Lewis JJ, Leung D, Woodruff JM, et al [ Mem Sloan-Kettering Cancer Ctr ]
Retroperitoneal Soft-Tissue Sarcoma: Analysis of 500 Patients Treated and Followed at a Single Institution
Ann Surg 228 : 355-365, 1998
This study of 500 patients with retroperitoneal sarcoma were prospectively analyzed. Stage at diagnosis, histologic grade, unresectable primary tumor and positive margin were associated with mortality. Curative aggressive surgery improves the outcome.
Knocke TH, Kucera H, Dorfler D, et al [Univ of Vienna]
Results of Postoperative Radiotherapy in the Treatment of Sarcoma of the Corpus Uteri
Cancer 83: 1972-1979, 1998
This study of 72 patients with sarcoma of corpus uteri of varying histologic received external beam radiation and brachytherapy. At 5 years, the actuarial overall survival rate was 52.3%, disease-specific survival was 58.5%, and local control rate was 77.9% and best results of which were in early stage whereas in advanced disease states it could prevent local recurrence.
Eary JF, Conrad EU, Bruckner JD, et al [ Univ of Washington, Seattle]
Quantitative [F-18] Fluorodeoxyglucose Positron Emission Tomography in Pretreatment and Grading of Sarcoma
Clin Cancer Res 4: 1215-1220, 1998
Positron emission tomography imaging with [F-18] fluorodeoxyglucose [FDG] of sarcoma was used to monitor tumor metabolism and this correlated with tumor grade and thereby overcome some of the limitation of traditional pathologic assessment. The overlap of MRFDG PET values with tumor grade offer an alternative way to assess tumor biological potential. The neo adjuvant therapy in bone and soft tissue sarcoma is dependent on tumor grade.
William S. Ferguson and Allen M. Goorin (Division of Pediatric Hematology-Oncology, Rhode Island Hospital, Providence, Rhode Island, and Brown University School of Medicine, Providence Rhode Island; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, and Harvard Medical School, Boston, Massachusetts)
Current Treatment of Osteosarcoma
Cancer Investigation 2001 Vol. 19 (3) Pg. 292-315
Osteosarcoma is a most common metaphyseal lesion. MRI is superior to plain radiographs in determining the extent of bony involvement and biopsy remains essential in distinguishing osteosarcoma from other malignant neoplasms. Conventional osteosarcomas are classified as osteoblastic, chondroblastic, or fibroblastic. Telangiectatic osteosarcomas have lytic lesions. Small cell osteosarcomas may bring out confusion with Ewings sarcomas. Lung and bone are the most common sites of distant spread. CT scan chest is more sensitive than regular chest x ray.
Bone scan and MRI are useful for diagnosis of metastasis. Small tumor do better than large, distal appendicular lesions do better than those with distal tumors. Jaw tumors also have good prognosis. LDH and alkaline phosphatase have poor prognosis.
Radical surgical removal of primary tumor is followed by distant recurrence in 80-90% of cases.
The chemotherapy drugs useful in treatment of osteosarcomas include doxorubicin, high dose methotrexate and cisplatin. Ifosfamide either alone or with etoposide. Adjuvant therapy is useful in control of micrometastasis and results in long term overall survival of > 60%. Intraarterial chemotherapy has not made an impact and is no longer used routinely.
Neoadjuvant chemotherapy or surgery followed by chemotherapy has given equivalent results however neoadjuvant therapy gives an idea of chemotherapy induced necrosis which may have correlation with subsequent survival. The surgical option of amputation versus limb salvage have overall same survival in properly selected individuals.
John F. Gibbs, Peter P. Huang, R. Jeffrey Lee, Brian McGrath, John Brooks, Brian McKinley, Deborah Driscoll, and William G. Kraybill (Division of Surgical Oncology, Division of Radiation Medicine, Department of Pathology, Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, New York)
Malignant Fibrous Histiocytoma: An Institutional Review
Cancer Investigation 2001 Vol. 19 (1) Pg. 23-27
Soft tissue sarcomas are malignant tumors arising from extra skeletal soft tissues of primitive mesodermal origin. Histologic grade and size of primary tumor are the two most important prognostic factors.
This study of 126 patients with MFH treated at a single center and followed after primary surgical therapy for a median time of 42 months.
The most important prognostic factor for the tumor is clinical stage defined by tumor grade, size, and presence of distant metastasis.
No significant influence on local recurrence on patient prognosis was noted in patients with MFH. Surgical management remains the corner stone of therapy with MFH.
Negative margins did decrease the incidence of local recurrence but did not influence the outcome.
Huuhtanen RL, Blomqvist CP, Wiklund TA, et al (Helsinki Univ; Karolinska Inst, Stockholm)
Comparison of the Ki-67 Score and S-phase Fraction as Prognostic Variables in Soft-Tissue Sarcoma
Br J Cancer 79: 945-951, 1999
The biological prognostic factor of proliferative activity is measured by Ki-67 antibody or flow cytometric S-phase fraction (SPF).
This retrospective study on patients with sarcomas compared immunohistochemically determined Ki-67 scores to flow cytometrically assessed SPF.
Ki-67 had better predictive value both for metastatic free and disease specific overall survival than SPF in soft tissue sarcomas.