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Lopes-Brás R, Muñoz P, Netto E, Fernández JÁ, Serradilla-Martín M, Lozano P, Esperança-Martins M, Blanco-Fernández G, González-López JA, Muñoz-Casares FC, Fernandes I, Asencio-Pascual JM, Vasques H. Ibero-American Consensus for the Management of Liver Metastases of Soft Tissue Sarcoma: Updated Review and Clinical Recommendations. Cancers (Basel) 2025; 17:1295. [PMID: 40282472 PMCID: PMC12025635 DOI: 10.3390/cancers17081295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2025] [Revised: 03/31/2025] [Accepted: 04/09/2025] [Indexed: 04/29/2025] Open
Abstract
Liver metastases from soft tissue sarcoma (STS) (excluding gastrointestinal stromal tumors) are rare and more commonly arise from retroperitoneal and intra-abdominal primary sites. Chemotherapy remains the mainstay of treatment for disseminated disease, but its effectiveness is limited and patients typically have a dismal prognosis with short survival. However, when metastases are confined to the liver (without pulmonary involvement), some patients may benefit from local techniques, either surgical or nonsurgical, that can provide long periods of disease-free survival. Due to the rarity of STS, especially with liver metastases, and the heterogeneity of histologies and biological behavior, there is a lack of standardized treatment guidelines and universally accepted criteria for this specific setting. To fill this gap, a multidisciplinary working group of experts in sarcoma and liver surgery reviewed the literature and available evidence and developed a set of clinical recommendations to be voted and discussed in the I Ibero-American Consensus on the Management of Metastatic Sarcoma, held at the III Spanish-Portuguese Update Meeting on the Treatment of Sarcomas in May 2024. Herein, the voting results of this meeting and the resulting consensus recommendations are presented, and their applicability, strengths, and limitations are discussed.
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Affiliation(s)
- Raquel Lopes-Brás
- Department of Medical Oncology, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisbon, Portugal (M.E.-M.)
| | - Paula Muñoz
- Department of General Surgery and Surgical Oncology, Hospital Quironsalud Torrevieja, 03184 Torrevieja, Spain;
| | - Eduardo Netto
- Department of Radiation Oncology, Instituto Português de Oncologia de Lisboa, 1099-023 Lisbon, Portugal
| | - Juan Ángel Fernández
- Department of General Surgery, Hospital Universitario Los Arcos del Mar Menor, 30739 Murcia, Spain;
- Department of Surgery, School of Medicine, Catholic University of Murcia, Campus Los Jerónimos, Guadalupe, 30107 Murcia, Spain
| | - Mario Serradilla-Martín
- Department of Surgery, Hospital Universitario Virgen de Las Nieves, Instituto de Investigación Biosanitaria Ibs.GRANADA, School of Medicine, University of Granada, 18014 Granada, Spain;
| | - Pablo Lozano
- Department of Surgical Oncology, Hospital General Universitario Gregorio Marañon, Universidad Complutense de Madrid, 28009 Madrid, Spain
| | - Miguel Esperança-Martins
- Department of Medical Oncology, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisbon, Portugal (M.E.-M.)
- Gulbenkian Institute for Molecular Medicine, 1649-028 Lisboa, Portugal
| | - Gerardo Blanco-Fernández
- Department of Hepato-pancreatic-biliary Surgery and Liver Transplantation, Hospital Universitario de Badajoz, Universidad de Extremadura, 06080 Badajoz, Spain
- Facultad de Medicina y Ciencias de la Salud, Universidad de Extremadura, 06006 Badajoz, Spain
- Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), 06080 Badajoz, Spain
| | | | | | - Isabel Fernandes
- EpiDoC Unit, CHRC, Nova Medical School, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
- Department of Hematology and Oncology, CUF Oncologia, 1998-018 Lisbon, Portugal
| | - José Manuel Asencio-Pascual
- Hepatobiliary Surgery and Liver Transplant Unit, Gregorio Marañón University Hospital, 28007 Madrid, Spain
- Department of Surgery, Faculty of Medicine, Universidad Complutense of Madrid, 28040 Madrid, Spain
| | - Hugo Vasques
- Department of Surgery, Instituto Português de Oncologia de Lisboa, 1099-023 Lisbon, Portugal;
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Ecker BL, Maki RG, Cavnar MJ, DeMatteo RP. Surgical Management of Sarcoma Metastatic to Liver. Hematol Oncol Clin North Am 2025; 39:55-65. [PMID: 39510677 DOI: 10.1016/j.hoc.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2024]
Abstract
Sarcomas are rare mesenchymal tumors with a propensity for hematogenous metastasis. Gastrointestinal stromal tumor (GIST) is the most common histologic subtype and the most common source of hepatic metastases. In the case of metastatic GIST, neoadjuvant imatinib can be used as a selection tool for the judicious application of surgery, where treatment-responsive patients who undergo resection to prevent the development of treatment-resistant clones have associated 10-year actuarial survival of 40%. Further advances for many of the non-GIST sarcoma subtypes will depend on the development of improved systemic therapies and evaluation of their activity in subtype or molecularly defined trials.
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Affiliation(s)
- Brett L Ecker
- Rutgers Cancer Institute, Rutgers Robert Wood Johnson Medical School, Cooperman Barnabas Medical Center 94 Old Short Hills Road, Suite 1172, Livingston, NJ 07039.
| | - Robert G Maki
- Department of Medicine, University of Pennsylvania, 3400 Spruce st, Philadelphia, PA 19104, USA
| | - Michael J Cavnar
- Department of Surgery, University of Kentucky, 800 Rose St First Floor, Lexington, KY 40536, USA
| | - Ronald P DeMatteo
- Rutgers Cancer Institute, Rutgers Robert Wood Johnson Medical School, Cooperman Barnabas Medical Center 94 Old Short Hills Road, Suite 1172, Livingston, NJ 07039
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Monton O, Gurau A, Kopecky K, Siddiqi A, Abreha FM, Greer JB, Johnston FM. The Use of Palliative Therapy in Patients With Advanced Retroperitoneal Sarcoma. J Surg Res 2024; 303:117-124. [PMID: 39303648 DOI: 10.1016/j.jss.2024.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 07/28/2024] [Accepted: 08/17/2024] [Indexed: 09/22/2024]
Abstract
INTRODUCTION Advanced retroperitoneal sarcoma (RPS) can include unresectable locoregional disease, systemic or multifocal intra-abdominal metastasis, or abdominal sarcomatosis, all of which are associated with high morbidity and may be addressed through palliative therapy. Current trends in the use of palliative therapy and factors associated with its use in patients with advanced RPS remain largely unexplored. The objectives of this study are to (1) describe the temporal trend in the use of palliative therapy and (2) identify factors associated with its use in patients with advanced RPS in the United States from 2004 to 2020. METHODS This study is a retrospective cohort study using the National Cancer Database. We identified adult patients who were diagnosed with advanced RPS (American Joint Committee on Cancer stages III and IV) from 2004 to 2020. We performed a trend analysis to describe the use of palliative therapy over time, followed by univariable and multivariable logistic regression analyses to identify predictors of palliative therapy use in this patient population. RESULTS A total of 6149 patients with advanced RPS were identified, of which only 383 used palliative therapy, including surgery (n = 28), radiation therapy (n = 87), systemic therapy (n = 115), pain management (n = 61), combination therapy (n = 55), or other palliative therapy (n = 37). The proportion of patients using palliative therapy increased significantly from 2.6% in 2004 to 6.5% in 2020 (Ptrend < 0.001). On multivariable logistic regression, age (odds ratio [OR] 1.03, 95 confidence interval [CI] 1.01-1.04), year of diagnosis (OR 1.05, 95 CI 1.02-1.08), lack of insurance (OR 2.18, 95 CI 1.17-4.04), community cancer program status (OR 1.83, 95 CI 1.05-3.19), stage IV disease (OR 5.19, 95 CI 4.49-7.79), and rhabdomyosarcoma (OR 2.75, 95 CI 1.32-5.72) histology were found to be predictors of palliative therapy use. CONCLUSIONS This study sheds light on the evolving landscape of palliative therapy use for patients with advanced RPS in the United States from 2004 to 2020. The observed gradual increase in the use of palliative therapy underscores the growing recognition of its importance in managing the unique challenges associated with this complex disease. Despite this positive trend, the persistently low overall rates highlight the need for further efforts to enhance awareness and accessibility of palliative therapy for this patient population.
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Affiliation(s)
- Olivia Monton
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrei Gurau
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kimberly Kopecky
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Amn Siddiqi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fasika M Abreha
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan B Greer
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Fabian M Johnston
- Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Ön S, Köksal B, Arık Z, Caner B, Ercan Uzundal D, Yazıcı O, Arslan Benli B, Eylemer Mocan E, Güngör C, Güç ZG, Akay S, Keskinkılıç M, Dik Avcı H, Karaca Yayla B, Çakar B, Şanlı UA. Trabectedin for L-Type Sarcoma: A Retrospective Multicenter Study. Curr Oncol 2024; 31:6803-6813. [PMID: 39590133 PMCID: PMC11592548 DOI: 10.3390/curroncol31110502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 10/14/2024] [Accepted: 10/28/2024] [Indexed: 11/28/2024] Open
Abstract
(1) Background: Metastatic L-type sarcomas (liposarcoma and leiomyosarcoma) are rare and have a poor prognosis. Trabectedin is an effective agent that can be used after anthracyclines. This study was designed to evaluate the real-life effectiveness and safety of trabectedin. (2) Methods: A retrospective multicenter study was conducted on patients who were treated with trabectedin for metastatic L-type sarcomas at ten tertiary oncology centers between 2015 and 2023. The objective response rate (ORR), disease control rate (DCR), time to treatment failure (TTF), and overall survival (OS) were evaluated in the cohort. Cox regression analysis was used to determine prognostic factors for survival. (3) Results: A total of 98 patients (52% liposarcoma and 48% leiomyosarcoma) were included in the study. The median treatment line was three (range: 1 to 6). Thirteen patients (13.3%) underwent local treatment due to oligoprogression, and dose reduction was required in seventeen patients (17.3%) due to toxicity. The ORR and DCR were 16% and 42%, respectively. The median TTF was 3 months, and the median OS was 10 months. In univariate analysis, a significantly longer median TTF was observed in patients who underwent local treatment (p = 0.008), obtained objective responses (p < 0.001), and underwent dose reduction (p = 0.002). No statistical differences were observed according to the histologic subtype and metastatic site. In the multivariate analysis for OS, it was found that obtaining an objective response was a good prognostic factor (p = 0.003), while the presence of liver metastases was associated with a poor prognosis (p = 0.016). (4) Conclusion: Trabectedin is a suitable option for L-type sarcoma after doxorubicin-based treatments. Survival was not worse in patients who underwent dose reduction. The use of local therapies simultaneously with trabectedin can be effective.
