scholarly journals Efficacy and Safety of Hypofractionated Preoperative Radiotherapy for Primary Locally Advanced Soft Tissue Sarcomas of Limbs or Trunk Wall

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2981
Author(s):  
Hanna Koseła-Paterczyk ◽  
Paweł Teterycz ◽  
Mateusz J. Spałek ◽  
Aneta Borkowska ◽  
Anna Zawadzka ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Multimodal Therapy ◽  
Preoperative Radiotherapy ◽  
Locally Advanced ◽  
Soft Tissue Sarcomas ◽  
High Grade ◽  
Free Survival ◽  
Phase 2 Trial ◽  
Median Tumor Size ◽  
Good Local Control

Background: The use of adjuvant radiotherapy (RT) shows a significantly decreased incidence of local recurrence (LR) in soft tissue sarcomas (STS). This study aimed to assess the treatment scheme’s effect in patients with primary STS treated at one institution. Methods: In this phase 2 trial, 311 patients aged ≥18 years with primary, locally advanced STS of the extremity or trunk wall were assigned to multimodal therapy conducted at one institution. The preoperative RT scheme consisted of 5 Gy per fraction for a total dose of 25 Gy. Surgery was performed within 2–4 days from the last day of RT. The primary endpoint was LR-free survival (LRFS). Adverse events of the treatment were assessed. Results: We included 311 patients with primary locally advanced STS. The median tumor size was 11 cm. In total, 258 patients (83%) had high-grade tumors. In 260 patients (83.6%), clear surgical margins (R0) were obtained. Ninety-six patients (30.8%) had at least one type of treatment adverse event. LR was observed in 13.8% patients. The 5-year overall survival was 63%. Conclusion: In this group, with a significant percentage of patients with extensive, high-grade STS, hypofractionated preoperative RT was associated with good local control and tolerance.

Adult-Type Soft Tissue Sarcomas in Pediatric-Age Patients: Experience at the Istituto Nazionale Tumori in Milan

2005 ◽  
Vol 23 (18) ◽  
pp. 4021-4030 ◽  
Author(s):  
Andrea Ferrari ◽  
Michela Casanova ◽  
Paola Collini ◽  
Cristina Meazza ◽  
Roberto Luksch ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcomas ◽  
Complete Resection ◽  
High Grade ◽  
Adult Type ◽  
Free Survival ◽  
Homogeneous Subgroup ◽  
Response To Chemotherapy ◽  
Patients Experience ◽  
Rate Of Response

Purpose Nonrhabdomyosarcoma soft tissue sarcomas are a heterogeneous group of tumors for which optimal treatment remains controversial. We report on a large group of 182 patients younger than 18 years old treated at a single institution over a 25-year period. Patients and Methods In this relatively homogeneous subgroup of adult-type histotypes, surgery was the mainstay of treatment; radiotherapy was administered to 73 patients, and chemotherapy was administered to 114 patients (70 received chemotherapy as adjuvant therapy). Results Overall survival at 5 years was 89% in patients who underwent complete resection at diagnosis, 79% in patients who had marginal resection, 52% in initially unresected patients, and 17% in patients with metastases at onset. Outcome was unsatisfactory in patients with large and high-grade tumors, even after gross resection; adjuvant chemotherapy seemed to improve the results in this group. Initially unresected patients who responded well to chemotherapy and subsequently underwent complete resection had an event-free survival rate of approximately 70%. The rate of response to chemotherapy was 58%. Conclusion The identification of prognostic variables should enable risk-adapted therapies to be planned. Patients with initially unresectable disease and patients with resected large and high-grade tumors are at high risk of metastases and treatment failure. Although the limits of this retrospective analysis are self-evident, our data would suggest that intensive chemotherapy (with an ifosfamide-doxorubicin regimen) might have a more significant role in these patients than what is generally assumed.

Metronomic continuous oral cyclophosphamide as second and further line in soft-tissue sarcomas (STS) of the adult.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 10572-10572
Author(s):  
Alessandro Comandone ◽  
Antonella Boglione ◽  
Elena Giubellino ◽  
Paola Bergnolo ◽  
Giancarlo Gino ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Locally Advanced ◽  
Soft Tissue Sarcomas ◽  
Progression Free Survival ◽  
Oral Cyclophosphamide ◽  
Second Line ◽  
Good Tolerability ◽  
Free Survival ◽  
Heavily Pretreated ◽  
Third Line

