Histologic Appearance After Preoperative Radiation Therapy for Soft Tissue Sarcoma: Assessment of the European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group Response Score.

PURPOSE: To critically assess the prognostic value of the European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group (EORTC-STBSG) response score and define histologic appearance after preoperative radiation therapy (RT) for soft tissue sarcoma (STS). METHODS AND MATERIALS: For a cohort of 100 patients with STS of the extremity/trunk treated at our institution with preoperative RT followed by resection, 2 expert sarcoma pathologists evaluated the resected specimens for percent residual viable cells, necrosis, hyalinization/fibrosis, and infarction. The EORTC response score and other predictors of recurrence-free survival (RFS) and overall survival (OS) were assessed by Kaplan-Meier and proportional hazard models. RESULTS: Median tumor size was 7.5 cm; 92% were intermediate or high grade. Most common histologies were unclassified sarcoma (34%) and myxofibrosarcoma (25%). Median follow-up was 60 months. The 5-year local recurrence rate was 5%, 5-year RFS was 68%, and 5-year OS was 75%. Distribution of cases according to EORTC response score tiers was as follows: no residual viable tumor for 9 cases (9% pathologic complete response); <1% viable tumor for 0, ≥1% to <10% for 9, ≥10% to <50% for 44, and ≥50% for 38. There was no association between EORTC-STBSG response score and RFS or OS. Conversely, hyalinization/fibrosis was a significant independent favorable predictor for RFS (hazard ratio 0.49, P=.007) and OS (hazard ratio 0.36, P=.02). CONCLUSION: Histologic evaluation after preoperative RT for STS showed a 9% pathologic complete response rate. The EORTC-STBSG response score and percent viable cells were not prognostic. Hyalinization/fibrosis was associated with favorable outcome, and if validated, may become a valid endpoint for neoadjuvant trials.

Racial Disparities in Extremity Soft-Tissue Sarcoma Outcomes: A Nationwide Analysis.

BACKGROUND: Racial disparities in access and survival have been reported in a variety of cancers. These issues, however, have yet to be explored in detail in patients with soft-tissue sarcomas (STS). The purpose of this paper was to investigate the independent role of race with respect to survival outcomes in STS. METHODS: A total of 7601 patients were evaluated in this study. A SEER registry query for patients over 20 years old with extremity STS diagnosed between 2004 and 2009 (n=7225) was performed. Survival outcomes were analyzed after patients were stratified by race. Multivariable survival models were used to identify independent predictors of sarcoma-specific death. The Wilcoxon rank-sum test was used to compare continuous variables. Statistical significance was maintained at P<0.05. RESULTS: This study showed that African American patients were more likely to die of their STS. They were younger at presentation (P=0.001), had larger tumors (P<0.001), had less surgery (P=0.002), received radiotherapy less frequently (P=0.024), had higher family income (P<0.001), and were less likely to be married (P<0.001). African American race by itself was not an independent predictor of death. CONCLUSIONS: African Americans encounter death due to STS at a much larger proportion and faster rate than their respective white counterparts. African Americans frequently present with a larger size tumor, do not undergo surgical resection, or receive radiation therapy as frequently as compared with their white peers. Barriers to timely and appropriate care should be further investigated in this group of at-risk patients.

Clinicopathological assessment of T1 soft tissue sarcomas.

INTRODUCTION: Many studies have identified factors prognostic for soft tissue sarcomas of local recurrence, and distant metastasis. Several studies demonstrated that some subsets of patients could be safely treated by surgery alone, with acceptable rates of local recurrence. The aim of this study was to better clarify the necessity for adjuvant therapy and the width of the resected margin, by investigating the clinicopathological results of T1 (≤5 cm) soft tissue sarcomas. PATIENTS AND METHODS: A retrospective review was conducted in 96 adult patients treated for nonmetastatic AJCC T1 primary non-small round cell soft tissue sarcomas in our institution from 1995 to 2008. There were 49 men and 47 women ranging in age from 18 to 85 years (mean 51), and the observation period was 6-159 months (mean 52). The site of origin was the upper extremity in 21 cases, the lower extremity in 45, and the trunk in 30. Forty-four cases had high-grade malignant tumors, and 52 had low-grade malignant ones. Tumor size ranged from 0.7 to 5.0 cm (median size, 3.5 cm). Thirty-nine cases (41%) had previously undergone unplanned excision elsewhere. RESULTS: Eighty-nine (93%) of the patients were continuously free of disease, four were alive and currently free of disease, one was alive with metastasis, and two had died. The event-free survival rate at 5 years was 93.3%. The overall survival rate at 5 years was 94.1%. In 23 of the 45 cases with unplanned excisions (51%) residual tumor was found on histological examination. After definitive surgery, 92 patients (96%) had R0 margins. Four patients (4%) had R1 margins and were treated with postoperative radiotherapy. Forty-five of 51 cases after planned biopsies (88%) showed infiltrative growth microscopically. CONCLUSION: Tumor size was found to have a major impact on the prognosis of soft tissue sarcomas, emphasizing the importance of early detection and early treatment of these tumors. Most patients suffering from T1 soft tissue sarcomas might be able to avoid adjuvant therapies including radiotherapy and chemotherapy. To achieve good local control with surgery alone, an adequate surgical margin must be achieved even for small lesions.

Retroperitoneal sarcomas: pre-operative assessment and surgical therapy.

The clinical and pathological records of 22 patients treated for retroperitoneal sarcomas were retrospectively studied. The initial symptoms were pain and swelling of the abdomen in 11 patients. All tumours had a diameter of more than 10 cm. The pathological diagnosis was in 16 cases liposarcoma or leiomyosarcoma. Fourteen tumours were graded as high and eight as low. Sixteen of the 22 operated patients had complete resection of the tumour. Eleven patients had recurrence after five to 42 months, nine of them local recurrence and two distant metastases. Eleven patients needed repeated radical or palliative resections. Additional therapy (pre- or post-operative radiation or chemotherapy) was given to 11 patients. Radical resection of primary and recurrent tumours seems to give the best results in patients with retroperitoneal sarcomas but debulking of the tumour improves the quality of life in selected patients.