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Affiliation(s)
- Sercan Ön
- Department of Medical Oncology, Tepecik Training and Research Hospital, 35180 Izmir, Türkiye
| | - Barış Köksal
- Department of Oncology, Hacettepe University Cancer Institute, 06410 Ankara, Türkiye
| | - Zafer Arık
- Department of Oncology, Hacettepe University Cancer Institute, 06410 Ankara, Türkiye
| | - Burcu Caner
- Department of Oncology, Atatürk Government Hospital, 09020 Aydın, Türkiye
| | - Duygu Ercan Uzundal
- Department of Oncology, Gazi University Medical School Hospital, 06560 Ankara, Türkiye
| | - Ozan Yazıcı
- Department of Oncology, Gazi University Medical School Hospital, 06560 Ankara, Türkiye
| | | | - Eda Eylemer Mocan
- Department of Oncology, Ankara University Medical School Hospital, 06620 Ankara, Türkiye
| | - Can Güngör
- Department of Oncology, Selçuk University Medical School Hospital, 42130 Konya, Türkiye
| | - Zeynep Gülsüm Güç
- Department of Oncology, Katip Çelebi University Atatürk Training and Research Hospital, 35150 Izmir, Türkiye
| | - Seval Akay
- Department of Oncology, Izmir City Hospital, 35540 Izmir, Türkiye
| | - Merve Keskinkılıç
- Department of Oncology, Burdur Government Hospital, 15000 Burdur, Türkiye
| | - Hande Dik Avcı
- Department of Internal Medicine, Ege University Medical School Hospital, 35100 Izmir, Türkiye
| | - Burçak Karaca Yayla
- Department of Medical Oncology, Ege University Tilay Aktaş Oncology Hospital, 35100 Izmir, Türkiye
| | - Burcu Çakar
- Department of Medical Oncology, Ege University Tilay Aktaş Oncology Hospital, 35100 Izmir, Türkiye
| | - Ulus Ali Şanlı
- Department of Medical Oncology, Ege University Tilay Aktaş Oncology Hospital, 35100 Izmir, Türkiye
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Awad A, Pal K, Yevich S, Kuban JD, Tam A, Odisio BC, Gupta S, Habibollahi P, Bishop AJ, Conley AP, Somaiah N, Araujo DM, Zarzour MA, Ratan R, Roland CL, Keung EZ, Huang SY, Sheth RA. Safety and efficacy of percutaneous image-guided ablation for soft tissue sarcoma metastases to the liver. Cancer 2024; 130:2703-2712. [PMID: 38642369 DOI: 10.1002/cncr.35330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE To evaluate outcomes following percutaneous image-guided ablation of soft tissue sarcoma metastases to the liver. MATERIALS AND METHODS A single-institution retrospective analysis of patients with a diagnosis of metastatic soft tissue sarcoma who underwent percutaneous image-guided ablation of hepatic metastases between January 2011 and December 2021 was performed. Patients with less than 60 days of follow-up after ablation were excluded. The primary outcome was local tumor progression-free survival (LPFS). Secondary outcomes included overall survival, liver-specific progression-free survival. and chemotherapy-free survival. RESULTS Fifty-five patients who underwent percutaneous ablation for 84 metastatic liver lesions were included. The most common histopathological subtypes were leiomyosarcoma (23/55), followed by gastrointestinal stromal tumor (22/55). The median treated liver lesions was 2 (range, 1-8), whereas the median size of metastases were 1.8 cm (0.3-8.7 cm). Complete response at 2 months was achieved in 90.5% of the treated lesions. LPFS was 83% at 1 year and 80% at 2 years. Liver-specific progression-free survival was 66% at 1 year and 40% at 2 years. The overall survival at 1 and 2 years was 98% and 94%. The chemotherapy-free holiday from the start of ablation was 71.2% at 12 months. The complication rate was 3.6% (2/55); one of the complications was Common Terminology Criteria for Adverse Events grade 3 or higher. LPFS subgroup analysis for leiomyosarcoma versus gastrointestinal stromal tumor suggests histology-agnostic outcomes (2 years, 89% vs 82%, p = .35). CONCLUSION Percutaneous image-guided liver ablation of soft tissue sarcoma metastases is safe and efficacious.
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Affiliation(s)
- Ahmed Awad
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Koustav Pal
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Steven Yevich
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Joshua D Kuban
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Alda Tam
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Bruno C Odisio
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanjay Gupta
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Peiman Habibollahi
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Andrew J Bishop
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Anthony Paul Conley
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Neeta Somaiah
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Dejka M Araujo
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Ravin Ratan
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Christina L Roland
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Emily Z Keung
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Steven Y Huang
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Rahul A Sheth
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas, USA
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6
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Øines MN, Smith HG, Preisler L, Penninga L. Leiomyosarcoma of the abdomen and retroperitoneum; a systematic review. Front Surg 2024; 11:1375483. [PMID: 39086921 PMCID: PMC11288885 DOI: 10.3389/fsurg.2024.1375483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/24/2024] [Indexed: 08/02/2024] Open
Abstract
Background Intraabdominal and retroperitoneal leiomyosarcomas are rare cancers, which cause significant morbidity and mortality. Symptoms, treatment and follow up differs from other cancers, and proper diagnosis and treatment of intraabdominal and retroperitoneal leiomyosarcomas is of utmost importance. We performed a systematic review to collect and summarize available evidence for diagnosis and treatment for these tumours. Methods We performed a systematic literature search of Pubmed from the earliest entry possible, until January 2021. Our search phrase was (((((colon) OR (rectum)) OR (intestine)) OR (abdomen)) OR (retroperitoneum)) AND (leiomyosarcoma). All hits were evaluated by two of the authors. Results Our predefined search identified 1983 hits, we selected 218 hits and retrieved full-text copies of these. 144 studies were included in the review. Discussion This review summarizes the current knowledge and evidence on non-uterine abdominal and retroperitoneal leiomyosarcomas. The review has revealed a lack of high-quality evidence, and randomized clinical trials. There is a great need for more substantial and high-quality research in the area of leiomyosarcomas of the abdomen and retroperitoneum. Systematic Review Registration PROSPERO, identifier, CRD42023480527.
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Affiliation(s)
- Mari Nanna Øines
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Louise Preisler
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Luit Penninga
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Parvinian A, Thompson SM, Schmitz JJ, Welch BT, Hibbert R, Adamo DA, Kurup AN. Update on Percutaneous Ablation for Sarcoma. Curr Oncol Rep 2024; 26:601-613. [PMID: 38647995 DOI: 10.1007/s11912-024-01532-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW To provide an update on the current state of percutaneous thermal ablation in the treatment of sarcoma. RECENT FINDINGS Data continue to accrue in support of ablation for local control and palliation of specific sarcoma subtypes such as extra-abdominal desmoid fibromatosis and for broader indications such as the treatment of oligometastatic disease. The synergistic possibilities of various combination therapies such as cryoablation and immunotherapy represent intriguing areas of active investigation. Histotripsy is an emerging non-invasive, non-thermal ablative modality that may further expand the therapeutic arsenal for sarcoma treatment. Percutaneous thermal ablation is a valuable tool in the multidisciplinary management of sarcoma, offering a minimally invasive adjunct to surgery and radiation therapy. Although there remains a paucity of high-level evidence specific to sarcomas, ablation techniques are demonstrably safe and effective for achieving local tumor control and providing pain relief in select patients and are of particular benefit in those with metastatic disease or requiring palliative care.
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Affiliation(s)
- Ahmad Parvinian
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Scott M Thompson
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Brian T Welch
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Rebecca Hibbert
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Daniel A Adamo
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - A Nicholas Kurup
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
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Wen H, Huang Y, Huang S, Xiao H, Xie W, Zhou Q, Tan L, Ding Y, Liu X, Yu Y, Song Z, Shen S, Chen Z, Zhang X. The long-term efficacy of imatinib with hepatic resection or other local treatment for gastrointestinal stromal tumours liver metastases：a retrospective cohort study. Int J Surg 2024; 110:01279778-990000000-00971. [PMID: 38619177 PMCID: PMC11020002 DOI: 10.1097/js9.0000000000001077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/27/2023] [Indexed: 04/16/2024]
Abstract
BACKGROUND The liver is the most common site of metastasis from gastrointestinal stromal tumours (GISTs). We aimed to evaluate imatinib (IM) combined with hepatic resection (HR) or other local treatments such as radiofrequency ablation (RFA) and transarterial chemoembolization (TACE), compared to IM monotherapy in long-term survival benefits in patients suffering from GIST liver metastases. METHODS Our research encompassed 238 patients diagnosed with liver metastases of GISTs from January 2002 to April 2022 at the XXX Hospital of XXX University. The oncological outcomes of concern included overall survival (OS), progression-free survival (PFS) and liver-specific PFS. RESULTS Of all 238 patients, 126 were treated with IM alone (IM group), 81 with IM combined with HR (IM+HR group), and 31 with IM combined with RFA/TACE (IM+RFA/TACE group). The median follow-up time was 44.83 months. The median OS in the IM group was 132.60 months and was not reached in either the IM+HR group or the IM+RFA/TACE group. The 10-year OS rate in the IM+HR group was significantly superior to the IM group and the IM+RFA/TACE group (91.9% vs. 61.1% vs. 55.2%, respectively, P=0.015), and the liver-specific PFS (P=0.642) and PFS (P=0.369) in the three groups showed a beneficial trend in the combined treatment group. Multivariate analyses showed that age ≤60 years (HR 0.280, P<0.001) and IM+HR (HR 0.361, P=0.047) were independently associated with better OS. Achieving no evidence of disease (NED) through surgical intervention was independently correlated with enhanced OS (HR 0.099, P=0.034), liver-specific PFS (HR 0.388, P=0.014), and PFS (HR 0.402, P=0.004). CONCLUSIONS In patients with GIST liver metastases, IM combined with HR might improve OS in selected patients compared with IM alone and IM combined with RFA/TACE. Achieving NED status with surgical treatment of patients results in significant prolonging of OS, liver-specific PFS and PFS.
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Affiliation(s)
| | - Yihao Huang
- Center of Hepato-Pancreatico-Biliary Surgery
| | | | - Han Xiao
- Division of Interventional Ultrasound
| | - Wenxuan Xie
- Center of Hepato-Pancreatico-Biliary Surgery
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trials Unit
| | - Li Tan
- Center of Hepato-Pancreatico-Biliary Surgery
| | - Yuqi Ding
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xiaofei Liu
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yang Yu
- Center of Hepato-Pancreatico-Biliary Surgery
| | - Zimin Song
- Center of Hepato-Pancreatico-Biliary Surgery
| | - Shunli Shen
- Center of Hepato-Pancreatico-Biliary Surgery
| | - Zebin Chen
- Center of Hepato-Pancreatico-Biliary Surgery
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9
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Liu L, Wang B, Zhang ZY, Wang S, Wu H, Wang H, Wu W, Yan K, Yang W. Percutaneous ultrasound-guided radiofrequency ablation for patients with liver metastases from gastrointestinal stromal tumors. Int J Hyperthermia 2023; 41:2292950. [PMID: 38159558 DOI: 10.1080/02656736.2023.2292950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES This study aimed to analyze the survival outcomes and prognostic factors of radiofrequency ablation (RFA) for liver metastases from gastrointestinal stromal tumors (GISTs). METHODS Between March 2011 and November 2022, 34 patients (16 males; age range, 25-72 [median age, 52.5] years) who underwent RFA for liver metastasis from GISTs were included. The mean maximum diameter of metastatic lesions was 2.4 ± 1.0 (range, 1.1-5.2) cm. Survival curves were constructed using the Kaplan-Meier method and compared using the log-rank test. Multivariate analyses were performed using a Cox proportional hazards model. RESULTS For 79 lesions among 34 patients, all targeted lesions were completely ablated. The mean hepatic progression-free survival (HPFS) period was 28.4 ± 3.8 (range, 1.0-45.7) months. The 1-, 3-, and 5-year HPFS rates were 67.2%, 60.5%, and 20.2%, respectively. Based on the univariate analysis, the number of metastatic tumors and tyrosine kinase inhibitors(TKI) therapy before RFA were prognostic factors for HPFS. Multivariate analysis showed that pre-RFA TKI therapy was associated with a better HPFS(p = 0.030). The mean overall survival (OS) period was 100.5 ± 14.1 (range, 3.8-159.5) months and the 1-, 3-, and 5-year survival rates were 96.9%, 77.1%, and 58.7%, respectively. Both univariate and multivariate analysis indicated that extrahepatic metastasis before RFA (p = 0.044) was a significant prognostic factor for OS. CONCLUSIONS Liver metastases from GIST exhibit relatively mild biological behavior. RFA is safe and effective, particularly in patients without pre-RFA extrahepatic metastases. Patients received targeted therapy before RFA can obtain an extended HPFS.
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Affiliation(s)
- Li Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Bing Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhong-Yi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Song Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hao Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hong Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wei Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Kun Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
| | - Wei Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, China
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10
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Guadagni S, Peri A, Palmeri M, Furbetta N, Di Franco G, Filardo M, Comandatore A, Pollina LE, Gaeta R, Sbrana A, Galli L, Mercinelli C, Pietrabissa A, Di Candio G, Morelli L. Surgical treatment of recurrent retroperitoneal sarcoma in its different patterns: A 15-years' two-centers experience. Surgeon 2023; 21:e249-e257. [PMID: 36707317 DOI: 10.1016/j.surge.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION There is limited data available regarding the role of surgery in the treatment of retroperitoneal sarcoma (RPS) recurrences. We herein report the short- and mid-term outcomes of patients who underwent surgical treatment of RPS recurrences at two Italian centers over a 15-years' experience. MATERIALS AND METHODS From January 2005 to January 2020, 33 patients underwent surgical treatment of isolated locally recurrent RPS (LR group), locally recurrent RPS associated with the presence of distant recurrence (LR + DM group), and distant-only recurrent RPS (DM group). Only procedures performed to obtain a macroscopically radical treatment with curative intent were included. Data regarding pre-, intra-, post-operative course, and follow-up, collected in an Institutional database, were retrospectively analyzed, and compared. RESULTS LR-group was composed of 15 patients, LR + DM group of 9 patients, and DM group of 9 patients. During the follow-up, 78.5% of the LR group, 77.8% of the DM group and 100% of the LR + DM group (p = 0.244) experienced a second recurrence. 7/11 (63.6%) patients in the LR group, 2/7 (28.5%) patients in the DM-group, and 0/9 (0.0%) patients in the LR + DM group underwent to almost one further local treatments of their recurrences (p = 0.010). No differences in the mean disease-free survival (p = 0.127), overall survival (OS) (p = 0.165) was reported among the three groups. Repeated surgery was an independent factor affecting survival in multivariate analysis (p = 0.01). CONCLUSIONS A surgical treatment of RPS recurrences should always be taken into consideration, also in metastatic patients and/or in those who have already undergone surgery for previous RPS recurrence, because this approach may offer survival benefits.
