Soft-tissue Sarcoma Metastases Identified on Abdomen and Pelvis CT Imaging

King, David M.; Hackbarth, Donald A.; Kilian, Christopher M.; Carrera, Guillermo F.

doi:10.1007/s11999-009-0989-1

Cited by 27 publications

(31 citation statements)

References 16 publications

(36 reference statements)

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“…8 Few case reports and studies have been published, describing the course of patients with abdominal or retroperitoneal metastases from STS. 7,13,14,[18][19][20] These studies either included relatively low numbers of patients with AM or did not describe factors associated with a higher risk of developing AM in a time-dependent manner.…”

Section: Discussionmentioning

confidence: 99%

“…Three studies have been published so far on the topic of AM of STS 7,13,14 . However, the number of patients with AM identified in these studies was relatively low and more importantly they did not distinguish between patients with AM as the first metastatic manifestation and those with AM developing after other metastases had occurred, therefore leaving many clinical questions unanswered.…”

Section: Introductionmentioning

confidence: 99%

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Incidence, treatment and outcome of abdominal metastases in extremity soft tissue sarcoma: Results from a multi‐centre study

Smolle

Schaffler

Leithner

et al. 2020

Journal of Surgical Oncology

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Background and Objectives Abdominal metastases (AM) from soft tissue sarcoma (STS) are rare and prognosis is poor. The aims of the study were to (a) identify risk factors for the development of AM and to (b) investigate the outcome of AM‐patients. Methods Seven‐hundred‐sixty‐nine STS‐patients with localised disease at diagnosis treated at three tumour centres (2000‐2016) were retrospectively included (409 males; mean age, 55.6 years [range, 8‐96 years]; median follow‐up, 4.1 years [interquartile‐range, 2.5‐6.6 years]). Results Two‐hundred‐two patients (26.3%) developed secondary metastases, and 24 of them AM (3.1%). Ten patients developed first AM (FAM) after a mean of 2.4 years and 14 patients late AM (LAM, after being diagnosed with metastases to other sites) after a mean of 2.0 years. Patients with liposarcoma had a significantly higher risk of developing AM (P = .007), irrespective of grading. There was no difference in post‐metastasis‐survival (PMS) between patients with AM at any time point and those with metastases to other sites (P = .585). Patients with LAM or FAM showed no difference in post‐abdominal‐metastasis‐survival (P = .884). Conclusions Survival in patients with AM is poor, irrespective of whether they develop secondarily to other metastases or not. Patients at high‐risk of AM (ie, liposarcoma) may be followed‐up regularly by abdominal‐ultrasound/CT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence, treatment and outcome of abdominal metastases in extremity soft tissue sarcoma: Results from a multi‐centre study

Smolle

Schaffler

Leithner

et al. 2020

Journal of Surgical Oncology

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“…In most cases CT abdomen/pelvis and isotope bone scan are not routine staging investigations, but CT may be considered, particularly in lower extremity tumours [26]. Depending on the histological type and other clinical features [26], further staging assessments may be advised as below:CT or MRI scan for regional lymph node assessment for synovial sarcoma, clear cell sarcoma, or epithelioid sarcoma due to a higher risk of nodal involvement.Atypical lipomatous tumours (ALT) of the extremities have a very low risk of metastatic spread and so chest X-ray may be considered adequate staging (see “Lipomas and atypical lipomatous tumours” section).In cases of myxoid liposarcoma soft-tissue metastases are more common and so abdominal and pelvic CT scan should be performed. Alternatively, although not yet established as routine practice, whole-body MRI has been shown to have potential utility in identifying occult metastatic disease and can be considered [27].…”

