The role of adjuvant radiotherapy after marginal excision for local control of extremity and truncal soft tissue sarcoma

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 9573-9573
Author(s):  
Y. B. Kim ◽  
K. H. Shin ◽  
G. E. Kim ◽  
S. B. Han ◽  
J. K. Roh ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Local Control ◽  
Adjuvant Radiotherapy ◽  
Wide Excision ◽  
Low Grade ◽  
Tumor Site ◽  
Marginal Excision ◽  
Group A ◽  
Group B

9573 Background: Adjuvant radiotherapy (RT) has been shown to improve local control (LC) in patients with extremity and truncal soft tissue sarcoma (STS). The purpose of this study was to analyze how much RT promoted LC in patients with marginally excised STS compared with patients with widely excised STS. Methods: Two hundred and thirty-two patients with STS (173 extremity cases and 59 trunk cases) who had received conserving surgery were divided into 3 groups according to marginal status and the addition of RT; (1) wide excision alone (n = 56, Group A), (2) wide excision plus RT (n = 64, Group B) and (3) marginal excision plus RT (n = 112, Group C). LC, overall survival, and morbidity rates were retrospectively compared among 3 groups. Results: There were no differences in age, gender, pathologic type, and tumor site among three groups, but Group A had the higher incidence of small-sized tumor and low grade tumor than other groups. Thirty-eight patients experienced local failures (LF) after completion of treatment. Group C had similar incidence of LF compared with Group B (Group A; 4%, Group B; 21%, and Group C; 19%). Overall 5-year and 10-year LC rates were 80% and 70%, and there were no significant differences between Group B and Group C in 10-year LC rate (Group A; 84%, Group B; 65%, and Group C; 68%). Tumor grade and tumor site were found to be significant predictors of LF. Group C had lower 10-year overall actuarial survival rate compared with Group B (Group A; 85%, Group B; 78%, and Group C; 69%). This was associated with significantly different incidence of distant failure (Group A; 11%, Group B; 16%, and Group C; 29%, p=0.008). Seven patients suffered from wound dehiscence, and 1 patient from bone necrosis. The incidence of Grade 3–4 late complication was higher in Group B than Group A and Group C (Group A; 0%, Group B; 9.3%, and Group C; 1.7%, p=0.03). Conclusions: Our data indicate that RT seems to promote LC in patients with positive or close margin up to that of patients with wide margin in extremity and truncal STS. We suggest that conserving surgery and RT for patients with marginal STS should be the alternative choice rather than aggressive surgery for better LC without deteriorating limb-function or causing serious complication. No significant financial relationships to disclose.

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 Preoperative accelerated radiotherapy combined with chemotherapy in a defined cohort of patients with high risk soft tissue sarcoma: a Scandinavian Sarcoma Group study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Kirsten Sundby Hall ◽  
Øyvind S. Bruland ◽  
Bodil Bjerkehagen ◽  
Elisabet Lidbrink ◽  
Nina Jebsen ◽  
...  
Keyword(s):  
High Risk ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Local Control ◽  
Survival Data ◽  
Locally Advanced ◽  
Resection Margins ◽  
Accelerated Radiotherapy ◽  
Group B