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Affiliation(s)
- Simone Guadagni
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Andrea Peri
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Palmeri
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
| | - Niccolò Furbetta
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Gregorio Di Franco
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Matteo Filardo
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Annalisa Comandatore
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Raffaele Gaeta
- Second Division of Surgical Pathology, University Hospital of Pisa, Italy
| | - Andrea Sbrana
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Luca Galli
- Unit of Oncology 2, University Hospital of Pisa, Italy
| | | | - Andrea Pietrabissa
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulio Di Candio
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Luca Morelli
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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11
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Janes LA, Angeles CV. The Role of Surgery in Oligometastatic Retroperitoneal Sarcoma. Curr Oncol 2023; 30:5240-5250. [PMID: 37366881 DOI: 10.3390/curroncol30060398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Retroperitoneal sarcomas are extremely rare, comprising <15% of primary sarcomas. Distant metastasis occurs in about 20% of cases, with pulmonary and hepatic metastasis as the most common sites of hematogenous spread. Although surgical resection is well established as the main treatment of localized primary disease, there are limited guidelines for the surgical treatment of intra-abdominal and distant metastases. There are inadequate systemic treatment options for patients with metastatic sarcoma, thereby necessitating the consideration of surgical options in carefully selected patients. Key points to consider include tumor biology, patient fitness and co-morbidities, overall prognosis, and goals of care. Multidisciplinary sarcoma tumor board discussion for each case is an essential practice in order to deliver the best care to these patients. The purpose of this review is to summarize the published literature on the past and present role of surgery in the treatment of oligometastatic retroperitoneal sarcoma in order to inform the management of this difficult disease.
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Affiliation(s)
- Lindsay A Janes
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Christina V Angeles
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
- Rogel Cancer Center, University of Michigan, 1500 E. Medical Center Drive, 6219 Cancer Center Ann Arbor, Ann Arbor, MI 48109, USA
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12
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Kniepeiss D, Talakić E, Portugaller RH, Fuchsjäger M, Schemmer P. Non-colorectal liver metastases: A review of interventional and surgical treatment modalities. Front Surg 2022; 9:945755. [PMID: 36406370 PMCID: PMC9666734 DOI: 10.3389/fsurg.2022.945755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/13/2022] [Indexed: 12/31/2023] Open
Abstract
Liver metastases (LM) occur in up to 90% either simultaneously with the diagnosis of the primary tumor or at a later time-point. While resection of colorectal LM and resection or transplantation of neuroendocrine LM is part of a standard therapy with a 5-year patient survival of up to 80%, resection of non-colorectal and non-neuroendocrine LM is still discussed controversially. The reason for it is the significantly lower survival benefit of all different tumor entities depending on the biological aggressiveness of the tumor. Randomized controlled trials are lacking. However, reviews of case series with ≥100 liver resections are available. They show a 5-year patient survival of up to 42% compared to only <5% in patients without treatment. Risk factors for poor survival include the type of primary tumor, a short interval between resection of the primary tumor and liver resection, extrahepatic manifestation of the tumor, number and size of the LM, and extent of liver resection. Overall, it has recently been shown that a good patient selection, the technical advances in surgical therapy and the use of a risk score to predict the prognosis lead to a significantly better outcome so that it is no longer justified not to offer liver resection to patients with non-colorectal, non- endocrine LM. Since modern therapy of LM is multimodal, the optimal therapeutic approach is decided individually by a multidisciplinary team consisting of visceral surgeons, oncologists, interventional radiologists and radiologists as part of a tumor board.
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Affiliation(s)
- Daniela Kniepeiss
- General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria
- University Transplant Center Graz, Medical University of Graz, Graz, Austria
| | - Emina Talakić
- University Transplant Center Graz, Medical University of Graz, Graz, Austria
- Department of Radiology, Division of General Radiology, Medical University of Graz, Graz, Austria
| | - Rupert Horst Portugaller
- University Transplant Center Graz, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Michael Fuchsjäger
- University Transplant Center Graz, Medical University of Graz, Graz, Austria
- Department of Radiology, Division of General Radiology, Medical University of Graz, Graz, Austria
| | - Peter Schemmer
- General, Visceral and Transplant Surgery, Medical University of Graz, Graz, Austria
- University Transplant Center Graz, Medical University of Graz, Graz, Austria
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13
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Zane KE, Nagib PB, Jalil S, Mumtaz K, Makary MS. Emerging curative-intent minimally-invasive therapies for hepatocellular carcinoma. World J Hepatol 2022; 14:885-895. [PMID: 35721283 PMCID: PMC9157708 DOI: 10.4254/wjh.v14.i5.885] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/20/2022] [Accepted: 04/25/2022] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common cause of liver malignancy and the fourth leading cause of cancer deaths universally. Cure can be achieved for early stage HCC, which is defined as 3 or fewer lesions less than or equal to 3 cm in the setting of Child-Pugh A or B and an ECOG of 0. Patients outside of these criteria who can be down-staged with loco-regional therapies to resection or liver transplantation (LT) also achieve curative outcomes. Traditionally, surgical resection, LT, and ablation are considered curative therapies for early HCC. However, results from recently conducted LEGACY study and DOSISPHERE trial demonstrate that transarterial radio-embolization has curative outcomes for early HCC, leading to its recent incorporation into the Barcelona clinic liver criteria guidelines for early HCC. This review is based on current evidence for curative-intent loco-regional therapies including radioembolization for early-stage HCC.
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Affiliation(s)
- Kylie E Zane
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Paul B Nagib
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Sajid Jalil
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Khalid Mumtaz
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Mina S Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.
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14
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Tsuzaka S, Asahi Y, Kamiyama T, Kakisaka T, Orimo T, Nagatsu A, Aiyama T, Uebayashi T, Kamachi H, Matsuoka M, Wakabayashi K, Otsuka T, Matsuno Y, Taketomi A. Laparoscopic liver resection for liver metastasis of leiomyosarcoma of the thigh: a case report. Surg Case Rep 2022; 8:47. [PMID: 35307790 PMCID: PMC8934789 DOI: 10.1186/s40792-022-01400-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Although there is no established treatment strategy for liver metastasis of leiomyosarcoma, liver resection has been reported to be effective in some cases. However, almost all liver resections performed for liver metastasis of primary leiomyosarcoma are reported to be open resections, and there are few reports of liver resection performed by laparoscopy. Here, we report a case of laparoscopic liver resection for liver metastasis of a leiomyosarcoma in the right thigh.
Case presentation An 80-year-old man was diagnosed with leiomyosarcoma of the right thigh with liver metastasis. The primary tumor was first resected, and he was discharged on the 25th postoperative day. Four months after primary tumor resection, a laparoscopic right posterior sectionectomy was performed. There were no postoperative complications, and the patient was discharged on the 11th postoperative day with a histopathological diagnosis of liver metastasis of leiomyosarcoma and negative resection margins. Currently, 9 months have passed since the resection of the primary tumor, and 5 months have passed since the laparoscopic liver resection; there is no recurrence. Conclusions The liver metastasis of leiomyosarcoma was successfully removed, with good short-term outcomes after the laparoscopic liver resection. Laparoscopic liver resection seems to be effective for liver metastasis of leiomyosarcoma, which is characterized by a high recurrence rate after surgery. However, more case studies may be necessary to examine the effectiveness and long-term results of laparoscopic liver resection for the treatment of liver metastasis of leiomyosarcoma.
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Affiliation(s)
- Shoichi Tsuzaka
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Yoh Asahi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan.
| | - Toshiya Kamiyama
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Tatsuhiko Kakisaka
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Tatsuya Orimo
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Akihisa Nagatsu
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Takeshi Aiyama
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Takeyuki Uebayashi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Hirofumi Kamachi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Masatake Matsuoka
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Kento Wakabayashi
- Department of Surgical Pathology, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Takuya Otsuka
- Department of Surgical Pathology, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
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15
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Kniepeiss D, Talakić E, Schemmer P. Interventionelle und chirurgische Therapie non-kolorektaler Lebermetastasen. TUMORDIAGNOSTIK & THERAPIE 2021; 42:585-597. [DOI: 10.1055/a-1557-7043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2025]
Abstract
ZusammenfassungIn der Vergangenheit wurden Resektionen oder Transplantationen wegen non-kolorektaler Lebermetastasen durch die Abwägung von geringem Überlebensvorteil und Komplikationsrate eher zurückhaltend indiziert. Mittlerweile zählt die Leberchirurgie jedoch zu den komplikationsarmen Standardverfahren in der Tumortherapie, die unter Einbettung in multimodale Therapiekonzepte zu einer deutlichen Steigerung des Patientenüberlebens führen.
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Affiliation(s)
- Daniela Kniepeiss
- Klinische Abteilung für Transplantationschirurgie an der Universitätsklinik für Chirurgie; Universitätsklinikum Graz, Österreich
| | - Emina Talakić
- Klinische Abteilung für Allgemeine Radiologie, Universitätsklinik für Radiologie, Medizinische Universität Graz, Österreich
| | - Peter Schemmer
- Fachbereich für Allgemein-, Viszeral- und Transplantationschirurgie Graz an der Universitätsklinik für Chirurgie; Medizinische Universität Graz, Österreich
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16
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Treatment of gastrointestinal stromal tumors: A single-center experience. North Clin Istanb 2021; 8:385-392. [PMID: 34585074 PMCID: PMC8430361 DOI: 10.14744/nci.2020.04468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/24/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract. We aimed to examine the clinical characteristics and treatment outcomes of patients diagnosed with gastrointestinal stromal tumor (GIST) who were followed up and treated in our center. METHODS: This study retrospectively evaluated the clinical characteristics, disease stages, administered treatments, and treatment responses of 67 patients diagnosed with GIST who presented to our center between 2007 and 2015. RESULTS: Of the 67 patients included in our study, 24 (35.8%) were female and 43 (64.2%) were male. Median age at diagnosis was 54 years (23–86). Primary tumor localization was the stomach in 38.8% (n=26), small intestine in 46.2% (n=31), colorectal in 6% (n=4), and extra-gastrointestinal in 9% (n=6) of the patients. At diagnosis, 19 patients (28.4%) were at a metastatic stage. Fifty-seven patients (85.1%) underwent surgery. Thirty-three patients received one line, 20 patients received two lines, and 12 patients received three lines of treatment. The first-line treatment resulted in complete response in 12 patients (36.4%), partial response in 15 patients (45.5%), stable disease in 5 patients (15.2%), and progression in 1 patient (3%). Progression-free survival (PFS) was 36 months for the first-line treatment. The second-line treatment resulted in partial response in 7 patients (35%), stable disease in 12 patients (60%), and progression in 1 patient (5%). PFS was 12 months for the second-line treatment. The third-line treatment resulted in complete response in 1 patient (8.3%), partial response in 3 patients (25%), stable disease in 5 patients (41.7%), and progression in 3 patients (25%). PFS was 9 months for the third-line treatment. The fourth-line treatment resulted in stable disease in 4 patients (80%) and progression in 1 patient (20%). PFS was 4 months for the fourth-line treatment. Overall survival was 90 months for all patients. CONCLUSION: The use of tyrosine kinase inhibitors such as imatinib has a significant favorable effect on the prognosis in the treatment of GISTs, both in adjuvant therapy and in advanced stage disease.
