scholarly journals Histologic Response Following Pre-Operative Radiotherapy for Soft Tissue Sarcoma (STS) in a French Reference Center and Review

2020 ◽  
pp. 1-8
Author(s):  
Sunyach Marie ◽  
Severine Prapan ◽  
Aurelie Bertaut ◽  
Marie Karanian ◽  
Gualter Vaz ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Local Recurrence ◽  
Soft Tissue Sarcoma ◽  
Tumor Cells ◽  
Distant Recurrence ◽  
Recurrence Free Survival ◽  
Histologic Response ◽  
Free Survival ◽  
Viable Cells ◽  
Viable Tumor

Background and Purpose: Limb sparing surgery and radiotherapy is the main treatment of patients harboring soft tissue sarcoma of the extremity. There is limited data regarding the prognostic impact of histologic response after pre-operative radiotherapy. Patients and Methods: Between 2010 and 2018, 123 patients were treated with a pre-operative radiotherapy for soft tissue sarcoma at Leon Berard Centre (Lyon, France) and were retrospectively reviewed. All patients received a dose of 50 Gy in 25 fractions. The histologic response has been analysed by considering the following factors: necrosis ≥ 90%, percentage of viable tumor cells ≤ 10% and fibrosis ≥ 10%. Overall survival (OS), local recurrence-free survival (LRFS), distant recurrence-free survival (DRFS) and event-free survival (EFS) were evaluated. Results: Median follow up was 33.2 months (range 2.3-128.1 months). Local recurrence occurred in 9 patients (7.5%) and 40 patients (33%) presented a distant recurrence. The 2 and 5-year OS was 84% and 63%. Histologic response factors (necrosis ≥ 90%, viable tumor cells ≤ 10% and fibrosis ≥ 10%) were not predictive in DRFS and EFS. In multivariate analysis, grade was the only significant prognostic factor for EFS P=0.0087. Among the 14 patients with ≤ 10% viable cells after irradiation 13 presented a metastatic evolution within 6 months. Conclusion: This study showed that current histological response evaluation based on necrosis, fibrosis and viable cells could not predict clinical outcomes after radiotherapy for extremity soft tissue sarcoma. A significant proportion of patients with a good response after pre-operative radiotherapy present a metastatic recurrence.

scholarly journals Factors Influencing Prognosis After Initial Inadequate Excision (IIE) for Soft Tissue Sarcoma

Sarcoma ◽  
2003 ◽  
Vol 7 (3-4) ◽  
pp. 159-165 ◽  
Author(s):  
Albert N. Van Geel ◽  
Alexander M. M. Eggermont ◽  
Patrick E. J. Hanssens ◽  
Paul I. M. Schmitz
Keyword(s):  
Overall Survival ◽  
Soft Tissue ◽  
Local Recurrence ◽  
Soft Tissue Sarcoma ◽  
Tumor Grade ◽  
Residual Tumor ◽  
Radical Resection ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Local Recurrence Free Survival

Purpose. The influence of initial inadequate excision (IIE) of soft tissue sarcoma (STS) on local control and overall survival is not well established. It is generally believed that an IIE may have a negative impact on both, despite subsequent treatment by radical surgery and radiotherapy. However, data on local recurrence-free survival/overall survival are conflicting and there are no data on the effect of IIE on overall survival.Patients and methods. A retrospective analysis was made of 86 patients with soft tissue sarcoma of the extremities and trunk after an IIE had been performed due to inappropriate work-up. The minimal follow-up was 7 years. Specimens of the subsequent radical resection were evaluated for residual tumor, grade of tumor and complications of IIE. Endpoints were recurrence-free survival and overall survival.Results. Specimens of the subsequent radical resection showed residual tumor in 66 patients (77%). The most common complication after IIE was hematoma. In both univariate and multivariate analyses, grade II/III tumors and complications after IIE are significant negative prognostic factors for local recurrence-free survival (P= 0.008 andP= 0.002, respectively, in the Cox model). For this survival, three prognostic groups could be formed based on grade, or presence or absence of complications. Adjuvant radiotherapy did not change the rate of local recurrence-free survival. For overall survival, only tumor grade is a significant factor (log-rank test).Conclusion. This retrospective study shows that complications associated with an IIE have a significant negative effect on local control, but not on overall survival, because IIE is often the result of inappropriate work-up before surgery. For better diagnosis and therapy STS should be treated in specialized centers.

