Atypical Lipomatous Tumors: Should They be Treated Like Other Sarcoma or Not? Surgical Consideration from a Bi-Institutional Experience

Mussi, Chiara; Daolio, Primo Andrea; Cimino, Matteo; Giardina, F; Sanctis, Rita De; Morenghi, Emanuela; Parafioriti, Antonina; Bartoli, Maria S.; Bastoni, Stefano; Cozzaglio, Luca; Colombo, Piergiuseppe; Quagliuolo, Vittorio

doi:10.1245/s10434-014-3855-7

Cited by 31 publications

(19 citation statements)

References 20 publications

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“…Surgical resection is the usual treatment for ALT, and the prognosis is usually excellent [142–144]. However, particularly in older patients, if surgery is likely to be morbid, or the patient has significant comorbidities then radiological surveillance can be considered.…”

Section: Borderline Tumoursmentioning

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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Section: Borderline Tumoursmentioning

confidence: 99%

UK guidelines for the management of soft tissue sarcomas

Dangoor¹,

et al. 2016

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“…CDPs were determined by collation of commonly quoted predictors of the margin status (tumor histology, tumor size, patient age, etc.) [4,9,10,[19][20][21]. It was hypothesized that CDPs determine the suitability of an indication calling for an immediate reconstructive approach.…”

Section: Methodsmentioning

confidence: 99%

Working with Orthopedic Oncologists: When to Offer Immediate and when and why to Delay Definitive Reconstruction of an Extremity

Dobke¹,

Mackert²,

Goldin³

et al. 2017

J Clin Exp Orthop

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A review of patients that were treated jointly by the plastic and the orthopedic surgery teams from 2011 to 2015 to evaluate the timing of definitive reconstruction of extremity defects was undertaken. The cohort consists of 81 patients, of which 4 presented with either a high-risk lesion or an advanced squamous cell carcinoma and of which the remaining 77 patients presented with different types of extremity sarcomas. In 58 cases, immediate-definitive reconstruction was performed, while in 23 cases the definitive procedure was delayed. Immediate definitive reconstruction, concurrent with ablative procedures, was offered whenever possible. In 16 cases, delayed reconstruction was due to diagnostic uncertainty (uncertain diagnosis per se or non-established negative margins). In 6 cases, delayed reconstruction was performed because of infection, in 1 case a bleeding disorder necessitated workup and in another, the intraoperative histology necessitated a plan-change, wound temporization and preparation of an arteriovenous fistula for microsurgical reconstruction. Indications for delayed reconstruction can be related to systemic conditions, donor or recipient site issues (infection, suspicion of margin-problems or tumor "not in continuity"). Although frozen sections have an overall diagnostic accuracy of 90%, changes in management were related to the inadequacy of frozen material, sampling errors resulting from heterogeneity or non-appositional growth of malignancy. A high rate (28%) of delayed reconstruction corresponds with new data reaffirming an old paradigm (radically excised margins "make a difference"), and with objectives dictated by customized, personalized, multimodal approaches. Wound temporization was offered whenever definitive reconstruction couldn't be performed immediately. Limb sparing, with the utilization of temporary spacers or distractors, mega-prostheses, or trials of reimplanting formerly tumorous bone autografts, which have been sterilized to eliminate malignant cells -may all necessitate temporary coverage or staged repair. Authors' clinical experience was evaluated in the context whether the rationale behind immediate versus delayed reconstruction was optimal.

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“…Note : When the tumor is not indicated for adequate resection, which occurs when the tumor is close to vessels, nerves, or main bone structures, the preoperative period can be planned adequately using neoadjuvant or adjuvant strategies with chemotherapy or RT, to preserve the limb (IIIA) 44‐46 In the case of atypical lipomatous tumors, which are considered low‐grade tumors with a low risk of local relapse and metastasis, the appropriate treatment can be the planned marginal excision without the need for neoadjuvant or adjuvant (IVB) strategies 47 Major surgeries such as disarticulation or amputation might be the appropriate surgical option to achieve local control and offer the chance of a cure—especially in cases in which there is an invasion of noble structures that do not respond to neoadjuvant treatment for nonmetastatic patients.…”

Section: Management Of Local/localized Disease (See Figure 1)mentioning

confidence: 99%

“…In the case of atypical lipomatous tumors, which are considered low‐grade tumors with a low risk of local relapse and metastasis, the appropriate treatment can be the planned marginal excision without the need for neoadjuvant or adjuvant (IVB) strategies 47 …”

Section: Management Of Local/localized Disease (See Figure 1)mentioning

confidence: 99%

“…[44][45][46] • In the case of atypical lipomatous tumors, which are considered low-grade tumors with a low risk of local relapse and metastasis, the appropriate treatment can be the planned marginal excision without the need for neoadjuvant or adjuvant (IVB) strategies. 47 • Major surgeries such as disarticulation or amputation might be the appropriate surgical option to achieve local control and offer the chance of a cure-especially in cases in which there is an invasion of noble structures that do not respond to neoadjuvant treatment for nonmetastatic patients. Vascular or nerve reconstruction should be discussed individually (IVC).…”

Section: Recommendationsmentioning

confidence: 99%

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Brazilian consensus on the diagnosis and treatment of extremities soft tissue sarcomas

Spencer¹,

Camargo²,

Silva³

et al. 2020

Journal of Surgical Oncology

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Introduction Soft tissue sarcomas (STSs) are rare tumors and constitute only 1% of all tumors in adults. Indeed, due to their rarity, most cases in Brazil are not treated according to primary international guidelines. Methods This consensus addresses the treatment of STSs in the extremities. It was made by workgroups from Brazilian Societies of Surgical Oncology, Orthopaedics, Clinical Oncology, Pathology, Radiology and Diagnostic Imaging, and Radiation Oncology. The workgroups based their arguments on the best level of evidence in the literature and recommendations were made according to diagnosis, staging, and treatment of STSs. A meeting was held with all the invited experts and the topics were presented individually with the definition of the degree of recommendation, based on the levels of evidence in the literature. Results Risk factors and epidemiology were described as well as the pathological aspects and imaging. All recommendations are described with the degree of recommendation and levels of evidence. Conclusion Recommendations based on the best literature regional aspects were made to guide professionals who treat STS. Separate consensus on specific treatments for retroperitoneal, visceral, trunk, head and neck sarcomas, and gastrointestinal stromal tumor, are not contemplated into this consensus.

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Atypical Lipomatous Tumors: Should They be Treated Like Other Sarcoma or Not? Surgical Consideration from a Bi-Institutional Experience

Cited by 31 publications

References 20 publications

UK guidelines for the management of soft tissue sarcomas

UK guidelines for the management of soft tissue sarcomas

Working with Orthopedic Oncologists: When to Offer Immediate and when and why to Delay Definitive Reconstruction of an Extremity

Brazilian consensus on the diagnosis and treatment of extremities soft tissue sarcomas

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