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Statistics3: Limb, Nose, Retroperitoneal
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Medical Journal Article Annotated Citations

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Am Surg 1998 Jan;64(1):53-60; discussion 60-1
Leiomyosarcoma: a 45-year review at Charity Hospital, New Orleans.
Hill MA, Mera R, Levine EA. Section of Surgical Oncology, Louisiana State Univ Medical Center, NewOrleans 70112, USA.

Approximately 2 to 9% of all soft tissue sarcomas are leiomyosarcomas (LMS). LMS arises nearly exclusively as tumors in adults, with peak incidence occurring in the fifth and sixth decades. The purpose of this study was to analyze disease-specific survival and define prognostic factors in patients with this disease who were treated and followed at a single institution. Fifty-eight cases of LMS were identified in the Tumor Registry of the Medical Center of Louisiana at New Orleans (charity Hospital) from 1950 to 1995. Charts were reviewed and tissue blocks reexamined to confirm the diagnosis. Follow-up information was available for 56 of 58 (96%) patients. Univariate and multivariate analyses were performed to analyze which factors predict outcome. The median survival time was 138 months. Univariate analysis identified age (> 48 years), location (retroperitoneal vs other sites), and extent of disease as prognostic factors. Multivariate analysis revealed that only age and the extent of disease at presentation are independent prognostic indicators. Race, sex, and adjuvant therapy were not significant prognostic factors. Surgical resection remains the therapeutic mainstay for patients with LMS. The value of other treatment modalities is largely limited to surgical failures. The data show that the age of the patient and the extent of disease at presentation are the best predictors of long-term survival. LMS has a good prognosis when complete resection of localized lesions can be achieved.

Fetch PMID: 9457038


Cancer 1995 Oct 15;76(8):1398-405
High grade soft tissue sarcoma of the flexor fossae. Size rather than compartmental status determine prognosis.
Yang RS, Lane JM, Eilber FR, Dorey FJ, al-Shaikh R, Schumacher LY, Rosen G, Forscher CA, Eckardt JJ. Department of Orthopaedic Surgery, UCLA School of Medicine, Cedars-Sinai Comprehensive Cancer Center, Los Angeles, California 90095-6902, USA.

,,, High grade soft tissue sarcoma arising in the popliteal space, axilla, and antecubital fossae (flexor fossae tumors) have by convention been classified as extracompartmental tumors ,,, Advances in neoadjuvant chemotherapy and radiation therapy have made surgical resection more feasible. The hypothesis to be tested is that compartmental status may not be of prognostic significance if the tumor is adjusted for size, histologic grade, and distant metastasis after undergoing adjuvant chemotherapy and radiation. ,,, From ...1976 to ...1992, 22 patients with high grade soft tissue sarcomas of the flexor fossae (Group A) were treated at UCLA Medical Center. The histologic subtypes were ,,, leiomyosarcoma (two), ,,, The popliteal fossa was the location in 11, the axilla in 10, and the antecubital fossa in 1. Wide resection was attempted in all patients after preoperative chemotherapy and radiation therapy. ,,, A group of 77 patients (Group B) with high grade soft tissue sarcoma located within an extremity compartment were chosen to test the hypothesis that survival of patients with tumors in the flexor fossae is equal to that of patients with intracompartmental tumors of similar size and grade if both are given adjuvant therapy. This group was chosen so that histologic subtype, size, sex, and location would be similar in the two groups,,, The median follow-up of survivors in Group A was 104 months and for patients in Group B was 79 months,,, The 5-year cumulative survival rate (Kaplan-Meier method) of patients in Group A was 76%, and 67% for those in Group B. The difference was not significant.

Three patients in Group A (14%) and 17 (22%) in Group B had local tumor recurrence. Eight patients in Group A (36%) and 27 (35%) in Group B had lung metastases. Age, sex, histologic subtype, and surgical margins did not affect survival outcomes, lung metastasis, and local recurrence. However, patients with larger tumors (maximum dimension > or = 8 cm or cross-sectional area > or = 40 cm2) had significantly poorer survival, more metastases, and local recurrences. ,,,Flexor fossae sarcomas do not have a poorer prognosis than extremity intracompartmental tumors when adjusted for size, distant metastasis, and histologic grade when they are treated with adjuvant radiation therapy, chemotherapy, and surgery. [NOTE: this is a group of mixed sarcomas, not LMS alone. Ed.]