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17
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Zane KE, Cloyd JM, Mumtaz KS, Wadhwa V, Makary MS. Metastatic disease to the liver: Locoregional therapy strategies and outcomes. World J Clin Oncol 2021; 12:725-745. [PMID: 34631439 PMCID: PMC8479345 DOI: 10.5306/wjco.v12.i9.725] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/14/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023] Open
Abstract
Secondary cancers of the liver are more than twenty times more common than primary tumors and are incurable in most cases. While surgical resection and systemic chemotherapy are often the first-line therapy for metastatic liver disease, a majority of patients present with bilobar disease not amenable to curative local resection. Furthermore, by the time metastasis to the liver has developed, many tumors demonstrate a degree of resistance to systemic chemotherapy. Fortunately, catheter-directed and percutaneous locoregional approaches have evolved as major treatment modalities for unresectable metastatic disease. These novel techniques can be used for diverse applications ranging from curative intent for small localized tumors, downstaging of large tumors for resection, or locoregional control and palliation of advanced disease. Their use has been associated with increased tumor response, increased disease-free and overall survival, and decreased morbidity and mortality in a broad range of metastatic disease. This review explores recent advances in liver-directed therapies for metastatic liver disease from primary colorectal, neuroendocrine, breast, and lung cancer, as well as uveal melanoma, cholangiocarcinoma, and sarcoma. Therapies discussed include bland transarterial embolization, chemoembolization, radioembolization, and ablative therapies, with a focus on current treatment approaches, outcomes of locoregional therapy, and future directions in each type of metastatic disease.
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Affiliation(s)
- Kylie E Zane
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Jordan M Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Khalid S Mumtaz
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Vibhor Wadhwa
- Department of Radiology, Weill Cornell Medical Center, New York City, NY 10065, United States
| | - Mina S Makary
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
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18
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Multidisciplinary Management of Retroperitoneal Sarcoma: Diagnosis, Prognostic Factors and Treatment. Cancers (Basel) 2021; 13:cancers13164016. [PMID: 34439171 PMCID: PMC8392612 DOI: 10.3390/cancers13164016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/06/2021] [Indexed: 01/07/2023] Open
Abstract
Simple Summary The management of retroperitoneal sarcomas can be challenging due to the variety of their presentation, histopathological types, and behaviours. This literature review provides a comprehensive and practical overview of the management of retroperitoneal sarcomas, focusing on diagnostic challenges, prognostic factors, multidisciplinary aspects of treatment and new research perspectives. Abstract Retroperitoneal sarcomas (RPS) are rare cancers whose management can be challenging due to various presentation patterns, multiple organ involvement, and a high local and distant recurrence rate. Histopathology and prognostic factors analysis are essential to predict the behaviour of the disease and plan the best therapeutic strategy. To date, surgery is still the main therapeutic option that guarantees a chance of cure from the primary disease. While chemotherapy and radiotherapy seem to be good options for controlling metastatic and recurrent irresectable disease, their role in the treatment of primary RPS remains unclear. This literature review aims to provide a comprehensive overview of the multidisciplinary aspects of RPS management in high-volume centres, summarising the diagnostic path, the prognostic factors, and the most suitable therapeutic options.
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19
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Su BB, Bai DS, Yu JQ, Zhang C, Jin SJ, Zhou BH, Jiang GQ. Can Patients with Pancreatic Cancer and Liver Metastases Obtain Survival Benefit from Surgery? A Population-Based Study. J Cancer 2021; 12:539-552. [PMID: 33391450 PMCID: PMC7739005 DOI: 10.7150/jca.51218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/29/2020] [Indexed: 02/06/2023] Open
Abstract
Background: Surgery for pancreatic cancer with liver metastases (PCL) is not recommended in the international guidelines, and investigation of its clinical significance in patients with PCL is very limited. This study explored whether surgery, especially synchronous resection of the primary tumor and liver metastases (SPL), could improve survival in PCL. Methods: Data of 14,248 patients with PCL from Surveillance, Epidemiology, and End Results database was analyzed. Patients were divided into following groups: SPL, synchronous primary site, and other resection (SPO), single resection of the primary site (SPS), and no resection (NR). Results: In this study, only 93 (0.7%) underwent SPL, 88 (0.6%) for SPO, and 232 (1.6%) for SPS. Multivariate Cox analysis showed surgical procedures of both the primary site and other sites were independent protective prognostic factors for pancreatic cancer cause-specific survival (PCSS) (all P < 0.001). Patients in the SPL group showed the most survival benefit, with a significant and gradually increased difference as compared with the SPO, SPS, and NR groups (median survival: 54, 34, 15, and 3 months, respectively, all P < 0.001). Compared with the NR group, mortalities were significant and gradually declining in the SPS, SPO, and SPL groups, with hazard ratio 0.329 (95% confidence interval [CI], 0.281 to 0.386), 0.220 (95% CI, 0.164 to 0.294), and 0.162 (95% CI, 0.118 to 0.222), respectively (all P < 0.001). Conclusions: Surgical procedures for both primary site and other sites improved survival. SPL, particularly, showed a considerable survival benefit in well-selected patients with PCL.
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Affiliation(s)
- Bing-Bing Su
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou 225001, China
| | - Dou-Sheng Bai
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou 225001, China
| | - Jiang-Quan Yu
- Department of Intensive Care Unit, Clinical Medical College, Yangzhou University, Yangzhou 225001, China
| | - Chi Zhang
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou 225001, China
| | - Sheng-Jie Jin
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou 225001, China
| | - Bao-Huan Zhou
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou 225001, China
| | - Guo-Qing Jiang
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou 225001, China
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20
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Ecker BL, Maki RG, Cavnar MJ, DeMatteo RP. Surgical Management of Sarcoma Metastatic to Liver. Surg Oncol Clin N Am 2020; 30:57-67. [PMID: 33220809 DOI: 10.1016/j.soc.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Sarcomas are rare mesenchymal tumors with a propensity for hematogenous metastasis. Gastrointestinal stromal tumor (GIST) is the most common histologic subtype and the most common source of hepatic metastases. In the case of metastatic GIST, neoadjuvant imatinib can be used as a selection tool for the judicious application of surgery, where treatment-responsive patients who undergo resection to prevent the development of treatment-resistant clones have associated 10-year actuarial survival of 40%. Further advances for many of the non-GIST sarcoma subtypes will depend on the development of improved systemic therapies and evaluation of their activity in subtype or molecularly defined trials.
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Affiliation(s)
- Brett L Ecker
- Department of Surgery, University of Pennsylvania, 3400 Spruce st, Philadelphia, PA 19104, USA.
| | - Robert G Maki
- Department of Medicine, University of Pennsylvania, 3400 Spruce st, Philadelphia, PA 19104, USA
| | - Michael J Cavnar
- Department of Surgery, University of Kentucky, 800 Rose St First Floor, Lexington, KY 40536, USA
| | - Ronald P DeMatteo
- Department of Surgery, University of Pennsylvania, 3400 Spruce st, Philadelphia, PA 19104, USA
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Ferrandina G, Aristei C, Biondetti PR, Cananzi FCM, Casali P, Ciccarone F, Colombo N, Comandone A, Corvo' R, De Iaco P, Dei Tos AP, Donato V, Fiore M, Franchi, Gadducci A, Gronchi A, Guerriero S, Infante A, Odicino F, Pirronti T, Quagliuolo V, Sanfilippo R, Testa AC, Zannoni GF, Scambia G, Lorusso D. Italian consensus conference on management of uterine sarcomas on behalf of S.I.G.O. (Societa' italiana di Ginecologia E Ostetricia). Eur J Cancer 2020; 139:149-168. [PMID: 32992154 DOI: 10.1016/j.ejca.2020.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/10/2020] [Accepted: 08/22/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Uterine sarcomas are very rare tumours with different histotypes, molecular features and clinical outcomes; therefore, it is difficult to carry out prospective clinical trials, and this often results in heterogeneous management of patients in the clinical practice. AIM We planned to set up an Italian consensus conference on these diseases in order to provide recommendations on treatments and quality of care in our country. RESULTS Early-stage uterine sarcomas are managed by hysterectomy + bilateral salpingo-oophorectomy according to menopausal status and histology; lymphadenectomy is not indicated in patients without bulky nodes, and morcellation must be avoided. The postoperative management is represented by observation, even though chemotherapy can be considered in some high-risk patients. In early-stage low-grade endometrial stromal sarcoma and adenosarcomas without sarcomatous overgrowth, hormonal adjuvant treatment can be offered based on hormone receptor expression. In selected cases, external beam radiotherapy ± brachytherapy can be considered to increase local control only. Patients with advanced disease involving the abdomen can be offered primary chemotherapy (or hormonal therapy in the case of low-grade endometrial stromal sarcoma and adenosarcoma without sarcomatous overgrowth), even if potentially resectable in the absence of residual disease in order to test the chemosensitivity (or hormonosensitivity); debulking surgery can be considered in patients with clinical and radiological response. Chemotherapy is based on anthracyclines ± ifosfamide or dacarbazine. Palliative radiotherapy can be offered for symptom control, and stereotactic radiotherapy can be used for up to five isolated metastatic lesions. CONCLUSIONS Treatment of uterine sarcoma should be centralised at referral centres and managed in a multidisciplinary setting.
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Affiliation(s)
- Gabriella Ferrandina
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology Unit, Roma, Italy; Universita' Cattolica Del Sacro Cuore, Roma, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Perugia General Hospital, Perugia, Italy
| | - Pietro Raimondo Biondetti
- Department of Radiology, Ca' Granda IRCSS Maggiore Policlinico Hospital Foundation Trust, Milan, Italy
| | | | - Paolo Casali
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Francesca Ciccarone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology Unit, Roma, Italy
| | - Nicoletta Colombo
- Gynecologic Cancer Program, University of Milan-Bicocca and European Institute of Oncology, IRCCS, Milan, Italy
| | - Alessandro Comandone
- Division of Medical Oncology, Humanitas Gradenigo Hospital, Turin, Italy; ASL Città di Torino, Turin, Italy
| | - Renzo Corvo'
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Health Science Department (DISSAL), University of Genoa, Genoa, Italy
| | - Pierandrea De Iaco
- Unit of Oncologic Gynecology, Department of Obstetrics and Gynecology, University of Bologna, Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Angelo Paolo Dei Tos
- Department of Pathology, Treviso General Hospital Treviso, Padova, Italy; University of Padua, Padova, Italy
| | - Vittorio Donato
- Radiation Oncology Division, Oncology and Specialty Medicine Department, San Camillo-Forlanini Hospital, Roma, Italy
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Franchi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Angiolo Gadducci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Alessandro Gronchi
- Chair Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - Amato Infante
- UOC COVID-2, Department of Bioimaging and Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy
| | - Franco Odicino
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, Università degli Studi di Brescia, Italy
| | - Tommaso Pirronti
- UOC COVID-2, Department of Bioimaging and Radiological Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Italy; Catholic University of Sacred Hearth, Department of Radiology, Rome, Italy
| | - Vittorio Quagliuolo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberta Sanfilippo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antonia Carla Testa
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology Unit, Roma, Italy; Universita' Cattolica Del Sacro Cuore, Roma, Italy
| | - Gian Franco Zannoni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Woman, Child and Public Health Sciences, Gynecopathology and Breast Pathology Unit, Rome, Italy; Pathological Anatomy Institute, Catholic University of Sacred Hearth, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology Unit, Roma, Italy; Universita' Cattolica Del Sacro Cuore, Roma, Italy.
| | - Domenica Lorusso
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Gynecologic Oncology Unit, Roma, Italy; Universita' Cattolica Del Sacro Cuore, Roma, Italy
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Shushkevich A, Thaker PH, Littell RD, Shah NA, Chiang S, Thornton K, Hensley ML, Slomovitz BM, Holcomb KM, Leitao MM, Toboni MD, Powell MA, Levine DA, Dowdy SC, Klopp A, Brown J. State of the science: Uterine sarcomas: From pathology to practice. Gynecol Oncol 2020; 159:3-7. [PMID: 32839026 DOI: 10.1016/j.ygyno.2020.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - Premal H Thaker
- Washington University School of Medicine, St. Louis, MO, United States
| | - Ramey D Littell
- Kaiser Permanente Northern California Gynecologic Cancer Program, San Francisco, CA, United States
| | | | - Sarah Chiang
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Martee L Hensley
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Kevin M Holcomb
- Weill Cornell Medical College at New York-Presbyterian Hospital, New York, NY, United States
| | - Mario M Leitao
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Michael D Toboni
- Washington University School of Medicine, St. Louis, MO, United States
| | - Matthew A Powell
- Washington University School of Medicine, St. Louis, MO, United States
| | - Douglas A Levine
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, United States
| | | | - Ann Klopp
- The University of Texas M.D., Anderson Cancer Center, Houston, TX, United States
| | - Jubilee Brown
- Levine Cancer Institute, Atrium Health, Charlotte, NC, United States.
