Soft-tissue sarcomas spread predominantly to the lung and it is unclear how often FDG-PET scans will detect metastases not already obvious by chest CT scan or clinical examination. Adult limb and body wall soft-tissue sarcoma cases were identified retrospectively. Ewing's sarcoma, rhabdomyosarcoma, GIST, desmoid tumors, visceral tumors, bone tumors, and retroperitoneal sarcomas were excluded as were patients imaged for followup, response assessment, or recurrence. All patients had a diagnostic chest CT scan. 109 patients met these criteria, 87% of which had intermediate or high-grade tumors. The most common pathological diagnoses were leiomyosarcoma (17%), liposarcoma (17%), and undifferentiated or pleomorphic sarcoma (16%). 98% of previously unresected primary tumors were FDG avid. PET scans were negative for distant disease in 91/109 cases. The negative predictive value was 89%. Fourteen PET scans were positive. Of these, 6 patients were already known to have metastases, 3 were false positives, and 5 represented new findings of metastasis (positive predictive value 79%). In total, 5 patients were upstaged by FDG-PET (4.5%). Although PET scans may be of use in specific circumstances, routine use of FDG PET imaging as part of the initial staging of soft-tissue sarcomas was unlikely to alter management in our series.

Vestibular schwannomas (VS) have a higher risk of recurrence following subtotal resection than following near-total resection. We measured tumor remnant growth volumetrically in an attempt to determine potential predictors for postoperative recurrence following subtotal resection. We reviewed the charts of patients who had undergone VS surgery between 1998 and 2007. Thirty patients had an incomplete resection. The principal outcome measure was change in tumor volume (TV) on serial imaging. At a median follow-up of 6.8 years, volumetric measurements showed that 12 patients (40%) developed further tumor growth, while 18 patients remained with stable residual disease. The median rate of growth was 0.53 cm3/year. Two-dimensional measurements confirmed growth in only eight of these patients. The postoperative residual TV correlated significantly with subsequent tumor growth (p?=?0.038). All patients with residual volumes in excess of 2.5 cm3 exhibited recurrence. On univariate analysis, only postoperative TV was significantly associated with growth. Median time to failure was 21.5 months. This is the first report of volumetric measurements of VS tumor growth postoperatively. Volumetric measurements appear to be superior to two-dimensional measurements in documenting VS growth and patients with residual tumors >2.5 cm3 have a significantly higher rate of recurrence.

BackgroundWe report our experience with patients who received re-irradiation to the head and neck area for locoregional recurrences (LRR) or second primaries (SP) in a previously irradiated field.MethodsWe reviewed 27 consecutive patients with a diagnosis of LRR or SP head and neck carcinoma treated with a second course of radiotherapy between April 2004 and July 2012. The main outcome measures were local control, overall survival, and complications. The results are expressed as actuarial values using the Kaplan–Meier estimates.ResultsThe median follow-up time was 24.7 months (range: 11 days–79.3 months). There were 23 males and four females with a median age of 61 years (range: 40–87 years). The actuarial overall survival rates at 1, 2, and 5 years were 77, 59, and 57 %, respectively. The actuarial local control rate was 80, 52, and 52 % at 1, 2, and 5 years, respectively. Three patients developed systemic metastases. The rate of grade 3 toxicity was 26 %, and that of grade 4 toxicity was 3 %. There were two treatment-related deaths (grade 5 toxicity).ConclusionsContinuous course re-irradiation in patients with LRR or SP head and neck cancer is feasible with acceptable toxicity. With current encouraging rates of local control and overall survival, this option should be discussed with patients who have few alternative therapeutic options.

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