Current follow-up strategies after potentially curative resection of extremity sarcomas

Beitler, Alan L.; Virgo, Katherine S.; Johnson, Frank E.; Gibbs, John F.; Kraybill, William G.

doi:10.1002/(sici)1097-0142(20000215)88:4<777::aid-cncr7>3.0.co;2-r

Cited by 39 publications

(34 citation statements)

References 28 publications

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“…Although the importance of following patients with sarcoma is widely accepted, frequent surveillance is time-consuming for both patients and physicians, increases healthcare expenditures [11,21,22], and, with respect to the use of CT scans, exposes patients to ionizing radiation [4]. Furthermore, limited evidence exists to support the intervals, modalities, or duration of monitoring [3,9,11].…”

Section: Introductionmentioning

confidence: 99%

Developing an Evidence-based Followup Schedule for Bone Sarcomas Based on Local Recurrence and Metastatic Progression

Cipriano

Griffin

Ferguson

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background The potential for local recurrence and pulmonary metastasis after treatment of primary bone sarcomas necessitates careful patient followup; however, minimal data exist regarding the incidence and timing of these events, and therefore an evidence-based surveillance protocol has not been developed. Questions/purposes The purposes of this study were to (1) describe the frequency and timing of local recurrence by histologic grade over time; (2) describe the frequency and timing of metastasis by histologic grade and diagnosis over time; and (3) use these data to either justify current surveillance schedules and/or propose modifications that may improve the rate of new pulmonary metastatic events detected per examination. Methods A retrospective review was performed of all patients who underwent resection of a primary, nonmetastatic bone sarcoma (excluding chordoma) at a single tertiary oncology center from 1989 to 2010. Of the 680 patients identified, 15 were excluded for loss of followup in the first 2 years, leaving 665 eligible for study. Of these, 437 patients were alive with no evidence of disease at the conclusion of the study (mean followup, 136 months; range, 25-321 months). Cox regression analysis was performed to evaluate and control for patient age, tumor size, tumor location, and surgical margins. With patients stratified by sarcoma grade, Kaplan-Meier survival curves were constructed for the endpoints of local recurrence and metastasis, and log-rank tests were used to compare the rates of these events between grades and diagnoses. The number of new pulmonary metastatic events per patientyear was calculated for each sarcoma grade over the time intervals used in current surveillance protocols (0-2, 2-5, 5-10, and [ 10 years) to facilitate development of a surveillance schedule that would maximize events detected per imaging study performed. In addition, to determine the effect of disease type, subset analysis was performed for osteosarcoma (OSA) and chondrosarcoma because these were the only diagnoses with sufficient numbers to support individual statistical analysis. Results With the numbers available for study, the overall local recurrence-free survival did not differ between sarcoma grades at any time points (p = 0.864). Metastasis-free survival curves differed between sarcoma grades (p \ 0.001), and the pattern of Grade 2 OSA metastasis was more consistent with other Grade 3 sarcomas, so it was

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Section: Introductionmentioning

confidence: 99%

Developing an Evidence-based Followup Schedule for Bone Sarcomas Based on Local Recurrence and Metastatic Progression

Cipriano

Griffin

Ferguson

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…In an increasingly ''costconscious'' healthcare scenario, allocation of limited health funding is best guided by evidence-based recommendations rather than empirical beliefs [18,19]. A well-designed prospective trial to evaluate the impact of followup strategies on disease outcomes would help develop an evidence-based surveillance schedule [1,8,9].…”

Section: Introductionmentioning

confidence: 99%

Does Intensity of Surveillance Affect Survival After Surgery for Sarcomas? Results of a Randomized Noninferiority Trial