scholarly journals Efficacy of hyperthermic isolated limb perfusion in the treatment of locally recurrent high-grade soft tissue sarcoma of the extremities

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Farhad Farzaliyev ◽  
Alexander Touma ◽  
Georg Taeger ◽  
Hans-Ulrich Steinau ◽  
Jendrik Hardes ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Local Recurrence ◽  
Soft Tissue Sarcoma ◽  
Isolated Limb Perfusion ◽  
High Grade ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Limb Perfusion ◽  
Locally Recurrent ◽  
Local Recurrence Free Survival

Abstract Background This novel study compared the use of tumor necrosis factor (TNF)-alpha and melphalan-based isolated limb perfusion (TM-ILP) to the standard treatment of locally recurrent soft tissue extremity sarcoma. The aim was to assess whether TM-ILP positively influences the recurrence-free survival of locally recurrent high-grade soft tissue sarcoma (STS) of the extremities. Methods We retrospectively analyzed our clinical database for patients with STS. Variables were analyzed using chi-square test or Mann-Whitney rank-sum test. Furthermore, Kaplan-Meier survival plots were calculated and a proportional hazard regression model was developed. Results Out of 448 patients with extraabdominal STS treated between August 2012 and December 2015, 52 cases involving 47 patients had locally recurrent STS. Twenty-eight of these patients were treated with TM-ILP prior to surgical resection (TM-ILP-group), and 24 were treated with standard therapy (without TM-ILP). The 3-year recurrence-free survival for the TM-ILP-group was estimated at 75% (95% confidence interval (CI), 71.5–78.5). Local recurrence-free survival in the standard group was significantly lower (LRFS: 43.4%, 95% CI 38.7–48.1, p = 0.026). Multivariable analysis revealed resection with negative margins, lower number of previous recurrences, and TM-ILP as positive predictors for recurrence-free survival. Conclusions TM-ILP and consecutive resection of residual tumor with negative resection margins significantly improves local recurrence-free survival for patients with a first local recurrence of high-grade STS in the extremities.

scholarly journals PD-L1 Tumour Expression is Predictive of Pazopanib Response in Soft Tissue Sarcoma

2020 ◽  
Author(s):  
Sang Kyun Kim ◽  
Jee Hung Kim ◽  
Seung Hyun Kim ◽  
Young Han Lee ◽  
Jung Woo Han ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Kinase Inhibitor ◽  
Progression Free Survival ◽  
Poor Response ◽  
Free Survival ◽  
Viable Cells ◽  
Molecular Determinants ◽  
Multitargeted Tyrosine Kinase Inhibitor ◽  
To Receive

Abstract Background Pazopanib, a multitargeted tyrosine kinase inhibitor, is recommended as the standard treatment for refractory soft tissue sarcoma (STS). However, there are comparatively few molecular determinants for predicting pazopanib efficacy. Based on correlative studies regarding the predictive impact of PD-L1, we investigated the clinical relevance of PD-L1 expression and evaluated its value for predicting pazopanib efficacy. Methods Tumour tissues from patients with advanced STS who went on to receive pazopanib were assessed for PD-L1 expression. Immunohistochemistry was performed using an anti-PD-L1 antibody, and the PD-L1 tumour proportion score (TPS) was calculated as the percentage of at least 100 viable cells with positive expression, defined as TPS ≥ 1%. ResultsAmong the 67 patients, 8 (11.9%) achieved partial response and a median progression-free survival (PFS) of 4.8 months (95% CI 3.8-5.7). PD-L1 expression in tumour cells was detected in 13 (19.4%) cases and the TPS scores ranged from 1‒100%, as follows: 0 (n=54, 80.6%), 1‒9% (n=3, 4.5%), 10‒49% (n=9, 13.4%), and ≥50% (n=1, 1.5%). PD-L1 positive tumours exhibited a poorer response to pazopanib treatment than the PD-L1 negative tumours (0% vs 14.8%, P=0.07). PD-L1-positive tumours had significantly shorter PFS than the PD-L1-negative tumours (median PFS 2.8 vs 5.1 months, P=0.003), and PD-L1 positivity was an independent predictor of poor response to pazopanib treatment (HR 2.77, 95% CI; 1.45-5.56, P=0.006). ConclusionWe identified that PD-L1 expression can help predict the clinical outcome of patients with advanced STS treated with pazopanib. Based on our study, stratification should be actively considered in order to identify patients who will benefit from pazopanib or further therapeutic strategies for future clinical trials.

