Effect on Survival of Local Ablative Treatment of Metastases from Sarcomas: A Study of the French Sarcoma Group

Falk, Alexander Tuan; Moureau-Zabotto, Laurence; Ouali, M.; Penel, Nicolas; Italiano, Antoîne; Bay, Jacques‐Olivier; Olivier, Timothée; Sunyach, M.P.; Boudou-Roquette, P.; Salas, Sébastien; Maignan, Christine Le; Ducassou, A.; Isambert, Nicolás; Kalbacher, Elsa; Pan, Chang Chuan; Saâda, Esma; Bertucci, François; Thyss, A.; Thariat, Juliette

doi:10.1016/j.clon.2014.09.010

Cited by 69 publications

(50 citation statements)

References 26 publications

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“…Due to limited systemic treatment options for the majority of patients, complete surgical resection may be the most efficient therapy for achieving long‐term responses or even cure in selected cases . Some retrospective analyses have revealed that resection of lung metastases may be accompanied by a longer chemotherapy‐free interval, a longer progression‐free interval (PFI), or even an improved overall survival (OS) . However, the benefit from local surgical procedures in individual cases remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Impact of surgery in patients with metastatic soft tissue sarcoma: A monocentric retrospective analysis

Wigge

Heissner

Steger³

et al. 2018

Journal of Surgical Oncology

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Section: Introductionmentioning

confidence: 99%

Impact of surgery in patients with metastatic soft tissue sarcoma: A monocentric retrospective analysis

Wigge

Heissner

Steger³

et al. 2018

Journal of Surgical Oncology

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“…In previous controlled studies, aggressive treatment strategies for metastatic sarcoma were shown to improve survival (5,6). Radical treatment techniques for local sites have significantly improved in recent decades.…”

Section: Discussionmentioning

confidence: 99%

“…This aggressive surgical approach was retrospectively assessed for several sarcoma subtypes, providing an evidential foundation for ablative techniques. Surgery currently has the highest level of evidential support for the ablation of limited metastases, due to reports of patients cured from metastases (6).…”

Section: Introductionmentioning

confidence: 99%

Outcomes and toxicity of radiotherapy for refractory bone and soft tissue sarcomas

Doi

Miura

et al. 2015

Molecular and Clinical Oncology

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Abstract. Surgical resection is a well-established treatment option for sarcoma. However, anatomical barriers often hamper radical surgical procedures. The treatment of unresectable sarcoma, including local or distant failures following initial treatment, is challenging. The aim of the present study was to analyze the outcome of radiotherapy (RT) for refractory sarcoma, including unresectable, metastatic and recurrent disease, following radical treatment. We retrospectively reviewed a total of 67 tumors in 28 patients who were treated with RT between 2007 and 2014. Clinical target volume (CTV) was generally not defined in a preventive manner; therefore, in the majority of the cases, CTV equaled the gross tumor volume. The total delivered dose, number of fractions and biological equivalent dose were 52 (range, 40-69), 10 (range, 4-24) and 92.2 (range, 56-119.6) Gy, respectively. Only 1 patient developed local failure, with a median follow-up of 11 months (range, 1-59 months). Therefore, the 12-month progression-free survival rate for 67 sites was 96.8%. The overall survival rates at 12 and 36 months were 75.8 and 30.2%, respectively. A total of 2 patients developed grade >2 toxicities, including grade 3 mucositis and grade 4 pericardial effusion. Our results demonstrated that radical RT using modern techniques is highly feasible, achieves excellent local control, and may be an effective treatment option for refractory sarcoma. IntroductionSurgical removal, requiring wide excision with negative margins, is a standard treatment option for sarcoma (1,2).However, several factors, including anatomical barriers, make radical surgical procedures more challenging.Approximately 50% of patients with sarcoma develop metastases during the course of the disease (3). However, the treatment for metastatic sarcoma is currently insufficient and represents a challenge (1-4).Solid tumor metastases are considered non-curable. In addition, metastatic disease is associated with poor outcome, as few patients achieve durable disease control (4). A number of sarcomas exhibit a unique biological preference for the lungs, which are often the only sites of metastatic disease. Therefore, controlling these specific sites of progression may improve survival (3).In recent years, the use of local treatment for sarcoma has increased. Historically, surgical resection of metastases has been primarily investigated in young patients. There is also evidence supporting the benefit of surgery for the treatment of metastases from soft tissue sarcomas, with surgery improving survival in selected cases (5). This aggressive surgical approach was retrospectively assessed for several sarcoma subtypes, providing an evidential foundation for ablative techniques. Surgery currently has the highest level of evidential support for the ablation of limited metastases, due to reports of patients cured from metastases (6).Radiotherapy (RT) is integral in multimodal treatment and palliative care (1,2). The use of RT is more generally accepted for the treatment of border...

