Management of Locally Recurrent Sarcoma in the Extremity

2017 ◽  
Author(s):  
Lauren Krumeich ◽  
Madalyn G Neuwirth ◽  
Giorgos Karakousis
Keyword(s):  
Local Recurrence ◽  
Local Control ◽  
Malignant Tumors ◽  
Short Interval ◽  
Locally Advanced ◽  
Isolated Limb Perfusion ◽  
High Grade ◽  
Factors Associated ◽  
Limb Perfusion ◽  
Locally Recurrent

Extremity sarcomas are a heterogeneous group of malignant tumors with a varied propensity for local recurrence. This review focuses on factors associated with local recurrence and survival, diagnostic workup, management, outcomes, and surveillance. Local recurrence is more common in patients with previous local recurrence, positive margins, high-grade histology, and deep tumors. In the absence of metastases, the mainstay of treatment is limb-sparing surgery, with radiation to improve local control. Modalities such as brachytherapy or proton therapy may be valuable in the setting of previous irradiation. Systemic chemotherapy is typically limited to the treatment of distant disease, although chemotherapy can be delivered locally via limb perfusion or infusion for locally advanced or recurrent disease. Amputation is used if local control cannot be achieved while preserving adequate limb function or as a palliative option for pain, bleeding, or fungating tumors. Prognostic factors associated with poor survival include tumors that recur with high-grade histology, with a large size (> 5 cm), or within a short interval (< 16 months). Reports of 5-year overall survival in patients with locally recurrent sarcomas vary from 36 to 65%. Surveillance includes physical examination, cross-sectional imaging, and chest x-ray. Genetic profiling and intratumoral injections provide novel therapeutic targets. This review contains 1 figure, 4 tables and 40 references.   Key words: chemotherapy, hyperthermic isolated limb perfusion, intratumoral injection, isolated limb perfusion, local recurrence, margin status, radiation, soft tissue sarcoma, wide local excision 

Management of Locally Recurrent Sarcoma in the Extremity

2017 ◽  
Author(s):  
Lauren Krumeich ◽  
Madalyn G Neuwirth ◽  
Giorgos Karakousis
Keyword(s):  
Local Recurrence ◽  
Local Control ◽  
Malignant Tumors ◽  
Short Interval ◽  
Locally Advanced ◽  
Isolated Limb Perfusion ◽  
High Grade ◽  
Factors Associated ◽  
Limb Perfusion ◽  
Locally Recurrent

Extremity sarcomas are a heterogeneous group of malignant tumors with a varied propensity for local recurrence. This review focuses on factors associated with local recurrence and survival, diagnostic workup, management, outcomes, and surveillance. Local recurrence is more common in patients with previous local recurrence, positive margins, high-grade histology, and deep tumors. In the absence of metastases, the mainstay of treatment is limb-sparing surgery, with radiation to improve local control. Modalities such as brachytherapy or proton therapy may be valuable in the setting of previous irradiation. Systemic chemotherapy is typically limited to the treatment of distant disease, although chemotherapy can be delivered locally via limb perfusion or infusion for locally advanced or recurrent disease. Amputation is used if local control cannot be achieved while preserving adequate limb function or as a palliative option for pain, bleeding, or fungating tumors. Prognostic factors associated with poor survival include tumors that recur with high-grade histology, with a large size (> 5 cm), or within a short interval (< 16 months). Reports of 5-year overall survival in patients with locally recurrent sarcomas vary from 36 to 65%. Surveillance includes physical examination, cross-sectional imaging, and chest x-ray. Genetic profiling and intratumoral injections provide novel therapeutic targets. This review contains 1 figure, 4 tables and 40 references.   Key words: chemotherapy, hyperthermic isolated limb perfusion, intratumoral injection, isolated limb perfusion, local recurrence, margin status, radiation, soft tissue sarcoma, wide local excision 

scholarly journals Efficacy of hyperthermic isolated limb perfusion in the treatment of locally recurrent high-grade soft tissue sarcoma of the extremities

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Farhad Farzaliyev ◽  
Alexander Touma ◽  
Georg Taeger ◽  
Hans-Ulrich Steinau ◽  
Jendrik Hardes ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Local Recurrence ◽  
Soft Tissue Sarcoma ◽  
Isolated Limb Perfusion ◽  
High Grade ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Limb Perfusion ◽  
Locally Recurrent ◽  
Local Recurrence Free Survival