Puri

Gulia

Hawaldar

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Whether current postoperative surveillance regimes result in improved overall survival (OS) of patients with extremity sarcomas is unknown. Questions/purposes We hypothesized that a less intensive followup protocol would not be inferior to the conventional followup protocol in terms of OS. We (1) assessed OS of patients to determine if less intensive followup regimens led to worsened survival and asked (2) whether chest radiograph followup group was inferior to CT scan followup group in detecting pulmonary metastasis; and (3) whether less frequent (6-monthly) followup interval was inferior to more frequent (3-monthly) followup in detecting pulmonary metastasis and local recurrence.Methods A prospective randomized single-center noninferiority trial was conducted between January 2006 and June 2010. On the basis of 3-year survival of 60% with intensive, more frequent followup, 500 nonmetastatic patients were randomized to demonstrate noninferiority by a margin (delta) of 10% (hazard ratio [HR], 1.36). The primary end point was OS at 3 years. The secondary objective was to compare disease-free survival (DFS) (time to recurrence) at 3 years. At minimum followup of 30 months (median, 42 months; range, 30-81 months), 178 deaths were documented. Results Three-year OS and DFS for all patients was 67% and 52%, respectively. Three-year OS was 67% and 66% in chest radiography and CT groups, respectively (HR, 0.9; upper 90% confidence interval [CI], 1.13). DFS rate was 54% and 49% in chest radiography and CT groups, respectively (HR, 0.82; upper 90% CI, 0.97). Three-year OS was 64% and 69% in 6-monthly and 3-monthly groups, respectively (HR, 1.2; upper 90% CI,

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“…It generally has the characteristic of slow and painless growth. The sites most frequently affected are the limbs and retroperitoneum (almost always in deep structures and originating from fascial planes between muscles) (3,8,9) . The clinical picture for this disease generally involves asymptomatic patients, but cases may present pain, fatigue, weight loss, nausea, vomiting and increased occurrence of varicose veins (10)(11)(12) .…”

Section: Discussionmentioning

confidence: 99%

Lipossarcoma de joelho em um atleta de tênis: relato de caso

Filho¹,

Sayum²,

Carvalho³

et al. 2012

Rev. bras. ortop.

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CASE REPORTThe patient was a 40-year-old white man who was an amateur tennis player. He came to the orthopedics and traumatology outpatient clinic at the Assunção Hospital and Maternity Hospital, in São Bernardo do Campo, São Paulo, presenting tumor formation in his right lower limb that had started around one year earlier, with gradual progression. He said that he had not had any other symptoms such as pain, fever, nausea or weight loss.On physical examination, he presented a good general state and was eutrophic, not jaundiced, not cyanotic and not febrile. On orthopedic examination, he presented painless tumor growth on the posterior face of the right knee and distal thigh, with fibroelastic consistency and without any temperature difference.Radiographs of the knee were requested and showed increased soft-tissue volume. Ultrasound showed a mass of solid appearance measuring 15 x 20 cm. Because of this, computed tomography and magnetic resonance imaging were requested to assess the tumor formation better. At that time, it was suspected that the diagnosis could be liposarcoma and therefore imaging examinations were requested for staging purposes (radiographs on the lungs, bone scintigraphy, PET SCAN and tomography on the chest, abdomen, pelvis and cranium). These were found to be normal (Figures 1 to 3).With these findings, surgical treatment was scheduled (radical tumor excision). During the operation, a tumor measuring 18 x 20 cm was removed, and this was sent for anatomopathological analysis (Figures 4 and 5).The anatomopathological diagnosis was that this was a case of myxoid liposarcoma, with free margins. The oncologist who was following up the case with the orthopedist advised that adjuvant radiotherapy should be administered, and this was done (Figure 6).Two years after the operation, the patient is asymptomatic (without recurrence or metastasis) and is continuing to practice tennis. DISCUSSIONSarcomas are rare tumors and originate from primitive mesenchymal cells. They account for 0.1 to 0.2 % of all cases of neoplasia in adults (1)(2)(3) .

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Current follow-up strategies after potentially curative resection of extremity sarcomas

Cited by 39 publications

References 28 publications

Developing an Evidence-based Followup Schedule for Bone Sarcomas Based on Local Recurrence and Metastatic Progression

Developing an Evidence-based Followup Schedule for Bone Sarcomas Based on Local Recurrence and Metastatic Progression

Does Intensity of Surveillance Affect Survival After Surgery for Sarcomas? Results of a Randomized Noninferiority Trial

Lipossarcoma de joelho em um atleta de tênis: relato de caso

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