The Need for Reconstructive Surgery in Soft Tissue Sarcomas - Long-Term Functional Results and Quality of Life

Leiomyosarcomas of the lower extremity are extremely rare disorders and account for 10–15% of limb soft tissue sarcomas. These tumours have poor prognosis and even in early stages, patients persist at high risk for local and distant relapse; consequently, the treatment of advanced leiomyosarcoma of the lower extremity embodies a substantial defy. We present the case of a 73-year-old man diagnosed with metastatic lower extremity leiomyosarcoma of the hallux soft tissue, and with bone, lung and lymph node metastasis. After core needle biopsy confirmation of high-grade fusocellular sarcoma, the patient underwent surgery of the primary tumour and received anthracycline-based chemotherapy. However, after a 7-month progression-free survival period, a CT revealed lung disease progression. Sequentially, the patient was treated with trabectedin (Yondelis®) at a dose of 1.5 mg/m2 resulting in complete remission of the lung metastasis and stable disease of the remaining lesions after 26 months of treatment. Afterwards, the patient started on maintenance therapy with trabectedin, resulting in long-lasting stable disease, as he was able to receive 94 cycles with very acceptable quality of life. Finally, in March 2019, the patient died of community-acquired pneumonia without objective progression disease. This clinical case reports the first patient ever treated with 94 cycles of trabectedin. Our results additionally confirm that trabectedin wields relevant oncostatic benefits with a manageable safety profile and without cumulative toxicities. Trabectedin properties enable a maintenance long-term therapy (until disease progression or unbearable toxicity), with a high impact on survival and with a preserved quality of life.

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Reconstructive Surgery in Soft Tissue Sarcomas—Long-Term Outcome and Quality of Life

International Surgery ◽

10.9738/intsurg-d-14-00267.1 ◽

2017 ◽

Vol 102 (11-12) ◽

pp. 480-488

Author(s):

Reiner Wirbel ◽

Steffen Weber ◽

Angela Olinger ◽

Wolf Mutschler ◽

Tim Pohlemann

Keyword(s):

Quality Of Life ◽

Functional Outcome ◽

Reconstructive Surgery ◽

Soft Tissue Sarcomas ◽

Tumor Stage ◽

Stage Ii ◽

C 30 ◽

Eortc Qlq

The long-term oncological and functional outcome including quality of life should be evaluated in soft tissue sarcomas (STS). The need for reconstructive surgery with possible influence on the results should also be analyzed. Tumor stage mainly influences the prognosis of STS. Advances in reconstructive surgery mostly allow limb salvage. Limited information exists about functional outcome and life quality. A total of 86 patients (51 men, 35 women, mean age 50.5 years) with a minimum follow-up of 10 years were analyzed. We determined the oncological outcome (local recurrences, metastases, overall survival) of tumors at varying stages: stage I (n = 30), stage II (n = 52), and stage III (n = 4). Functional outcome and quality of life of the survivors were measured using the Musculoskeletal Tumor Society (MSTS) criteria and the EORTC-QLQ-C-30 (European Organisation for Research and Treatment of Cancer-Quality of Life-Questionnaire-Core-30 module) questionnaire. Tumor stage influenced the survival and the development of metastases. Survival rates were 89.5 and 88% after 5 and 10 years in stage I, and 56.5 and 49% in stage II tumors. Surgical margin influenced the development of local recurrence. Reconstructive procedures were necessary in 27 patients. After a median follow-up of 144 months, 36 patients were dead: 29 of their malignancy and 7 of other diseases. Fifty long-term survivors presented good results for MSTS (mean score: 82.4) and EORTC-QLQ-C-30 (mean score: 79.8), the results were independent on the need of reconstructive surgery. In stage II STS, the survival drops even after 5 years. The surgical treatment of STS requires the knowledge of different reconstructive techniques; functional results and quality of life are not compromised by the need for reconstructive surgery.

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Long-Term Outcomes of the Minimally Invasive Ponto Surgery vs. Linear Incision Technique With Soft Tissue Preservation for Installation of Percutaneous Bone Conduction Devices

Frontiers in Neurology ◽

10.3389/fneur.2021.632987 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ruben M. Strijbos ◽

Louise V. Straatman ◽

Tim G. A. Calon ◽

Martin L. Johansson ◽

Arthur J. G. de Bruijn ◽

...