Fetch PMID: 8620414


Rev Chir Orthop Reparatrice Appar Mot 1995;81(4):338-43
[Bone metastasis of leiomyosarcoma. Apropos of a case]. [Article in French]
Mariconda M, Tacchetti C, Misiti CM, Lotti G, Ammendolia A, Millo R, Milano C. Clinique Orthopedique, Faculte de Medecine de Catanzaro, Universite de Reggio Calabria, Italie.

,,, Bone leiomyosarcoma is a rare tumor, whether it may be primary or secondary. The authors report on the case of a woman, aged 67, admitted in January 1992 complaining of pain in the left hip and the upper end of the femur. ,,, In 1985 the patient underwent surgical excision of a soft tissue tumor in the right thigh, histologically diagnosed as a benign fibrous tumor. This lesion recurred locally four times and repeated excisions were performed throughout the years, always with a histological diagnosis of a benign lesion. On admission to hospital, the physical examination as well as laboratory data and plain roentgenograms were unremarkable.[ ! Ed.] Both tomography and MRI showed a lesion in the upper end of the left femur. An isotopic bone scan showed marked increased uptake in the left hip extending to the femoral diaphysis. An open biopsy was performed for histology, immunohistochemistry and electron microscopy. A diagnosis of metastatic leiomyosarcoma was made. The retrospective histological examination of specimens of the soft tissue tumor excised in 1985 showed the same immunohistochemical features of the contralateral leiomyosarcoma. On this basis, one stage resection of the left hip and the upper end of the femur was performed and a Kotz modular prosthesis was inserted. Postoperative healing was achieved without any complications and the function of the operated limb was satisfactory. Three months after the operation pulmonary lesions were noted on chest radiographs and CT scan. The patient died two years after the first admission for widespread metastasis. ,,, In the reported case, the bony metastasis appeared to be the presenting finding of the soft tissue tumor of the contralateral thigh. This presentation is rare in previously published series. The misdiagnosis of the primary tumor had caused local recurrences, and an increased malignity occurred. According to the literature, a soft tissue leiomyosarcoma can be easily confused with other spindle cell lesions. Therefore an accurate histological and ultrastructural diagnosis is necessary for adequate surgical treatment.

Fetch PMID: 8560004


Cancer 1992 Jul 1;70(1):114-9
Soft tissue leiomyosarcoma. A population-based epidemiologic and prognostic study of 48 patients, including cellular DNA content.
Gustafson P, Willen H, Baldetorp B, Ferno M, Akerman M, Rydholm A. Department of Orthopedics, University Hospital, Lund, Sweden.

,,, Leiomyosarcoma of soft tissue is a rare tumor. ,,,Epidemiology and prognosis were analyzed in a consecutive, population-based series of 48 patients with subcutaneous and deep-seated leiomyosarcoma in the extremities and trunk wall with a complete follow-up of a minimum of 3 years. Cutaneous tumors were not included. ,,, The annual incidence was 0.13/10(5). The ratio of men to women was 1.2, and the median age was 65 years. The thigh was the most common location. Almost half of the tumors were subcutaneous. The median tumor size was 6 cm (range, 1-25 cm). All patients were treated with surgery, and in 19 cases it was combined with adjuvant radiation therapy or chemotherapy. The cumulative 5-year survival rate was 64%. Multivariate analysis indicated that age of 60 years or greater (relative risk [RR] = 8) and intratumoral vascular invasion (RR = 4) were independent risk factors for death resulting from tumor. DNA aneuploidy (RR = 4) and tumor necrosis (RR = 3) were associated with poor prognosis, but did not reach statistic significance. ,,,

Fetch PMID: 1606532


Cancer 1986 Apr 1;57(7):1395-400
Intramural venous leiomyosarcomas.
Leu HJ, Makek M.

Five cases of intramural venous leiomyosarcomas are described. Only one was localized in the inferior vena cava, the classic site; the other four cases were situated in smaller veins, namely, the short and long saphenous veins, the external jugular vein, and a superficial vein at the back of the hand. Light and, in two cases, electron microscopy, as well as immunohistochemical examinations for factor VIII, helped to establish the diagnosis. The fate of these cases indicates that size and localization are the main determining factors of outcome, whereas the level of mitotic activity is informative only if it is high. Small tumors in superficial veins that are detected early may have an excellent prognosis, even after limited removal of the tumor.

