Modern surgical techniques for management of soft tissue sarcomas involving the spine: Outcomes and complications

Mattei, Tobias A.; Teles, Alisson Roberto; Mendel, Ehud

doi:10.1002/jso.23805

Cited by 12 publications

(6 citation statements)

References 75 publications

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“…We reported on an aggressive multi-step upfront surgery that provided mid-term disease-free survival in a locally-advanced paravertebral UPS. In this case, the peculiar location of the primary UPS represented an oncological challenge, as the involvement of the axial skeleton along with the thoracic aorta is extremely infrequent and is associated with poor outcome (4,5). The MDT's final decision to proceed to an upfront radical resection was supported by several considerations.…”

Section: Discussionmentioning

confidence: 94%

Multi-Step Combined Upfront Surgery for Locally Advanced Paravertebral Sarcoma: A Case Report

et al. 2021

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Background: Paravertebral localization of primary undifferentiated pleomorphic sarcoma (UPS) with bone and vascular involvement is infrequent and challenging. Multi-step surgical procedure has been described as a feasible and effective option to achieve sustained local tumor control.Methods: We report on a 62-year old man with paravertebral UPS infiltrating the aortic wall and the 9th thoracic vertebra who underwent a multi-step surgical procedure aimed at achieving oncologic radicality through a coordinated effort between thoracic, vascular and spinal surgeons. After balancing the risks and benefits of perioperative therapies, upfront surgery was performed including aortic resection with bypass grafting followed by a triple en bloc vertebrectomy with tumor excision. Mid-term follow-up (22 months) is then provided.Results: The combined procedure achieved oncological radicality and no local recurrence in the mid-term. No major complications occurred.Conclusions: Multi-step and multi-specialty surgery is a feasible and effective strategy to treat primary UPS in unfavorable localization. A strategic cooperation between surgeons and a multidisciplinary tumor board is required to define an optimal, personalized treatment strategy in sarcoma patients.

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Section: Discussionmentioning

confidence: 94%

Multi-Step Combined Upfront Surgery for Locally Advanced Paravertebral Sarcoma: A Case Report

et al. 2021

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“…These tumors have been found to be chemoresistant. The 5-year survival has ranged from 12 % to about 25 % [6]. Treatment of this rare neoplasm is complicated by the large size of the tumor at …”

Section: Discussionmentioning

confidence: 99%

Large Retroperitoneal Extraosseous Osteosarcoma Invading into the Spine: a Case Report

Nagpal¹,

Chandra

Goel

2016

Indian J Surg Oncol

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Extraosseous osteogenic sarcoma is a very rare malignant neoplasm. The most common sites are the extremities, thorax, and the abdomen. Retroperitoneal osteosarcomas are rare and very few cases have been reported. They are similar in their biology to high-grade soft tissue sarcomas. R0 resection appears to be the best possible treatment for these tumors but there are no published cases on how to manage them when it involves posterior and intra-spinal regions. We report a 62-year-old male who presented with a backache, and investigations revealed a large retroperitoneal fibrosarcoma invading into the lumbar spine, but was found to be an extra osseous osteosarcoma on final histopathological examination. It is important to emphasize that due to the rarity of soft tissue sarcomas as well as the uniqueness of the multimodal treatment plan for each subtype, soft tissue sarcomas involving the spine are best managed by a multi disciplinary team. Overall, patients with soft tissue sarcomas involving the spine usually present a poor long-term prognosis. Therefore, whenever feasible, Ben bloc^resection of such lesions has been shown to play a crucial role in improving the overall and recurrence-free survival rates.

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“…Although certain imaging features can be suggestive of a specific aetiology, pathology reports are often vital to establishing therapeutic strategies. The area and target of image-guided biopsies must therefore be defined through discussion by a multidisciplinary tumour board [ 21 ].…”

Section: Practical Approaches To Analysis Of Paraspinal Tumour Imagesmentioning

confidence: 99%

“…Although the value of radiographs in evaluating paraspinal lesions is limited-most of the relevant information being better explored with computed tomography (CT)-they should not be ignored (Figs. 11,12,13) [18,21]. Firstly, a standing radiograph is the only modality that gives a functional overview of the spine and provides insight into the overall morphology of the spine.…”

Section: Radiographsmentioning

confidence: 99%

“…12,13,15). CT evaluates the presence of soft tissue calcifications or ossifications within the tumour and determines its morphological characteristics (osteoid, chondroid, dystrophic) [21]. Bone changes, including exostosis formation, periosteal reactions, extrinsic cortical erosion (scalloping) or foramen enlargement, reflect the biological activity of the lesion.…”

Section: Ct Imagingmentioning

confidence: 99%

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Understanding a mass in the paraspinal region: an anatomical approach

Creze,

Ghaouche,

Missenard

et al. 2023

Insights Imaging

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The paraspinal region encompasses all tissues around the spine. The regional anatomy is complex and includes the paraspinal muscles, spinal nerves, sympathetic chains, Batson’s venous plexus and a rich arterial network. A wide variety of pathologies can occur in the paraspinal region, originating either from paraspinal soft tissues or the vertebral column. The most common paraspinal benign neoplasms include lipomas, fibroblastic tumours and benign peripheral nerve sheath tumours. Tumour-like masses such as haematomas, extramedullary haematopoiesis or abscesses should be considered in patients with suggestive medical histories. Malignant neoplasms are less frequent than benign processes and include liposarcomas and undifferentiated sarcomas. Secondary and primary spinal tumours may present as midline expansile soft tissue masses invading the adjacent paraspinal region. Knowledge of the anatomy of the paraspinal region is of major importance since it allows understanding of the complex locoregional tumour spread that can occur via many adipose corridors, haematogenous pathways and direct contact. Paraspinal tumours can extend into other anatomical regions, such as the retroperitoneum, pleura, posterior mediastinum, intercostal space or extradural neural axis compartment. Imaging plays a crucial role in formulating a hypothesis regarding the aetiology of the mass and tumour staging, which informs preoperative planning. Understanding the complex relationship between the different elements and the imaging features of common paraspinal masses is fundamental to achieving a correct diagnosis and adequate patient management. This review gives an overview of the anatomy of the paraspinal region and describes imaging features of the main tumours and tumour-like lesions that occur in the region.

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Modern surgical techniques for management of soft tissue sarcomas involving the spine: Outcomes and complications

Cited by 12 publications

References 75 publications

Multi-Step Combined Upfront Surgery for Locally Advanced Paravertebral Sarcoma: A Case Report

Multi-Step Combined Upfront Surgery for Locally Advanced Paravertebral Sarcoma: A Case Report

Large Retroperitoneal Extraosseous Osteosarcoma Invading into the Spine: a Case Report

Understanding a mass in the paraspinal region: an anatomical approach

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