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23
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The Evolving Role of Radiation Therapy in Patients with Metastatic Soft Tissue Sarcoma. Curr Oncol Rep 2020; 22:79. [DOI: 10.1007/s11912-020-00936-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Baumann BC, Bernstein KDA, DeLaney TF, Simone CB, Kolker JD, Choy E, Levin WP, Weber KL, Muniappan A, Berman AT, Staddon A, Hartner L, Van Tine B, Hirbe A, Glatstein E, Hahn SM, Nagda SN, Chen YL. Multi-institutional analysis of stereotactic body radiotherapy for sarcoma pulmonary metastases: High rates of local control with favorable toxicity. J Surg Oncol 2020; 122:877-883. [PMID: 32588468 DOI: 10.1002/jso.26078] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/09/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND/OBJECTIVES Oligometastatic sarcoma pulmonary metastases (PM's) are traditionally treated with resection and/or chemotherapy. We hypothesize that stereotactic body radiotherapy (SBRT) is an effective, safe alternative to surgery that can achieve excellent local control (LC) with a favorable toxicity profile. METHODS Patients treated with SBRT for sarcoma PM's from 2011 to 2016 at Massachusetts General Hospital and the University of Pennsylvania were included. Median dose was 50 Gy. Patients underwent computed tomography (CT) or positron emission tomography/CT Q3 months post-SBRT. RESULTS 44 patients with 56 separate PM's were treated with SBRT. Median age was 59 (range 19-82). 82% received prior chemotherapy, 66% had prior pulmonary resections (range, 1-5 resections), and 32% received prior thoracic radiotherapy. Median lesion size was 2.0 cm (range, 0.5-8.1 cm). Median follow-up was 16 months and 25 months for patients alive at last follow-up. Overall survival at 12 and 24 months was 74% (95% confidence interval [CI], 67%-81%) and 46% (95% CI, 38%-55%). LC at 12 and 24 months was 96% (95% CI, 93%-98%) and 90% (95% CI, 84%-96%). LC and overall survival did not differ based on age, gender, histology, fractionation, lesion location, or size (P > .05). Three developed Common Terminology Criteria for Adverse Events version 4 grade-2 chest-wall toxicities; one had grade-2 pneumonitis. CONCLUSIONS In the first multi-institutional series on SBRT for sarcoma PM's, SBRT has excellent LC and is well-tolerated. SBRT should be considered as an alternative/complement to resection.
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Affiliation(s)
- Brian C Baumann
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - James D Kolker
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Edwin Choy
- Division of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - William P Levin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristy L Weber
- Division of Orthopaedic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ashok Muniappan
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Abigail T Berman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Arthur Staddon
- Department of Medicine, Division of Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lee Hartner
- Department of Medicine, Division of Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian Van Tine
- Department of Medicine, Division of Medical Oncology, Washington University in St. Louis, St. Louis, Missouri
| | - Angela Hirbe
- Department of Medicine, Division of Medical Oncology, Washington University in St. Louis, St. Louis, Missouri
| | - Eli Glatstein
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen M Hahn
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
- Office of the Commissioner, Food and Drug Administration, Washington DC
| | - Suneel N Nagda
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yen-Lin Chen
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
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25
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Yang DP, Zhuang BW, Wang YZ, Lin MX, Xu M, Kuang M, Lei YY, Xie XY, Xie XH. Thermal ablation versus hepatic resection for the treatment of liver metastases from gastrointestinal stromal tumors: a retrospective study. Int J Hyperthermia 2020; 37:592-599. [PMID: 32484012 DOI: 10.1080/02656736.2020.1772513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Objective: The study aimed to compare effectiveness and safety of thermal ablation and hepatic resection in patients with liver metastases of gastrointestinal stromal tumors (GISTs).Method: A total of 55 patients (27 in the ablation group and 28 in the surgery group) with liver metastases were included. Overall survival (OS) and progression-free survival (PFS) were assessed with Kaplan-Meier's survival estimate curves. Univariate and multivariate regression analyses were carried out to identify potential prognostic factors.Results: The median OS was 102.0 months in the ablation group and 117.0 months in the surgery group (p = .875). The 1-, 3- and 5-year OS rates were 100%, 88.9% and 74.1% in the ablation group and 92.8%, 82.1% and 78.6% in the surgery group, respectively. The 1-, 3- and 5-year PFS rates were 48.1%, 25.9% and 18.5% in the ablation group and 67.8%, 64.3% and 64.3% in the surgery group, respectively. Multivariate analysis showed that preoperative tyrosine kinase inhibitor (TKI) treatment (progressive disease, PD) (HR, 13.985; 95% CI, 1.791-109.187; p = .012) was the only significant independent prognostic factor for OS. Tumor number (HR, 1.318; 95% CI, 1.021-1.702; p = .034) was identified as an independent predictor for PFS in multivariate analysis. There were fewer postoperative complications (18.5% vs. 78.6%, p = .001) and shorter lengths of hospital stay (8.0 vs. 16.5 days, p = .001) in the ablation group.Conclusion: Compared with resection, thermal ablation offered comparable OS for liver metastases of GISTs. Furthermore, thermal ablation had the advantages of fewer complications and shorter lengths of hospital stay.
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Affiliation(s)
- Dao-Peng Yang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bo-Wen Zhuang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yu-Zhao Wang
- Sun Yat-Sen University School of Medicine, Guangzhou, China
| | - Man-Xia Lin
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming Xu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming Kuang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yang-Yang Lei
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Hua Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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26
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Lee SM, Ko HK, Shin JH, Kim JH, Chu HH. Combination of intraoperative radiofrequency ablation and surgical resection for treatment of cholangiocarcinoma: feasibility and long-term survival. Diagn Interv Radiol 2020; 26:45-52. [PMID: 31904570 PMCID: PMC7075581 DOI: 10.5152/dir.2019.18552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/07/2019] [Accepted: 06/11/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Most patients with intrahepatic cholangiocarcinoma (ICC) are not eligible for surgical resection due to advanced stage. We aimed to evaluate the feasibility, local tumor control, and long-term survival of intraoperative radiofrequency ablation (IORFA) with surgical resection to treat unresectable intrahepatic cholangiocarcinoma (ICC). METHODS From 2009 to 2016, 20 consecutive patients (12 primary ICC, 8 recurrent ICC) underwent curative IORFA with hepatic resection for surgically unresectable ICC. Patients were not qualified to undergo surgical resection due to multiple lesions causing postoperative hepatic insufficiency and undesirable tumor locations for surgical resection or percutaneous RFA. Of the 51 treated tumors (mean, 2.6±0.9 tumors/patient), 24 were treated by IORFA and 27 were surgically removed. The technical success and effectiveness, overall survival, progression-free survival (PFS), and complications were assessed retrospectively. The overall survival and PFS rates were estimated by the Kaplan-Meier method. RESULTS The technical success and effectiveness of IORFA were 100%. The overall survival rates at 6 months, 1, 3, and 5 years were 95%, 79%, 27%, and 14%, respectively. The median overall survival time was 22.0±3.45 months. The PFS rates at 6 months, 1, 3, and 5 years were 70%, 33%, 13%, and 13%, respectively. The median PFS was 9.0±1.68 months. The prognosis was significantly worse for patients with recurrent ICC than for patients with primary ICC. One patient (5%) had major complications due to IORFA such as liver abscess and biliary stricture. CONCLUSION IORFA with surgical resection can be a feasible option for ICC cases that are not amenable to treatment with surgical resection alone. This strategy provides acceptable local tumor control and overall survival.
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Affiliation(s)
- Sang Min Lee
- From the Department of Radiology (S.M.L.), Gyeongsang National University Hospital, Jinju, Korea; Department of Radiology (S.M.L., H.K.K. , J.H.S., J.H.K., H.H.C.), University of Ulsan College of Medicine and Asian Medical Center, Seoul, Korea
| | - Heung Kyu Ko
- From the Department of Radiology (S.M.L.), Gyeongsang National University Hospital, Jinju, Korea; Department of Radiology (S.M.L., H.K.K. , J.H.S., J.H.K., H.H.C.), University of Ulsan College of Medicine and Asian Medical Center, Seoul, Korea
| | - Ji Hoon Shin
- From the Department of Radiology (S.M.L.), Gyeongsang National University Hospital, Jinju, Korea; Department of Radiology (S.M.L., H.K.K. , J.H.S., J.H.K., H.H.C.), University of Ulsan College of Medicine and Asian Medical Center, Seoul, Korea
| | - Jin-Hyoung Kim
- From the Department of Radiology (S.M.L.), Gyeongsang National University Hospital, Jinju, Korea; Department of Radiology (S.M.L., H.K.K. , J.H.S., J.H.K., H.H.C.), University of Ulsan College of Medicine and Asian Medical Center, Seoul, Korea
| | - Hee Ho Chu
- From the Department of Radiology (S.M.L.), Gyeongsang National University Hospital, Jinju, Korea; Department of Radiology (S.M.L., H.K.K. , J.H.S., J.H.K., H.H.C.), University of Ulsan College of Medicine and Asian Medical Center, Seoul, Korea
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27
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Wakabayashi T, Hibi T, Yoneda G, Iwao Y, Sawada Y, Hoshino H, Uemura S, Ban D, Kudo A, Takemura Y, Mishima K, Shinoda M, Itano O, Otsubo T, Endo I, Kitagawa Y, Tanabe M, Egawa H, Yamamoto M. Predictive model for survival after liver resection for noncolorectal liver metastases in the modern era: a Japanese multicenter analysis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2019; 26:441-448. [PMID: 31271511 DOI: 10.1002/jhbp.654] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Survival benefit of liver resection for noncolorectal liver metastases (NCRLM) remains to be defined. METHODS This multicenter, retrospective cohort analysis included consecutive patients with NCRLM whose primary tumor and all metastases were treated with curative intent between 2000 and 2013. The primary endpoint was 5-year overall survival. Clinicopathological factors that affected prognoses were identified using multivariate Cox regression analyses and were included in a predictive model. RESULTS Data for 205 patients were analyzed. The three most common primary tumor sites were stomach (39%), pancreas (13%), and urinary tract (10%), with adenocarcinomas the main pathology (52%). R0 resection was achieved in 85%, and the overall survival at 5 years was 41%. In the multivariate analysis, synchronous liver metastases, R1/2 resection, and adenocarcinomas and other carcinomas (with gastrointestinal stromal tumors, neuroendocrine tumors G1/G2, and sarcomas set as the reference group) were independent negative indicators of overall survival. A predictive model effectively stratified the NCRLM patients into low-, intermediate-, and high-risk groups with overall 5-year survival rates of 63%, 38%, and 21%, respectively (P < 0.001). CONCLUSIONS Patients who underwent curative resection for metachronous disease and favorable tumor pathology are expected to have better survival in the NCRLM cohort.
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Affiliation(s)
- Taiga Wakabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Taizo Hibi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Godai Yoneda
- Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasuhito Iwao
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yu Sawada
- Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| | - Hiroyuki Hoshino
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Shuichiro Uemura
- Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Daisuke Ban
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Kudo
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Takemura
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kohei Mishima
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Shinoda
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osamu Itano
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
- Department of Gastrointestinal Surgery, International University of Health and Welfare, Chiba, Japan
| | - Takehito Otsubo
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Minoru Tanabe
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroto Egawa
- Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Bui NQ, Wang DS, Hiniker SM. Contemporary management of metastatic soft tissue sarcoma. Curr Probl Cancer 2019; 43:289-299. [DOI: 10.1016/j.currproblcancer.2019.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/08/2019] [Indexed: 01/31/2023]
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Abstract
OPINION STATEMENT Soft tissue sarcomas are rare cancers with an expected incidence of about 14,000 new cases in 2018, and account for less than 1% of all cancers. It includes in excess of 75 heterogeneous subtypes with varying biology, molecular aberrations, and variable response to treatment. Because of the rarity of these tumors and the many different subtypes, there is no large-scale data to guide treatment, and hence the need for a multidisciplinary individualized approach to treatment, preferably at a high-volume tertiary referral center. For localized disease, surgery with or without radiation is the preferred treatment. In metastatic disease, the longest track record is with use of anthracyclines, either alone or in combination with ifosfamide, but the median overall survival even with combination was just over a year. There have been recent advances in understanding the heterogeneity of these tumors and the need for an individualized approach. With that new knowledge, recent approvals of trabectedin, eribulin, and pazopanib have been limited to some select histologic subtypes with improved outcomes. More recently, immunotherapy has been tested in select histotypes of sarcoma with encouraging activity and has led to further evaluation in combination with immunotherapeutic agents, as well as with chemotherapy and radiation treatments. Here, in this article, we summarize the data of the currently approved therapies in metastatic soft tissue sarcoma, with the principal focus on first-line therapies. We also review the recent encouraging data with PDGFR-targeted antibody (olaratumab) with doxorubicin which showed an impressive improvement in overall survival in phase II study. Molecular characterization of sarcoma subtypes will likely improve understanding of these very diverse tumors and improve target characterization. The ongoing efforts in better understanding these rare tumors hold the key to make a difference in the outcome of these patients.