Fetch PMID: 3081244
Nose
Medical Journal Article Annotated Citations

Latest Pubmed/Medline Search for Leiomyosarcoma with nasal primary


Acta Otorhinolaryngol Belg 1999;53(3):199-205
Possibilities and limitations of endoscopic management of nasal and paranasal sinus malignancies.
Stammberger H, Anderhuber W, Walch C, Papaefthymiou G. Department of ENT, University Medical School of Graz, Austria.

,,, From 1989-1999 we have treated 43 patients with invasive/destructive tumors of the paranasal sinuses and the anterior skull base strictly endoscopically, transnasally. ,,, Whereas the very first patients were approached endoscopically in a palliative intention, we have started endoscopic surgery for selected malignancies with curative intention in the last years. ,,, Our first results appear to indicate, that outcome is at least equal to standard external approaches, however with excellent functional terms and significantly better overall quality of life. The limitations result from the anatomical spread of the tumor, when extensive infiltration of orbit, dura/brain and other vital structures exist. However, in experienced hands, endoscopic surgery in this region can be rather radical, bone and even dura of the anterior skull base can be resected as can the periorbit, and all structures reconstructed in the same session. Endoscopic techniques lend themselves very well to cooperation with neighbouring specialities like neurosurgery. In individual cases, gamma-knife therapy has proven an extremely helpful adjunctive. ,,, However we recommend, that these techniques are only applied at centers, where all other surgical approaches can be performed, should need for this arise.

Fetch PMID: 10635393


ORL J Otorhinolaryngol Relat Spec 1996 Mar-Apr;58(2):115-20
Leiomyosarcoma of the nasal cavity. Case report and literature review.
Lippert BM, Godbersen GS, Luttges J, Werner JA. Department of Otorhinolaryngology, Head and Neck Surgery, University of Kiel, Germany.
Leiomyosarcoma (LMS) accounts for approximately 7% of all soft tissue sarcomas and occurs most frequently in the gastrointestinal tract and uterus. LMS of the nasal cavity and paranasal sinuses are rare and only about 40 cases of LMS of the nose and paranasal sinuses have been reported in the literature. A further case of LMS of the right turbinate is presented, treated twice by surgery. To date, the patient has been free of disease for more than 48 months. The symptoms, pathology, treatment and prognosis, and origin of this tumor are discussed. Initially, LMS should be treated by extensive surgical excision, but long-term follow-up is essential due to the high rate of local recurrence. Radiotherapy and chemotherapy are insufficient therapeutic approaches. Frequency of recurrence and prognosis depend on the tumor site. The prognosis of LMS of the nasal cavity is better than LMS of the paranasal sinuses. Review, tutorial

Fetch PMID: 8736058


HNO 1995 Apr;43(4):250-2
[Rare tumor of the nose and paranasal sinuses. Leiomyosarcoma]. [Article in German]
Schmal F, Laubert A. Universitats-HNO-Klinik Munster.

Leiomyosarcoma is a rare malignant tumor of the nose and paranasal sinuses. Including our patient, 32 cases have been reported in the literature. Radical surgery is currently the best therapy. In comparison with results of conventional irradiation, postoperative neutron treatment appears to be more effective. Review of reported cases

Fetch PMID: 7790237
Retroperitoneal
Medical Journal Article Annotated Citations

Definition of Retroperitoneal:
The omentum, or peritoneum, is a thin layer of tissue that covers all of the intestines, and carries the blood supply to them. The area of the abdomen that is behind the peritoneum, outside of it, is called the retroperitoneum. This would include the abdominal wall, and a leiomyosarcoma tumor on the abdominal wall [a retroperitoneal leiomyosarcoma] could also come into contact with liver, spleen, pancreas, major arteries and veins, and the ureters and kidneys.

Latest Pubmed/Medline Search for Leiomyosarcoma with retroperitoneal primary



Am Surg 2000 Sep;66(9):832-6
Retroperitoneal soft-tissue sarcomas: prognosis and treatment of primary and recurrent disease.
Bautista N, Su W, O'Connell TX. Department of Surgery, Kaiser Permanente Medical Center, Los Angeles, California 90027, USA.

