Local Control of Soft Tissue and Bone Sarcomas

Crompton, Joseph G.; Bernthal, Nicholas M.; Kawai, Akira; Eilber, Fritz C.

doi:10.1200/jco.2017.75.2717

Cited by 37 publications

(37 citation statements)

References 75 publications

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“…With the implementation of functional imaging, FDG-PET is highly accurate in detecting both primary and metastatic lesions of STS (2,8,30). In our cohort, PET was used in 12 patients and the initial SUV value seemed to predict the PFS (p=0.04), supporting the development of PET-adaptive treatment strategies.…”

Section: Discussionsupporting

confidence: 55%

“…In a recent review, Crompton et al reported that surgery and RT are the most important factors for local disease control (8), although other therapeutic options may also have local influence. Gustafson et al indicated that patients should be treated in a specialized Sarcoma Center, and further reported a 2.4-fold higher risk of LRR in patients who were not treated at such a facility (24).…”

Section: Discussionmentioning

confidence: 99%

“…In the era of targeted therapies, further research in term of radiogenomic and personalized medicine is warranted to optimize treatment decisions (31,32). Our understanding of STS is evolving as current investigations continue to improve our comprehension of such molecular mechanisms, especially those concerning this rare entity (8). Regarding targeted therapies, immunotherapy has been demonstrated to have efficacy in patients with metastatic synovial cell sarcoma and other advanced stages (5,33).…”

Section: Discussionmentioning

confidence: 99%

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Using Image-guided Intensity-modulated Radiotherapy on Patients With Head and Neck Soft-tissue Sarcoma

Elsayad

Stockmann

Channaoui

et al. 2019

In Vivo

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Background: Image-guided intensity-modulated radiotherapy (IG-IMRT) is increasingly being used to treat patients with soft-tissue sarcoma (STS) of the head and neck. Although there is no comparison between IMRT and conventional radiation therapy (CRT) concerning their efficacy. In this analysis, we compared CRT and IMRT outcomes for head and neck STS. Patients and Methods: Sixty-seven patients who underwent radiotherapy between 1994 and 2017 were identified. Results: The median follow-up was 31 months. Of the 67 patients, 34% were treated with CRT technique and 66% with IG-IMRT. The locoregional relapse rate following IMRT was 21% versus 70% with CRT (p<0.001) and the 5-year locoregional control was 69% versus 28%, respectively (p=0.01). IG-IMRT was associated with non-significant, less acute, and chronic adverse events. In the multivariate analysis, a significant influence of radiation technique on locoregional control was confirmed (p=0.04). Conclusion: IG-IMRT seems to be associated both with higher locoregional control as well as lower acute and chronic toxicities. Head and neck soft-tissue sarcoma (STS) is a rare tumor arising from soft tissue, and represents ~10% of all sarcomas (1, 2). Thus, patient groups presented in such studies are often small and non-homogeneous. STS in the head and neck, specifically, requires special management due to both its location and threat to numerous organs. Prognosis, as well as treatment, of head and neck sarcomas differs from that of other locations, owing to the limited scope for wide local excision due to the presence of important nearby structures and organs. Such localizations bear approximately 10% lower absolute difference in 5-year locoregional control (LRC) and overall survival (OS) as compared to sarcoma of the extremities (1-4). In addition to surgical resection, radiotherapy (RT) represents an important cornerstone of treatment. For instance, the most common RT indications are high tumor grade, large tumor, close resection margins, and locally advanced stage (2, 5). Recently, the TNM classification system has been revised to consider tumor size more heavily for better prognostic stratification (6). The role of adjuvant chemotherapy (CTX) is unclear and depends on many factors, such as histological subtype, grade. Therefore, treatment must be individualized and made on a case-by-case basis (5, 7). Emerging treatments, such as use of checkpoint inhibitors, is currently under investigation as an adjuvant therapy with the hope of reducing risk of relapse (8). Image-guided intensity-modulated radiotherapy (IMRT) aims to deliver a homogeneous dose distribution into the tumor bed with maximum protection or sparing of organs at risk (OAR), with optimal positioning of patients (9). In addition, interfractional imaging may allow further adaptive planning in order to escalate the radiation dose, suggesting an improvement of outcome in comparison with conventional radiotherapy (CRT) (10, 11).

