Adjuvant Radiation for Soft Tissue Sarcomas

2015 ◽  
pp. e634-e642 ◽  
Author(s):  
Colleen I. Dickie ◽  
Rick Haas ◽  
Brian O'Sullivan
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Local Control ◽  
Soft Tissue Sarcomas ◽  
Intensity Modulated Radiotherapy ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Surgical Approaches ◽  
Adjuvant Radiation ◽  
En Bloc

Over recent decades, limb-preservation surgery in combination with radiotherapy achieves local control rates exceeding 90% for extremity soft tissue sarcoma (STS). Local control is not as successful for retroperitoneal sarcoma (approximately 60%) despite aggressive surgical approaches including en bloc resection of uninvolved adjacent organs combined with intensity modulated radiotherapy (IMRT). This review will discuss the indications for adjuvant radiation therapy (RT) for primary presentation of soft tissue sarcoma: “What,” referring to the type and manner of planning and delivery of RT; “When,” referring to the timing and scheduling of RT; and “Why,” referring to the rationale for the use of RT will be addressed. From a practical stand point, this Educational Chapter on “adjuvant RT” will focus on pre- and postoperative RT in the context of gross total resection for extremity and retroperitoneal soft tissue sarcoma, the two most frequent paradigms for the use of adjuvant RT.

Use of a Fascia Lata Autograft to Reconstruct a Large Triceps Tendon Defect After En-Bloc Resection of a Soft-Tissue Sarcoma

2020 ◽  
Vol 10 (1) ◽  
pp. e0390-e0390
Author(s):  
Rachel Clancy ◽  
Zachary Lim ◽  
Robert A. Ravinsky ◽  
Anne O'Neill ◽  
Peter Ferguson ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Fascia Lata ◽  
En Bloc ◽  
Tendon Defect ◽  
Triceps Tendon

En-bloc resection of soft-tissue sarcoma of anterior chest wall and reconstruction with titanium bars and free anterolateral thigh flap

2021 ◽  
Vol 14 (7) ◽  
pp. e241603
Author(s):  
Walter Sebastián Nardi ◽  
Agustin Buero ◽  
Leonardo Pankl ◽  
Sergio Damián Quildrian
Keyword(s):  
Soft Tissue ◽  
Chest Wall ◽  
Soft Tissue Sarcomas ◽  
En Bloc Resection ◽  
Anterior Chest Wall ◽  
Bloc Resection ◽  
Anterolateral Thigh Flap ◽  
En Bloc ◽  
Complete Surgical Resection ◽  
Anterolateral Thigh

Primary soft-tissue sarcomas (STSs) of the chest wall are uncommon. Complete surgical resection remains the mainstay of treatment being sternal resection ocassionally required. We present a 25-year-old man with an anterior chest wall STS. The patient underwent complete oncological resection with reconstruction using titanium bars combined with a free vascularised anterolateral thigh flap. STSs of the chest wall are very rare and they comprise a surgical challenge for both resection and reconstruction.

Myofibroma of the cervical spine presenting as brachialgia

2014 ◽  
Vol 21 (6) ◽  
pp. 916-918 ◽  
Author(s):  
Benjamin M. Davies ◽  
Daniel du Plessis ◽  
Kanna K. Gnanalingham
Keyword(s):  
Soft Tissue ◽  
Facet Joint ◽  
Surgical Excision ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Benign Tumors ◽  
Histopathological Analysis ◽  
En Bloc ◽  
Left Posterior ◽  
Midline Approach

Myofibromas are rare, benign tumors of myofibroblasts. Their occurrence in adults, involving bone outside of the head and neck, is especially uncommon. The authors report the case of a 34-year-old woman who presented with left-sided brachialgia. Magnetic resonance imaging identified an expansile soft-tissue lesion of the C6–7 facet joint. En bloc resection via a left posterior midline approach was undertaken. Histopathological analysis confirmed the lesion to be a myofibroma. Brachialgia resolved following surgery and there is no evidence of recurrence at 20 months follow-up. Myofibroma is a rare cause of primary soft-tissue tumor of the spine. Surgical excision remains the mainstay of treatment.