Soft-tissue sarcomas of the retroperitoneum constitute a heterogeneous group of tumors with varying histology, potential for complete resection, and propensity for recurrent disease-making the development of effective treatment difficult and challenging. A retrospective review of 23 patients with retroperitoneal sarcomas from 1985 through 1998 was performed to assess the biological behavior and clinical outcomes and to identify factors that may influence prognosis and optimize treatment strategy. Liposarcomas were the most common pathology ,,,. Leiomyosarcomas were the next most common pathology (30%); 43 per cent of these were of low grade. Low-grade sarcomas overall accounted for 62 per cent of the total group. Low-grade tumors independent of histologic type exhibited good prognosis for long-term survival with a median survival of 44 months. In contrast, intermediate- or high-grade tumors were associated with a median survival of only 9 months (P < 0.02). On the other hand, tumor histologic type independent of grade did not have a significant survival difference. Complete tumor resection was possible in 21 of 23 patients, which gives an overall resectability rate of 91 per cent. Eight patients (36%) remain disease-free after initial surgical treatment. However, local recurrence was common; this occurred in 11 of 22 patients (50%). Local recurrence, however, did not preclude long-term survival. Surgical resection of recurrent disease was done in nine patients with a median survival of 91 months (range 24-150 months). Three patients had as many as three operations for recurrent disease. With subsequent recurrences there was a decrease in interval from approximately 4 years to 2 years, and 33 per cent of these patients developed tumor dedifferentiation to high grade. An aggressive surgical approach with reoperation can produce prolonged survival in patients with low-grade retroperitoneal sarcoma. [Ed. This is combined sarcomas, not LMS alone.]

Fetch PMID: 10993610

World J Surg 1999 Jul;23(7):670-5
Primary retroperitoneal soft tissue sarcomas: results of aggressive surgical treatment.
Malerba M, Doglietto GB, Pacelli F, Carriero C, Caprino P, Piccioni E, Crucitti P, Crucitti F. Istituto di Clinica Chirurgica, Universita Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy.

,,, The hospital records of 42 patients with primary retroperitoneal sarcomas who underwent surgical exploration at our unit from 1984 to 1995 were reviewed. A univariate analysis was used to identify the main clinical, pathologic, and treatment-related factors affecting long-term survival. Twenty-five patients (59.6%) underwent radical surgery. The 5-year survival and 5-year disease-free survival after radical resection were 48.1% and 38.8%, respectively. According to the univariate analysis of survival tumor classification (T), stage and gross surgical margins significantly affected prognosis. The study indicates that even though there are predetermined and unmodifiable tumor-related factors, such as tumor classification (T) and stage, that influence survival in patients with retroperitoneal sarcomas, wide surgical excision offers a concrete chance for long-term survival. [Ed. This is combined sarcomas, not LMS alone.]

Fetch PMID: 10390584

Mod Pathol 1999 Jan;12(1):21-8
Retroperitoneal leiomyosarcomas unassociated with the gastrointestinal tract: a clinicopathologic analysis of 17 cases.
Rajani B, Smith TA, Reith JD, Goldblum JR. Department of Anatomic Pathology, The Cleveland Clinic Foundation, Ohio 44195, USA.

Data are limited on leiomyosarcomas within the abdomen and retroperitoneum, particularly if one discounts those associated with the gastrointestinal (GI) tract. Recently, some authors proposed that certain tumors in this location are more appropriately termed extra-GI stromal tumors, given their histologic resemblance to GI stromal tumors as opposed to conventional soft tissue leiomyosarcomas. We evaluated the clinical and pathologic features of 17 cases of leiomyosarcoma ,,, Follow-up intervals ranged from 4 to 169 months (median, 47 mo). Fifteen (88%) of seventeen patients developed an adverse outcome, defined as the development of metastatic disease or death due to tumor. Patients whose tumors had greater than 10 MFs/10HPFs had significantly shorter intervals to either metastasis or death than did those whose tumors had 10 or fewer MFs/10HPFs (8.4 mo vs. 42 mo; P = .003). No other features correlated with time to adverse outcome. In conclusion, the majority of patients with leiomyosarcomas located within the abdomen or retroperitoneum progress to metastatic disease or die from their tumor. The only feature that is significantly associated with a shorter interval to either metastasis or death is more than 10 MFs/10HPFs. [Metastatic disease does not preclude longterm survival. Ed.]