Adjuvant radiotherapy after primary surgical resection in patients with adrenocortical carcinoma: Retrospective cohort analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4641-4641
Author(s):  
Mouhammed Amir Habra ◽  
Shamim Ejaz ◽  
Lei Feng ◽  
Prajnan Das ◽  
Ferhat Deniz ◽  
...  
Keyword(s):  
Overall Survival ◽  
Local Recurrence ◽  
Adrenocortical Carcinoma ◽  
Adjuvant Radiotherapy ◽  
Distant Recurrence ◽  
Hazard Ratio ◽  
Control Group ◽  
Recurrence Free Survival ◽  
Free Survival

4641 Background: Adrenocortical carcinoma (ACC) is a rare malignancy with high recurrence and mortality rates. The role of adjuvant radiotherapy (RT) to improve outcome remains unclear. Considering the rarity of ACC, we conducted a historical cohort study to ascertain the effect of adjuvant RT on overall survival and recurrence rates. Methods: Patients were selected from the MD Anderson Cancer Center (MDACC) ACC registry (1998- 2011) who had primary tumor resection with no evidence of distant metastasis at the time of initial diagnosis and a minimum follow-up of 6-months. The adjuvant RT group included patients who received adjuvant RT within 3 months of diagnosis. Control group included patients who did not receive RT and matched based on resection margin status and stage at diagnosis. Results: There were no significant differences between the adjuvant RT group (n=15) and comparison group (n =45) in gender distribution, age, tumor size, functional status, and use of adjuvant mitotane therapy. On multivariate Cox proportional hazard model for overall survival, the adjuvant RT group had hazard ratio of 1.981(95% confidence interval [CI] 0.894-4.391, p=0.0922) compared to the control group. The differences in median time to local recurrence, distant recurrence and of recurrence free survival were not significant between the two groups. In subgroup analysis including only the patients whose initial treatments were from outside of MDACC, RT group (n=15) had hazard ratio of overall survival of 1.604 (95% CI 0.712- 3.613, p=0.2543) compared to group without adjuvant RT (n= 32). Median times to local recurrence, distant recurrence, or of recurrence free survival were also not significantly different between the two groups. Conclusions: To our knowledge, this is the largest single institution report about adjuvant RT use in ACC. In our study, RT did not appear to cause a significant difference in overall survival, recurrence rate, or time to recurrence. However, it is still possible that patients offered adjuvant RT and control groups may have been inherently different. Hence, a prospective study is needed to clarify the role of adjuvant RT in patients with resectable ACC.

scholarly journals Oncological outcome and prognostic factors in the therapy of soft tissue sarcoma of the extremities

2012 ◽  
Vol 4 (4) ◽  
pp. 34 ◽  
Author(s):  
Ingmar Ipach ◽  
Tobias Wingert ◽  
Beate Kunze ◽  
Torsten Kluba
Keyword(s):  
Prognostic Factors ◽  
Soft Tissue ◽  
Local Recurrence ◽  
Soft Tissue Sarcoma ◽  
Survival Time ◽  
Cancer Center ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Free Survival ◽  
Therapeutic Concepts

Uniform conclusions about therapeutic concepts and survival time of bone and soft tissue sarcoma patients are difficult due to the heterogeneity of histological subtypes as well as the different responses to neoadjuvant therapy. The subject of this retrospective study was the analysis of tumour free survival, risk and prognostic factors of sarcoma patients treated by limb sparing techniques or amputation. We included 118 patients with soft tissue sarcoma of the extremities treated primarily or secondarily at our institution between 1990 and 2008 with a minimum follow-up of 12 months. Data about the tumour free survival time, operative techniques and potential prognostic factors were analysed. The tumour-specific and overall survival were significantly influenced by two factors: the grading and distant metastases present at time of diagnosis. Optimal multimodal therapeutic concepts at a specialized Cancer Center decreased the risk of local recurrence. The importance of optimal preoperative and surgical course concerning the oncological long term outcome was investigated. The decrease in local recurrence as a result of multimodal therapeutic concepts at a specialized Cancer Center was confirmed. To evaluate the individual prognosis of a patient, multiple factors have to be considered. Factors for a poor prognosis are primary metastasis, high-grade tumours and several histological entities (<em>e.g</em>. synovial sarcoma, not other specified).