Abstract Background This novel study compared the use of tumor necrosis factor (TNF)-alpha and melphalan-based isolated limb perfusion (TM-ILP) to the standard treatment of locally recurrent soft tissue extremity sarcoma. The aim was to assess whether TM-ILP positively influences the recurrence-free survival of locally recurrent high-grade soft tissue sarcoma (STS) of the extremities. Methods We retrospectively analyzed our clinical database for patients with STS. Variables were analyzed using chi-square test or Mann-Whitney rank-sum test. Furthermore, Kaplan-Meier survival plots were calculated and a proportional hazard regression model was developed. Results Out of 448 patients with extraabdominal STS treated between August 2012 and December 2015, 52 cases involving 47 patients had locally recurrent STS. Twenty-eight of these patients were treated with TM-ILP prior to surgical resection (TM-ILP-group), and 24 were treated with standard therapy (without TM-ILP). The 3-year recurrence-free survival for the TM-ILP-group was estimated at 75% (95% confidence interval (CI), 71.5–78.5). Local recurrence-free survival in the standard group was significantly lower (LRFS: 43.4%, 95% CI 38.7–48.1, p = 0.026). Multivariable analysis revealed resection with negative margins, lower number of previous recurrences, and TM-ILP as positive predictors for recurrence-free survival. Conclusions TM-ILP and consecutive resection of residual tumor with negative resection margins significantly improves local recurrence-free survival for patients with a first local recurrence of high-grade STS in the extremities.

Regional Therapies for Extremity Sarcoma

2018 ◽  
Author(s):  
Chiara Colombo ◽  
Sandro Pasquali
Keyword(s):  
Local Recurrence ◽  
Local Treatment ◽  
Tumor Resection ◽  
Treatment Strategies ◽  
Soft Tissue Sarcomas ◽  
Isolated Limb Perfusion ◽  
External Beam Radiation ◽  
Resection Margins ◽  
Beam Radiation ◽  
Limb Perfusion

Several regional therapies are used for the local treatment of patients with soft tissue sarcomas (STS), especially for tumors at high risk for local recurrence. Surgery with negative tumor resection margins is the main treatment for primary STS. External-beam radiation therapy is considered for deeply seated, large, and high-grade disease to lower the risk of local recurrence. A combination of preoperative chemo-radiation is associated with improved local control. TNF-α-based isolated limb perfusion is another regional chemotherapy strategy available at specialized surgical oncology units for unresectable STS. Other strategies suitable for management of advanced STS include cryoablation and radiofrequency. This review discusses these and other current regional treatment strategies.  This review contains 10 figures, 6 tables and 64 references Key words: cryoablation, extremity, hyperthermia, isolated limb perfusion, limb infusion, radiotherapy, regional therapy, sarcoma

Randomized Multicenter Trial of Hyperthermic Isolated Limb Perfusion With Melphalan Alone Compared With Melphalan Plus Tumor Necrosis Factor: American College of Surgeons Oncology Group Trial Z0020

2006 ◽  
Vol 24 (25) ◽  
pp. 4196-4201 ◽  
Author(s):  
Wendy R. Cornett ◽  
Linda M. McCall ◽  
Rebecca P. Petersen ◽  
Merrick I. Ross ◽  
Henry A. Briele ◽  
...  
Keyword(s):  
Tumor Necrosis Factor ◽  
Tumor Necrosis ◽  
Response Rate ◽  
Complete Response Rate ◽  
Locally Advanced ◽  
Complete Response ◽  
Isolated Limb Perfusion ◽  
Limb Perfusion ◽  
Tnf Α ◽  
Necrosis Factor

Purpose To determine in a randomized prospective multi-institutional trial whether the addition of tumor necrosis factor alpha (TNF-α) to a melphalan-based hyperthermic isolated limb perfusion (HILP) treatment would improve the complete response rate for locally advanced extremity melanoma. Patients and Methods Patients with locally advanced extremity melanoma were randomly assigned to receive melphalan or melphalan plus TNF-α during standard HILP. Patient randomization was stratified according to disease/treatment status and regional nodal disease status. Results The intervention was completed in 124 patients of the 133 enrolled. Grade 4 adverse events were observed in 14 (12%) of 129 patients, with three (4%) of 64 in the melphalan-alone arm and 11 (16%) of 65 in the melphalan-plus-TNF-α arm (P = .0436). There were two toxicity-related lower extremity amputations in the melphalan-plus-TNF-α arm, and one disease progression–related upper extremity amputation in the melphalan-alone arm. There was no treatment-related mortality in either arm of the study. One hundred sixteen patients were assessable at 3 months postoperatively. Sixty-four percent of patients (36 of 58) in the melphalan-alone arm and 69% of patients (40 of 58) in the melphalan-plus-TNF-α arm showed a response to treatment at 3 months, with a complete response rate of 25% (14 of 58 patients) in the melphalan-alone arm and 26% (15 of 58 patients) in the melphalan-plus-TNF-α arm (P = .435 and P = .890, respectively). Conclusion In locally advanced extremity melanoma treated with HILP, the addition of TNF-α to melphalan did not demonstrate a significant enhancement of short-term response rates over melphalan alone by the 3-month follow-up, and TNF-α plus melphalan was associated with a higher complication rate.