Fetch PMID: 9950158


J Gastrointest Surg 1998 Mar-Apr;2(2):151-5
Complete hepatic resection of metastases from leiomyosarcoma prolongs survival.
Chen H, Pruitt A, Nicol TL, Gorgulu S, Choti MA. Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md, USA.

,,, To determine whether hepatic resection has a role in the management of metastatic leiomyosarcoma, medical records from 11 consecutive patients who underwent resection of isolated metastases from leiomyosarcoma between 1984 and 1995 were reviewed. All liver resections were for leiomyosarcomas originating in the viscera (n = 6) or retroperitoneum (n = 5). The average disease-free interval was 16 months. Five of 11 primary tumors were classified as low grade, whereas six were high grade. Hepatic resections included lobectomy or extended lobectomy (n = 4), segmentectomy and/or wedge resection (n = 5), and complex resection (n = 2). There were no operative deaths. Median survival of all patients after liver resection was 39 months. Patients who underwent complete resection of hepatic metastases (n = 6) had a significantly longer survival than those who had incomplete resections (n = 5) (P = 0.03, log-rank test). Furthermore, five of six patients who underwent complete resection are alive after hepatectomy with a median follow-up of 53 months. Therefore, in selected patients with isolated liver metastases from visceral and retroperitoneal leiomyosarcomas, complete resection of hepatic metastases results in prolonged survival.

Fetch PMID: 9834411


Am Surg 1998 Jan;64(1):53-60; discussion 60-1
Leiomyosarcoma: a 45-year review at Charity Hospital, New Orleans.
Hill MA, Mera R, Levine EA. Section of Surgical Oncology, Louisiana State Univ. Medical Center, New Orleans 70112,USA.

Approximately 2 to 9% of all soft tissue sarcomas are leiomyosarcomas (LMS). LMS arises nearly exclusively as tumors in adults, with peak incidence occurring in the fifth and sixth decades. The purpose of this study was to analyze disease-specific survival and define prognostic factors in patients with this disease who were treated and followed at a single institution. Fifty-eight cases of LMS were identified in the Tumor Registry of the Medical Center of Louisiana at New Orleans (charity Hospital) from 1950 to 1995. Charts were reviewed and tissue blocks reexamined to confirm the diagnosis. Follow-up information was available for 56 of 58 (96%) patients. Univariate and multivariate analyses were performed to analyze which factors predict outcome. The median survival time was 138 months. Univariate analysis identified age (> 48 years), location (retroperitoneal vs other sites), and extent of disease as prognostic factors. Multivariate analysis revealed that only age and the extent of disease at presentation are independent prognostic indicators. Race, sex, and adjuvant therapy were not significant prognostic factors. Surgical resection remains the therapeutic mainstay for patients with LMS. The value of other treatment modalities is largely limited to surgical failures. The data show that the age of the patient and the extent of disease at presentation are the best predictors of long-term survival. LMS has a good prognosis when complete resection of localized lesions can be achieved.

Fetch PMID: 9457038


Am Surg 1996 Jul;62(7):525-8; discussion 528-9
Hepatic and vena cava resection using cardiopulmonary bypass with hypothermic circulatory arrest.
Sener SF, Arentzen CE, O'Connor B, Drueck C, Keeler T. Department of Surgery, Evanston Hospital, Illinois 60201, USA.

When large hepatic or retroperitoneal tumors encroach upon hepatic veins or vena cava and make conventional resection hazardous, the most commonly used method of hepatic resection or vena cava reconstruction includes hepatic vascular exclusion, at times with venovenous bypass or aortic occlusion. These techniques result in warm liver ischemia, and may be accompanied by significant systemic hypotension, despite aggressive central venous preloading. Hepatic lobe (two patients) and retroperitoneal sarcoma (one patient) resections were done in a cold, bloodless field without significant complications. Standard cardiopulmonary bypass techniques with heparin and cardioplegia were used. Systemic circulatory arrest was done at 15 degrees C with isolated retrograde perfusion of the brain through the jugular veins. Hepatic vein and vena cava reconstructions were performed with arrest times of between 30 and 78 minutes. Blood loss was gradual and easily controlled, occurring during the rewarming phase when clot formation was inhibited by cold and heparin.
Fetch PMID:8651545


Gynecol Oncol 1995 Dec;59(3):333-7
Retroperitoneal leiomyosarcoma: eight cases and a literature review.
Todd CS, Michael H, Sutton G. Department of Obstetrics/Gynecology, Indiana Univ. Medical Center,Indianapolis 46202, USA.

