The problem of local recurrence and metastasis in soft-tissue sarcoma

BACKGROUND: The purpose of this study was to evaluate local recurrence of soft-tissue sarcomas as a prognostic factor reflecting adequate or inadequate excision. METHODS: We reviewed the cases of 53 patients who had soft-tissue sarcomas and were treated between 1991 and 2001. All patients were treated operatively, but 11 of them (20.75%), before being sent to us were operated elsewhere with inadequate surgical margins. The oncology status, including local recurrence and metastasis was determined at the follow-up evaluation. RESULTS: All of 11 patients treated with inadequate excision had palpably or histologically determined local recurrence. The most common histological diagnosis of local recurrence was dermatofibroma protuberans (7 patients, 63.63%). In patients who were treated with planned and adequate excision there were 4 (9.52%) recurrences. Five patients (45.45%) had metastases in the group of inadequate and only one patient (1.88%) in the group of adequate surgical margins. CONCLUSION: Our study demonstrated that excellent rates of survival and low rates of local recurrence and distant metastasis of soft-tissue sarcomas could be obtained with the use of carefully planned radical resection. The quality of operation is the most important factor.

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Lymph Node Metastasis after a Soft Tissue Sarcoma of the Leg: A Case Report and a Review of the Literature

Case Reports in Surgery ◽

10.1155/2013/930361 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

S. D. Nelen ◽

F. J. Vogelaar ◽

F. Gilissen ◽

J. C. Van der Linden ◽

K. Bosscha

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Lower Extremity ◽

Distant Metastasis ◽

Soft Tissue Sarcomas ◽

Dermatofibrosarcoma Protuberans ◽

Regional Lymph Nodes ◽

Histological Types ◽

Appropriate Treatment

Introduction. Soft tissue sarcomas (STSs) represent 1 percent of all adult malignancies and sarcomas only rarely spread to the regional lymph nodes.Case Presentation. We present a case of a woman with a dermatofibrosarcoma protuberans and a sarcoma not therwise specified of the lower extremity. The patient had no distant metastasis during follow-up, but did develop a regional lymph nodemetastasis (RLNM) in the groin. We reviewed the literature about RLNM in STSs.Discussion. Reviewing the literature we see that within specific histological types RLNM occurs as often as distant metastasis. Furthermore RLNM occurs in over 10% for specific histological types and in 24% of all patients with a soft tissue sarcoma of the lower extremity. Except for radical lymphadenectomy with a 5-year survival rate of 46% there is no appropriate treatment.Conclusion. The risk for a RLNM in certain histological types and anatomical locations might transcend the risk for a distant lung metastasis.

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Quality of surgical margins and local recurrence in primary extremity soft tissue sarcoma (STS).

Journal of Clinical Oncology ◽

10.1200/jco.2010.28.15_suppl.10068 ◽

2010 ◽

Vol 28 (15_suppl) ◽

pp. 10068-10068 ◽

Cited By ~ 4

Author(s):

S. Bonvalot ◽

A. Dunant ◽

C. le Pechoux ◽

P. Terrier ◽

F. Rimareix ◽

...

Keyword(s):

Soft Tissue ◽

Local Recurrence ◽

Soft Tissue Sarcoma ◽

Surgical Margins ◽

Extremity Soft Tissue Sarcoma

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Can Multistate Modeling of Local Recurrence, Distant Metastasis, and Death Improve the Prediction of Outcome in Patients With Soft Tissue Sarcomas?

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-017-5232-x ◽

2017 ◽

Vol 475 (5) ◽

pp. 1427-1435 ◽

Cited By ~ 16

Author(s):

Florian Posch ◽

Lukas Leitner ◽

Marko Bergovec ◽

Angelika Bezan ◽

Michael Stotz ◽

...

Keyword(s):

Soft Tissue ◽

Local Recurrence ◽

Distant Metastasis ◽

Soft Tissue Sarcomas ◽

Prediction Of Outcome

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Limb-sparing surgery without radiotherapy based on anatomic location of soft tissue sarcoma.

Journal of Clinical Oncology ◽

10.1200/jco.1991.9.10.1757 ◽

1991 ◽

Vol 9 (10) ◽

pp. 1757-1765 ◽

Cited By ~ 141

Author(s):

A Rydholm ◽

P Gustafson ◽

B Rööser ◽

H Willén ◽

M Akerman ◽

...

Keyword(s):

Soft Tissue ◽

Local Recurrence ◽

Soft Tissue Sarcoma ◽

Soft Tissue Sarcomas ◽

Deep Fascia ◽

Open Biopsy ◽

Radiographic Findings ◽

Wide Margin ◽

Anatomic Location ◽

Local Surgery

From 1980 through 1986, 119 patients with soft tissue sarcomas of the extremities were referred to our tumor center either before surgery (n = 78) or immediately after incisional biopsy or marginal excision (n = 41). The tumors were classified according to anatomic location at admittance as subcutaneous (n = 40), intramuscular (n = 30), and extramuscular tumors (n = 49). Open biopsy was omitted in 75 of the 78 patients referred before surgery; the preoperative diagnosis was based on physical and radiographic findings and fine-needle aspiration cytology. The surgical intention for subcutaneous tumor was to obtain a wide margin, which required a cuff of fat tissue around the tumor and inclusion of the deep fascia beneath the tumor. A wide margin for an intramuscular tumor implied no open biopsy and an unbroken muscle fascia or thick muscle cuff around the tumor (primary myectomy). The 70 patients with subcutaneous and intramuscular tumors were all treated by local surgery. A wide margin was obtained in 56 patients who were not given radiotherapy. During a median follow-up of 5 years (range, 3.5 to 10 years), four of these 56 patients--47 of whom had high-grade malignant tumors--had a local recurrence. We conclude that routine combination of limb-sparing surgery with adjuvant radiotherapy is not necessary in patients with soft tissue sarcoma. Two thirds of soft tissue sarcomas of the extremities are primarily subcutaneous or intramuscular tumors, the majority of which can be treated by local surgery without local adjuvant therapy with a local recurrence rate of less than 10%, irrespective of malignancy grade.