10572 Background: In STS third line treatment is poorly defined. However many patients (pts), after aggressive therapy as first and second line progress in their disease ask to be treated. Oral cyclophosphamide (CPM) was already used in breast cancer, prostate cancer and in elderly pts with STS with favourable results. Aim of our study was to define the feasibility, tolerability and activity of oral CPM as third line and further line chemotherapy Methods: 45 pts (19 M; 26 F) with advanced or metastatic STS heavily pretreated were included. Oral CPM was given daily at total dose of 50 mg/day without interruption excepted for toxicity or progressive disease Results: Median age was 60 (32-81), histological subtypes were: leiomyosarcoma 12, liposarcoma 10, condrosarcoma 5, sinovialsarcoma 4, sarcoma NOS 4, other 10. Primary sites were: extremities 21, retroperitoneum 19, trunk 5. 41 pts were metastatic, 4 locally advanced. 41 pts were pretreated with chemotheraphy (15 were in II line, 17 in III line, 7 in IV line, 2 in V line). Median PS (ECOG) was 2 . Median duration of theraphy was 4 months (1-38). Progression free survival (PFS) ranged from 0 to 42+ months (median 4 months). Treatment was well tolerated, we registred only one episode of leucopenia G2 and one of asthenia G2. No complete responses were seen. Only 3 minimal responses and 18 stable disease were seen. Conclusions: Oral CPM showed a mild activity and good tolerability in advanced soft tissue and metastatic STS. It could be an appropriate solution as second line and further therapy and in unfit or elderly pts.

Efficacy and safety of hypofractionated preoperative radiotherapy in treatment of patient with primary locally advanced soft tissue sarcoma of limbs/trunk wall.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 11555-11555
Author(s):  
Hanna Kosela ◽  
Mateusz Spalek ◽  
Aneta Borkowska ◽  
Pawel Teterycz ◽  
Tadeusz Morysinski ◽  
...  
Keyword(s):  
Overall Survival ◽  
Soft Tissue ◽  
Tumor Size ◽  
Preoperative Radiotherapy ◽  
Locally Advanced ◽  
Surgical Margin ◽  
Margin Status ◽  
Lower Limbs ◽  
Adverse Impact ◽  
High Grade

11555 Background: Soft tissue sarcomas (STS) are rare often malignant tumors. The primary treatment of most STS is radical resection with adjuvant radiotherapy. Our previous study showed that the use of preoperative hypofractionated radiotherapy is safe and efficient in the treatment of unselected group of patients with STS. Aim of this study was to assess the use of the treatment scheme in patients with primary STS treated in one institution. Methods: 311 patients (52% female) with primary locally advanced STS participated in this prospective trial conducted from 2010 till 2017. Median age was 55 years (range: 17-91). Median follow up is 57 months (95%CI 55-61). The most common subtypes were pleomorphic sarcoma, liposarcoma and synovial sarcoma. Median tumor size was 11cm. 258 patients (83%) had high grade tumors. The most common tumor localization were lower limbs (72%). 30% of patients received preoperative chemotherapy. For five consecutive days radiotherapy in 5 x 5Gy fraction was applied, with immediate (2-4 days) resection of the tumor. Results: In 260 patients (83.6%) clear surgical margins (R0) were obtained. 107 patients were dead at the time of the analysis.5-year overall survival is 63%. 156 (50%) had a recurrence of the disease. Local recurrence (LR) was found in 13.8% of the patients. Median time from surgery to LR was 14.7 months. In 56% of patients with LR another limb spearing radical surgery could be performed. Factors that had a significant adverse impact on LR were histological subtype (p = 0.017) and surgical margin status (p = 0.013). Factors that had a significant adverse impact on overall survival were tumor size (p < 0.0001), grade (p = 0.0047) and surgical margin status (p = 0.013). 96 patients (30.8%) had any kind of treatment toxicity, factor having negative impact on the toxicity was lower limb location of the tumor (p = 0.0012). 20 patients (6.4%) required surgery for treatment of the complications. 14.6% patients had prolonged healing of the wound ( > 1 month), 8.3% had wound dehiscence, 1.4% required prolonged punctures of the lymph fluid, 2.3% had severe fibrosis leading to contracture of limb, 11% patients prolonged edema of the operated limb. 0.9% of patients had a fracture of the treated limb. Conclusions: In this group, with a big percentage of patients with large, high grade STS use of hypofractionated preoperative radiotherapy was associated with similar local control when compared to published studies. The early toxicity is tolerable, with a small amount of late complications.

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.

scholarly journals Thromboembolic Events Associated with Thalidomide and Multimodality Therapy for Soft Tissue Sarcomas: Results of RTOG 0330

Sarcoma ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
J. M. Kane ◽  
J. Harris ◽  
W. G. Kraybill ◽  
D. C. Harmon ◽  
D. S. Ettinger ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcomas ◽  
Low Grade ◽  
Preoperative Radiation ◽  
High Grade ◽  
Thromboembolic Events ◽  
Median Tumor Size ◽  
Venous Thromboembolic ◽  
Locally Recurrent ◽  
Grade 3

