Factors Influencing Prognosis After Initial Inadequate Excision (IIE) for Soft Tissue Sarcoma.

Department of Surgical Oncology University Hospital Rotterdam/Daniel den Hoed Cancer Center Groene Hilledijk 301 Rotterdam 3075 EA The Netherlands.
Sarcoma 01/2003; 7(3-4):159-65. DOI: 10.1080/13577140310001650321
Source: PubMed

ABSTRACT Purpose. The influence of initial inadequate excision (IIE) of soft tissue sarcoma (STS) on local control and overall survival is not well established. It is generally believed that an IIE may have a negative impact on both, despite subsequent treatment by radical surgery and radiotherapy. However, data on local recurrence-free survival/overall survival are conflicting and there are no data on the effect of IIE on overall survival.Patients and methods. A retrospective analysis was made of 86 patients with soft tissue sarcoma of the extremities and trunk after an IIE had been performed due to inappropriate work-up. The minimal follow-up was 7 years. Specimens of the subsequent radical resection were evaluated for residual tumor, grade of tumor and complications of IIE. Endpoints were recurrence-free survival and overall survival.Results. Specimens of the subsequent radical resection showed residual tumor in 66 patients (77%). The most common complication after IIE was hematoma. In both univariate and multivariate analyses, grade II/III tumors and complications after IIE are significant negative prognostic factors for local recurrence-free survival (P = 0.008 and P = 0.002, respectively, in the Cox model). For this survival, three prognostic groups could be formed based on grade, or presence or absence of complications. Adjuvant radiotherapy did not change the rate of local recurrence-free survival. For overall survival, only tumor grade is a significant factor (log-rank test).Conclusion. This retrospective study shows that complications associated with an IIE have a significant negative effect on local control, but not on overall survival, because IIE is often the result of inappropriate work-up before surgery. For better diagnosis and therapy STS should be treated in specialized centers.

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    International Journal of Cancer Research 05/2013;
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    ABSTRACT: Purpose The purpose of this paper is to review the experience of our hospital in treating patients diagnosed with a soft-tissue sarcoma (STS) in one of their limbs who sought consultation further to inappropriate surgical resections or a local relapse. Materials and methods This is a retrospective study of 64 patients treated for STS in another hospital; the patients were divided into 2 groups: group A, comprised 27 patients where the initial excision proved to be inappropriate («whoops procedure»); group B was made up of 37 patients that had a local recurrence of a STS. The disease-free and accumulated (Kaplan-Meier) survivorship rates were calculated. Results Group A: all 27 patients were reoperated and in 12 cases a residual tumoral disease was detected (44%). Twenty-three patients received associated radiotherapy (intraoperatively, brachytherapy and/or external beam radiotherapy). Mean follow up was 67 months (24-216) Three had a local recurrence, two of them requiring amputation. Eleven percent of patients had died at the time of examination. The disease-free survivorship rate at 216 months was 85%. Group B: 35 of the 37 patients were reoperated (94%). Chemotherapy was used in 21 cases and in four cases isolated limb perfusion was used with TNF and melphalan (10.8%). Twenty-seven patients received radiotherapy (external beam, intraoperative and/or brachytherapy) (72%), 19 of them had received radiotherapy after the first one (70%). In 20 cases (10%) both chemotherapy and radiotherapy were used. Mean follow-up was 80 months (range: 12-264). Sixteen patients had metastasis further to treatment and nineteen had major complications. Forty-three percent of patients had died at the time of this review. Disease-free survivorship at 264 months was 16%. Conclusions After a «whoops procedure» it is possible to obtain a high disease-free survivorship rate in patients referred immediately to specialized units. Nevertheless, when local recurrence occurs, the disease-free survivorship rate decreases sharply.
    Revista Española de Cirugía Ortopédica y Traumatología. 02/2008; 52(1).
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    ABSTRACT: Objetivo El objetivo de este trabajo es revisar la experiencia de nuestro centro en el tratamiento de pacientes diagnosticados de sarcoma de partes blandas (SPB) en una extremidad que consultan tras resecciones quirúrgicas inadecuadas o recidiva local. Material y método Se trata de un estudio retrospectivo de 64 pacientes remitidos tras el tratamiento de un SPB en otro centro, divididos en 2 grupos: el grupo A, compuesto por 27 pacientes a quienes se realizó una escisión inadecuada inicial (whoops procedure) y el grupo B, con 37 pacientes afectos de una recidiva local de un SPB. Se calculó la tasa de supervivencia libre de enfermedad y la tasa de supervivencia acumulada (Kaplan-Meier). Resultados Grupo A: la totalidad de los 27 pacientes fueron reintervenidos y en 12 casos se detectó enfermedad tumoral residual (un 44%). Veintitrés pacientes recibieron radioterapia asociada (intraoperatoria, braquiterapia y/o externa). El seguimiento medio ha sido de 67 meses (24-216) Tres pacientes presentaron recidiva local, uno de los cuales precisó amputación. El 11% de los pacientes habían fallecido en el momento de la revisión. La tasa de supervivencia libre de enfermedad a los 216 meses ha sido del 85%. Grupo B: 35 de los 37 pacientes fueron reintervenidos (94%). En 21 casos se asoció quimioterapia y en 4 perfusión aislada de la extremidad con factor de necrosis tumoral (TNF) y melfalan (10,8%). Veintisiete pacientes recibieron radioterapia (externa, intraoperatoria y/o braquiterapia) (72%), 19 de ellos habían recibido ya radioterapia después de la primera (70%). En 20 casos (10%) se asoció quimioterapia y radioterapia. La media de seguimiento ha sido de 80 meses (12-264). Dieciséis pacientes presentaron metástasis después del tratamiento y diecinueve tuvieron complicaciones mayores. El 43% de los pacientes había fallecido en el momento de la revisión. La tasa de supervivencia libre de enfermedad a los 264 meses ha sido del 16%. Conclusiones Después de una escisión inadecuada inicial se puede obtener una alta tasa de supervivencia libre de enfermedad en pacientes remitidos inmediatamente a centros especializados. Sin embargo, cuando aparece la recidiva local, las posibilidades de supervivencia libre de enfermedad disminuyen drásticamente.
    Aquatic Botany - AQUAT BOT. 01/2008; 52(1):21-26.

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