Outcome After Surgical Resections of Recurrent Chest Wall Sarcomas

Wouters, Michel W. J. M.; Geel, A.N. van; Nieuwenhuis, Lotte L.; Tinteren, Harm van; Verhoef, C.; Coevorden, Frits van; Klomp, Houke M.

doi:10.1200/jco.2008.17.4631

Cited by 53 publications

(61 citation statements)

References 16 publications

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“…But, a considerable proportion of the patients are presenting with locally advanced tumors not amenable to wide local excision with negative margins due to the bulk and extent of the tumor or proximity to critical tissues. Postoperative radiotherapy as an adjunct to surgical treatment is required for the patients with large and high grade tumors and with close or positive margins (Lindberg et al, 1981;Wouters et al, 2008;Burt et al, 2013). On the other hand preoperative radiotherapy, chemotherapy, or combined chemoradiotherapy can be applied to these patients in order to allow more conservative surgery with negative margins (Kraybill et al, 2010;Burt et al, 2013).…”

Section: Long-term Treatment Results In Soft Tissuementioning

confidence: 99%

“…The DFS rate is inferior in the current series than the others, that might be related with the large tumor size and the significant number of high grade tumors. The overall 5-year OS has been reported in range of 60 to 66% with LC exceeding 70% (Gordon et al, 1991;Wouters et al, 2008;Salas et al, 2009). In the Gross et al study, the 5-year OS rate was 87.3% and DFS rate was 75.3% which was greater than those observed by our study and the others (Gross et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Treatment Results in Soft Tissue Sarcomas of the Thoracic Wall Treated with Pre-or-Postoperative Radiotherapy - a Single Institution Experience

Öksüz¹,

Özdemir²,

Kaydıhan³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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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 pleomorphic sarcoma (26.9%). Tumor size varied between 2-25 cm (median 6.5 cm). Seventeen of the cases had marginal and 9 had wide local resection. Four cases received preoperative radiotherapy and 22 postoperative radiotherapy. Six of the patients with large and high grade tumors received chemotherapy. Median follow-up time was 82 months (9-309 months). Local recurrence and metastasis was detected in 34.6% and 42.3% of patients, respectively. Fiveyear local control (LC), disease-free survival (DFS), overall survival (OS), and disease-specific survival (DSS) were 62%, 38%, 69%, and 76% respectively. On univariate analysis, the patients with positive surgical margins had a markedly lower 5-year LC rate than patients with negative surgical margin, but the difference was not significant (43% vs 78%, p=0.1). Five-year DFS (66% vs 17%) and DSS (92% vs 60%) rates were significantly worse for the patients who had high grade tumors (p=0.01, p=0.008 respectively). Conclusions: Tumor grade and surgical margin are essential parameters for determining the prognosis of thoracic wall soft tissue sarcoma both in our series and the literature.

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Section: Long-term Treatment Results In Soft Tissuementioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long-Term Treatment Results in Soft Tissue Sarcomas of the Thoracic Wall Treated with Pre-or-Postoperative Radiotherapy - a Single Institution Experience

Öksüz¹,

Özdemir²,

Kaydıhan³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…[12-14] Loco-regional recurrence of breast cancer in the chest wall occurs in approximately 9% of patients undergoing breast conservation therapy. [14] Multi-modality treatment including chemotherapy, radiation, and surgery is typically employed.…”

Section: Surgical Resection Of the Irradiated Chest Wallmentioning

confidence: 99%

Surgical Management of the Radiated Chest Wall and Its Complications

Raz

Clancy

Erhunmwunsee

2017

Thoracic Surgery Clinics

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Synopsis Radiation to the chest wall is common before resection of tumors. History of radiation does not necessarily change the surgical approach of soft tissue coverage needed for reconstruction. Osteoradionecrosis can occur after radiation treatment, particularly after high dose radiation treatment. Radical resection and reconstruction is feasible and can be life saving. Soft tissue coverage using myocutaneous flap or omental flap is determined by the quality of soft tissue available and the status of the vascular pedicle supplying available myocutaneous flaps. Radiation induced sarcomas of the chest wall occur most commonly after radiation therapy for breast cancer. While angiosarcomas are the most common histology of radiation induced sarcoma, osteosarcoma, myosarcomas, rhabdomyosarcoma, and undifferentiated sarcomas also occur. The most effective treatment is surgical resection. Tumors not amenable to surgical resection are treated with chemotherapy with low response rates.

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“…For the primary chest wall sarcomas the five-year overall and disease-free survivals were 66% and 47%, respectively (24). Favorable prognostic variables for survival included age below 50 years, bony tumor, chondrosarcoma, and low grade soft tissue sarcoma (7).…”

Section: Prognosismentioning

confidence: 99%

Chest Wall Reconstruction after Oncological Resections

Tukiainen

2013

Scand J Surg

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Most chest wall defects requiring reconstruction result from tumor resection. bone and soft tissue sarcomas and recurrent mammary cancer are the most common tumors. Careful preoperative evaluation, meticulous surgical technique and active postoperative treatment are important. the selection of reconstruction is based on the nature, size and location of the defect as well as on the general health and prognosis of the patient. the goals of the reconstruction are adequate stability, water-and airtight closure of the chest cavity, and acceptable cosmetic appearance. the pedicled muscular or musculocutaneous flaps are usually the first choice for tissue coverage. these include flaps such as latissimus dorsi, vertical or transverse rectus abdominis and pectoralis. in certain cases also the breast flap or omental flap can be used. in selected cases, a free flap reconstruction is indicated if the local options for reconstruction have been used, or if they are unreliable due to earlier scars or radiotherapy. the free flaps to be used for chest wall can be harvested from the thigh (tensor fascia latae flap, anterolateral thigh flap), from the abdomen (transverse rectus abdominis flaps, deep epigastric perforator flaps) or from the chest wall (latissimus dorsi flap and other flaps based on the subscapular artery). sometimes a fillet forearm can be used as a flap to cover a defect after extended forequarter amputation. artificial meshes are commonly used to give stability in the defect and to give a platform for the flap. Methylmethacrylate embedded between the two layers of a mesh, or one or two rib grafts fixed to the mesh, can be used to give additional stability in extensive defects to prevent paradoxical movement.

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Outcome After Surgical Resections of Recurrent Chest Wall Sarcomas

Abstract: Although chances for local control are lower after surgical treatment of recurrent chest wall sarcoma, chest wall resection is a safe and effective procedure, with an acceptable survival.

Cited by 53 publications

References 16 publications

Long-Term Treatment Results in Soft Tissue Sarcomas of the Thoracic Wall Treated with Pre-or-Postoperative Radiotherapy - a Single Institution Experience

Long-Term Treatment Results in Soft Tissue Sarcomas of the Thoracic Wall Treated with Pre-or-Postoperative Radiotherapy - a Single Institution Experience

Surgical Management of the Radiated Chest Wall and Its Complications

Chest Wall Reconstruction after Oncological Resections

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