Introduction. RTOG 0330 was developed to address the toxicity of RTOG 9514 and to add thalidomide (THAL) to MAID chemoradiation for intermediate/high grade soft tissue sarcomas (STSs) and to preoperative radiation (XRT) for low-grade STS.Methods. Primary/locally recurrent extremity/trunk STS: ≥8 cm, intermediate/high grade (cohort A): >5 cm, low grade (cohort B). Cohort A: 3 cycles of neoadjuvant MAID, 2 cycles of interdigitated THAL (200 mg/day)/concurrent 22 Gy XRT, resection, 12 months of adjuvant THAL. Cohort B: neoadjuvant THAL/concurrent 50 Gy XRT, resection, 6 months of adjuvant THAL. Planned accrual 44 patients.Results. 22 primary STS patients (cohort A/B 15/7). Cohort A/B: median age of 49/47 years; median tumor size 12.8/10 cm. 100% preoperative THAL/XRT and surgical resection. Three cycles of MAID were delivered in 93% cohort A. Positive margins: 27% cohort A/29% cohort B. Adjuvant THAL: 60% cohort A/57% cohort B. Grade 3/4 venous thromboembolic (VTE) events: 40% cohort A (1 catheter thrombus and 5 DVT or PE) versus 0% cohort B. RTOG 0330 closed early due to cohort A VTE risk and cohort B poor accrual.Conclusion. Neoadjuvant MAID with THAL/XRT was associated with increased VTE events not seen with THAL/XRT alone or in RTOG 9514 with neoadjuvant MAID/XRT.

The role of ifosfamide-doxorubicin chemotherapy in the treatment histology-specific, high grade, locally advanced soft tissue sarcoma: A 14-year experience.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e23529-e23529
Author(s):  
Barry W Goy
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Locally Advanced ◽  
Local Therapy ◽  
Synovial Cell ◽  
Favorable Effect ◽  
High Grade ◽  
Undifferentiated Sarcoma ◽  
Free Survival ◽  
Prognostic Features

e23529 Background: To compare long-term outcomes of high grade, locally advanced, primary soft tissue sarcoma (STS), using Ifosfamide-Doxorubicin vs local therapy alone, in histology-specific sarcomas. Methods: Retrospective analysis was performed on 127 patients from 2005 to 2018, who had STS of extremity or trunk, > 5cm, that were either Synovial Cell, Dedifferentiated Liposarcoma (DDL), Myxofibrosarcoma, Round Cell Liposarcoma (RCLS), Undifferentiated Pleomorphic Sarcoma (UPS), or Undifferentiated Sarcoma not otherwise specified (NOS), with central pathology review. Ifosfamide-doxorubicin was generally given neoadjuvant, followed by radiation and wide excision, with chemotherapy given in 38 patients, while 89 received local therapy alone. Multi-variable analysis of prognostic factors was performed, and local-recurrence-free-survival (LRFS), distant-metastases-free-survival (DMFS), disease-specific-survival (DSS), and overall-survival(OS) were estimated using Kaplan-Meier. Results: Median follow-up was 4.5 years. Younger age (p < 0.0001) and Synovial histology (p = 0.0002) had significantly higher rates of receiving chemotherapy. Size > 10cm and trunk location were poor prognostic features on multivariable analysis (MVA) affecting DMFS, DSS, and OS, while DDL histology had a more favorable effect; although size, trunk location, and DDL histology were not significantly different between treatment groups. Ifosfamide-Doxorubicin vs local therapy alone improved 5-year DMFS at 70.2% vs 49.5% ,p = 0.02, DSS 83.5% vs 57.9%, p = 0.009, and OS 80.6% vs 53.8%, p = 0.002. Sub-analysis of non-synovial histologies still showed a significant improvements in favor of chemotherapy in DMFS,(p = 0.04), DSS (p = 0.02), and OS (p = 0.003). Conclusions: Ifosfamide-Doxorubicin chemotherapy benefits younger patients with > 5cm, high grade, STS of the trunk or extremity, with histologies of Synovial Cell, DDL, Myxofibrosarcoma, RCLS, UPS, or Undifferentiated Sarcoma NOS.

scholarly journals Clinical Significance of Additional Wide Resection for Unplanned Resection of High Grade Soft Tissue Sarcoma

2008 ◽  
Vol 2 (1) ◽  
pp. 126-129 ◽  
Author(s):  
T Morii ◽  
H Yabe ◽  
H Morioka ◽  
U Anazawa ◽  
Y Suzuki ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Soft Tissue Sarcomas ◽  
Wide Resection ◽  
High Grade ◽  
Event Free Survival ◽  
Free Survival ◽  
Musculoskeletal Sarcoma ◽  
Oncological Outcomes ◽  
Local Recurrence Free Survival

Purpose: Unplanned resection of musculoskeletal sarcoma involves tumor excision without any suspicion of malignancy or regard for the necessity of defining adequate margins. For orthopaedic oncologists, many opportunities arise for management of unplanned resections initially performed by non-specialist surgeons. The puropose of this study is to assess the clinical outcomes and the problems of the patients with unplanned resection of high-grade soft tissue sarcoma. Methods: 77 consecutive patients were retrospectively reviewed. Oncological outcomes together with validity and problems of additional treatments were analyzed. Results: Five-year local recurrence-free survival, metastasis-free survival, event-free survival and total survival were 71.55%, 73.2%, 57.5% and 85.9%, respectively. Among adjuvant therapy including additional wide resection, radiotherapy and systemic chemotherapy, only additional wide resection significantly improved oncological outcomes. Conclusion: Additional wide resection appears to be effective in the treatment of high-grade soft tissue sarcomas following primary resection with compromised margins of resection.

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