Keyword(s):

Quality Of Life ◽

Soft Tissue ◽

Bone Conduction ◽

Tissue Preservation ◽

Implant Stability ◽

Implant Stability Quotient ◽

Incision Technique

Objective: Comparing the surgical outcomes of the Minimally Invasive Ponto Surgery (MIPS) technique with the linear incision technique with soft tissue preservation (LITT-P) for bone conduction devices after a follow-up of 22 months.Methods: In this multicenter randomized controlled trial, there was the inclusion of 64 adult patients eligible for unilateral surgery. There was 1:1 randomization to the MIPS (test) or the LITT-P (control) group. The primary outcome was an (adverse) soft tissue reaction. Secondary outcomes were pain, loss of sensibility, soft tissue height/overgrowth, skin sagging, implant loss, Implant Stability Quotient measurements, cosmetic scores, and quality of life questionnaires.Results: Sixty-three subjects were analyzed in the intention-to-treat population. No differences were found in the presence of (adverse) soft tissue reactions during complete follow-up. Also, there were no differences in pain, wound dehiscence, skin level, soft tissue overgrowth, and overall quality of life. Loss of sensibility (until 3-month post-surgery), cosmetic scores, and skin sagging outcomes were better in the MIPS group. The Implant Stability Quotient was higher after the LITT-P for different abutment lengths at various points of follow-up. Implant extrusion was nonsignificantly higher after the MIPS (15.2%) compared with LITT-P (3.3%).Conclusion: The long-term results show favorable outcomes for both techniques. The MIPS is a promising technique with some benefits over the LITT-P. Concerns regarding nonsignificantly higher implant loss may be overcome with future developments and research.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02438618.

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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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Health-related quality Of Life In patients with advanced Soft TIssue sarcomas treated with Chemotherapy (The HOLISTIC study): protocol for an international observational cohort study

BMJ Open ◽

10.1136/bmjopen-2019-035171 ◽

2020 ◽

Vol 10 (6) ◽

pp. e035171 ◽

Cited By ~ 1

Author(s):

Eugenie Younger ◽

Robin L Jones ◽

Ingrid M E Desar ◽

Clare Peckitt ◽

Winette T A van der Graaf ◽

...

Keyword(s):

Quality Of Life ◽

Soft Tissue ◽

Soft Tissue Sarcomas ◽

Health Related Quality ◽

First Line ◽

Patient Reported ◽

Related Quality ◽

Health Related ◽

Line Chemotherapy

IntroductionChemotherapy is the mainstay of treatment for patients with advanced soft tissue sarcomas (STS). Treatment intent is usually palliative, aiming to improve symptoms, stabilise or reduce tumour burden and extend life. Clinical trials have traditionally used radiological response, time to progression and survival as measures of treatment efficacy. Health-related quality of life (HRQoL) is at least equally important or more important than survival for many patients with advanced cancer. Systematically collecting HRQoL data during chemotherapy can provide greater insight into treatment efficacy from the patient perspective.The primary aims of this study are to evaluate HRQoL in patients with advanced STS treated with chemotherapy over time, explore the decision-making process and patient reflection post-treatment.Methods and analysisThis is an observational, international cohort study for 132 patients aged ≥18 years with advanced STS treated at eight centres (three in the UK, five in the Netherlands). Patients will be recruited prior to starting first-line or third-line chemotherapy and invited to complete questionnaires using the Patient-Reported Outcomes Following Initial treatment and Long-term Evaluation of Survivorship registry (PROFILES); an established international registry for collection of cancer patient-reported outcomes. Online (or paper) questionnaires will be completed at baseline, each cycle of chemotherapy and 2–3 monthly during follow-up. The questionnaire package includes the Decisional Conflict Scale, Control Preferences Scale, Quality–Quantity Questionnaire, treatment expectations, European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ-C30), EORTC financial toxicity items, Work Ability Index, Functional Assessment of Cancer Therapy-General (FACT-G) items and Decisional Regret Scale. Clinical data will be extracted from patient records and linked with questionnaire responses. The primary outcome measure is the change in global HRQoL from baseline to after cycle 4 of first-line chemotherapy (based on published data showing that patients with advanced STS complete a median number of four cycles of first-line chemotherapy).Ethics and disseminationHeath Research Authority and Research Ethics Committee (REC 17/NI/0197). Results from the Health-related quality Of Life In patients with advanced Soft TIssue sarcomas treated with Chemotherapy (HOLISTIC) study will be published in peer-reviewed journals and disseminated at local, national and international conferences. We will also present our findings at any appropriate patient meetings and involve patients in study-related publications.Trial registration numberNCT03621332.