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Affiliation(s)
- Megan Meyer
- Internal Medicine, Mayo Clinic, 5777 E Mayo Blvd., Phoenix, AZ, 85054, USA
| | - Mahesh Seetharam
- Hematology and Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, 85054, USA.
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30
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Grilley-Olson JE, Webber NP, Demos DS, Christensen JD, Kirsch DG. Multidisciplinary Management of Oligometastatic Soft Tissue Sarcoma. Am Soc Clin Oncol Educ Book 2018; 38:939-948. [PMID: 30231386 DOI: 10.1200/edbk_200573] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Soft tissue sarcomas (STS) encompass a group of rare but heterogeneous diseases. Nevertheless, many patients, particularly those with oligometastatic disease can benefit from thoughtful multimodality evaluation and treatment regardless of the STS subtype. Here, we review surgical, interventional radiology, radiation, and chemotherapy approaches to maximize disease palliation and improve survival, including occasionally long-term disease-free survival. Surgical resection can include lung or other visceral, soft tissue and bone metastases with a goal of rendering the patient disease free. Staged resections can be appropriate, and serial resection of oligometastatic recurrent disease can be appropriate. Retrospective series suggest survival benefit from this approach, although selection bias may contribute. Interventional radiology techniques such as percutaneous thermal ablation (PTA) and arterial embolization can present nonoperative local approaches in patients who are not medically fit for surgery, surgery is too morbid, or patients who decline surgery. Similarly, radiation therapy can be delivered safely to areas that are inaccessible surgically or would result in excessive morbidity. Currently no randomized trials exist comparing interventional radiologic approaches or radiation therapy to surgery but retrospective reviews show relatively similar magnitude of benefit in terms of disease palliation and survival, although it is felt unlikely that these procedures will render a patient to long-term disease-free status. Chemotherapy has evolved recently with the addition of several new treatment options, briefly reviewed here. Importantly, if a patient sustains a good response to chemotherapy resulting in true oligometastatic disease, consideration of multimodality local therapy approaches can be considered in the appropriate patient.
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Affiliation(s)
- Juneko E Grilley-Olson
- From the Department of Medicine, Division of Hematology-Oncology, UNC Lineberger Cancer Center, The University of North Carolina, Chapel Hill, NC; Orthopaedic Oncology at Aurora Cancer Care, Orthopaedic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, Aurora Healthcare, Milwaukee, WI; Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
| | - Nicholas P Webber
- From the Department of Medicine, Division of Hematology-Oncology, UNC Lineberger Cancer Center, The University of North Carolina, Chapel Hill, NC; Orthopaedic Oncology at Aurora Cancer Care, Orthopaedic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, Aurora Healthcare, Milwaukee, WI; Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
| | - David S Demos
- From the Department of Medicine, Division of Hematology-Oncology, UNC Lineberger Cancer Center, The University of North Carolina, Chapel Hill, NC; Orthopaedic Oncology at Aurora Cancer Care, Orthopaedic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, Aurora Healthcare, Milwaukee, WI; Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
| | - Jared D Christensen
- From the Department of Medicine, Division of Hematology-Oncology, UNC Lineberger Cancer Center, The University of North Carolina, Chapel Hill, NC; Orthopaedic Oncology at Aurora Cancer Care, Orthopaedic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, Aurora Healthcare, Milwaukee, WI; Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
| | - David G Kirsch
- From the Department of Medicine, Division of Hematology-Oncology, UNC Lineberger Cancer Center, The University of North Carolina, Chapel Hill, NC; Orthopaedic Oncology at Aurora Cancer Care, Orthopaedic Surgery, Aurora St. Luke's Medical Center, Milwaukee, WI; Department of Cardiothoracic Surgery, Aurora Healthcare, Milwaukee, WI; Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiation Oncology, Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC
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Treatment of metastatic, imatinib refractory, gastrointestinal stroma tumor with image-guided high-dose-rate interstitial brachytherapy. Brachytherapy 2018; 18:63-70. [PMID: 30385116 DOI: 10.1016/j.brachy.2018.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/12/2018] [Accepted: 09/25/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE Evaluation of efficacy and safety of CT- or MRI-guided high-dose-rate interstitial brachytherapy (iBT) in the treatment of advanced, imatinib refractory, metastatic gastrointestinal stroma tumors (GISTs) was the objective of this retrospective study. METHODS AND MATERIALS A cumulative number of 40 unresectable metastases (30 hepatic, 10 peritoneal) were treated with iBT in 10 selected patients with histologically proven GISTs. Six patients had peritoneal disease, and 5 patients were even progressing under sunitinib (second line)-thus iBT was applied as a salvage maneuver. IBT uses an interstitially introduced 192iridium source in a high-dose-rate irradiation regime to destroy vital cells in a single fraction. Response to treatment was assessed clinically and with acquisition of MRI/CT every 3 months. RESULTS Local tumor control was reached in 97.5% of all treated metastases during a median time of 25 months-only one local relapse was observed during followup. The median diameter of the irradiated lesions was 2.4 cm (range 0.6-11.2 cm); a median dose of 15 Gy (range 6.7-21.96 Gy) was applied. The median progression-free survival after iBT was 6.8 (range 3.0-20.2) months; the median overall survival was 37.3 months (range 11.4-89.7). Two major complications (Common Terminology for Adverse Events grade 3) occurred following the intervention: local hemorrhage and pneumothorax, successfully dealt with by angiographic embolization and pleural drainage, respectively. CONCLUSIONS In selected patients with metastatic, imatinib refractory GISTs, iBT safely enables high rates of local tumor control and presents an alternative, anti-neoplastic treatment option even in a salvage situation.
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Madkhali AA, Shin SH, Song KB, Lee JH, Hwang DW, Park KM, Lee YJ, Kim SC. Pancreatectomy for a secondary metastasis to the pancreas: A single-institution experience. Medicine (Baltimore) 2018; 97:e12653. [PMID: 30334949 PMCID: PMC6211914 DOI: 10.1097/md.0000000000012653] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 08/18/2018] [Indexed: 12/27/2022] Open
Abstract
The aim of the present study was to evaluate the short- and long-term outcomes of secondary metastasis to the pancreas in terms of overall survival (OS) and disease-free survival (DFS) after pancreatectomy.This retrospective study included 29 patients who underwent pancreatectomy for secondary metastasis to the pancreas between December 1995 and August 2016.The study group was divided into renal cell carcinoma (RCC) (17 patients) and non-RCC (12 patients). The non-RCC group had 5 cases of colorectal cancer and 7 of another primary origin. The OS for the whole cohort was 86.2% at 1 year, 63.2% at 3 years, and 46.7% at 5 years. There was no significant difference between the 2 groups at 1, 3, and 5 years survival and OS. In subgroup analysis of patients who underwent curative resection, there was no significant difference in OS between the 2 groups at 1, 3, and 5 years. However, there was a significant difference in recurrence rate at 3 years (P = .035). Pathologic analysis showed that the non-RCC group had significantly more positive lymph node metastasis than the RCC group (P = .002).Pancreatectomy for secondary metastasis has promising short- and long-term outcomes in terms of OS and DFS.
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Affiliation(s)
- Ahmad Abdullah Madkhali
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Hepato-Biliary and Pancreatic Surgery unit, Department of Surgery, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Sang-hyun Shin
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Byung Song
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hoon Lee
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Wook Hwang
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kwang Min Park
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Joo Lee
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Song Cheol Kim
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Vos M, Ho VKY, Oosten AW, Verhoef C, Sleijfer S. Minimal Increase in Survival Throughout the Years in Patients with Soft Tissue Sarcoma with Synchronous Metastases: Results of a Population-Based Study. Oncologist 2018; 24:e526-e535. [PMID: 30190301 DOI: 10.1634/theoncologist.2017-0383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 07/24/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Treatment options for patients with metastatic soft tissue sarcoma (STS) have increased in the last decade. We aimed to examine whether this is associated with improved overall survival (OS) in patients with STS with synchronous metastases. PATIENTS AND METHODS Patients diagnosed with STS and synchronous metastases from 1989 to 2014 were queried from The Netherlands Cancer Registry. Trends in OS were assessed by the Kaplan-Meier method and log-rank test in time intervals of 5 years, for the whole study population and in subgroups for liposarcomas, leiomyosarcoma, and other STS subtypes. A multivariable Cox regression analysis was performed to identify characteristics prognostic for OS. RESULTS Median OS of the 1,393 identified patients did not improve significantly over the years from 5.8 months in 1989-1994 to 8.1 months in 2010-2014, but there was an evident trend. Median OS was prolonged in the subgroups of liposarcomas (3.6 to 9.3 months), leiomyosarcomas (11.3 to 14.6 months), and other STS subtypes (5.7 to 6.3 months), although there were no significant improvements in OS over the years. Primary tumor site in one of the extremities and surgery in an academic center had a favorable effect on OS, whereas significant negative predictors were no treatment, elderly age, STS subtype other than liposarcoma or leiomyosarcoma, high or unknown grade, and nodal involvement. CONCLUSION Although overall survival of patients with STS with synchronous metastases in this nationwide and "real-life" population has improved over the years, the improvement was not statistically significant, despite new treatment options. IMPLICATIONS FOR PRACTICE Treatment of patients with metastatic soft tissue sarcoma (STS) has changed in the past years, with new drugs such as trabectedin (2007) and pazopanib (2012) becoming available. By using data from the nationwide Netherlands Cancer Registry, the impact of these changes in treatment policies on survival is analyzed in a "real-life" population of patients with STS with synchronous metastases, rather than in a strictly selected trial population. Unfortunately, overall survival improved only minimally and not significantly for these patients diagnosed from 1989 to 2014. Hopefully, the advent of novel treatment options, such as eribulin and olaratumab, will further improve the outcome of this patient group.
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Affiliation(s)
- Melissa Vos
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Vincent K Y Ho
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Astrid W Oosten
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Stefan Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Smolle MA, van Praag VM, Posch F, Bergovec M, Leitner L, Friesenbichler J, Heregger R, Riedl JM, Pichler M, Gerger A, Szkandera J, Stöger H, Smolle-Jüttner FM, Liegl-Atzwanger B, Fiocco M, van de Sande MA, Leithner A. Surgery for metachronous metastasis of soft tissue sarcoma - A magnitude of benefit analysis using propensity score methods. Eur J Surg Oncol 2018; 45:242-248. [PMID: 30031674 DOI: 10.1016/j.ejso.2018.06.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/14/2018] [Accepted: 06/20/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Metastasectomy is hypothesised to improve OS in metastatic STS, but evidence in favour of this approach derives from non-controlled single-arm cohorts affected by selection bias. The objective was to quantify the effect of metastasectomy vs. non-surgical management on overall survival (OS) in patients with metachronous metastases from extremity- and trunk soft tissue sarcoma (STS). MATERIALS AND METHODS From a population of 1578 STS patients, 135 patients who underwent surgery for localised STS at two European centres between 1998 and 2015 and developed metachronous STS metastases were included. Propensity score analyses with inverse-probability-of-treatment-weights (IPTW) and landmark analyses were performed to control for selection and immortal time bias, respectively. RESULTS OS was significantly longer in the 68 patients undergoing metastasectomy than in the 67 patients who were treated non-invasively for their metastasis (10-year OS: 23% vs. 4%; hazard ratio (HR) = 0.34, 95% CI: 0.22-0.53, p < 0.0001). This association prevailed after IPTW-weighting of the data to control for the higher prevalence of favourable prognostic factors in the surgery group (adjusted 10-year OS: 17% vs. 3%, log-rank p < 0.0001; HR = 0.33, 95% CI: 0.20-0.52, p < 0.0001). Five-year OS estimates were 27.8% in patients who had and 14.5% in patients who had not undergone metastasectomy within the first 3 months after diagnosis of a metastasis (p < 0.0001). CONCLUSION In this observational bi-centre study, metastasectomy was associated with prolonged survival in patients with metachronous STS metastases. In the absence of randomized studies, our results indicate that metastasectomy should be considered as an important treatment option for metachronous STS metastases.
