Long-Term Treatment Results in Soft Tissue Sarcomas of the Thoracic Wall Treated with Pre-or-Postoperative Radiotherapy - a Single Institution Experience
Abstract:Objective: To evaluate the long term results among patients with soft tissue sarcoma of the thoracic wall. Materials and Methods: Twenty-six patients who were treated with pre-or postoperative radiotherapy between December 1980-December 2007, with a diagnosis of soft tissue sarcoma of the thoracic wall were retrospectively evaluated. Results: The median age was 44 years (14-85 years) and 15 of them were male. A total of 50% of patients were grade 3. The most common histologic type of tumor was undifferentiated… Show more
“…Tsukushi et al ( 5 ) performed a study on 44 patients with chest wall STS involving a high proportion of dermatofibrosarcoma protuberans (27.2 vs. 7.5% in the current study), which rarely metastasizes and, therefore, may have resulted in the high 5-year OS rate of 89%. The distribution of histological subtypes in the series of Oksuz et al ( 4 ) was comparable with that in the patient population of the present study, resulting in similar 5-year OS rates (69 vs. 66%). The study by Oksuz et al ( 4 ) is the only analysis on chest wall STS to date that determined the prognostic effects of surgical margins.…”
Section: Discussionsupporting
confidence: 87%
“…The remaining studies on chest wall STS by Oksuz et al ( 4 ) and Tsukushi et al ( 5 ) revealed age and histological grade to be significant prognostic factors of survival based on univariate analyses. Tsukushi et al ( 5 ) performed a study on 44 patients with chest wall STS involving a high proportion of dermatofibrosarcoma protuberans (27.2 vs. 7.5% in the current study), which rarely metastasizes and, therefore, may have resulted in the high 5-year OS rate of 89%.…”
Data on prognostic factors and treatment outcomes for chest wall soft tissue sarcomas (STS) are sparse. Wide resections with negative margins are the mainstay of therapy, but the prognostic impact of surgical margins remains controversial. The purpose of the present study was to determine the significance of microscopic margins through a long-term follow-up. The associations between local recurrence-free survival (LRFS), overall survival (OS) and potential prognostic factors were retrospectively assessed in a consecutive series of 110 patients who were suitable for surgical treatment with curative intent. Potential prognostic factors were assessed using univariate and multivariate analyses. The median follow-up time following primary diagnosis was 9.6 years [95% confidence interval (CI), 7.2–10.5]. In the entire cohort, the 5-year estimates of the OS and LRFS rates were 66.0% (95% CI, 55.9–74.3) and 60.6% (95% CI, 50.3–69.4), respectively. A total of 27 patients (24.5%) developed distant metastases with a median survival time of 0.9 years following the diagnosis of metastasis. Surgical margins attained at the initial resection and eventual re-excisions significantly influenced OS in univariate analysis (5-year OS, R0 69.9% vs. R1/R2 38.5%; P=0.046), but this failed to reach statistical significance in the multivariate analysis. In the multivariate analysis, significant adverse prognostic features of LRFS included angiosarcoma subtype, G2 and G3 histology. For OS, the only independent significant predictors were age >50 years, tumor size >5 cm, angiosarcoma subtype and G3 histology. The results of the present study suggest that tumor biology, as reflected by the histological grade, influences the final outcome in patients with chest wall STS. Surgical margins failed to reach statistical significance in multivariate analysis as they demonstrated a dependency towards the independent predictors of OS. Subsequently, a positive margin status may be a result rather than a cause of biological aggressiveness, and it may not influence the outcome directly.
“…Tsukushi et al ( 5 ) performed a study on 44 patients with chest wall STS involving a high proportion of dermatofibrosarcoma protuberans (27.2 vs. 7.5% in the current study), which rarely metastasizes and, therefore, may have resulted in the high 5-year OS rate of 89%. The distribution of histological subtypes in the series of Oksuz et al ( 4 ) was comparable with that in the patient population of the present study, resulting in similar 5-year OS rates (69 vs. 66%). The study by Oksuz et al ( 4 ) is the only analysis on chest wall STS to date that determined the prognostic effects of surgical margins.…”
Section: Discussionsupporting
confidence: 87%
“…The remaining studies on chest wall STS by Oksuz et al ( 4 ) and Tsukushi et al ( 5 ) revealed age and histological grade to be significant prognostic factors of survival based on univariate analyses. Tsukushi et al ( 5 ) performed a study on 44 patients with chest wall STS involving a high proportion of dermatofibrosarcoma protuberans (27.2 vs. 7.5% in the current study), which rarely metastasizes and, therefore, may have resulted in the high 5-year OS rate of 89%.…”
Data on prognostic factors and treatment outcomes for chest wall soft tissue sarcomas (STS) are sparse. Wide resections with negative margins are the mainstay of therapy, but the prognostic impact of surgical margins remains controversial. The purpose of the present study was to determine the significance of microscopic margins through a long-term follow-up. The associations between local recurrence-free survival (LRFS), overall survival (OS) and potential prognostic factors were retrospectively assessed in a consecutive series of 110 patients who were suitable for surgical treatment with curative intent. Potential prognostic factors were assessed using univariate and multivariate analyses. The median follow-up time following primary diagnosis was 9.6 years [95% confidence interval (CI), 7.2–10.5]. In the entire cohort, the 5-year estimates of the OS and LRFS rates were 66.0% (95% CI, 55.9–74.3) and 60.6% (95% CI, 50.3–69.4), respectively. A total of 27 patients (24.5%) developed distant metastases with a median survival time of 0.9 years following the diagnosis of metastasis. Surgical margins attained at the initial resection and eventual re-excisions significantly influenced OS in univariate analysis (5-year OS, R0 69.9% vs. R1/R2 38.5%; P=0.046), but this failed to reach statistical significance in the multivariate analysis. In the multivariate analysis, significant adverse prognostic features of LRFS included angiosarcoma subtype, G2 and G3 histology. For OS, the only independent significant predictors were age >50 years, tumor size >5 cm, angiosarcoma subtype and G3 histology. The results of the present study suggest that tumor biology, as reflected by the histological grade, influences the final outcome in patients with chest wall STS. Surgical margins failed to reach statistical significance in multivariate analysis as they demonstrated a dependency towards the independent predictors of OS. Subsequently, a positive margin status may be a result rather than a cause of biological aggressiveness, and it may not influence the outcome directly.
