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The role of postoperative radiotherapy in treatment of soft tissue sarcomas
G?rkem AKSU,Hakan A?IR
Turkish Journal of Oncology , 2007,
Abstract: Soft-tissue sarcomas account for approximately 1% of adult malignancies and they occur in up to 50% of cases in the extremities, followed by visceral/retroperitoneal regions. Different histological subtypes exist and primary therapy is predicated on surgical resection with an adequate margin of normal tissue. n most of the extremity tumors, limb-sparing surgery is possible. Local recurrence rates vary depending on the anatomic site and for high-risk patients, identified by tumor grade, size and site, local control is clearly improved with postoperative adjuvant radiation. In this review, the role of radiotherapy in the treatment of soft tissue sarcomas are analyzed regarding the recent literature.
Application of Proteomics to Soft Tissue Sarcomas  [PDF]
Tadashi Kondo,Daisuke Kubota,Akira Kawai
International Journal of Proteomics , 2012, DOI: 10.1155/2012/876401
Abstract: Soft tissue sarcomas are rare and account for less than 1% of all malignant cancers. Other than development of intensive therapies, the clinical outcome of patients with soft tissue sarcoma remains very poor, particularly when diagnosed at a late stage. Unique mutations have been associated with certain soft tissue sarcomas, but their etiologies remain unknown. The proteome is a functional translation of a genome, which directly regulates the malignant features of tumors. Thus, proteomics is a promising approach for investigating soft tissue sarcomas. Various proteomic approaches and clinical materials have been used to address clinical and biological issues, including biomarker development, molecular target identification, and study of disease mechanisms. Several cancer-associated proteins have been identified using conventional technologies such as 2D-PAGE, mass spectrometry, and array technology. The functional backgrounds of proteins identified were assessed extensively using in vitro experiments, thus supporting expression analysis. These observations demonstrate the applicability of proteomics to soft tissue sarcoma studies. However, the sample size in each study was insufficient to allow conclusive results. Given the low frequency of soft tissue sarcomas, multi-institutional collaborations are required to validate the results of proteomic approaches. 1. General Background of Soft Tissue Sarcomas Soft tissue sarcomas are defined as malignancies that originate from nonepithelial extraskeletal tissues, excluding the reticuloendothelial system, glia, and supporting tissue of parenchymal organs [1].Thus, soft tissue sarcomas may occur anywhere in the body including fibrous tissues, adipose tissues, muscles, vessels, and peripheral nerves. Thus, soft tissue sarcomas are a highly heterogeneous tumor group that is classified histogenetically. Clinically, soft tissue sarcomas range from curable tumors to those causing death via metastasis and recurrence. Thus, histological classification is accompanied by grading and staging information, which depends on clinical and pathological observations, to assess the degree of malignancy, predict prognosis, and evaluate possible therapies. Genetic alterations such as recurrent chromosomal translocations and genetic deregulations have been reported in soft tissue sarcomas. For example, chimeric genes have been reported in Ewing sarcoma, alveolar rhabdomyosarcoma (RMS), desmoplastic small round cell tumor, clear cell sarcoma (CCS), myxoid/round cell liposarcoma, myxoid chondrosarcoma, synovial sarcoma, alveolar soft
Bone tumor and soft tissue sarcomas
Reynaldo Jesus Garcia Filho
Einstein (S?o Paulo) , 2008,
Abstract: When we evaluate a rheumatologic patient we have to think aboutthe differential diagnosis among primary bone tunors, secondarybone tumors and soft tissue sarcomas. Muscle skeletal tumors,like rheumatologic diseases, have a predilection for old patients.Their knowledge is very important for a correct diagnosis andtreatment.
