Transcript Diapositiva 1

12th Annual CTOS Meeting 2006
POSTER VIEWING OF
SESSION 6
12th Annual CTOS Meeting 2006
Treatment for sacral chordoma; surgery or carbon ion radiotherapy
Introduction: Prognosis of the patients with sacral chordoma is
dismal. Surgical treatment with tumor-free margin often results in severe
complication, whereas intralesional margin leads to high rate of local
recurrence. Recently, carbon ion radiotherapy is being performed for the
patients of sacral chordoma. Difference of the clinical outcome of these
treatments is still unknown.
Aim: To evaluate the clinical outcome for the patients
of sacral chordoma with surgical treatment or carbon ion radiotherapy
as a conservative therapy. To clarify the criteria to determine the
treatment modality for the patients with sacral chordoma
Patients: 15 cases
Since 1990, No previous treatment
Originated in sacrum, Diagnosed as a chordoma pathologically
Methods:
treatment, pre- or post- operative symptoms, highest level of tumor,
complications, walking ability, prognosis
ABSTRACT 668
12th Annual CTOS Meeting 2006
Results
complications
walking
ability
prognosis
Discussion
Carbon ion
Surgery
urinary, anorectal
dysfunction : 4/6
urinary, anorectal
dysfunction : all cases
free gait: 4 cases
one cane: 4
wheel chair: 1
free gait: 3 cases
one cane: 3
NED
AWD
DOD
NED
DOD
5 cases
3
1
5 cases
1
Complications, ADL, prognosis
Urinary, anorectal worsen in surgical therapy
ADL, prognosis surgery
Surgery = Carbon ion
Criteria to determine the treatment modality
One S2 root can be preserved
Wide margin can be obtained
Conclusion
surgery
Not otherwise = carbon ion radiotherapy
•Clinical outcome for 15 cases with sacral chordomawas analyzed.
•Urinary, anorectal function was worsened in cases with surgical treatment
•Cabon ion radiotherapy is good therapeutic tool for sacral chordomas with less complications
12th Annual CTOS Meeting 2006
Radiation Induced Pathologic Fractures After Surgery
for Soft Tissue Sarcomas
Kevan Saidi, Anthony Griffin, Peter Ferguson, Robert Bell, Jay Wunder
The Musculoskeletal Oncology Unit, Mount Sinai Hospital, The University of Toronto, Canada
Aim of Study:
• Determine healing rates of radiation induced fractures
• Determine results of surgical management
• Fracture Fixation vs Endoprosthetic Replacement
Background:
• Previous studies established risk factors for fracture
• Helmstedter (CORR 2001) - prophylactic IM nail with periosteal stripping
• Lin (CORR 1998) - Consider primary arthroplasty in proximal & distal femur
fractures
Methods:
• Retrospective review 1986 to present
• 32 patients with 34 fractures (2 acetabular fractures - 1o THA)
12th Annual CTOS Meeting 2006
Radiation Induced Pathologic Fractures After Surgery for Soft Tissue Sarcomas
Results:
11 of 34 Fractures Healed (32%)
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Femur: 25% (3/12) proximal 12% (1/8) diaphysis 50% (1/2) distal healed
Tibia: 100% (2/2) proximal
33% (1/3) diaphysis
Others: 60% (3/5) patella, metatarsals
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5/16 (31%) healed after periosteal stripping
4/9 (44%) Men & 7/23 (30%) Women Healed
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2/8 (25%) healed after 50 Gy
9/24 (38%) healed after 66 Gy
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Risk Factors For Fracture (Holt, JBJS 2005):
4.5 yrs
5 yrs
• Females > 50, High Dose Radiation (60 or 66 Gy), Proximal 2/3 Femur
OR x 2
Conclusion:
• Fractures of the proximal 2/3 of the femur and diaphysis of tibia are at high
risk of non-union
• Primary endoprosthetic replacement should be considered when treating
pathologic radiation induced fractures of the proximal femur
12th Annual CTOS Meeting 2006
A multivariate analysis of a series of 382 primary retroperitoneal
sarcomas (RPS) from the French Association of Surgery
Castaing M1, Laplanche A1 (statisticians),
Bonvalot S1, Rivoire M2, Stoeckle E3 (surgeons), for the French Association of Surgery
1
Gustave-Roussy Institute, Villejuif, France; 2 Léon Bérard Center, Lyon, France;3 Bergonié Institute, Bordeaux, France.
