Unplanned Excision of Soft Tissue Sarcoma Results in Increased Rates of Local Recurrence Despite Full Further Oncological Treatment

Qureshi, Yassar A.; Huddy, Jeremy R; Miller, Jeffrey D.; Strauß, D.; Thomas, Joseph; Hayes, Andrew

doi:10.1245/s10434-011-1876-z

Cited by 126 publications

(95 citation statements)

References 21 publications

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“…[8][9][10] Despite the present study not demonstrating a significant association between residual tumor and LR, other groups have reported that initial unplanned ESTS resection and residual disease predicted LR. 8,9 In a study of 142 unplanned ESTS resections from Charoenlap, the amputation rate was significantly higher in patients with residual disease (18.5 vs. 1.8 %, p = 0.003). Of note, only 10 % of patients in the Charoenlap study had leiomyosarcoma compared with 22 % in the report from Bonvalot.…”

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confidence: 94%

Tailoring Surgical Therapy for Extremity Soft Tissue Sarcoma

Katz

2016

Ann Surg Oncol

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Limb-sparing multimodality therapy for extremity soft tissue sarcoma (ESTS) affords excellent disease control and functional outcomes in the majority of patients.1 In a study of 4977 extremity and superficial trunk STS, 20-25 % experienced recurrence, with some recurrent events occurring more than two decades after initial treatment. 2Determining the optimal surgical approach to minimize the risk of ESTS recurrence is a complex undertaking due to extreme biologic heterogeneity, with more than 100 histologic subtypes.3 The consideration of ESTS as a single entity is a matter of necessity rather than reason. The wide range of ESTS biologic behavior makes it exceedingly difficult to define broad policies or recommendations for most management dilemmas. 4 Bonvalot et al. conducted a retrospective study of 541 ESTS patients to examine the minimum necessary margin and the issue of mandatory re-excision followed unplanned resections.5 As stated in the title, the authors also set out to examine the relationship between local control of ESTS and survival. The lack of a causal link between ESTS local control and survival has been thoroughly verified previously and, as such, will not be the focus of this editorial. 6 Among all patients, 82 % underwent R0 resection and the median margin was 2 mm. The median follow-up of 7 years allows for reasonable survival and recurrence estimates. Local recurrences (LR) were experienced by 8 % and 20 % of patients died from all causes. Predictors of worse OS were grade, leiomyosarcoma subtype, and presence of residual disease upon re-excision. Importantly, 47 % of patients were treated following unplanned excision at other hospitals; 58 % of those patients had residual disease upon re-excision. LR was predicted by specific subtypes, such as myxofibrosarcoma, and a margin less than 1 mm.The impact of residual disease, likelihood of LR occurring before death due to distant metastases, and hence importance of re-excision after unplanned ESTS resection will vary by histologic subtype. In the present study, 22 % of patients had leiomyosarcoma, a disease in which distant recurrence predominates, with only 11 % experiencing isolated LR.7 Fewer than 10 % of patients had subtypes with highly aggressive LR patterns, including myxofibrosarcoma and dermatofibrosarcoma protuberans. Whereas deferring re-excision following an unplanned lower-extremity leiomyosarcoma resection may be appropriate in selected cases given that the outcome is driven by distant recurrence, omission in a myxofibrosarcoma patient would generally be inadvisable. As acknowledged by the authors, consideration of subtype biologic behavior is a critical factor when deciding if re-excision following unplanned ESTS surgery is warranted.The goal of reoperation following unplanned ESTS resection is to eradicate potential residual disease, prevent LR, and improve the likelihood of limb salvage. The majority of unplanned ESTS resections in the present study were indeed inadequate, because 58 % of patient who underwent re-excision were fo...

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contrasting

confidence: 94%

Tailoring Surgical Therapy for Extremity Soft Tissue Sarcoma

Katz

2016

Ann Surg Oncol

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“…Local recurrence rates in such patients are significantly higher than those undergoing a planned wide excision, even following re-excisions and radiotherapy. 18 The decision to excise an elastofibroma should be made jointly by the patient and surgeon. In the absence of significant symptoms, there is no benefit in removing these lesions, and non-operative management should be pursued.…”

Section: Discussionmentioning

confidence: 99%

Elastofibroma dorsi: The clunking tumour that need not cause alarm

Smith

Hannay

Thway

et al. 2016

annals

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Introduction Elastofibromas are rare, pseudo-tumours arising at the inferior pole of the scapula that have a characteristic presentation. Due to their tissue of origin and size, they may often be mistaken for soft tissue sarcomas. We present the management of patients diagnosed with elastofibroma at a single institution. Methods Patients diagnosed with elastofibroma between January 1995 and January 2015 were identified from a prospectively maintained histopathology database. Electronic patient records, imaging and pathology reports were retrieved and reviewed. Results Thirty seven patients were identified, with a median age of 66 years and a male-to-female ratio of 1:1.6. All tumours occurred in the characteristic subscapular location. The median maximum tumour diameter was 8.2cm. A synchronous contralateral lesion (15.8%) was found in six patients. Cross-sectional imaging was performed in 29 patients, with magnetic resonance imaging the most common modality (59.5%). Diagnosis was confirmed with percutaneous biopsy in all but one patient, who proceeded directly to surgery. Eighteen patients were managed non-operatively; 19 opted for surgical excision due to significant symptoms. Excision was performed in a marginal fashion and, at a median follow-up of 5 months, no functional impairment or local recurrences were observed. Conclusions Soft tissue masses greater than 5cm in diameter should prompt the clinician to exclude soft tissue sarcoma. The diagnosis of elastofibroma may be alluded to by its typical presentation and can be confirmed by percutaneous biopsy. After excluding malignancy, these lesions can be safely managed non-operatively, with surgery reserved for symptomatic patients.

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“…Tumor biopsies that are done incorrectly often compromise the chance of local control, may complicate reconstructive procedures, and have been shown to increase the rate of local recurrence. 20 If the biopsy is not performed at a medical center with expertise in treating osteosarcoma, there is a greater likelihood of biopsy-associated complications, such as obtaining non-diagnostic tissue, hematoma, infection, and pathologic fracture. 21,22 Histological Evaluation OS cells are of mesenchymal origin and are histologically characterized by the abnormal production of osteoid.…”

Section: Os Biopsymentioning

confidence: 99%