scholarly journals Complication avoidance in the treatment of malignant tumors of the skull base

2002 ◽  
Vol 12 (5) ◽  
pp. 1-6 ◽  
Author(s):  
James T. Kryzanski ◽  
Donald J. Annino ◽  
Carl B. Heilman
Keyword(s):  
Skull Base ◽  
Malignant Tumors ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Surgical Approaches ◽  
High Complication Rate ◽  
En Bloc ◽  
Complications Of Surgery ◽  
Skull Base Lesions ◽  
Skull Base Defects

The treatment of malignant skull base tumors has improved with the development of skull base surgical approaches that allow en bloc resection of a lesion and increase the efficacy of adjuvant therapies. The anatomical complexity of these lesions and their surroundings has led to a relatively high complication rate. Infection and cerebrospinal fluid fistulas are the most common serious procedure-related complications. They result from the frequent necessity of working in a contaminated space such as the paranasal sinuses as well as from the creation of large dural and skull base defects. The authors have reviewed the literature regarding complications of surgery for malignant skull base lesions and present several techniques and strategies for minimizing their incidence by performing the craniofacial approach to anterior skull base lesions.

En bloc resection of primary sacral tumors: classification of surgical approaches and outcome

2005 ◽  
Vol 3 (2) ◽  
pp. 111-122 ◽  
Author(s):  
Daryl R. Fourney ◽  
Laurence D. Rhines ◽  
Stephen J. Hentschel ◽  
John M. Skibber ◽  
Jean-Paul Wolinsky ◽  
...  
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Surgical Approaches ◽  
En Bloc ◽  
Sacral Tumors ◽  
Tumors Classification

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.

Impact of the smallest surgical margin on local recurrence in soft tissue sarcoma treated with surgery with or without radiotherapy: First ten year results of a prospective treatment protocol at Helsinki University Central Hospital

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 10064-10064
Author(s):  
M. Tarkkanen ◽  
M. Sampo ◽  
R. Huuhtanen ◽  
E. Tukiainen ◽  
T. Bohling ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Local Control ◽  
Postoperative Radiotherapy ◽  
Local Treatment ◽  
Treatment Protocol ◽  
Soft Tissue Sarcomas ◽  
Surgical Margin ◽  
Multimodality Treatment ◽  
Central Hospital

10064 Background: A single-institution experience using a prospective treatment protocol for soft tissue sarcoma (STS) of the extremity and trunk wall was reviewed. Special interest of smallest surgical margin on local control was taken. Methods: Between 1987 and 1997 361 patients with STS were treated by the STS Group at Helsinki University Central Hospital. Patients with borderline malignancies or metastatic disease were excluded leaving 270 patients to the present study. All patients included underwent surgery. Postoperative radiotherapy was administered if the smallest surgical margin was less than 2.5 cm when there was no natural barrier, irrespective of tumor grade. Results: With a median follow-up of 6.6 years, the 5-year local control for the whole study population was 76 %. On multivariate analysis, the smallest surgical margin in centimeters, adequacy of treatment according to protocol and postirradiation sarcoma were prognostic for local control. A margin of at least 2,5 cm yielded recurrence-free rate of 89 % at five years. Conclusions: Our findings show that size, depth and grade of the tumor, and patient`s age at diagnosis do not have independent prognostic effect on local control, nor has recurrent disease at referral. Instead, surgical margin in centimeters and adequacy of treatment according to protocol had independent prognostic value for local control. This is encouraging since these factors can be affected by aggressive local treatment. Soft tissue sarcomas should be referred to a specialized multimodality treatment group before biopsy or any surgery. A surgical margin of 2–3 cm yield a reasonable local control in STS even without radiotherapy. No significant financial relationships to disclose.