Abstract Background We recently reported outcomes from a Scandinavian Sarcoma Group adjuvant study (SSG XX group A) conducted on localized and operable high risk soft tissue sarcoma (STS) of the extremities and trunk wall. SSG XX, group B, comprised of patients in a defined cohort with locally advanced STS considered at high risk for intralesional surgery. These patients received preoperative accelerated radiotherapy, together with neoadjuvant and adjuvant chemotherapy. Herein we report the results of this group B. Methods Twenty patients with high-grade, locally advanced and deep STS located in lower extremities (n = 12), upper extremities (5) or trunk wall (3) were included. The median age was 59 years and 14 patients were males. The treatment regimen consisted of 6 cycles of doxorubicin (60 mg/m2) and ifosfamide (6 g/m2), with three cycles given neoadjuvantly, and preoperative radiotherapy (1, 8 Gyx2/daily to 36 Gy) between cycles 2 and 3. After a repeated MRI surgery was then conducted, and the remaining 3 chemotherapy cycles were given postoperatively at 3 weeks intervals. Survival data, local control, toxicity of chemotherapy and postoperative complications are presented. Results Median follow-up time for metastasis-free survival (MFS) was 2.8 years (range 0.3–10.4). The 5-year MFS was 49.5% (95% confidence interval [CI] 31.7–77.4). The median follow-up time was 5.4 years (range 0.3–10.4) for overall survival (OS). The 5-year OS was 64.0% (95% CI 45.8–89.4). The median tumour size was 13 cm, with undifferentiated pleomorphic sarcoma (n = 10) and synovial sarcoma (n = 6) diagnosed most frequently. All patients completed surgery. Resection margins were R0 in 19 patients and R1 in 1 patient. No patients had evidence of disease progression preoperatively. Three patients experienced a local recurrence, in 2 after lung metastases had already been diagnosed. Eleven patients (55%) had postoperative wound problems (temporary in 8 and persistent in 3). Conclusions Preoperative chemotherapy and radiotherapy were associated with temporary wound-healing problems. Survival outcomes, local control and toxicities were deemed satisfactory when considering the locally advanced sarcoma disease status at primary diagnosis. Trial registration This study was registered at ClinicalTrials.gov Identifier NCT00790244 and with European Union Drug Regulating Authorities Clinical Trials No. EUDRACT 2007-001152-39

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

scholarly journals Central nervous system involvement in children and adolescents with rhabdomyosarcoma. A report from the AIEOP Soft Tissue Sarcoma Committee

2018 ◽  
Vol 5 (4) ◽  
pp. 241-245
Author(s):  
Marta Pierobon ◽  
Andrea Ferrari ◽  
Giovanni Scarzello ◽  
Angela Tamburini ◽  
Lucia Quaglietta ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Children And Adolescents ◽  
Central Nervous System Involvement ◽  
Cns Disease ◽  
Dismal Prognosis ◽  
Group A ◽  
Group B

Abstract Background Rhabdomyosarcoma (RMS) is a highly malignant tumor typically affecting children and adolescents. Central nervous system (CNS) dissemination is rare in RMS patients, but seems to have a particularly negative impact. The aim of this study was to analyze treatment and outcome of patients with RMS and evidence of CNS disease who were registered in the protocols coordinated by the Italian Soft Tissue Sarcoma Committee from March 1979 to December 2016. Methods We analyzed 39 patients with CNS disease. Depending on when their CNS disease was identified, we grouped patients as: Group A, at diagnosis; Group B, progression during treatment; Group C, at first relapse. Results Six patients were in Group A (2.7% of metastatic RMS patients at diagnosis); 24 were in Group B and 9 in Group C (6.5% of patients with tumor progression/relapse included in the protocols). Only 5 patients (4 in Group A, 1 in Group B) survived the event and are alive in complete remission with a median follow-up of 17.5 years. These 5 patients received systemic chemotherapy and craniospinal radiotherapy, and 2 of them also received intrathecal therapy with topotecan. Conclusions CNS involvement at diagnosis is a rare and prognostically negative event in RMS patients, but not always fatal when it is found at diagnosis. It is more frequent during or shortly after treatment, and the more dismal prognosis in these cases underscores the need to improve our ability to identify patients at risk of CNS dissemination in order to attempt more effective treatments that can sterilize the meninges.

scholarly journals Non-locking buttress plate in distal tibial metaphyseal fractures