Leiomyosarcoma, a rare malignancy of smooth muscle, may arise from the retroperitoneum and present with the same vague symptoms as a malignancy of the pelvic organs. The purpose of this paper is to review eight cases of retroperitoneal leiomyosarcoma and to illustrate the presenting symptoms, prognostic indicators, and outcomes of patients seen at Indiana University Medical Center between 1989 and 1994. Patients in this study were white females who presented between the ages of 46 and 73 (mean age of 61.4) with nonspecific presenting symptoms of weight loss and back pain (37.5% for each).Tumor size (mean diameter of 14.6 cm in the range 4 to 35 cm), tumor extension, and the presence of distant metastases were of greater prognostic significance than tumor grade (7/8 were grade II, 1/8 was grade I). Surgical resection improved long-term prognosis; three of five patients undergoing resection are alive with no evidence of disease compared to zero of three treated nonsurgically. Due to location and vague presenting symptoms, this tumor continues to have a bleak prognosis and further evaluation and innovative treatment are required before a reasonable cure rate may be expected.

Fetch PMID: 8522250


Chirurg 1995 Sep;66(9):899-904
[Intraoperative radiotherapy within the treatment concept of retroperitoneal soft tissue sarcomas]. [in German]
Willeke F, Eble MJ, Lehnert T, Schwarzbach M, Hinz U, Wannenmacher M, Herfarth C. Chirurgische Universitatsklinik Heidelberg.

Sarcomas of the retroperitoneum are characterized by a high rate of local recurrence. External beam radiotherapy is known to improve local control after surgical therapy. To increase local dosage of radiotherapy without affection of sensitive structures we applied intraoperative radiotherapy (IORT) since 1991 in a dedicated operative unit. To compare morbidity and tumor control we used a partly historic control group of patients treated since 1988 for retroperitoneal soft tissue sarcoma. 25 patients with a mean age of 53 years were operated. Tumor histology was dominated by liposarcoma and leiomyosarcoma, UICC stage IIB (T2 G2 N0 M0) was present in 45% of cases. Distant metastasis were diagnosed in 19% at therapeutic intervention. Tumor free margins were achieved in 55% while 29% showed microscopic and 16% macroscopic tumor residues after surgical intervention. 11 patients received IORT with a mean of 18 Gy, eight of those patients were treated additionally with a mean of 40,4 Gy externally. There were no differences in distribution of known risk factors for recurrence in the group of patients treated with or without IORT. The analysis showed no difference for perioperative morbidity. Tolerance for IORT and additional external beam radiotherapy was good. Local tumor control tended to be improved by IORT (p = 0.082) while overall survival was not affected at a mean follow-up of 24 months.

Fetch PMID: 7587564


Int J Radiat Oncol Biol Phys 1994 Jul 30;29(5):1005-10
Outcome and prognosis in retroperitoneal soft tissue sarcoma.
Catton CN, O'Sullivan B, Kotwall C, Cummings B, Hao Y, Fornasier V. Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Canada.

,,, The records of 104 patients with retroperitoneal soft tissue sarcoma (RSTS) managed with surgery and irradiation at Princess Margaret Hospital between 1975 and 1988 were retrospectively reviewed. ,,, Presentation was new primary disease, 74; primary recurrence, 20; metastases, 10. Pathology was liposarcoma for 42, leiomyosarcoma for 22, ,,, Grade was low for 36, high for 35, and 33 were not graded. Median tumor size was 17 cm. Grossly complete surgical excision was achieved for 45 (43%), of whom 6 (6%) also had clear surgical margins. Adjuvant postoperative irradiation was administered to 36 patients to a median dose of 40 Gy/20 fractions/4 weeks and 16 received adjuvant chemotherapy. Nine patients received no adjuvant postoperative radiotherapy. Gross residual tumor was present postoperatively in 57 patients. The overall 5- and 10-year survival rates were 36% and 14%, respectively. The locoregional relapse free rate (RFR) was 28% at 5 years and 9% at 10 years, and the distant RFR was 76% at 5 years and 60% at 10 years. For the 45 patients treated with complete excision, survival was 55% and 22% at 5 and 10 years, and locoregional RFR was 50% and 18% at 5 and 10 years. Univariate analysis demonstrated that complete surgical removal was the only factor significant for improved survival, locoregional RFR, and distant RFR. ,,, leiomyosarcoma histology [predicted] for a lower distant RFR, compared to other histologies (p = 0.003). Patients under 62 years had an improved survival (p = 0.002) and local RFR (p = 0.02), and patients presenting with recurrent disease had improved survival (p = 0.03). Sex, tumor size, or grade, or the use of adjuvant chemotherapy were not predictive for any of the endpoints tested. Those who received adjuvant irradiation following gross surgical clearance experienced a prolonged median locoregional RFR over those who did not, and this approached statistical significance for those receiving radiation doses > 35 Gy. (103 months vs. 30 months, p = 0.06). Statistical significance was reached (p = 0.02) if only the infield RFR was considered. ,,, This study demonstrates that failure to achieve local control is the primary cause of treatment failure for patients with RSTS, and that postoperative irradiation in doses > 35 Gy after complete surgery delayed, but did not prevent local recurrence. Improvements in outcome for patients with RSTS will require alternate treatment strategies, and preoperative irradiation with an aggressive surgical attempt at complete excision is currently under investigation. Publication Types: Clinical trial