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Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Using Image-guided Intensity-modulated Radiotherapy on Patients With Head and Neck Soft-tissue Sarcoma

Elsayad

Stockmann

Channaoui

et al. 2019

In Vivo

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“…[ 6 ] However, multiple side effects exist after amputation, limb‐sparing procedure, and high‐dose chemotherapy, such as severe cardiac toxicity and poor life quality. [ 7–10 ] The delicate biomaterials constructed with releasable chemotherapeutic agents are of great priority to be designed for the reconstruction of bone defects and removal of recalcitrant tumors. [ 11 ]…”

Section: Introductionmentioning

confidence: 99%

Engineering 2D Mesoporous Silica@MXene‐Integrated 3D‐Printing Scaffolds for Combinatory Osteosarcoma Therapy and NO‐Augmented Bone Regeneration

Yang

Yin

et al. 2020

Small

120

118

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The rising concerns of the recurrence and bone deficiency in surgical treatment of malignant bone tumors have raised an urgent need of the advance of multifunctional therapeutic platforms for efficient tumor therapy and bone regeneration. Herein, the construction of a multifunctional biomaterial system is reported by the integration of 2D Nb2C MXene wrapped with S‐nitrosothiol (RSNO)‐grafted mesoporous silica with 3D‐printing bioactive glass (BG) scaffolds (MBS). The near infrared (NIR)‐triggered photonic hyperthermia of MXene in the NIR‐II biowindow and precisely controlled nitric oxide (NO) release are coordinated for multitarget ablation of bone tumors to enhance localized osteosarcoma treatment. The in situ formed phosphorus and calcium components degraded from BG scaffold promote bone‐regeneration bioactivity, augmented by sufficient blood supply triggered by on‐demand NO release. The tunable NO generation plays a crucial role in sequential adjuvant tumor ablation, combinatory promotion of coupled vascularization, and bone regeneration. This study demonstrates a combinatory osteosarcoma ablation and a full osseous regeneration as enabled by the implantation of MBS. The design of multifunctional scaffolds with the specific features of controllable NO release, highly efficient photothermal conversion, and stimulatory bone regeneration provides an intriguing biomaterial platform for the diversified treatment of bone tumors.

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“…The bone and soft tissue sarcomas most frequently originate in extremities. [ 6 , 7 ] Because they tend to be very invasive, they may extend into the boundary compartments and invade the neurovascular bundle. Nowadays, the tumor can be eradicated either by amputation or limb-salvage surgery.…”

Section: Introductionmentioning

confidence: 99%

Biological reconstruction in the treatment of extremity sarcoma in femur, tibia, and humerus

et al. 2020

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To understand the feasibility, clinical effect, and complications related to biological reconstruction techniques for long limb malignant bone tumors after excision. This retrospective study included eighty patients with malignant bone tumors treated at our hospital between January 2007 and January 2019. After tumor resection, 52 cases of intercalary and 28 cases of osteoarticular bone grafts were used. The implanted bone included devitalized recycling bone, fibular, and allograft. The average follow up period was 42.19 months for 80 patients, among whom 15 (18.75%) died. The 5-year EFS and OS were 58% and 69%, respectively. The average length of the replanted bone was 18.57 cm. The MSTS scores of intercalary and osteoarticular bone grafts were 87.24% and 64.00%, respectively. In 23 cases (44.23%) of metaphyseal and 26 cases (32.5%) of the diaphysis, bone graft union was obtained at the first stage. The factors affecting bone union were the patient's gender, age, devitalization bone methods and whether the implanted bone was completely fixed. Postoperative complications included delayed bone union in 15 patients, fractures in 25 cases, nonunion in 22 cases, bone resorption in 14 cases, and postoperative infection in 4 cases. Twenty-eight cases of bone grafting required revision surgery, including replacement of internal fixation, autologous bone graft, debridement, removal of internal fixation, and replacement with prosthetic replacement. Biological reconstructions with massive bone grafts are useful in the reconstruction of certain malignant extremity bone tumors after wide excision.

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Local Control of Soft Tissue and Bone Sarcomas

Cited by 37 publications

References 75 publications

Using Image-guided Intensity-modulated Radiotherapy on Patients With Head and Neck Soft-tissue Sarcoma

Using Image-guided Intensity-modulated Radiotherapy on Patients With Head and Neck Soft-tissue Sarcoma

Engineering 2D Mesoporous Silica@MXene‐Integrated 3D‐Printing Scaffolds for Combinatory Osteosarcoma Therapy and NO‐Augmented Bone Regeneration

Biological reconstruction in the treatment of extremity sarcoma in femur, tibia, and humerus

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