Section: Referral and Assessmentmentioning

confidence: 99%

UK guidelines for the management of soft tissue sarcomas

Dangoor¹,

et al. 2016

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Soft tissue sarcomas (STS) are rare tumours arising in mesenchymal tissues, and can occur almost anywhere in the body. Their rarity, and the heterogeneity of subtype and location means that developing evidence-based guidelines is complicated by the limitations of the data available. However, this makes it more important that STS are managed by teams, expert in such cases, to ensure consistent and optimal treatment, as well as recruitment to clinical trials, and the ongoing accumulation of further data and knowledge. The development of appropriate guidance, by an experienced panel referring to the evidence available, is therefore a useful foundation on which to build progress in the field. These guidelines are an update of the previous version published in 2010 (Grimer et al. in Sarcoma 2010:506182, 2010). The original guidelines were drawn up following a consensus meeting of UK sarcoma specialists convened under the auspices of the British Sarcoma Group (BSG) and were intended to provide a framework for the multidisciplinary care of patients with soft tissue sarcomas. This current version has been updated and amended with reference to other European and US guidance. There are specific recommendations for the management of selected subtypes of disease including retroperitoneal and uterine sarcomas, as well as aggressive fibromatosis (desmoid tumours) and other borderline tumours commonly managed by sarcoma services. An important aim in sarcoma management is early diagnosis and prompt referral. In the UK, any patient with a suspected soft tissue sarcoma should be referred to one of the specialist regional soft tissues sarcoma services, to be managed by a specialist sarcoma multidisciplinary team. Once the diagnosis has been confirmed using appropriate imaging, plus a biopsy, the main modality of management is usually surgical excision performed by a specialist surgeon. In tumours at higher risk of recurrence or metastasis pre- or post-operative radiotherapy should be considered. Systemic anti-cancer therapy (SACT) may be utilized in some cases where the histological subtype is considered more sensitive to systemic treatment. Regular follow-up is recommended to assess local control, development of metastatic disease, and any late-effects of treatment. For local recurrence, and more rarely in selected cases of metastatic disease, surgical resection would be considered. Treatment for metastases may include radiotherapy, or systemic therapy guided by the sarcoma subtype. In some cases, symptom control and palliative care support alone will be appropriate.

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“… 3 The current standard of care for newly diagnosed extremity soft-tissue sarcoma involves imaging of the chest for staging and surveillance for metastatic lesions. 3 , 6 - 9 Most sarcomas have been felt to spread first to the lungs prior to extra-pulmonary sites, however, specific sarcoma sub-types have been previously observed to spread to the abdomen initially. 6 , 10 , 11 The observation of isolated abdominal metastatic disease is rare, 6 , 10 - 12 but leads to many centres routinely imaging the abdomen/pelvis as a measure of screening and surveillance.…”

Section: Introductionmentioning

confidence: 99%

Screening and surveillance CT abdomen/pelvis for metastases in patients with soft-tissue sarcoma of the extremity

Thompson

Ross

Domson

et al. 2015

Bone & Joint Research

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ObjectivesThe clinical utility of routine cross sectional imaging of the abdomen and pelvis in the screening and surveillance of patients with primary soft-tissue sarcoma of the extremities for metastatic disease is controversial, based on its questionable yield paired with concerns regarding the risks of radiation exposure, cost, and morbidity resulting from false positive findings.MethodsThrough retrospective review of 140 patients of all ages (mean 53 years; 2 to 88) diagnosed with soft-tissue sarcoma of the extremity with a mean follow-up of 33 months (0 to 291), we sought to determine the overall incidence of isolated abdominopelvic metastases, their temporal relationship to chest involvement, the rate of false positives, and to identify disparate rates of metastases based on sarcoma subtype.ResultsA total of four patients (2.9%) exhibited isolated abdominopelvic metastatic disease during the surveillance period. In all cases of concomitant chest and abdominopelvic disease, chest involvement preceded abominopelvic involvement. There was a significant false positive rate requiring invasive workup.ConclusionsIn the setting of a relative paucity of evidence concerning a rare disease process and in difference to recently published investigations, we add a clinical cohort not supportive of routine cross sectional imaging of the abdomen and pelvis.Cite this article: Bone Joint Res 2015;4:45–9.

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Soft-tissue Sarcoma Metastases Identified on Abdomen and Pelvis CT Imaging

Abstract: Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

Cited by 27 publications

References 16 publications

Incidence, treatment and outcome of abdominal metastases in extremity soft tissue sarcoma: Results from a multi‐centre study

Incidence, treatment and outcome of abdominal metastases in extremity soft tissue sarcoma: Results from a multi‐centre study

UK guidelines for the management of soft tissue sarcomas

Screening and surveillance CT abdomen/pelvis for metastases in patients with soft-tissue sarcoma of the extremity

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