Introduction: no consensus concerning the precise value of the extent of surgery and the
value of additional treatment modalities
Material & methods: retrospective national study
Aim of the study:
to define the best surgical technique to achieve clear margins
and determine prognostic factors for abdominal recurrences
and patient survival
Definitions of surgery
1. Systematic complete resection: complete or
partial resection of non-involved contiguous
organs to achieve wide margins
2. Contiguously involved organ resection
3. Simple complete resection of the tumor with
grossly negative margins
4. Re-excision: systematic complete surgery
after previous simple resection
12th Annual CTOS Meeting 2006
Results discussion
Prognostic factors (multivariate)
Abdominal recurrences
Overall survival
• TYPE OF SURGERY (1/2/3/4)
• TUMOR GRADE (1/2/3)
• SPILLING OF THE TUMOR (Yes/No)
• PRE OPERATIVE BIOPSY (Percut/Surg/No)
• NB OF TREATED PATIENTS PER CENTER
(<10, 10-30, >30)
• TUMOR GRADE
• SPILLING OF THE TUMOR
• MACROSCOPIC RESIDUAL (Yes/No)
Simple complete resection (median=2.5 years)
Contiguously involved organ resection (median=2.5 years)
Re-excision (median not reached)
Systematic complete resection (median=9 years)
80%
80%
Survival
Abdominal recurrence rate
100%
No spilling of the tumor (median=8.5 years)
No macroscopic residual (median=7 years)
Spilling of the tumor (median=1.5 years)
Macroscopic residual (median=1 year)
100%
60%
60%
40%
p < 0.0001
for both
40%
20%
20%
logrank : p < 0.0001
0%
0
0%
0
1
2
3
36
58
9
66
26
38
9
51
Patients at risk
84
147
21
116
49
85
16
95
4
5
6
7
8
20
28
7
31
13
18
3
23
11
11
2
17
5
8
1
10
1
7
1
4
Years
1
2
3
195
210
30
14
152
165
22
8
Patients at risk
304
335
76
45
253
271
44
25
4
Years
112
121
16
6
5
6
7
8
82
88
11
5
58
64
8
2
41
45
4
27
30
3
Conclusions: systematic complete surgery, percutaneous pre operative biopsy,
no spilling of the tumor. Additional treatment modalities need further investigation.
12th Annual CTOS Meeting 2006
Factors Predicting Actual Longterm Survival After Soft Tissue
Sarcoma Pulmonary
Metastasectomy
Richard R. Smith M.D.*, Youngji Pak M.S.#, William G.
Kraybill M.D.*, and John M. Kane III M.D.*
Department of Surgical Oncology* and Biostatistics#
Roswell Park Cancer Institute and State University of
New York at Buffalo
Abstract 707
12th Annual CTOS Meeting 2006
INTRODUCTION AND METHODS
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There were an estimated 9,420 soft tissue sarcomas (STS) in the United States in 2005 with 3490 deaths. Approximately
20-25% of all STS patients will develop pulmonary metastases and 70% of these patients will have disease confined to
the lungs. Pulmonary metastasectomy (PM) has been employed as a potentially curative therapy for isolated lung
metastases with a reported 3 year overall survival (OS) of 30-42%. Factors predictive of post-PM survival include
completeness of resection, number of metastases, tumor doubling time, and disease-free interval. Unfortunately, even
with complete resection, recurrence occurs in 45-83% of patients. The purpose of this study was to examine the factors
predictive of actual long-term survival in STS patients undergoing PM with greater than 5 years of follow-up.
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The records of all STS patients undergoing PM from January 1976 - December 2000 were identified through a
computerized coding search of sarcoma patients who underwent pulmonary resection. Ninety-nine patients were
identified and 94 patients had complete follow up information for a minimum of 5 years. The hospital and outpatient
records were reviewed for each patient to collect the clinicopathologic variables. For care received outside of the institute,
records and correspondence from outside physicians were reviewed.
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Five year actual disease-free survival (DFS) and OS were calculated for all patients. The complete resection (R0) group
was also examined as a subgroup. Data analysis was performed by software package SAS, version 9.1. Fisher’s exact
test, test, and Cochran-Armitage trend test were used to assess the statistical significance of associations between
expressions of resection margin (R) and other clinicopathologic variables. Univariate survival analysis was done using
Kaplan-Meier method; difference in survival curves was assessed with the log-rank test. Multivariate survival analysis
was done via Cox’s proportional hazard model. Hazard Ratios (HR) and 95 % Confidence Interval were calculated based
upon parameters estimates from the finally fitted Cox’s proportional hazard model. P-values less than 0.05 were
considered to be significant.
12th Annual CTOS Meeting 2006
Results and Conclusions
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RESULTS
Median age for the 94 patients undergoing pulmonary metastasectomy (PM) was 49 years (range 9-75 years).