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Affiliation(s)
- Maria A Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria; Comprehensive Cancer Centre Graz, Graz, Austria.
| | - Veroniek M van Praag
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Florian Posch
- Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Marko Bergovec
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria; Comprehensive Cancer Centre Graz, Graz, Austria.
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria; Comprehensive Cancer Centre Graz, Graz, Austria.
| | - Jörg Friesenbichler
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria; Comprehensive Cancer Centre Graz, Graz, Austria.
| | - Ronald Heregger
- Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Jakob M Riedl
- Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Martin Pichler
- Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria; Department of Experimental Therapeutics, The UT MD Anderson Cancer Center, Sout Campus Research Building 4, 1901 East Road, Houston, TX, USA.
| | - Armin Gerger
- Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Joanna Szkandera
- Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Herbert Stöger
- Comprehensive Cancer Centre Graz, Graz, Austria; Division of Oncology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Freyja-Maria Smolle-Jüttner
- Comprehensive Cancer Centre Graz, Graz, Austria; Division of Thoracic and Hyperbaric Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Austria.
| | - Bernadette Liegl-Atzwanger
- Comprehensive Cancer Centre Graz, Graz, Austria; Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, 8036, Graz, Austria.
| | - Marta Fiocco
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands; Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands; Mathematical Institute Leiden University, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Michiel Aj van de Sande
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria; Comprehensive Cancer Centre Graz, Graz, Austria.
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Sanchez-Hidalgo JM, Duran-Martinez M, Molero-Payan R, Rufian-Peña S, Arjona-Sanchez A, Casado-Adam A, Cosano-Alvarez A, Briceño-Delgado J. Gastrointestinal stromal tumors: A multidisciplinary challenge. World J Gastroenterol 2018; 24:1925-1941. [PMID: 29760538 PMCID: PMC5949708 DOI: 10.3748/wjg.v24.i18.1925] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/27/2018] [Accepted: 05/06/2018] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors located in the alimentary tract. Its usual manifestation is gastrointestinal bleeding. However, small asymptomatic lesions are frequently detected as incidental finding. Characteristically, most GISTs (> 95%) are positive for the KIT protein (CD117) by IHC staining and approximately 80%-90% of GISTs carry a mutation in the c-KIT or PDGFRA genes. Mutational analysis should be performed when planning adjuvant and neoadjuvant therapy, due to its possible resistance to conventional treatment. The arise of tyrosine kinase inhibitor has supposed a revolution in GISTs treatment being useful as adjuvant, neoadjuvant or recurrence disease treatment. That is why a multidisciplinary approach to this disease is required. The correct characterization of the tumor at diagnosis (the diagnosis of recurrences and the evaluation of the response to treatment with tyrosine kinase inhibitors) is fundamental for facing these tumors and requires specialized Endoscopist, Radiologists and Nuclear Medicine Physician. Surgery is the only potentially curative treatment for suspected resectable GIST. In the case of high risk GISTs, surgery plus adjuvant Imatinib-Mesylate for 3 years is the standard treatment. Neoadjuvant imatinib-mesylate should be considered to shrink the tumor in case of locally advanced primary or recurrence disease, unresectable or potentially resectable metastasic tumors, and potentially resectable disease in complex anatomic locations to decrease the related morbidity. In the case of Metastatic GIST under Neoadjuvant treatment, when there are complete response, stable disease or limited disease progression, complete cytoreductive surgery could be a therapeutic option if feasible.
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Affiliation(s)
- Juan Manuel Sanchez-Hidalgo
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Manuel Duran-Martinez
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Rafael Molero-Payan
- Department of Intern Medicine, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
- Lipids and Atherosclerosis Research Unit, IMIBIC/Hospital Universitario Reina Sofía/Universidad de Córdoba, Cordoba 14004, Spain
| | - Sebastian Rufian-Peña
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Alvaro Arjona-Sanchez
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Angela Casado-Adam
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Antonio Cosano-Alvarez
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
| | - Javier Briceño-Delgado
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain
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Management of metastatic retroperitoneal sarcoma: a consensus approach from the Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG). Ann Oncol 2018; 29:857-871. [PMID: 29432564 PMCID: PMC6354678 DOI: 10.1093/annonc/mdy052] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Retroperitoneal sarcoma (RPS) is a rare disease accounting for 0.1%-0.2% of all malignancies. Management of RPS is complex and requires multidisciplinary, tailored treatment strategies at all stages, but especially in the context of metastatic or multifocal recurrent disease. Due to the rarity and heterogeneity of this family of diseases, the literature to guide management is limited. METHODS The Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG) is an international collaboration of sarcoma experts from all disciplines convened in an effort to overcome these limitations. The TARPSWG has compiled the available evidence surrounding metastatic and multifocally recurrent RPS along with expert opinion in an iterative process to generate a consensus document regarding the complex management of this disease. The objective of this document is to guide sarcoma specialists from all disciplines in the diagnosis and treatment of multifocal recurrent or metastatic RPS. RESULTS All aspects of patient assessment, diagnostic processes, local and systemic treatments, and palliation are reviewed in this document, and consensus recommendations provided accordingly. Recommendations were guided by available evidence, in conjunction with expert opinion where evidence was lacking. CONCLUSIONS This consensus document combines the available literature regarding the management of multifocally recurrent or metastastic RPS with the practical expertise of high-volume sarcoma centers from multiple countries. It is designed as a tool for decision making in the complex multidisciplinary management of this condition and is expected to standardize management across centers, thereby ensuring that patients receive the highest quality care.
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Yoon IS, Shin JH, Han K, Kim PN, Kim KH, Kang YK, Ko HK. Ultrasound-Guided Intraoperative Radiofrequency Ablation and Surgical Resection for Liver Metastasis from Malignant Gastrointestinal Stromal Tumors. Korean J Radiol 2018; 19:54-62. [PMID: 29354000 PMCID: PMC5768508 DOI: 10.3348/kjr.2018.19.1.54] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 07/01/2017] [Indexed: 01/22/2023] Open
Abstract
Objective To evaluate the effectiveness, safety, and feasibility of intraoperative radiofrequency ablation (IORFA) under ultrasound guidance for the treatment of liver metastases from gastrointestinal stromal tumors (GISTs). Materials and Methods From August 2009 to February 2017, 24 patients with liver metastases of GISTs underwent IORFA, 14 underwent concurrent IORFA and primary GIST resection, and 10 underwent IORFA to treat hepatic recurrence after previous primary GIST resection. Seventy-six hepatic metastases were treated, of which 47 were surgically resected and 29 underwent IORFA. All included patients received imatinib therapy as standard treatment before and after IORFA or surgical resection. A retrospective medical record review was conducted, and follow-up data were collected. Technical success and effectiveness, overall and GIST-specific survival, and complications were assessed. Results The mean follow-up duration was 50.7 ± 34.7 months. The technical success rate of IORFA was 100%. New metastases developed in three of the 24 patients (12.5%) following a complete response 16, 51, and 95 months after IORFA, respectively. The cumulative one-, three-, and five-year overall survival rates were 100, 94.4, and 87.7%, respectively. The one-, three-, and five-year GIST-related survival rates were 100, 94.4, and 94.4%, respectively. Two major complications (biliary stricture and hepatic abscess) were observed. Conclusion IORFA appears to be a feasible and safe treatment option for liver metastasis in patients with primary GISTs. In addition, IORFA and surgical resection may be complementary, helping to obtain complete response in cases of otherwise inoperable liver metastases secondary to GISTs.
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Affiliation(s)
- In Sun Yoon
- Department of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul 05505, Korea
| | - Ji Hoon Shin
- Department of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul 05505, Korea
| | - Kichang Han
- Department of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul 05505, Korea
| | - Pyo Nyun Kim
- Department of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul 05505, Korea
| | - Ki Hun Kim
- Department of Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul 05505, Korea
| | - Yoon-Koo Kang
- Department of Oncology, Asan Medical Center, Ulsan University College of Medicine, Seoul 05505, Korea
| | - Heung Kyu Ko
- Department of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul 05505, Korea
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Goumard C, Marcal LP, Wang WL, Somaiah N, Okuno M, Roland CL, Tzeng CWD, Chun YS, Feig BW, Vauthey JN, Conrad C. Long-Term Survival According to Histology and Radiologic Response to Preoperative Chemotherapy in 126 Patients Undergoing Resection of Non-GIST Sarcoma Liver Metastases. Ann Surg Oncol 2018; 25:107-116. [PMID: 29116489 DOI: 10.1245/s10434-017-6144-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Non-gastrointestinal stromal tumor sarcomas (NGSs) have heterogeneous histology, and this heterogeneity may lead to uncertainty regarding the prognosis of patients with liver metastases from NGS (NGSLM) and decision regarding their surgical management. Furthermore, the role of preoperative chemotherapy in treatment of NGSLM remains poorly defined. We investigated long-term survival and its correlation to response to preoperative chemotherapy in patients with NGSLM. PATIENTS AND METHOD Patients who underwent liver resection for NGSLM during 1998-2015 were identified. Clinical, histopathologic, and survival data were analyzed. Multivariate analysis was performed using a Cox proportional hazards model. RESULTS 126 patients [62 (49%) with leiomyosarcoma] were included. Five-year overall survival (OS) and recurrence-free survival (RFS) rates were 49.3 and 14.9%, respectively. Survival did not differ by histologic subtype, primary tumor location, or use of preoperative or postoperative chemotherapy. NGSLM ≥ 10 cm and extrahepatic metastases at NGSLM diagnosis were the only independent risk factors for OS. In the 83 (66%) patients with metachronous NSGLM, disease-free interval > 6 months was associated with improved OS and RFS. Among the 65 patients (52%) who received preoperative chemotherapy, radiologic response according to Choi criteria specifically was associated with improved OS (p = 0.04), but radiologic response according to RECIST 1.1 criteria was not. CONCLUSIONS Resection of NGSLM led to a 5-year OS rate of 49%, independent of histologic subtype and primary tumor location. Choi criteria (which take into account tumor density) are superior to RECIST 1.1 in assessing radiologic response and should be used to assess response to preoperative chemotherapy.
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Affiliation(s)
- Claire Goumard
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Leonardo P Marcal
- Division of Diagnostic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei-Lien Wang
- Division of Pathology/Laboratory Medicine, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Neeta Somaiah
- Division of Cancer Medicine, Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Masayuki Okuno
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christina L Roland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yun Shin Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Barry W Feig
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Claudius Conrad
- Department of Surgical Oncology, Hepato-Pancreato-Biliary Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Labgaa I, Slankamenac K, Schadde E, Jibara G, Alshebeeb K, Mentha G, Clavien PA, Schwartz M. Liver resection for metastases not of colorectal, neuroendocrine, sarcomatous, or ovarian (NCNSO) origin: A multicentric study. Am J Surg 2018; 215:125-130. [DOI: 10.1016/j.amjsurg.2017.09.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/25/2017] [Accepted: 09/19/2017] [Indexed: 12/24/2022]
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40
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The role and outcomes of palliative surgery for retroperitoneal sarcoma. J Surg Oncol 2017; 117:105-110. [DOI: 10.1002/jso.24934] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/03/2017] [Indexed: 11/07/2022]
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41
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Machairas N, Prodromidou A, Molmenti E, Kostakis ID, Sotiropoulos GC. Management of liver metastases from gastrointestinal stromal tumors: where do we stand? J Gastrointest Oncol 2017; 8:1100-1108. [PMID: 29299371 DOI: 10.21037/jgo.2017.08.08] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The recommended management of liver metastases (LM) from gastrointestinal stromal tumors (GISTs) disease consists of perioperative administration of tyrosine kinase inhibitors (TKIs) and surgical resection. The aim of our study was to investigate the efficacy of this therapeutic approach. Studies reporting outcomes for patients underwent liver resection from metastatic gastrointestinal stromal tumor (GIST) were overviewed. Eleven studies were included, which enrolled 240 patients with liver metastasis from GISTs. A median overall survival (OS) interval of 41.8 months was calculated while a median disease free interval of 17.9 [17-43] months following resection was also measured. Recurrences were recorded in 63 patients. Prognostic factors identified by the studies included surgical resection, R0 resection, age <55 years, clinical response to TKIs, pre- and postoperative administration of TKIs. The included studies highlight the importance of complete resection and the timing of resection, as well underline the importance of pre- and post-operative administration of TKIs.