Guidelines for the Management of Soft Tissue Sarcomas  [PDF]
Robert Grimer,Ian Judson,David Peake,Beatrice Seddon
Sarcoma , 2010, DOI: 10.1155/2010/506182
Abstract: These guidelines were drawn up following a consensus meeting of UK sarcoma specialists convened under the auspices of the British Sarcoma Group and are intended to provide a framework for the multidisciplinary care of patients with soft tissue sarcomas. The guidelines published by the European Society of Medical Oncology (ESMO) and the National Comprehensive Cancer Network (NCCN) were used as the basis for discussion and adapted according to UK clinical practice and local requirements. Note was also taken of the National Institute for Health and Clinical Excellence (NICE) improving outcomes guidance (IOG) for people with sarcoma and existing technology appraisals. The guidelines are not intended to challenge NICE guidance but discrepancies may exist where current guidance does not reflect an international standard of care owing to the ever-evolving nature of cancer treatment. It is acknowledged that these guidelines will require updating on a regular basis. An appendix lists the key recommendations which are summarised below. Any patient with a suspected soft tissue sarcoma should be referred to a diagnostic centre and managed by a specialist sarcoma multidisciplinary team. Surgical excision followed by post operative radiotherapy is the standard management of high grade limb sarcomas although occasionally amputation remains the only option. Pre-operative treatment with chemotherapy or radiotherapy should be considered for patients with borderline resectable tumours. Isolated limb perfusion may permit limb salvage in some cases where amputation is the only other option. Adjuvant chemotherapy is not routinely recommended but may be considered in certain specific situations. Regular follow up is recommended to assess local control and the development of metastatic disease. Single agent doxorubicin is the standard first line therapy for metastatic disease. Ifosfamide is an alternative if anthracyclines are contraindicated. Combination therapy may be considered in individual patients. Second line agents include ifosfamide, dacarbazine, trabectedin and the combination of gemcitabine + docetaxel. Surgical resection of local recurrence and pulmonary metastases should be considered in individual patients. There is specific guidance on the management of retroperitoneal and uterine sarcomas. 1. Introduction 1.1. Rationale and Objective of Guidelines Soft tissue sarcomas (STS) are a relatively uncommon group of malignancies. Although over the past few years, there have been advances in the understanding of the pathology, clinical behaviour and the treatment of
Guidelines for the Management of Soft Tissue Sarcomas  [PDF]
Robert Grimer,Ian Judson,David Peake,Beatrice Seddon
Sarcoma , 2010, DOI: 10.1155/2010/506182
Abstract: These guidelines were drawn up following a consensus meeting of UK sarcoma specialists convened under the auspices of the British Sarcoma Group and are intended to provide a framework for the multidisciplinary care of patients with soft tissue sarcomas. The guidelines published by the European Society of Medical Oncology (ESMO) and the National Comprehensive Cancer Network (NCCN) were used as the basis for discussion and adapted according to UK clinical practice and local requirements. Note was also taken of the National Institute for Health and Clinical Excellence (NICE) improving outcomes guidance (IOG) for people with sarcoma and existing technology appraisals. The guidelines are not intended to challenge NICE guidance but discrepancies may exist where current guidance does not reflect an international standard of care owing to the ever-evolving nature of cancer treatment. It is acknowledged that these guidelines will require updating on a regular basis. An appendix lists the key recommendations which are summarised below. Any patient with a suspected soft tissue sarcoma should be referred to a diagnostic centre and managed by a specialist sarcoma multidisciplinary team. Surgical excision followed by post operative radiotherapy is the standard management of high grade limb sarcomas although occasionally amputation remains the only option. Pre-operative treatment with chemotherapy or radiotherapy should be considered for patients with borderline resectable tumours. Isolated limb perfusion may permit limb salvage in some cases where amputation is the only other option. Adjuvant chemotherapy is not routinely recommended but may be considered in certain specific situations. Regular follow up is recommended to assess local control and the development of metastatic disease. Single agent doxorubicin is the standard first line therapy for metastatic disease. Ifosfamide is an alternative if anthracyclines are contraindicated. Combination therapy may be considered in individual patients. Second line agents include ifosfamide, dacarbazine, trabectedin and the combination of gemcitabine
Delays in Referral of Soft Tissue Sarcomas  [PDF]
G. D. Johnson,G. Smith,A. Dramis,R. J. Grimer
Sarcoma , 2008, DOI: 10.1155/2008/378574
Abstract: Introduction and aims. It is well established that soft tissue sarcomas (STSs) are more effectively treated in a specialist centre. However, delays in time taken for a patient to be referred to a specialist centre may lead to a poorer prognosis. This study aims to identify the length of these delays and where they occur. Patients and methods. Patients with a proven STS were included. They were recruited from both outpatient clinics and from the surgical ward of the Royal Orthopaedic Hospital (Birmingham, UK). A structured interview was used to take a detailed history of the patients' treatment pathway, before arriving at the specialist centre. Dates given were validated using the case notes. Results. The median time for the patient to present to a specialist centre from the onset of symptoms was 40.4 weeks. The median delay until presentation to a medical professional (patient delay) was 1.3 weeks. Median delay in referral to a specialist centre (service delay) was 25.0 weeks. Discussion. Medical professionals rather than patients contribute the greatest source of delay in patients reaching a specialist centre for treatment of STS. Adherence to previously published guidelines could decrease this delay for diagnosis of possible sarcoma. Steps should be taken to refer patients directly to a diagnostic centre if they have symptoms or signs suggestive of STS.