Stereotactic Radiosurgical Salvage Treatment for Locally Recurrent Esthesioneuroblastoma

Neurosurgery ◽  
2012 ◽  
Vol 72 (3) ◽  
pp. 332-340 ◽  
Author(s):  
Jamie J. Van Gompel ◽  
Matthew L. Carlson ◽  
Bruce E. Pollock ◽  
Eric J. Moore ◽  
Robert L. Foote ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Local Control ◽  
Additional Patient ◽  
Median Dose ◽  
Single Institution ◽  
Treatment Volume ◽  
Locally Recurrent ◽  
Assess Treatment Response ◽  
Grade 3

Abstract BACKGROUND: Esthesioneuroblastoma (ENB) is a rare malignant neuroendocrine tumor considered to be radiation sensitive. Local recurrence may be treated in a variety of ways, including stereotactic radiosurgery (SRS); however, little information on its effectiveness is available. OBJECTIVE: To determine whether SRS is effective in providing local control for recurrent ENB. METHODS: This was a retrospective single-institution experience including 109 patients with ENB treated at the Mayo Clinic (1962–2009). Sixty-three patients presented with Kadish stage C disease, and 21 patients developed local recurrence. Of these 21 patients, 7 patients underwent SRS at our institution and an additional patient underwent SRS after transnasal biopsy. Therefore, a total of 8 patients are reported. RESULTS: The median age at time of local recurrence was 50 years. All patients had Kadish C disease at initial diagnosis. Six of 8 patients were found to have Hyams grade 3 disease; the remaining 2 patients had grade 2 disease. The median treatment volume was 8.4 cm3 (mean, 18.9 cm3; range, 1.4-76.3 cm3), and the median dose to the tumor margin was 15 Gy (mean, 14.4 ± 2.2 Gy; range, 10-18 Gy). Of the 16 treatments, 13 had adequate follow-up to assess treatment response, with 92% achieving local control over a median follow-up of 42 months from the time of SRS. Five lesions decreased in size, 7 lesions stabilized, and only 1 lesion had in-field progression. There were no documented complications secondary to SRS. CONCLUSION: SRS appears to be a reasonable and safe option for treatment of intracranial recurrence of ENB.

Early detection of high-grade prostate cancer using digital rectal examination in men with a normal PSA and risk of death.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 147-147
Author(s):  
Jona Ashok Hattangadi ◽  
Ming-Hui Chen ◽  
Leon Sun ◽  
Anthony Victor D'Amico
Keyword(s):  
Prostate Cancer ◽  
Locally Advanced ◽  
Digital Rectal Examination ◽  
High Grade ◽  
White Race ◽  
Factors Associated ◽  
Rectal Examination ◽  
Risk Of Death ◽  
Increased Risk ◽  
Multivariable Regression

147 Background: A digital rectal examination (DRE) is less commonly practiced in the PSA screening era. Whether detection of high-grade prostate cancer (PC) while still clinically localized on DRE can improve survival in men with a normal PSA is unknown. Methods: From the Surveillance, Epidemiology and End Results database, 166,498 men with PC diagnosed between 2004-2008 were identified. Logistic regression was used to identify factors associated with the occurrence of palpable, PSA-occult (PSA <2.5 ng/ml) and Gleason score (GS) 8-10 PC. Factors examined included age at and year of diagnosis and race. Fine and Grays and Cox multivariable regression were performed to analyze whether these factors, treatment and known prognostic factors were associated with the risk of PC-specific mortality (PCSM) and all-cause mortality (ACM), respectively. Results: Of 166,498, 685 men (0.4%) had palpable, PSA-occult and GS 8 to 10 PC. Median age and PSA at diagnosis in this group were 68 years [IQR: 61-75] and 1.5 ng/ml [IQR: 1-2], respectively. Most (83%) men were white. Both increasing age (adjusted odds ratio (AOR): 1.02 [95% confidence interval (CI) 1.01-1.03]; p<0.0001) and white race (AOR: 1.26 [95% CI 1.03-1.54]; p =0.03) were associated with palpable, Gleason 8 to 10 PC with normal PSA. Significant factors associated with an increased risk of PCSM and ACM in this cohort are shown in the table. For these 685 men, detecting locally advanced as compared to localized PC on DRE was associated with a significantly lower survival (p = 0.0001). Conclusions: Detecting PSA-occult high-grade PC with DRE while disease remains clinically localized amongst high-risk men (over age 68 and white race) has the potential to improve survival. [Table: see text]

Isolated limb perfusion in locally advanced cutaneous melanoma

2002 ◽  
Vol 29 (4) ◽  
pp. 400-409 ◽  
Author(s):  
Carlo Riccardo Rossi ◽  
Mirto Foletto ◽  
Pierluigi Pilati ◽  
Simone Mocellin ◽  
Mario Lise
Keyword(s):  
Cutaneous Melanoma ◽  
Locally Advanced ◽  
Isolated Limb Perfusion ◽  
Limb Perfusion
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