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“…7 Traitement par cryothérapie d'une récidive de synovialosarcome après chirurgie et radiothérapie. a : le scanner de référence montre une récidive bifocale dans la graisse sous-cutanée et contre la côte (flèches longues) ; b,c,d : cryothérapie de rattrapage : deux cryosondes sont insérées sous guidage échographique selon des trajets perpendiculaires, dans le grand axe des nodules (flèches courtes) ; le scanner confirme la position des sondes et permet de contrôler la couverture tumorale complète par la boule de glace hypodense ; noter l'hydrodissection autour de la glace pour protéger la peau ; e,f : le suivi scanographique à trois puis neuf mois sans traitement systémique montre un aspect de coagulation complète : dévascularisation et rétraction fibreuse progressive de la zone d'ablation consolider la réponse au traitement systémique, voire pour envisager une pause du traitement systémique afin de limiter sa toxicité [19]. La RFA pulmonaire a démontré une efficacité majeure supérieure à 95 % pour le contrôle local des nodules pulmonaires inférieurs à 2 cm, à condition que ces nodules soient situés à plus de 1 cm du hile [20].…”

Section: Introductionunclassified

Radiologie interventionnelle et tumeurs des tissus mous : du diagnostic au traitement

et al. 2016

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Reçu le 24 novembre 2015 ; accepté le 4 avril 2016 © Lavoisier SAS 2016Résumé La radiologie interventionnelle joue un rôle clé pour la prise en charge des tumeurs des tissus mous. D'abord au stade diagnostique par la réalisation de biopsies ciblées ; ces biopsies doivent répondre aux guides de bonnes pratiques dictées par les sociétés savantes internationales, dont nous rappelons les points clés. Ensuite, au stade thérapeu-tique, grâce aux techniques d'ablathermie (radiofréquence, cryothérapie) pour des indications très spécifiques. Ces procédures peuvent s'envisager en traitement de rattrapage sur la tumeur primaire, sur certaines récidives postchirurgie et radiothérapie ; elles peuvent aussi être proposées sur des formes oligométastatiques de sarcomes ; enfin, elles peuvent être indiquées en première ligne de traitement focal sur certaines tumeurs bénignes à agressivité locale telles qu'héman-giomes agressifs ou tumeurs desmoïdes. La radiologie interventionnelle vient renforcer l'arsenal thérapeutique en oncologie. Une approche multidisciplinaire reste indispensable pour sélectionner les meilleures indications.Mots clés Radiologie interventionnelle · Biopsie · Radiofréquence · Cryothérapie · Tumeurs des tissus mous · Sarcome · Oligométastases · Tumeur desmoïde Abstract Interventional radiology plays an increasing role in the management of soft tissue tumors. For initial diagnosis, precise and safe image-guided biopsies; soft tissue tumor biopsies must be performed in accordance with international guidelines. Then, in a therapeutic phase, interventional radiology, particularly with thermal ablation techniques (radiofrequency, cryoablation), can be proposed for specific indications like salvage treatment of recurrent tumor after surgery and radiotherapy, focal ablation for oligometastatic sarcomas, or treatment of benign locally aggressive tumors such as symptomatic hemangiomas or desmoid tumors. A multidisciplinary approach remains mandatory to achieve optimal patient selection for interventional radiology techniques.

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Effect on Survival of Local Ablative Treatment of Metastases from Sarcomas: A Study of the French Sarcoma Group

Cited by 69 publications

References 26 publications

Impact of surgery in patients with metastatic soft tissue sarcoma: A monocentric retrospective analysis

Impact of surgery in patients with metastatic soft tissue sarcoma: A monocentric retrospective analysis

Outcomes and toxicity of radiotherapy for refractory bone and soft tissue sarcomas

Radiologie interventionnelle et tumeurs des tissus mous : du diagnostic au traitement

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