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Long-term functional results and quality of life after transanal endoscopic microsurgery (Br J Surg 2011; 98: 1635-1643)

British Journal of Surgery ◽

10.1002/bjs.7604 ◽

2011 ◽

Vol 98 (11) ◽

pp. 1643-1643

Author(s):

N. Borley

Keyword(s):

Quality Of Life ◽

Transanal Endoscopic Microsurgery ◽

Functional Results ◽

Endoscopic Microsurgery

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Compartmental resection for subfascial extremity soft tissue sarcoma and quality of life in long-term survivors

Wiener klinische Wochenschrift ◽

10.1007/s00508-011-1592-5 ◽

2011 ◽

Vol 123 (15-16) ◽

pp. 488-495 ◽

Cited By ~ 5

Author(s):

Matthias Peiper ◽

Hanno Matthaei ◽

Edwin Bölke ◽

David Zurakowski ◽

Klaus Orth ◽

...

Keyword(s):

Quality Of Life ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Extremity Soft Tissue Sarcoma ◽

Compartmental Resection ◽

Long Term Survivors

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Interventional radiotherapy (brachytherapy) achieves very good long‐term quality of life in children and adolescents with soft‐tissue sarcoma

Pediatric Blood & Cancer ◽

10.1002/pbc.28464 ◽

2020 ◽

Vol 67 (10) ◽

Author(s):

Anna Lotte Sütterlin ◽

Martin Demmert ◽

György Kovács ◽

Alexander Claviez ◽

Christian Schulz ◽

...

Keyword(s):

Quality Of Life ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Children And Adolescents

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Functional outcome and quality of life in patients undergoing salvage radical prostatectomy (SRPE).

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.212 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 212-212 ◽

Cited By ~ 1

Author(s):

David Pfister ◽

Jasmin Pullankavumkal ◽

Friederike Haidl ◽

Vahudin Zugor ◽

Tobias Kohl ◽

...

Keyword(s):

Quality Of Life ◽

Radical Prostatectomy ◽

Functional Outcome ◽

Functional Results ◽

High Rate ◽

Surgical Interventions ◽

Eortc Qlq ◽

Salvage Radical Prostatectomy

212 Background: Salvage radical prostatectomy is one option for patients with locally recurrent disease with proven long term oncologic control. There are concerns about worse functional results due to fibrotic tissue after radiotherapy and patients are treated with palliative systemic androgendreptivation. We retrospectively analyzed continence and quality of life in patients undergoing SRPE. Methods: After biopsy proven local recurrent prostate cancer 138 patients were offered SRPE and extended lymphadenectomy. Continence and quality of life had been collected before 6 and 12 months after surgery. Validated questionaires with ICIQ and EORTC qlq 30 had been used. Results: Präoperatively at 6 monts and 12 months the feed back was available in 93, 84 and 82 patients respectively. Präoperatively there was no or mild incontinence in 38(40.8%), moderate in 33 (35.5%) and strong incontinence in 22 (23.7%) of the patients. There is a significant decrease in the rate of continence after 6 and 12 months to no or mild in 19 (23.1%), moderate in 19 (23.2%) and strong incontinence in 44 (53.7%) of the patients. In 5 patients an artifitial sphinkter was implanted. Quality of life did not change significantly before and 12 months after surgery. Median value of Question 30 was 6 and five respectively. Conclusions: Patients need to be informed about a worse functional outcome and the potential need for further surgical interventions as artificial sphinkter implantion compared to primary radical prostatectomy. Quality of life seems to be affected only moderatly. Nevertheless there is already a rather high rate of any incontinence before surgery that needs to be taken into account.

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