Median time from diagnosis to metastasis was 15 months (range 0-176 months) .
Median follow-up was 99 months (range 65-206 months).
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The 30 day surgical mortality was 3.7%.
34 patients (36%) had concomitant extra-pulmonary disease that was resected in a staged fashion with PM.
73 patients (78%) underwent a complete pulmonary metastasectomy with microscopically negative margins (R0).
33 patients (35%) underwent subsequent re-resections of recurrent pulmonary metastatic disease.
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The actual 5 year DFS and OS for the entire group were 5% and 15%, respectively.
The actual 5 year DFS and OS for the R0 group were 7% and 18%, respectively.
Median OS of the R0 group was 22 months (range 1-206) vs. 11.5 months (range 5-126) for R1 vs. 9.5 months (range 0-24) for R2
(P < 0.0001).
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On univariate analysis, variables significantly associated with OS included: resection status, disease-free interval ≤ vs. > 15 months,
bilateral metastases, and number of metastases.
On multivariate analysis, only resection status and disease-free interval were significantly associated with OS.
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CONCLUSIONS
Less than 20% of soft tissue sarcoma patients undergoing pulmonary metastasectomy will be alive 5 years after resection of their
metastatic disease and the majority of these patients will have active sites of disease.
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A prolonged disease-free interval (> 15 months from primary diagnosis to metastatic disease) and complete negative margin
resection of all pulmonary metastases are the only variables associated with improved overall survival.
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Surgically treatable recurrence at the primary tumor site, extension of lung metastases into the thorax, and re-resection of
subsequent pulmonary recurrences do not negatively impact upon overall survival following pulmonary metastasectomy.
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Pulmonary metastasectomy for soft tissue sarcomas remains the primary, potentially curative treatment for patients with lung
metastases as long as all known disease can be resected with negative margins.
12th Annual CTOS Meeting 2006
ILP: abstracts 598, 678,684
• AB 598: Efficacy of TNF ILP for locally advanced soft tissue
sarcoma, is it dose dependent? Ido Nachmany et al.
• 35 pts with 3-4 mg CR 37% limb preservation 85%
• 17 pts low dose CR 1/17, most had amputation
• AB 678: Single agent experience for hyperthermic ILP of extremity
sarcoma. M. Moller et al
• 15 pts HILP with melphalan alone: overall initial CR 100%
• Overall limb salvage 90%, local recurrence rate 40%
• AB 684: ILP for unresectable extremity sarcoma C. Wray et al.
• Study 1: TNF and melphalan: 16 pts 56% PR, 50 % limb salvage
• Study 2: Doxorubicine: 12 pts no CR no PR, 8/12 amputations, 6
rhabdomyolisis
12th Annual CTOS Meeting 2006
Cover of soft tissue defect after surgery
• AB 575: Use of human allogenic virus inactivated
acellular dermal matrix populated with autologous
fibroblasts to close soft tissue defects after sarcoma
resection. E Roessner et al.
• Tissue donations, skin was virus inactivated, kinetic of
fibroblast demonstrated good cell proliferation. 2 pts
successfully treated.
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AB 562: CHEST WALL RESECTIONS FOR SARCOMA - THE NORTH OF ENGLAND EXPERIENCE
Craig Gerrand et al.
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AB 609: STABLE AND WELL VASCULARISED COVER AFTER WIDE EN BLOC RESECTION OF
THE STERNAL BONE Lene Birk-Soerensen et al.
12th Annual CTOS Meeting 2006
FIBROMATOSIS
• [Abstract ID:613] DESMOIDS: INITIAL PRESENTATION
DETERMINES OUTCOME Eberhard Stoeckle et al. 95 pts, . A
differentiated approach, favoring first-line medical treatment
should be done in the shoulder girdle, pelvic girdle, thoracic wall
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[Abstract ID:708]LONG TERM DISEASE CONTROL IN PATIENTS
(PTS) WITH DESMOID FIBROMATOSIS MANAGED WITH
MULTIMODALITY THERAPY Chandrajit P Raut et al. 57 pts, intra
and extra abdominal. In the setting of unresectable DF, treatment
with chemotherapy may be associated with disease stability or
partial response.
12th Annual CTOS Meeting 2006
AB 723: Prognostic value of unplanned excision of a
soft tissue sarcoma on subsequent outcome
H. Wafa et al.
• 316 pts with a previous unplanned surgery
• 281 had reexcision, 56% had residual tumor
• Factors affecting LR recurrence: High grade,
MPNST, and myxofibrosarcoma
• No residual tumor on reexcision affected
survival