Preoperative radiotherapy for soft tissue sarcoma: The Peter MacCallum Cancer Centre experience

Hui, A.C.; Ngan, Samuel Y; Wong, Kevin; Powell, Gerard; Choong, Peter F. M.

doi:10.1016/j.ejso.2006.04.003

Cited by 31 publications

(26 citation statements)

References 20 publications

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“…Adjuvant radiotherapy was administered to some patients, either preoperatively (1-100%) or postoperatively (6-88%), in 24 of the included studies. Preoperative radiotherapy, which may allow for the use of smaller field sizes and lower radiation doses and have lower long-term morbidity than postoperative radiotherapy (Pisters et al, 2007), seemed to be the standard of care at an Australian study centre (Choong et al, 2003;Hui et al, 2006;Rudiger et al, 2009;Miki et al, 2010), despite the potential for acute postoperative wound complications (Hui et al, 2006;Rudiger et al, 2009). Although the use of adjuvant chemotherapy may help local control, its marginal, if any, survival benefit (Pervaiz et al, 2008;Woll et al, 2012) has generally restricted its use to treatment of metastatic disease (Casali et al, 2010;National Comprehensive Cancer Network, 2012).…”

Section: Discussionmentioning

confidence: 99%

“…The number of patients [minimum, 12 (Jun et al, 2010); maximum, 324 (Dickinson et al, 2006) was fewer than 50 in 17 of the 32 studies. Only 13 studies specified whether STS was primary or recurrent [8 primary (Dickinson et al, 2006;Hui et al, 2006;Wu et al, 2006;An et al, 2007;Kim et al, 2008a;Ng and Tan, 2009;Wang et al, 2009;Liu et al, 2010); 5 primary or recurrent (Hsieh et al, 2003;Kiatisevi et al, 2006;Moncrieff et al, 2008;Miki et al, 2010;Cho et al, 2011)]. Patients had local disease in 15 studies (Choong et al, 2003;Campbell et al, 2004;Hsu et al, 2004;Dickinson et al, 2006;Hui et al, 2006;An et al, 2007;Kim et al, 2007;2008c;Pervaiz et al, 2008;Rudiger et al, 2009;Wang et al, 2009;Liu et al, 2010;Cho et al, 2011;Han et al, 2011), and local or metastatic disease in 7 studies (Wu et al, 2006;Chan et al, 2008;Moncrieff et al, 2008;Koh et al, 2009;Jun et al, 2010;Park et al, 2010;Lee et al, 2011).…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

“…Nearly all patients were treated with surgery: 100% in 5 studies and 86%, 92%, and 99% in the other 3 studies ( Table 2). The remaining patients were not treated with surgery because it was not indicated (Wang et al, 2009), the surgery was biopsy only , or distant metastases were detected during restaging studies (eg, magnetic resonance imaging of primary tumour site) done after preoperative radiotherapy (Hui et al, 2006). Only 5 patients from 2 studies had amputations (Table 2).…”

Section: Studies Of Primary Soft-tissue Sarcomamentioning

confidence: 99%

“…Only 5 patients from 2 studies had amputations (Table 2). In 1 study, complications arising from surgery (minor or major dehiscence, infection, delayed healing, haematoma/ seroma, flap necrosis, and wound edge necrosis) affected 27 (41%) patients (Hui et al, 2006). Few patients (14%, 1 study) had preoperative chemotherapy, whereas 1% (1 study) and 100% (1 study) of patients had preoperative (Huang et al, 2006;Lin et al, 2006;Huang et al, 2008;Huang et al, 2010) report data from a single group of patients over time, only data from the most recent publication (Huang et al, 2010) were reviewed; k Follow-up data were available for 74 of the 78 patients; l Of the 20 patients, 15 died of causes related to soft-tissue sarcoma and 5 died of other causes radiotherapy.…”

