 76% in the BRT and no BRT groups (P = .60), respectively. Analysis by histologic grade did not demonstrate an impact of BRT on the development of distant metastasis, despite the improvement in local control noted in patients with high-grade lesions. The 5-year disease-specific survival rates for the BRT and no BRT groups were 84% and 81% (P = .65), respectively, with no impact of BRT regardless of tumor grade. CONCLUSION Adjuvant brachytherapy improves local control after complete resection of soft tissue sarcomas. This improvement in local control is limited to patients with high-grade histopathology. The reduction in local recurrence in patients with high-grade lesions is not associated with a significant reduction in distant metastasis or improvement in disease-specific survival.

Association of local recurrence with subsequent survival in extremity soft tissue sarcoma.

1997 ◽  
Vol 15 (2) ◽  
pp. 646-652 ◽  
Author(s):  
J J Lewis ◽  
D Leung ◽  
M Heslin ◽  
J M Woodruff ◽  
M F Brennan
Keyword(s):  
Soft Tissue ◽  
Local Recurrence ◽  
Soft Tissue Sarcoma ◽  
Distant Metastasis ◽  
High Grade ◽  
Disease Specific Survival ◽  
Primary Tumors ◽  
Poor Prognostic Factor ◽  
Extremity Soft Tissue Sarcoma ◽  
Disease Specific

PURPOSE The aim of this study was to analyze local recurrence in a large cohort of prospectively followed patients with primary extremity soft tissue sarcoma. In particular, we analyzed the correlation of local recurrence with subsequent metastasis and disease-specific survival. PATIENTS AND METHODS Patients who underwent treatment for primary extremity soft tissue sarcoma from July 1982 through July 1995 at Memorial Sloan-Kettering Cancer Center were the subject of this study. Local recurrence, distant metastasis, and disease-specific survival were used as end points of the study. The influence of local recurrence on subsequent distant metastasis and disease-specific survival were examined using the Cox proportional hazards model. RESULTS We treated 911 patients, of whom 297 (33%) developed recurrent disease. Local recurrence occurred in 116 patients (13%), metastasis in 167 (18%), and synchronous local recurrence and metastasis in 13 (2%). Of 116 patients who developed local recurrence, 38 subsequently developed metastasis and 34 died of disease. Metastasis after local recurrence was predicted in patients with initial high-grade (P = .005; risk = 3.5) or deep (P = .02; risk = 2.9) tumors. Tumor mortality after local recurrence was predicted in patients with initial high-grade (P = .007; risk = 3.7) or large (> 5 cm; P = .01; risk = 3.2) primary tumors. DISCUSSION These findings suggest that there is a strong association of local recurrence with the development of subsequent metastasis and tumor mortality, and that local recurrence is a poor prognostic factor. It would seem prudent to consider patients who develop local recurrence and have high-grade tumors as being at high risk for systemic disease and therefore eligible for investigational adjuvant systemic therapy.

scholarly journals A review of adult head and neck soft tissue sarcoma in a tertiary centre: malaysia experience

2017 ◽  
Vol 16 (1) ◽  
pp. 69-76 ◽  
Author(s):  
Salman Amiruddin ◽  
Mohd Razif Muhamad Yunus ◽  
Marina Mat Baki
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Head And Neck ◽  
Local Control ◽  
Adjuvant Radiotherapy ◽  
Soft Tissue Sarcomas ◽  
Optimal Treatment ◽  
High Morbidity ◽  
High Grade ◽  
Adult Head

Background: Head and neck tissue sarcoma are rare with potential high morbidity and mortality. The purpose of the present study was to present these cases and determine the optimal treatment for adult patients with head and neck soft tissue sarcomas.Methods: It is a retrospective study of adult head and neck soft tissue sarcoma conducted in the Department of Otorhinolaryngology at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) which is one of the national referral center within the period of 16 years from 1998 till 2014.Results: Fourteen cases were reviewed in which7 histopathological variations of soft tissue sarcomas were identified. Local control after surgery alone or combined with radiotherapy was obtained in 50 % of the patients which is influenced by histologic grade, tumor size, and surgical margins. Patients with high-grade tumors or positive margins have improved local control if adjuvant radiotherapy is used. Distant metastases occurred in 14.2 % of patients and the 5-year survival rate was 50 %.Conclusions: The optimal treatment for adult head and neck soft tissue sarcomas is surgery. Adjuvant radiotherapy improves outcomes for those with high-grade tumors or positive margins.Bangladesh Journal of Medical Science Vol.16(1) 2017 p.69-76

18F-FLT PET/CT as a prognostic imaging biomarker of disease specific survival in patients with primary soft tissue sarcoma

2021 ◽  
pp. jnumed.121.262502
Author(s):  
Joseph Crompton ◽  
Wesley R. Armstrong ◽  
Mark A. Eckardt ◽  
Ameen Seyedroudbari ◽  
William D. Tap ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Imaging Biomarker ◽  
Disease Specific Survival ◽  
Flt Pet ◽  
Pet Ct ◽  
Disease Specific

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.

