The role of radiotherapy in adult soft tissues sarcoma of the extremities

Cammelli, S.; Cortesi, A.; Buwenge, M.; Zamagni, Alice; Ferioli, Martina; Ghigi, G.; Romeo, Antonino; Morganti, Alessio Giuseppe

doi:10.1007/s00590-021-02990-6

Cited by 9 publications

(9 citation statements)

References 57 publications

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“…However, such wide margins were not possible in most cases and resulted in limb loss. With perioperative radiation, recurrence was significantly reduced in narrow margins, making limb salvage surgery feasible in tumors surrounding vital structure [ 27 ]. In our study, nearly 70% of patients underwent postoperative radiation.…”

Section: Discussionmentioning

confidence: 99%

The Outcome of Extremity Soft Tissue Sarcomas in Terms of Resection Margins: A Study From a Cancer Dedicated Center

Shafiq¹,

Rafi²,

Ahmed³

et al. 2022

Cureus

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Introduction Extremity soft-tissue sarcomas are uncommon malignancies of mesenchymal tissue, it accounts for <1 % of cancers and has a high recurrence rate with positive resection margins and unplanned excision. This study aims to determine the influence of unplanned excision and resection margins on local recurrence, metastasis, and overall survival in soft tissue sarcoma of the extremities. Methods A retrospective review was conducted from January 2005 to December 2015 on all the patients with soft tissue sarcoma of the extremities. Age, sex, histopathology, site, tumor grade, biopsy type, recurrence, metastasis, and end outcome were analyzed. Kaplan-Meir curves were used for Survival analysis, and log-rank or the Cox proportional-hazards regression model was used for Significance analysis. The data were entered into SPSS version 20, and Statistical significance was set at a p-value ≤0.05. Results One hundred forty-five patients with soft tissue sarcoma of extremities were managed with a mean follow-up of 76.3+/-6.7 months. Undifferentiated pleomorphic sarcoma 47 (32.4%) was the most common pathology found in this cohort, followed by Synovial sarcoma 34 (23.4%) and Liposarcoma 19 (13.1%). The most common site of occurrence was lower extremity 102 (70.3%). All the patients had residual disease after unplanned excisions; 107 underwent R0 resection, while 38 underwent R1 resection. Five-year overall survival was 70.2 & 71.1 % for R1 & R0 resections, respectively, and 71.3% for excisional and 74.2% for incisional biopsy. The tumor grade significantly influences overall survival, while other variables were not found to affect Recurrence-free survival and metastasis-free survival. Conclusion The data indicates that the high-grade tumor has a negative influence on overall survival, while resection margins width and unplanned excision have no significant effect on local recurrence, Metastasis free survival, and overall survival; however, before excision, adequate planning and awareness among general surgeons is necessary to improve the surgical morbidity and financial burden over the health care facilities.

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Section: Discussionmentioning

confidence: 99%

The Outcome of Extremity Soft Tissue Sarcomas in Terms of Resection Margins: A Study From a Cancer Dedicated Center

Shafiq¹,

Rafi²,

Ahmed³

et al. 2022

Cureus

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“…In the study of Falk et al (18,19) ablation therapies such as surgery, radiofrequency and radiotherapy had a significant survival advantage in metastatic sarcomas compared to patients who did not receive these treatments (p=0.0001). In the study of Lindsay et al (20), it was shown that stereotactic body RT provided a survival advantage in lung metastases.…”