Fetch PMID: 8083069


Cancer 1994 Feb 1;73(3):637-42
Resectable retroperitoneal soft tissue sarcomas. The effect of extent of resection and postoperative radiation therapy on local tumor control.
van Doorn RC, Gallee MP, Hart AA, Gortzak E, Rutgers EJ, van Coevorden F, Keus RB, Zoetmulder FA. Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam.

,,, Soft tissue malignancies of the retroperitoneum are rare. Surgery is commonly considered the first choice of treatment. There is still no consensus concerning the precise value of the extent of surgery and the value of additional treatment modalities. ,,, From 1973 to 1990, 34 patients were initially treated by surgery for retroperitoneal soft tissue sarcomas at the Netherlands Cancer Institute. In a retrospective study, the prognostic effect of extent of primary surgery and postoperative radiation therapy was examined. ,,, Liposarcomas (47%) and leiomyosarcomas (29%) were the histologic types most commonly found. Grade of malignancy was defined as medium to high (II/III) in 44% and as low (I) in 38%. Complete (extended or marginal) resection of the tumor was achieved in 29 patients. After complete resection, the 5-year survival rate and the local recurrence rate were 35% and 63%, respectively. Extended surgery (performed in eight patients) showed a local recurrence rate of 50%. Thirteen patients received high-dose postoperative radiation therapy, which was found to have a significant favorable effect on the recurrence-free interval (P < 0.01). CONCLUSIONS. We conclude that complete (extended) resection followed by high-dose postoperative radiation therapy improves the prognostic outcome of patients with retroperitoneal soft tissue sarcomas. [NOTE: we don't have the figures broken down for lms vs. other sarcomas in terms of response to radiation. It might be worthwhile to try to get the complete article. Ed.] Publication Types: Clinical trial

Fetch PMID: 8299085


Zentralbl Chir 1994;119(7):488-94
[Results of surgical therapy of soft tissue sarcoma of the retroperitoneum]. [Article in German]
Nagel M, Ockert D, Stoelben E, Saeger HD. Chirurgische Universitatsklinik Mannheim.

Between 1.1.1973 and 30.6. 1993 57 patients underwent operation for soft-tissue sarcoma of the retroperitoneum. The histological classification showed in 21 cases a liposarcoma and in 14 cases a leiomyosarcoma. Other histological types like fibrosarcoma, malignant fibrous histiocytoma or malignant schwannoma were only rarely seen. Complete resection (R-0-resection) was possible in 39 cases (73.5%). 6 patients underwent partial resection (R-2-resection) and 8 patients had only an explorative laparotomy because of an unresectable tumor. To realize a complete resection in 23 cases a multivisceral resection was necessary. The postoperative staging according to AJCC showed for 47.7% of the patients a stage III- or stage IV- disease. The clinical follow-up was observed between 3 months and 14.3 years. The cumulative 5-year-survival-rate for all patients was 38.2%. The most important factor for prognosis was the complete resection, while other factors like sex and age of patients, size of the tumor and histological type did not predict outcome. After complete resection the cumulative 5-year-survival-rate was 46.7%, while after partial resection or explorative laparotomy no patient survived 5 years.

Fetch PMID: 7524249


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