Adult-Type Soft Tissue Sarcomas in Pediatric-Age Patients: Experience at the Istituto Nazionale Tumori in Milan

2005 ◽  
Vol 23 (18) ◽  
pp. 4021-4030 ◽  
Author(s):  
Andrea Ferrari ◽  
Michela Casanova ◽  
Paola Collini ◽  
Cristina Meazza ◽  
Roberto Luksch ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcomas ◽  
Complete Resection ◽  
High Grade ◽  
Adult Type ◽  
Free Survival ◽  
Homogeneous Subgroup ◽  
Response To Chemotherapy ◽  
Patients Experience ◽  
Rate Of Response

Purpose Nonrhabdomyosarcoma soft tissue sarcomas are a heterogeneous group of tumors for which optimal treatment remains controversial. We report on a large group of 182 patients younger than 18 years old treated at a single institution over a 25-year period. Patients and Methods In this relatively homogeneous subgroup of adult-type histotypes, surgery was the mainstay of treatment; radiotherapy was administered to 73 patients, and chemotherapy was administered to 114 patients (70 received chemotherapy as adjuvant therapy). Results Overall survival at 5 years was 89% in patients who underwent complete resection at diagnosis, 79% in patients who had marginal resection, 52% in initially unresected patients, and 17% in patients with metastases at onset. Outcome was unsatisfactory in patients with large and high-grade tumors, even after gross resection; adjuvant chemotherapy seemed to improve the results in this group. Initially unresected patients who responded well to chemotherapy and subsequently underwent complete resection had an event-free survival rate of approximately 70%. The rate of response to chemotherapy was 58%. Conclusion The identification of prognostic variables should enable risk-adapted therapies to be planned. Patients with initially unresectable disease and patients with resected large and high-grade tumors are at high risk of metastases and treatment failure. Although the limits of this retrospective analysis are self-evident, our data would suggest that intensive chemotherapy (with an ifosfamide-doxorubicin regimen) might have a more significant role in these patients than what is generally assumed.

Risk assessment in high grade sarcoma patients during neoadjuvant chemotherapy using multiple tracer PET

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 20006-20006
Author(s):  
J. F. Eary ◽  
E. Conrad ◽  
J. Link ◽  
A. Cizik ◽  
D. Mankoff ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Soft Tissue ◽  
Neoadjuvant Chemotherapy ◽  
Soft Tissue Sarcoma ◽  
Pet Imaging ◽  
Cellular Proliferation ◽  
Soft Tissue Sarcomas ◽  
Response To Treatment ◽  
High Grade ◽  
Hypoxic Volume

20006 Background: Patients with high grade soft tissue sarcomas are treated with neoadjuvant chemotherapy. Sarcomas have biological features that may predict for poor outcome. Some of these features are tumor proliferation rate, level of tumor hypoxia, and upregulation of tumor drug resistance mechanisms. Methods: We have a group of specific PET imaging agents to quantify the level of activity of these tumor processes. Patients with soft tissue sarcomas receive [C-11]Thymidine (TdR) to assess cellular proliferation, [O-15] Water to quantify tumor blood flow and to serve as the input function for quantification of the other tracers, [C-11]Verapamil to assess drug resistance mechanism activity, and [F-18]Fluoromisonidazole) FMISO to quantify changes in tumor hypoxic volume in response to treatment. These studies are performed in a single PET imaging session prior to neoadjuvant chemotherapy, after the second of four cycles of therapy and in the week prior to resection. Results: An example of this complex study result, is demonstrated by a recent patient with a high grade soft tissue sarcoma. The tumor showed increased TdR uptake, a moderate hypoxic volume, and [C-11] verapamil uptake prior to initiation of neoadjuvant adriamycin based chemotherapy. After 2 cycles of therapy, there was a significant decrease in the maximum level and volume of TdR uptake and a large reduction in tumor hypoxic volume. Conclusions: These data would imply a high risk soft tissue sarcoma due the presence of increased cellular proliferation, a significant hypoxic volume and the absence of p-glycoprotein activity determined by the presence of [C-11]Verapamil uptake. However, early response is also suggested by the findings above. Patient outcome will be assessed and correlated with these tumor parameters to further understand what tumor biological risk factors can be quantified non-invasively and repeated throughout the clinical course in soft tissue sarcoma patients. Supported by NIH NCI PO1 42045–18 and S10 RR017229–01 [Table: see text] No significant financial relationships to disclose.