Limb preserving surgery for soft-tissue sarcoma in the hand: a retrospective study of 51 cases

2020 ◽  
Vol 45 (6) ◽  
pp. 629-635 ◽  
Author(s):  
Mehran Dadras ◽  
Hans-Ulrich Steinau ◽  
Ole Goertz ◽  
Marcus Lehnhardt ◽  
Björn Behr ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Soft Tissue ◽  
Local Recurrence ◽  
Soft Tissue Sarcoma ◽  
Tumour Size ◽  
Long Term Results ◽  
Resection Margins ◽  
Incomplete Resection ◽  
Free Survival

Our retrospective study analysed the long-term results of a conservative limb-preserving surgical strategy in 51 patients with soft-tissue sarcoma of the hand from a single institution. We assessed survival and prognostic factors, including the surgical margins. No transradial amputations were performed. Microscopically free resection margins were obtained in 45 of the patients. The remaining six patients had microscopically incomplete resection. Forty-four surviving patients had a median follow-up of 6.5 years (range 12–307), and one patient had no follow-up beyond 3 months following surgery. Among those patients, 29 had more than 5 years of follow-up. Five-year local-recurrence-free survival was 65%, metastasis-free survival was 84%, and disease-specific survival was 91%. Tumour size was predictive of all outcome parameters, but positive resection margins adversely affected local recurrence only. Survival was similar to the survival after a more radical surgical approach reported in the literature. Level of evidence: IV

scholarly journals PD-L1 tumour expression is predictive of pazopanib response in soft tissue sarcoma

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sang Kyum Kim ◽  
Jee Hung Kim ◽  
Seung Hyun Kim ◽  
Young Han Lee ◽  
Jung Woo Han ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Kinase Inhibitor ◽  
Progression Free Survival ◽  
Poor Response ◽  
Free Survival ◽  
Viable Cells ◽  
Molecular Determinants ◽  
Multitargeted Tyrosine Kinase Inhibitor ◽  
To Receive

Abstract Background Pazopanib, a multitargeted tyrosine kinase inhibitor, is recommended as the standard treatment for refractory soft tissue sarcoma (STS). However, there are comparatively few molecular determinants for predicting pazopanib efficacy. Based on correlative studies regarding the predictive impact of PD-L1, we investigated the clinical relevance of PD-L1 expression and evaluated its value for predicting pazopanib efficacy. Methods Tumour tissues from patients with advanced STS who went on to receive pazopanib were assessed for PD-L1 expression. Immunohistochemistry was performed using an anti-PD-L1 antibody, and the PD-L1 tumour proportion score (TPS) was calculated as the percentage of at least 100 viable cells with positive expression, defined as TPS ≥ 1%. Results Among the 67 patients, 8 (11.9%) achieved partial response and a median progression-free survival (PFS) of 4.8 months (95% CI 3.8–5.7). PD-L1 expression in tumour cells was detected in 13 (19.4%) cases and the TPS scores ranged from 1 to 100%, as follows: 0 (n = 54, 80.6%), 1–9% (n = 3, 4.5%), 10–49% (n = 9, 13.4%), and ≥ 50% (n = 1, 1.5%). PD-L1 positive tumours exhibited a poorer response to pazopanib treatment than the PD-L1 negative tumours (0% vs 14.8%, P = 0.07). PD-L1-positive tumours had significantly shorter PFS than the PD-L1-negative tumours (median PFS 2.8 vs 5.1 months, P = 0.003), and PD-L1 positivity was an independent predictor of poor response to pazopanib treatment (HR 2.77, 95% CI; 1.45–5.56, P = 0.006). Conclusion We identified that PD-L1 expression can help predict the clinical outcome of patients with advanced STS treated with pazopanib. Based on our study, stratification should be actively considered in order to identify patients who will benefit from pazopanib or further therapeutic strategies for future clinical trials.