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Prognostic Factors in Extremity Soft Tissue Sarcoma Patients Treated with Preoperative Radiotherapy

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol04-i03/579 ◽

2019 ◽

Vol 4 (03) ◽

Author(s):

Berrin Inanc, MD ◽

Kubilay Inanc, MD

Keyword(s):

Prognostic Factors ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Preoperative Radiotherapy ◽

Soft Tissue Sarcomas ◽

Tumor Grade ◽

Metastatic Recurrence ◽

Extremity Soft Tissue Sarcoma ◽

Metastatic Relapse

Purpose: The purpose of the study was to investigate the prognostic factors and survival after preoperative radiotherapy in Extremity Soft Tissue Sarcomas (ESTS). Materials and Methods: In this retrospective study, all patients treated for an extremity sarcoma with pre-operative radiotherapy followed by surgery. Results: The mean follow-up for all 24 ESTS patients was 15.5 (range: 10-39 months). At last follow-up, 9 patients (37%) were alive, 15 patients (62%) had died of distant disease progression. Among the patients died, there were 15 with metastatic relapse (13 lung and 2 cranial metastasis), 5 with both local and metastatic recurrence. The median OS was 16 month. The 2-years actuarial OS rate and 3-years OS rate were 39% and 26%, respectively. The median RFS was 14(12.5-15.4) month. The 2-years and 3-years RFS rate was 71%.The median MFS was 12 months. The 2-years and 3-years MFS rate were 33%, 17%, respectively. The effects of age, sex, histopathologic type, tumor size, tumor localization, tumor grade, tumor depth, radiation doses and recestion margin on OS, RFS, MFS were not observed. In univariate and multivariate model, it was observed that recurrence decreased OS time significantly (p<0.05). Conclusion: Recurrens and metastasis are strong and negative prognostic factor for survival in extremity soft tissue sarcoma patients.

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NCCN Guidelines Insights: Soft Tissue Sarcoma, Version 1.2021

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2020.0058 ◽

2020 ◽

Vol 18 (12) ◽

pp. 1604-1612

Author(s):

Margaret von Mehren ◽

John M. Kane ◽

Marilyn M. Bui ◽

Edwin Choy ◽

Mary Connelly ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Body Wall ◽

Panel Discussion ◽

Soft Tissue Sarcomas ◽

Nccn Guidelines ◽

Stromal Tumors ◽

Retroperitoneal Sarcomas ◽

Head Neck

The NCCN Guidelines for Soft Tissue Sarcoma provide recommendations for the diagnosis, evaluation, treatment, and follow-up for patients with soft tissue sarcomas. These NCCN Guidelines Insights summarize the panel discussion behind recent important updates to the guidelines, including the development of a separate and distinct guideline for gastrointestinal stromal tumors (GISTs); reconception of the management of desmoid tumors; inclusion of further recommendations for the diagnosis and management of extremity/body wall, head/neck sarcomas, and retroperitoneal sarcomas; modification and addition of systemic therapy regimens for sarcoma subtypes; and revision of the principles of radiation therapy for soft tissue sarcomas.

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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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Soft Tissue Sarcoma Follow-up Imaging: Strategies to Distinguish Post-treatment Changes from Recurrence

Seminars in Musculoskeletal Radiology ◽

10.1055/s-0040-1721464 ◽

2020 ◽

Vol 24 (06) ◽

pp. 627-644

Author(s):

Iris-M. Noebauer-Huhmann ◽

Snehansh R. Chaudhary ◽

Olympia Papakonstantinou ◽

Joannis Panotopoulos ◽

Marc-André Weber ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Surgical Techniques ◽

Soft Tissue Sarcomas ◽

Late Complications ◽

Treatment Modalities ◽

Recurrence Rates ◽

Precise Knowledge ◽

Inflammatory Pseudotumors

AbstractSoft tissue sarcomas encompass multiple entities with differing recurrence rates and follow-up intervals. The detection of recurrences and their differentiation from post-therapeutic changes is therefore complex, with a central role for the clinical radiologist. This article describes approved recommendations. Prerequisite is a precise knowledge of the current clinical management and surgical techniques. We review recurrence rates and treatment modalities. An adequate imaging technique is paramount, and comparison with previous imaging is highly recommended. We describe time-dependent therapy-related complications on magnetic resonance imaging compared with the spectrum of regular post-therapeutic changes. Early complications such as seromas, hematomas, and infections, late complications such as edema and fibrosis, and inflammatory pseudotumors are elucidated. The appearance of recurrences and radiation-associated sarcomas is contrasted with these changes. This systematic approach in follow-up imaging of soft tissue sarcoma patients will facilitate the differentiation of post-therapeutic changes from recurrences.

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