Total mesometrial resection: High resolution nerve-sparing radical hysterectomy based on developmentally defined surgical anatomy

2003 ◽  
Vol 13 (6) ◽  
pp. 791-803 ◽  
Author(s):  
M. HÖCKEL ◽  
L.-C. Horn ◽  
B. Hentschel ◽  
S. HÖCKEL ◽  
G. Naumann
Keyword(s):  
Therapeutic Index ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Surgical Anatomy ◽  
Autonomic Nerve ◽  
Nerve Sparing ◽  
Adjuvant Radiation ◽  
En Bloc ◽  
Hypogastric Plexus

Total mesometrial resection (TMMR) is characterized by: i) the en bloc resection of the uterus, proximal vagina, and mesometrium as a developmentally defined entity; ii) transection of the rectouterine dense subperitoneal connective tissue above the level of the exposed inferior hypogastric plexus; and iii) extended pelvic/periaortic lymph node dissection preserving the superior hypogastric plexus. Since July 1998 we have studied prospectively the outcome in patients treated with TMMR for cervical carcinoma FIGO stages IB, IIA, and selected IIB. By July 2002, 71 patients with cervical cancer stages pT1b1 (n = 48), pT1b2 (n = 8), pT2a (n = 3), pT2b (n = 12) had undergone TMMR without adjuvant radiation. Fifty-four percent of the patients exhibited histopathologic high risk factors. At a median observation period of 30 months (9–57 months) two patients relapsed locally, two patients developed pelvic and distant recurrences and two patients only distant recurrences. Three patients died from their disease. Grade 1 and 2 complications occurred in 20 patients, no patient had grade 3 or 4 complications. No severe long-term impairment of pelvic visceral functions related to autonomic nerve damage was detected. Based on these preliminary results, we believe TMMR achieves a promising therapeutic index by providing a high probability of locoregional control at minimal short and long-term morbidity.

scholarly journals Comparison of Esophagectomy outcomes between a National Center, a National Audit Collaborative, and an International database using the Esophageal Complications Consensus Group (ECCG) standardized definitions

2020 ◽  
Author(s):  
John V Reynolds ◽  
Noel Donlon ◽  
Jessie A Elliott ◽  
Claire Donohoe ◽  
Narayanasamy Ravi ◽  
...  
Keyword(s):  
Anastomotic Leak ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Leak Rate ◽  
Surgical Approaches ◽  
Consecutive Series ◽  
Recurrent Nerve ◽  
En Bloc ◽  
Curative Intent ◽  
Anastomotic Leak Rate

Summary The ECCG developed a standardized platform for reporting operative complications, with consensus definitions. The Dutch Upper Gastrointestinal Cancer Audit (DUCA) published a national comparison against these benchmarks. This study compares ECCG data from the Irish National Center (INC) with both published benchmark studies. All patients undergoing multimodal therapy or surgery with curative intent from 2014 to 2018 inclusive were studied, with data recorded prospectively and entered onto a secure online database (Esodata.org). 219 patients (mean age 67; 77% male) underwent open resection, 66.6% via transthoracic en bloc resection. 30-day and 90-day mortality were 0.0 and 0.9%,nrespectively. Anastomotic leak rate was 5.4%, pneumonia 18.2%, respiratory failure 10%, ARDS 2.7%, atrial dysrhythmia 22.8%, recurrent nerve injury 3%, and delirium in 5% of patients. Compared with both ECCG and DUCA, where MIE constituted 47 and 86% of surgical approaches, respectively, overall complications were similar, as were severity of complications; however, anastomotic leak rate was several-fold less, and mortality was significantly lower (P < 0.001). In this consecutive series and comparative audit with benchmark averages from the ECCG and DUCA publications, a low mortality and anastomotic leak rate were the key differential findings. Although not risk stratified, the severity of complications from this ‘open’ series is consistent with series containing large numbers of total or hybrid MIE, highlighting a need to adhere to these strictly defined definitions in further prospective research and randomized studies.

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