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Affiliation(s)
- Nikolaos Machairas
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Anastasia Prodromidou
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Ernesto Molmenti
- Department of Surgery, North Shore University Hospital, Manhasset, New York, USA
| | - Ioannis D Kostakis
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgios C Sotiropoulos
- Second Department of Propaedeutic Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Seo JW. Percutaneous radiofrequency ablation for a recurrent metastasis after resection of liver metastases from an ileal clear-cell sarcoma: Long-term local tumor control. Radiol Case Rep 2017; 12:764-767. [PMID: 29484066 PMCID: PMC5823301 DOI: 10.1016/j.radcr.2017.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/20/2017] [Accepted: 08/08/2017] [Indexed: 01/08/2023] Open
Abstract
Clear-cell sarcomas (CCSs) in the gastrointestinal tract are extremely rare and aggressive tumors. We present the first case of a CCS arising in the ileum and metastasizing to the liver; our patient was a 60-year-old man. After the resection of the CCS and the liver metastases, a new liver metastasis developed, which was treated via percutaneous radiofrequency ablation only. At the 5-year follow-up, the ablated region was stable without local tumor progression. Percutaneous radiofrequency ablation is a viable local treatment option for recurrent metastases from an ileal CCS if they are detected when small and at an early stage in follow-up studies.
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43
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Gemcitabine and docetaxel in a patient with primary ovarian leiomyosarcoma: a case report and review of literature. Int Cancer Conf J 2017; 7:11-15. [PMID: 31149505 DOI: 10.1007/s13691-017-0309-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 09/06/2017] [Indexed: 12/23/2022] Open
Abstract
Primary ovarian leiomyosarcoma (POLMS) is extremely rare, and optimal therapy for this disease is unknown. A 40-year-old woman presented at a local hospital with abdominal pain. Tumor resection of the left ovary was performed. The pathological diagnosis was leiomyoma of the left ovary. Nine months after surgery, she developed of severe back pain and a subcutaneous tumor on her left shoulder. Magnetic resonance imaging and computed tomography revealed left ovarian tumor recurrence, pelvic bone metastasis, and multiple liver masses. Biopsy of the subcutaneous tumor on her left shoulder demonstrated metastatic leiomyosarcoma. The previously resected left ovarian tumor was re-examined, and the tumor was found to be a leiomyosarcoma. The patient received gemcitabine 800 mg/m2 and docetaxel 60 mg/m2 (GD therapy), administered at 3-week intervals. After three cycles of GD therapy, the patient experienced dyspnea and was diagnosed with mild interstitial pneumonia. Oral corticosteroid therapy resulted in complete symptom improvement. Thereafter, the dosage of GD was decreased, and after 13 cycles of GD therapy, radiofrequency ablation was performed twice for liver metastases. The tumors have shrunk by 65.5% after 23 cycles of GD. She remains alive after undergoing 24 cycles of GD. GD therapy may be effective for POLMS.
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Lim KT, Tan KY. Current research and treatment for gastrointestinal stromal tumors. World J Gastroenterol 2017; 23:4856-4866. [PMID: 28785140 PMCID: PMC5526756 DOI: 10.3748/wjg.v23.i27.4856] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/11/2017] [Accepted: 06/18/2017] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and have gained considerable research and treatment interest, especially in the last two decades. GISTs are driven by mutations commonly found in the KIT gene and less commonly in the platelet-derived growth factor receptor alpha gene, BRAF gene and succinate dehydrogenase gene. GISTs behave in a spectrum of malignant potential, and both the tumor size and mitotic index are the most commonly used prognostic criteria. Whilst surgical resection can offer the best cure, targeted therapy in the form of tyrosine kinase inhibitors (TKIs) has revolutionized the management options. As the first-line TKI, imatinib offers treatment for advanced and metastatic GISTs, adjuvant therapy in high-risk GISTs and as a neoadjuvant agent to downsize large tumors prior to resection. The emergence of drug resistance has altered some treatment options, including prolonging the first-line TKI from 1 to 3 years, increasing the dose of TKI or switching to second-line TKI. Other newer TKIs, such as sunitinib and regorafenib, may offer some treatment options for imatinib-resistant GISTs. New molecular targeted therapies are being evaluated, such as inhibitors of BRAF, heat shock protein 90, glutamine and mitogen-activated protein kinase signaling, as well as inhibitors of apoptosis proteins antagonist and even immunotherapy. This editorial review summarizes the recent research trials and potential treatment targets that may influence our future patient-specific management of GISTs. The current guidelines in GIST management from Europe, North America and Asia are highlighted.
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Kanda T, Masuzawa T, Hirai T, Ikawa O, Takagane A, Hata Y, Ojima H, Sodeyama H, Mochizuki I, Ishikawa T, Kagimura T, Nishida T. Surgery and imatinib therapy for liver oligometastasis of GIST: a study of Japanese Study Group on GIST. Jpn J Clin Oncol 2017; 47:369-372. [PMID: 28073945 DOI: 10.1093/jjco/hyw203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 12/15/2016] [Indexed: 11/14/2022] Open
Abstract
We conducted a multicenter prospective study to clarify the efficacy and safety of surgery and imatinib for liver oligometastasis of gastrointestinal stromal tumors. Eligible gastrointestinal stromal tumor patients were enrolled in the surgery trial or the imatinib trial. Primary endpoints were recurrence-free survival and progression-free survival, respectively. The trials were prematurely terminated due to amendment of guidelines for adjuvant imatinib therapy and low patient accrual. In the surgery trial, all the six patients showed hepatic recurrence: median recurrence-free survival was 145 days (range: 62-1366 days). Of the five patients receiving salvage imatinib therapy, two showed progressive disease although no death was observed. Of the five patients enrolled in the imatinib trial, one died of pneumonia after progressive disease, and four had not shown progressive disease as of last visit. The results suggest that liver oligometastasis of gastrointestinal stromal tumor may not be controllable by surgery alone and require concomitant imatinib therapy.
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Affiliation(s)
- Tatsuo Kanda
- Department of Surgery, Sanjo General Hospital, Sanjo, Japan
| | - Toru Masuzawa
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Toshihiro Hirai
- Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Japan
| | - Osamu Ikawa
- Department of Surgery, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Akinori Takagane
- Department of Gastrointestinal Surgery, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Yasuhiro Hata
- Department of Radiology, Kochi Health Sciences Center, Kochi, Japan
| | - Hitoshi Ojima
- Department of Surgery, Gunma Prefectural Cancer Center, Ota, Japan
| | | | - Izumi Mochizuki
- Department of Surgery, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Takashi Ishikawa
- Department of Medical Informatics, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Tatsuo Kagimura
- Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan
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Fahrner R, Dennler SGC, Dondorf F, Ardelt M, Rauchfuss F, Settmacher U. Experiences with surgically treated primary or secondary hepatic sarcoma. Langenbecks Arch Surg 2017; 402:585-590. [PMID: 28110373 DOI: 10.1007/s00423-017-1558-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Liver resection in hepatic sarcoma is rare, but other alternative treatment options are scarce. Surgery offers the only aggressive approach to achieve a tumour-free state. The aim of this investigation was to evaluate the outcome and survival of these patients at a single hepato-biliary university hospital. METHODS Between January 2004 and July 2013, 896 anatomical liver resections were performed. Eleven liver resections (1.2%) were performed due to primary hepatic sarcoma or hepatic sarcoma metastases. The demographic and clinical parameters were collected from the institutional patients' records. RESULTS In eight patients (83%), liver resection was performed due to hepatic sarcoma metastases. The surgical procedures were as follows: two patients (18%) had segmentectomy, six patients (55%) had hemihepatectomy or extended hemihepatectomy and three patients (27%) had multivisceral resections. In nine patients (82%), the resection margins were tumour free. In 55% (n = 6) of the patients, the maximal tumour diameter was greater than 10 cm. The postoperative morbidity was low with a Clavien-Dindo score of 2 (range 0-5). One patient died on postoperative day 2 after multivisceral resection. During the follow-up of 932 days (range 2-2.220 days) the 1-, 2- and 3-year survival rates were 91, 63 and 45%, respectively. Tumour recurrence was detected in seven patients (63%). CONCLUSIONS Liver resections in patients with primary or secondary hepatic sarcoma are rare. The main goal in these patients is to achieve complete tumour resection because chemotherapy offers no suitable alternative, but the long-term survival rates are limited because of high a recurrence rate even after aggressive surgical approaches.
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Affiliation(s)
- René Fahrner
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Sandra G C Dennler
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Felix Dondorf
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Michael Ardelt
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Falk Rauchfuss
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
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47
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Nanji S, Tsang ME, Wei X, Booth CM. Outcomes after repeat hepatic resection for recurrent metastatic colorectal cancer: A population-based study. Am J Surg 2017; 213:1053-1059. [DOI: 10.1016/j.amjsurg.2016.08.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/17/2016] [Accepted: 08/20/2016] [Indexed: 02/07/2023]
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Takemura N, Saiura A. Role of surgical resection for non-colorectal non-neuroendocrine liver metastases. World J Hepatol 2017; 9:242-251. [PMID: 28261381 PMCID: PMC5316844 DOI: 10.4254/wjh.v9.i5.242] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/29/2016] [Accepted: 12/07/2016] [Indexed: 02/06/2023] Open
Abstract
It is widely accepted that the indications for hepatectomy in colorectal cancer liver metastases and liver metastases of neuro-endocrine tumors result in relatively better prognoses, whereas, the indications and prognoses of hepatectomy for non-colorectal non-neuroendocrine liver metastases (NCNNLM) remain controversial owing to the limited number of cases and the heterogeneity of the primary diseases. There have been many publications on NCNNLM; however, its background heterogeneity makes it difficult to reach a specific conclusion. This heterogeneous disease group should be discussed in the order from its general to specific aspect. The present review paper describes the general prognosis and risk factors associated with NCNNLM while specifically focusing on the liver metastases of each primary disease. A multidisciplinary approach that takes into consideration appropriate timing for hepatectomy combined with chemotherapy may prolong survival and/or contribute to the improvement of the quality of life while giving respite from systemic chemotherapy.
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Affiliation(s)
- Nobuyuki Takemura
- Nobuyuki Takemura, Department of Gastroenterological Surgery, JR Tokyo General Hospital, Tokyo 151-8528, Japan
| | - Akio Saiura
- Nobuyuki Takemura, Department of Gastroenterological Surgery, JR Tokyo General Hospital, Tokyo 151-8528, Japan
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Abstract
Gastrointestinal stromal tumors had the reputation for poor outcomes because of their lack of response to nonsurgical interventions. The discovery of gain-of-function mutations involving receptor tyrosine kinase growth factor receptors altered the biological understanding and management. Beginning in 2000, management of these tumors has changed dramatically because of the availability of tyrosine kinase inhibitors. The role of surgery continues to be refined. This article reviews how surgery and systemic therapy are being used, incorporating definitions of risk. Decisions on how to treat a patient is based on the risk of progression, pathologic characteristics, and tumor location.
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50
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Gronchi A, Guadagnolo BA, Erinjeri JP. Local Ablative Therapies to Metastatic Soft Tissue Sarcoma. Am Soc Clin Oncol Educ Book 2017; 35:e566-75. [PMID: 27249769 DOI: 10.1200/edbk_157450] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The approach to metastatic soft tissue sarcoma is complex and depends upon several factors, such as the extent of the disease, the histologic subtype of the primary tumor, the disease-free interval, patient status and comorbidities, and previous treatments. The effect of systemic chemotherapy is suboptimal, therefore local ablative therapies are often considered when the disease is limited, especially if confined to a single site/organ. Historically, surgery has been considered the treatment of choice for isolated lung metastases. This approach also has been extended to metastases in the liver, although a formal demonstration of its benefit has never been provided. Radiation therapy instead has been mainly used to obtain pain control and to reduce the risk of bone fracture and cord compression. Advances in techniques, such as the development of more precise conformational modalities and the employment of particles, may change the role of this modality in the strategic approach to metastatic soft tissue sarcoma. Recently, the use of interventional radiology in this scenario has expanded. Ablative approaches, such as radiofrequency ablation and cryoablation, have shown durable eradication of tumors. Catheter-directed therapies, such as hepatic artery embolization, are potential techniques for treating the patient who has multiple unresectable liver metastases. Understanding the timing and role of these three different modalities in the multidisciplinary approach to metastatic soft tissue sarcoma is critical to provide better care and to personalize the approach to the single patient.
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Affiliation(s)
- Alessandro Gronchi
- From the Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - B Ashleigh Guadagnolo
- From the Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph Patrick Erinjeri
- From the Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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