“…Several previous retrospective studies have also focused exclusively on patients with primary chest wall STS; however, these studies are difficult to compare because of heterogeneous patient selection criteria and variable frequencies of high‐grade sarcomas (Table ). Nevertheless, these studies have identified several prognostic factors that influence survival in chest wall STS patients, including tumor grade, tumor size, completeness of surgical margins, and age . For example, Gross et al and Harati et al noted that a tumor size of <5 cm was associated with improved OS.…”
Background: Primary soft tissue sarcomas (STSs) involving the chest wall are uncommon. The aim of this study was to identify factors that influence the prognosis of patients with primary chest wall STS. Methods: The records of 38 patients (23 men and 15 women) who were treated at our institutions during 2002 to 2018 were reviewed. The following variables were evaluated as potential prognostic factors: sex, tumor size, chemotherapy, and completeness of surgical margins. Multivariate analysis was conducted to identify predictors of overall survival (OS) and disease-free survival (DFS). Results: Of the 38 included patients, 5 had low-grade tumors and 33 had high-grade tumors. Five patients required chest wall reconstruction including rib resection. Thirty patients (79%) underwent R0 resection. The 5-year OS and DFS rates were 45% and 27%, respectively. Local recurrence developed in 7 patients. Multivariate analysis identified tumor size (hazard ratio [HR]: 4.13; 95% confidence interval [CI]: 1.05-16.24; P = .04) and R1/2 resection (HR: 3.92; 95% CI: 1.12-13.66; P = .03) as predictors of OS. Conclusions: Prognostic factors for survival included tumor size and completeness of surgical margins. Complete tumor excision is desirable, particularly in cases of early detection.
“…Generally, wide local excision can be adequate for small superficial lesions. But, when the recurrence of tumor on the chest wall occurs, advanced cutaneous neoplasm and lymphoma, patients are not amenable to wide local excision with negative margins due to the bulk and extent of the tumor [2]. Meanwhile, radiotherapy to the chest wall could carry the risks of radiation-related toxicity such as pneumonitis, lung fibrosis, and coronary heart disease because considerable volumes of heart and lung are likely to receive high doses [2].…”
Section: Introductionmentioning
confidence: 99%
“…But, when the recurrence of tumor on the chest wall occurs, advanced cutaneous neoplasm and lymphoma, patients are not amenable to wide local excision with negative margins due to the bulk and extent of the tumor [2]. Meanwhile, radiotherapy to the chest wall could carry the risks of radiation-related toxicity such as pneumonitis, lung fibrosis, and coronary heart disease because considerable volumes of heart and lung are likely to receive high doses [2]. Although modern radiation therapy techniques have been introduced to avoid high dose exposure to surrounding and underlying healthy tissue, their clinical benefit is still a matter of debate [1].…”
Treatment of malignancies on the chest wall, like chest wall recurrence of tumor, advanced cutaneous neoplasm and lymphoma, is still a challenge due to the involvement of the critical structures of heart and lung by the conventional strategy. The aim of the current study was to investigate targeted photo-chemo therapy mediated by Fe3O4@ZnO nanocomposites for malignancy on the chest wall while cardiopulmonary avoidance. Fe3O4@ZnO/Dox nanocomposites, the synthesis of the core-shell Fe3O4@ZnO nanocomposites followed by loading doxorubicin (Dox), were prepared to act as multifunctional drug delivery system (DDS). The synergistic anticancer effects on tumor on the chest wall and protection performance of heart and lung were evaluated in vitro and in vivo using cell viability assay, apoptosis detection, histopathologic examination, and serum biochemistry tests. Our observations demonstrated that Fe3O4@ZnO/Dox nanocomposites, could play the role of magnetic drug targeting to deliver Dox into tumor tissues and cells to enhance its chemotherapeutic efficiency. Besides, with ultraviolet (UV) illumination, Fe3O4@ZnO showed the excellent property of photosensitizer, further attacking the cancer cells by photodynamic therapy (PDT). Thus, apoptosis was synergistically induced by the photo-chemo therapy, resulting in a distinct improvement in anticancer activity. Since UV has a limited penetration distance in tissue, causing PDT to fail in the critical structures of heart and lung, cardiopulmonary hurt could be avoided during the treatment. Therefore, targeted photo-chemo therapy mediated by Fe3O4@ZnO nanocomposites may have promise as a potent treatment option for superficial malignancies on the chest wall while cardiopulmonary avoidance.
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