Section: Studies Of Primary Soft-tissue Sarcomamentioning

confidence: 99%

See 3 more Smart Citations

Soft-tissue Sarcomas in the Asia-Pacific Region: A Systematic Review

Ngan¹,

Wang²,

Porter³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Asian Pac J Cancer Prev, 14 (11), [6821][6822][6823][6824][6825][6826][6827][6828][6829][6830][6831][6832] Introduction Soft-tissue sarcomas (STS) are a heterogeneous group of rare tumours. More than 50 STS histotypes have been identified, with most having unique clinical, prognostic, and therapeutic features. Although less than 1% of all adult malignant tumours are STS (Fletcher et al., 2002a), their treatment and management is complex because many tumour-related (eg, histotype, site, size, depth, grade, primary vs recurrent) (Singer et al., 1994;2000;Pisters et al., 1996) and treatment-related (eg, surgical margins, use of adjuvant therapy) (Singer et al., 2000) factors influence patient outcomes. Because these factors are inherently variable and because STS is rare, the management of patients with STS is best undertaken by an experienced multidisciplinary team in specialist centres to minimise recurrence, maximise survival, and preserve functionality and quality of life (Ray-Coquard et al., 2004;Luis et al., 2010; National Comprehensive Cancer Network, 2012).The standard primary treatment for STS is surgical AbstractBackground: Soft-tissue sarcomas require tailored and multidisciplinary treatment and management. However, little is known about how sarcomas are treated and managed throughout the Asia-Pacific region. Materials and Methods: MEDLINE was systematically searched using prespecified criteria. Publications (previous 10 years) that reported tumour characteristics, treatment patterns, survival outcomes, and/or safety outcomes of patients with soft-tissue sarcoma were selected. Exclusion criteria were studies of patients <18 years of age; ≤10 patients; countries other than Australia, Hong Kong, Indonesia, Korea, Malaysia, New Zealand, Philippines, Singapore, Taiwan, or Thailand; >20% benign tumours; sarcomas located in bones or joints; gastrointestinal stromal tumour; Kaposi's sarcoma; or not reporting relevant outcomes. Results: Of the 1,822 publications retrieved, 35 (32 studies) were included. Nearly all patients (98%, 1,992/2,024; 31 studies) were treated with surgery, and more studies used adjuvant radiotherapy than chemotherapy (24 vs 17 studies). Survival outcomes and recurrence rates varied among the studies because of the different histotypes, sites, and disease stages assessed. Only 5 studies reported safety findings. Conclusions: These findings highlight the lack of specific data available about soft-tissue sarcomas in the Asia-Pacific region. Better efforts to understand how the sarcoma is managed and treated will help improve patient outcomes in the region.

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Section: Discussionmentioning

confidence: 99%

Section: Study and Patient Characteristicsmentioning

confidence: 99%

Section: Studies Of Primary Soft-tissue Sarcomamentioning

confidence: 99%

Section: Studies Of Primary Soft-tissue Sarcomamentioning

confidence: 99%

See 2 more Smart Citations

Soft-tissue Sarcomas in the Asia-Pacific Region: A Systematic Review

Ngan¹,

Wang²,

Porter³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…19,20 At an early stage, the growth consists of both well-differentiated and undifferentiated cells, with undifferentiated cells dominating composition as the tumor progresses in size. Cells of the myxiod variety (intermediate stage disease) were mostly noted, with very few of the round cells/pleomorphic (aggressive, late stage) variety.…”

Section: Discussionmentioning

confidence: 99%

Involvement of c-jun in human liposarcoma growth: supporting data from clinical immunohistochemistry and DNAzyme efficacy

Dass

Galloway²,

Clark³

et al. 2008

Cancer Biology & Therapy

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The significance of a marginal excision after preoperative radiation therapy for soft tissue sarcoma of the extremity

Dagan

Indelicato

McGee

et al. 2011

Cancer

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BACKGROUND: Marginal excision of soft tissue sarcoma (STS), defined as resection through the tumor pseudocapsule or surrounding reactive tissue, increases the likelihood of local recurrence and necessitates re-excision or postoperative radiation. However, its impact after preoperative radiation therapy (RT) remains unclear. This study therefore investigated the significance of marginal margins in patients treated with preoperative RT for extremity STS, reporting long-term local control and limb preservation endpoints. METHODS: The records of 317 adults at the University of Florida with nonmetastatic extremity STS treated from 1980 to 2008 with preoperative RT as part of a limb conservation strategy were reviewed. The median follow-up was 4.7 years (8.3 years for living patients). The median tumor size was 10 cm (range, 2-36 cm), and 86% were high grade. The median RT dose was 50.4 Gy (range, 12.5-57.6 Gy). Margins were classified as wide/radical (n ¼ 105), marginal (n ¼ 179), contaminated (n ¼ 15), positive (n ¼ 17), or unknown (n ¼ 1). Endpoints were local control (LC), amputation-free survival (AFS), cause-specific survival (CSS), and overall survival (OS). RESULTS: Five-year CSS and OS rates were 62% and 59%, respectively. Five-year LC and AFS was 93% and 89%, respectively. AFS by margin status was 64%, 83%, 97%, and 92% for positive, contaminated, marginal, and wide/radical margins, respectively (P<.005). Marginal excision following preoperative RT resulted in equivalent LC and AFS compared with wide/radical margins. CONCLUSIONS: Marginal resection after preoperative RT does not compromise LC or AFS in extremity STS. This finding may be related to radiosterilization of tumor cells within the reactive zone following preoperative RT.

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Preoperative radiotherapy for soft tissue sarcoma: The Peter MacCallum Cancer Centre experience

Cited by 31 publications

References 20 publications

Soft-tissue Sarcomas in the Asia-Pacific Region: A Systematic Review

Soft-tissue Sarcomas in the Asia-Pacific Region: A Systematic Review

Involvement of c-jun in human liposarcoma growth: supporting data from clinical immunohistochemistry and DNAzyme efficacy

The significance of a marginal excision after preoperative radiation therapy for soft tissue sarcoma of the extremity

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