scholarly journals The Impact of Unplanned Excision on the Outcomes of Patients With Soft Tissue Sarcoma of the Trunk and Extremity: A Propensity Score Matching Analysis

2021 ◽  
Vol 10 ◽  
Author(s):  
Yao Liang ◽  
Tian-Hui Guo ◽  
Bu-Shu Xu ◽  
Dong-Chun Hong ◽  
Hai-Bo Qiu ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Local Recurrence ◽  
Soft Tissue Sarcoma ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Residual Disease ◽  
R0 Resection ◽  
Free Survival ◽  
Unplanned Excision ◽  
The Impact

BackgroundUnplanned excision (UPE) of soft tissue sarcoma (STS) is often chosen in the early phase by general physicians without any radiological evaluation.PurposeThe present study aimed to evaluate the impact of UPE on the clinical outcomes of patients with STS of the trunk and extremity.Materials and MethodsPatients with STS of the trunk and extremity who underwent R0 resection between 1998 and 2016 were included and divided into the UPE and planned excision (PE) groups. Propensity score matching (PSM) was used to control the selection bias. The endpoints were disease-specific survival (DSS), local recurrence-free survival (LRFS), and metastasis-free survival (MFS).ResultsIn total, 458 patients (277 males, 181 females; median age: 43 years) were included: 329 (71.8%) in the PE group and 129 (28.2%) in the UPE group. The follow-up time ranged from 7.1 to 313.78 months, with a median of 112.18 months. UPE patients were more likely to have a smaller or superficial lesion and were more frequently administered adjuvant therapy. After PSM, compared with the PE group, the UPE group had a longer LRFS (P=0.015), but there was no difference between the two groups regarding DSS and MFS. Residual disease was observed in 77.5% of the re-resected specimens in the UPE group and was a risk factor for DSS (P = 0.046) and MFS (P = 0.029) but was not associated with local recurrence (LR) (P=0.475) or LRFS (P=0.334). Moreover, we found no difference in DSS, LRFS or MFS according to the interval from UPE to definitive resection.ConclusionSTS treated with UPE had distinct characteristics. Patients who undergo UPE followed by an additional wide R0 resection have similar oncological survival compared to patients who undergo an initial PE, although the high incidence of residual tumor in the UPE group leads to an unfavorable clinical course.

scholarly journals The Effect of Resection Margin on Local Recurrence and Survival in High Grade Soft Tissue Sarcoma of the Extremities: How Far Is Far Enough?

Cancers ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2560
Author(s):  
Annika Bilgeri ◽  
Alexander Klein ◽  
Lars H. Lindner ◽  
Silke Nachbichler ◽  
Thomas Knösel ◽  
...  
Keyword(s):  
Overall Survival ◽  
Soft Tissue ◽  
Local Recurrence ◽  
Resection Margin ◽  
Soft Tissue Sarcomas ◽  
High Grade ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Positive Margins ◽  
Local Recurrence Free Survival

Background: The significance of surgical margins after resection of soft tissue sarcomas in respect to local-recurrence-free survival and overall survival is evaluated. Methods: A total of 305 patients with deep-seated, G2/3 soft tissue sarcomas (STS) of the extremity, the trunk wall, or the pelvis were reviewed. The margin was defined according to the Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) classification system (R0-2), the Union Internationale Contre le Cancer (UICC) classification (R + 1 mm) for which a margin <1 mm is included into the R1 group, and in groups of <1 mm, 1–5 mm, >5 mm, or >10 mm. Results: Of these patients, 31 (10.2%) had a contaminated margin, 64 (21%) a margin of <1 mm, 123 (40.3%) a margin of 1–5 mm, 47 (15.4%) a margin of >5 mm, and 40 (13.1%) a margin of >10 mm. The 5-year local recurrence-free survival (LRFS) was 81.6%. Overall survival (OS) at 5 years was 65.9%. Positive margins worsened LRFS and OS. A margin of >10 mm did not improve LRFS and OS as compared to one of >5 mm. Conclusions: A resection margin of <1 mm showed a trend but not significantly better LRFS or OS compared to a contaminated margin. This finding supports use of the UICC classification. A margin of more than 10 mm did not improve LRFS or OS.

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