scholarly journals Platelet-Derived Growth Factors in Non-GIST Soft-Tissue Sarcomas Identify a Subgroup of Patients with Wide Resection Margins and Poor Disease-Specific Survival

Sarcoma ◽  
2010 ◽  
Vol 2010 ◽  
pp. 1-10 ◽  
Author(s):  
Thomas Karsten Kilvaer ◽  
Andrej Valkov ◽  
Sveinung W. Sorbye ◽  
Tom Donnem ◽  
Eivind Smeland ◽  
...  
Keyword(s):  
Growth Factors ◽  
Soft Tissue ◽  
Prognostic Markers ◽  
Soft Tissue Sarcomas ◽  
Tissue Microarrays ◽  
Wide Resection ◽  
Resection Margins ◽  
Prognostic Impact ◽  
Disease Specific Survival ◽  
Disease Specific

Background. Optimal treatment of nongastrointestinal stromal tumor soft-tissue sarcomas (non-GIST STSs) is resection with wide margins. This study investigates the prognostic impact of the angiogenesis-associated platelet-derived growth factors (PDGFs) and their receptors (PDGFRs) in non-GIST STS patients with wide and nonwide resection margins.Method. Tumor samples and clinical data from 249 patients with non-GIST STS were obtained, and tissue microarrays were constructed for each specimen. Immunohistochemistry was used to evaluate the expression of PDGF-A, -B, -C, and -D and PDGFR-αand -β.Results. In the multivariate analysis of patients with wide resection margins, high expression of PDGF-B (, HR = 2.954, and 95% CI = 1.255–6.956) and the coexpression of PDGF-B and PDGFR-α(overall; , high-low/low-high; , HR = 2.678, 95% CI = 0.996–7.200, high/high; , HR = 3.930, 95% CI = 1.542–10.015) were independent negative prognostic markers for disease-specific survival.Conclusion.PDGF-B and the coexpression of PDGF-B and PDGFR-αare strong and independent prognostic factors in non-GIST STSs with wide resection margins.

scholarly journals Smoking and Family Cancer History Are Associated With Sarcomas in A Japanese Population Study

2020 ◽  
Author(s):  
Yoshihiro Araki ◽  
Norio Yamamoto ◽  
Yoshikazu Tanzawa ◽  
Takahiro Higashi ◽  
Katsuhiro Hayashi ◽  
...  
Keyword(s):  
Family History ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Smoking Habit ◽  
Soft Tissue Sarcomas ◽  
High Grade ◽  
Cancer History ◽  
Family Cancer History ◽  
History Of ◽  
History Of Cancer

Abstract Background: Sarcoma is a rare cancer, and it is also the cause of the development of various kinds of sarcomas, such as gene abnormalities, which has recently becoming evident due to advances of genetic testing. The approach to solve the origin of diseases is essential to elucidate both the external environmental factors and the internal genetic factors. However, the lifestyle habits, lifestyle-related diseases, personal and family cancer history of sarcoma patients remain unclear.Methods: A total of 1320 sarcoma patients were enrolled in this study. A questionnaire on lifestyle habits, life-style diseases, and the patient’s personal and family cancer history was completed at presentation. A total of 1320 controls were selected by propensity score matching for age and gender. Smoking, drinking, obesity, hypertension, dyslipidemia and diabetes mellitus were compared. In addition, we investigated the incidence of a personal and family cancer history in sarcoma patients. Results: A smoking habit was the only independent risk factor for high-grade soft tissue sarcoma development in adults ≥20 years old (n=952), excluding low-grade and intermediate malignant soft tissue tumors (Odds ratio [OR], 2.45; 95% confidence interval [CI] 1.88-3.20, p<0.001). The ORs of high-grade liposarcoma and undifferentiated pleomorphic sarcoma (UPS) were 2.56 and 3.00, respectively. Eight percent of sarcoma patients had a personal history of another cancer. Thirty percent of soft tissue sarcoma patients had a family history of cancer in a first-degree relatives (malignant peripheral nerve sheath tumor, 52%; leiomyosarcoma, 46%). Conclusions: We confirmed that a smoking habit were associated with the development of high-grade soft tissue sarcomas. A family history of cancer might be associated with certain soft tissue sarcomas, but a further investigation will be necessary.

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