Section: Discussionmentioning

confidence: 97%

Local control results in extremity soft tissue sarcomas

Ertas

ALTUNDAĞ

Akkaş

et al. 2022

Journal of Health Sciences and Medicine

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Aim: The aim of this study is to investigate local control results and effective predictive factors in local control of extremity soft tissue sarcomas, retrospectively. Material and Method: 51 patients underwent postoperative adjuvant radiotherapy (RT) in Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital between October 2008-January 2022. Patients who underwent post-operative adjuvant RT were treated with 60-68 Gy in 2 phases from 2 Gy /day using conformal radiotherapy technique. IMA chemotherapy protocol was applied to 31.4% of the patients after radiotherapy. Results: The median follow up time was 46 months range (1-135). Recurrence was detected in 5 of the patients and the mean time of recurrence was 11.6 months (min: 3-max: 27). 10 patients developed metastasis at follow-up, the mean time until metastasis was 27 months (min: 18- max: 46). The mean overall survival (OS) was 103 (min:4-max:139) months and the OS of 2, 5 and 10 years were 93%, 65% and 60%, respectively. Disease-free survival (DFS) was 97 (min:4-max:139) months; 2, 5 and 10 years of DFS were 77%, 65% and 60%, respectively. The OS in patients aged ≥65 years old was significantly lower than in patients <65 years old (p=0.02). Overall and disease-free survival was significantly lower in patients undergoing chemotherapy (p=0.037 for overall survival, p=0.013 for disease-free survival). The occurrence of recurrence, metastasis or death within 3 years after the operation was significantly higher than after 3 years (p<0.001). Local failure was significantly higher in grade 3 tumors (p=0.05). All patients who recurred had grade 3 tumors. Metastasis and excitus were significantly higher in the follow-up of patients who underwent chemotherapy at one point during their treatment (p=0.027 for metastasis, p=0.042). Conclusion: While favorable local control results are obtained with adjuvant high dose-conformal radiotherapy in extremity sarcomas, close follow up is important for distant metastasis and local recurrence, especially in the first 3 years.

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“…1,6,9 Pertaining to anatomical site involvement, extremities predominantly the lower extremity are the most commonly involved anatomical site ranging from 40-60% which is analogous to this study with an involvement of 36%. 6,13,15 All three type of resections R0,R1,R2 have been opted as surgical treatment in both the local and international studies with on average R0 being done in 70%, R1 in 15% and R2 in 8 %of the patients. 1,6,9,10 While in this study resections were R0-46%, R1-49.5% and R2-5.5%.…”

Section: Discussionmentioning

confidence: 99%

“…Most recurrences occurred within 6 months after the surgery in 22% cases which is consistent with both the national and international literature. 6,9,10,15 For soft tissue sarcoma, the recommended surgical treatment is wide local excision with negative margins. 1,2,16 .…”

Section: Discussionmentioning

confidence: 99%

Spectrum of soft tissue sarcomas: Experience of surgery at a tertiary care referral hospital in Central Lahore

Nazir¹,

Naveed

Bano

et al. 2023

J Fatima Jinnah Med Univ

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Background: Soft tissue sarcomas (STS) are malignant tumours arising from mesenchymal tissue, comprising <1% of all the tumours of the human body and represent the second most common type of solid tumours in children and adolescents. Surgical resection is considered the mainstay of treatment, supported by multimodal therapies including chemotherapy and radiotherapy. Resource-limited countries, like Pakistan, face additional challenges due to inadequate resources. This study presents the experience of management of soft tissue sarcomas presenting to a tertiary care hospital in Central Lahore. Patients and methods: This was an observational study conducted in Surgical Unit I of Sir Ganga Ram Hospital Lahore from January 2017 till June 2022. American Joint Committee on Cancer (AJCC) staging system and Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) resection classification was applied. Surgical treatment including R0, R1 and R2 resections were carried out. SPSS 23 version was used for statistical analysis of collected data. Results: A total of 36 patients; 24 male (66.7%) and 12 females (33.3%) were included. Anatomical site involvement was observed as 23 (63.8%) limb sarcomas and 13 (36.1%) trunk sarcomas. Out of 36 patients, 20 (55.6%) patients were staged as stage II, 11 (30.5%) patients as stage III and 5 (13.9%) as stage I. Total 17 (47.2%) patients underwent wide excision, 13 (36.1%) patients underwent limited excision, 4 (11.1%) patients underwent compartmental excision and 2 (5.6%) patients underwent palliative excision. Recurrence was observed in 8 patients for which palliative 2 (5.6%), limited 3 (8.3%) or potentially curative resection 3 (8.3%) was performed. Conclusion: Thigh was the commonest site of involvement in extremity sarcomas. Retroperitoneal sarcomas were most frequent among trunk tumours. Leiomyosarcoma was the most common histopathological diagnosis followed by malignant peripheral nerve sheath tumours. Most of the patients presented with stage II disease. Resectional surgery, whether curative or palliative, was found to be the management modality of choice. Rhabdomyosarcoma most frequently recurred within 6 months of potentially curative surgery (R1), most likely due to compromised initial resection.

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The role of radiotherapy in adult soft tissues sarcoma of the extremities

Cited by 9 publications

References 57 publications

The Outcome of Extremity Soft Tissue Sarcomas in Terms of Resection Margins: A Study From a Cancer Dedicated Center

The Outcome of Extremity Soft Tissue Sarcomas in Terms of Resection Margins: A Study From a Cancer Dedicated Center

Local control results in extremity soft tissue sarcomas

Spectrum of soft tissue sarcomas: Experience of surgery at a tertiary care referral hospital in Central Lahore

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