No abstract

Purpose: The purpose of the study was to investigate the prognostic factors and survival after preoperative radiotherapy in Extremity Soft Tissue Sarcomas (ESTS). Materials and Methods: In this retrospective study, all patients treated for an extremity sarcoma with pre-operative radiotherapy followed by surgery. Results: The mean follow-up for all 24 ESTS patients was 15.5 (range: 10-39 months). At last follow-up, 9 patients (37%) were alive, 15 patients (62%) had died of distant disease progression. Among the patients died, there were 15 with metastatic relapse (13 lung and 2 cranial metastasis), 5 with both local and metastatic recurrence. The median OS was 16 month. The 2-years actuarial OS rate and 3-years OS rate were 39% and 26%, respectively. The median RFS was 14(12.5-15.4) month. The 2-years and 3-years RFS rate was 71%.The median MFS was 12 months. The 2-years and 3-years MFS rate were 33%, 17%, respectively. The effects of age, sex, histopathologic type, tumor size, tumor localization, tumor grade, tumor depth, radiation doses and recestion margin on OS, RFS, MFS were not observed. In univariate and multivariate model, it was observed that recurrence decreased OS time significantly (p<0.05). Conclusion: Recurrens and metastasis are strong and negative prognostic factor for survival in extremity soft tissue sarcoma patients.

Malignant Fibrous Histiocytoma (MFH) is a fairly common tumor in the deep soft tissues: the most frequent primary sites are the lower (49%) and upper (19%) limbs, but it has been reported even in the retroperitoneum and abdomen (16%), while localization in the breast is extremely rare (1-2). Breast cancer is rarely seen in males, accounts for approximately 1% of all breast cancer, and the breast sarcomas constitute less than 1% of breast tumors in both sexes. In the review of the literature, this is the third male and first young male with MFH. Here, we present a 37-years-old male patient who is diagnosed to have malignant fibrous histiocytoma in a variant of pleomorphic fusiform cell localized in the left breast. Following the wide local excision, the patient was given an adjuvant 50 Gy of external radiotherapy. He remained alive and well after 42 months of followup. We believe that reporting such few cases would contribute to forming treatment algorithms of rare tumors.

Objectives: Determining boost volume (BV) during breast radiotherapy can be challenging at times. Therefore, surgical clips are now being widely used. At times, when surgical clips are inadequate in determining the BV, other additional imaging methods are required. In the present study, we aimed to demonstrate that pre-operative positron emission tomography/computed tomography (PET-CT) can be used to determine the BV after a breast-conversing surgery. Methods: We selected thirty patients who underwent breast-conserving surgery with surgical clips and had preoperative Fluorine-18-Fluorodeoxyglucose PET (18 FDG PET/CT). The BV in planning tomography (CT) and primary tumor volume (TV) in pre-operative F-18 FDG PET/CT was contoured by a radiation oncologist. These two volumes were superposed using rigid image fusion. In every patient, two BVs were measured. The mean shift between the two volumes by the calculation of the center of mass and percentage of the PET-CT TV (PET-CT TV) in planning the BV (planning target volume [PTV]-BV) was calculated. Results: The median age was 52 years (range 25-72 years). The pre-operative PET-CT TV median was 8.89 cm 3 (range 1.00-64.30 cm 3 ). The median PTV-BV was 62.92 cm 3 (12.57-123.07 cm 3 ). The median shifts between the center of volumes were 1.76 cm (range 0.90-3.50) in X(coronal), 1.73 cm (range 0.60-3.60) in the Y(axial), and 1.20 cm (0.40-2.80) in the Z(sagittal) directions, respectively. The shifts in these three planes were determined to be statistically significant (p<0.001). The percent volume of PET-CT TV included PTV TV, ranging from 35% to 100% (mean 54%, standard deviation 29.53) and 100% in two out of 31 patients. Conclusion:Our study has shown that pre-operative PET-CT cannot be used to determine the BV in patients who replaced surgical clips and had undergone breast-conserving surgery. To define a more accurate BV, surgical clips should be placed in four planes, and more PTV margins should be given in treatment planning.