Pulmonary metastasectomy from soft tissue sarcomas
Sardenberg, Rodrigo Afonso da Silva;Figueiredo, Luiz Poli de;Haddad, Fábio José;Gross, Jefferson Luiz;Younes, Riad Naim;
Clinics , 2010, DOI: 10.1590/S1807-59322010000900010
Abstract: introduction: isolated pulmonary metastases from soft tissue sarcomas occur in 20-50% of these(the issue is about metastases, not lung cancer )patients, and 70% of these patients will present disease limited only to the lungs. surgical resection is well accepted as a standard approach to treat metastases from soft tissue sarcomas isolated in the lungs, and many studies investigating this technique have reported an overall 5-year survival ranging from 30-40%. the most consistent predictor of survival in these patients is complete resection. the aim of the present study was to determine the demographics and clinical treatment-related variables associated with long-term (90-month) overall survival in patients with lung metastases undergoing pulmonary metastasectomy from soft tissue sarcomas. methods: we performed a retrospective review of patients admitted in the thoracic surgery department with lung metastases who underwent thoracotomy for resection following treatment of the primary tumor. data regarding primary tumor features, demographics, treatment, and outcome were collected. results: one hundred twenty-two thoracotomies and 273 nodules were resected from 77 patients with previously treated soft tissue sarcomas. the median follow-up time of all patients was 36.7 months (range: 10-138 months). the postoperative complication rate was 9.1%, and the 30-day mortality rate was 0%. the 90-month overall survival rate for all patients was 34.7%. multivariate analysis identified the following independent prognostic factors for overall survival: the number of metastases resected, the disease-free interval, and the number of complete resections. conclusion: these results confirm that lung metastasectomy is a safe and potentially curative procedure for patients with treated primary tumors. a select group of patients can achieve long-term survival after lung resection.
The new era of trabectedin in soft tissue sarcomas
Axel Le Cesne
European Journal of Oncology Pharmacy , 2008,
Abstract: Prognosis for patients with soft tissue sarcomas remains poor and pharmaceutical research in this area is limited. Therefore the regulatory approval of trabectedin for the treatment of adult soft tissue sarcomas is an important milestone.
Neoadjuvant chemoradiation therapy for soft tissue sarcomas of the extremities
Aguiar Junior, Samuel;Ferreira, Fábio de Oliveira;Rossi, Benedito Mauro;Santos, érika Maria Monteiro;Salvajoli, Jo?o Victor;Lopes, Ademar;
Clinics , 2009, DOI: 10.1590/S1807-59322009001100005
Abstract: introduction and objective: neoadjuvant and adjuvant therapies for soft tissue sarcomas of the extremities are still controversial. the aim of this study was to analyze the results of a protocol of neoadjuvant chemoradiation therapy for extremity sarcomas. methods: a retrospective analysis was carried out in a consecutive series of 49 adult patients with advanced extremity soft tissue sarcomas that could not be resected with adequate margins during the primary resection. all patients were treated with a protocol of preoperative radiation therapy at a total dose of 30 gy, concomitant with doxorubicin (60 mg/m2) chemotherapy. the main endpoints assessed were local recurrence-free survival, metastasis-free survival and overall survival. the median follow-up time was 32.1 months. results: the five-year local recurrence-free survival, metastasis-free survival and overall survival rates were 81.5%, 46.7% and 58.3%, respectively. for high-grade tumors, the five-year metastasis-free and overall survival rates were only 36.3% and 41.2%, respectively. severe wound complications were observed in 41.8% of the patients who underwent surgery. these complications precluded adjuvant chemotherapy in 73.7% (14/19) of the patients eligible to receive it. conclusions: in this study, neoadjuvant chemoradiation therapy was associated with a good local control rate, but the distant relapse-free rate and overall survival rate were still poor. the high rate of wound complications modified the planning of adjuvant treatment in most patients.
Difficulties in the diagnosis of soft tissue sarcomas  [PDF]
R Jha
Journal of Institute of Medicine , 2010, DOI: 10.3126/joim.v32i2.4941
Abstract: Introduction: Soft tissue tumors represent diagnostic challenge to general practicing pathologists because of overlap in morphologic features. The usual approach is to diagnose by presumed cell lineage. A major utility of immunohistochemistry is to identify a tumor being mesenchymal or nonmesenchymal and once mesenchymal lineage has been confirmed, histologic sub typing according to specific lineage may be achieved with help of lineage specific markers.
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