2018 ◽  
Vol 1 (2) ◽  
pp. 87-91
Author(s):  
Norman Lamichhane ◽  
Bhogendra Bahadur KC ◽  
Chandra Bahadur Mishra ◽  
Sabita Dhakal
Keyword(s):  
Soft Tissue ◽  
Weight Bearing ◽  
Delayed Union ◽  
Full Weight Bearing ◽  
Distal Fibula ◽  
Fibula Fracture ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Metaphyseal Fractures

Background: Treatment of distal tibial metaphyseal fractures is often challenging and no single technique has been unanimously advocated. Open reduction and internal fixation with plates and screws allows better restoration of anatomical alignment but with more soft tissue complication. Simultaneous fixation of the fibula is not universally carried out. This study aims at evaluation of the outcome of plating technique and the effect of fixation of fibula fracture in treatment of distal tibial metaphyseal fractures. Material and methods: Thirty-one cases (14 cases in Group A with concomitant distal fibula fracture and 17 cases in Group B without distal fibula fracture) were analyzed retrospectively for the mean duration of full weight bearing, mean union time and complications, and compared. Results: The mean time for full weight bearing and radiological union in our study was 14.2 weeks (15.9 in Group A and 13.1 in Group B) and 23.8 weeks (26.6 in Group A and 21.5 in Group B) respectively. 16.1% of cases had post-operative complications including one case of deep infection and malalignment of 6 degree varus (following delayed union) was seen in one case of Group A. Range of motion (ROM) at ankle was not problem in any of the cases except the one delayed union which had 5 degrees of dorsiflexion and 15 degrees of plantiflexion. Conclusion: Open reduction and internal fixation with plate and screws in distal tibial metaphyseal fracture is more economic means of treatment modality with comparable incidence of post-union malalignment and union time,though more soft tissue complications compared to other modalities. Fixation of fibula fracture aids in reducing the incidence of malalignment.

scholarly journals Effect of Ultrasound Therapy with Cryokinetics versus Ultrasound Therapy with Soft Tissue Massage (Deep Friction Massage) in Acute Supraspinatus Tendinitis - A Comparative Study

2021 ◽  
Vol 11 (7) ◽  
pp. 249-256
Author(s):  
Pradeep Krishna Reddy ◽  
Jayashree Dey ◽  
Yashodhara S Joshi
Keyword(s):  
Soft Tissue ◽  
Analogue Scale ◽  
Ultrasound Therapy ◽  
Exclusion Criteria ◽  
Functional Scale ◽  
Analysis Group ◽  
Total Treatment ◽  
Group A ◽  
Group B ◽  
Supraspinatus Tendinitis

Background and Objective: In supraspinatus tendinitis there is inflammatory and or degenerative changes of tendon. This study was done to assess the effectiveness of ultrasound and cryokinetics versus ultrasound and soft tissue massage (deep friction massage) in patients with acute supraspinatus tendinitis. Method: All subjects were clinically diagnosed by orthopaedician and were screened as per the inclusion and exclusion criteria. 60 patients were randomly divided into 2 groups with n= 30 each group, Group A- received ultrasound therapy and cryokinetics, whereas Group B- received ultrasound therapy and soft tissue massage. The treatment was given 1 session/day, 6 days/week. The total treatment duration was for 2 weeks. Outcome Measures: Patients were evaluated on day 1, day 7 and day 14. All the patients were assessed for pain and shoulder functional scale by taking VAS and SPADI. Results: Both the groups showed statistically significant changes in pre and post values. However, Group B showed greater improvement from baseline to week 1 on VAS and SPADI. After analysis group B showed significance with P<0.001*. Conclusion: Ultrasound therapy with cryokinetics, and ultrasound therapy with soft tissue massage both were effective in reducing pain intensity and increasing the shoulder functional scale but ultrasound therapy with soft tissue massage showed superior hand over ultrasound therapy with cryokinetics. Key words: Acute Supraspinatus Tendinitis, Ultrasound Therapy, Cryokinetics, Soft Tissue Massage, Visual Analogue Scale, Shoulder Pain And Disability Index.

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