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1.
Zhonghua Bing Li Xue Za Zhi ; 49(9): 910-915, 2020 Sep 08.
Artigo em Chinês | MEDLINE | ID: mdl-32892556

RESUMO

Objective: To investigate the clinicopathological characteristics, immunophenotypes, and diagnostic and differential diagnostic features of myxoid solitary fibrous tumor (SFT). Methods: Seven cases of myxoid SFT were collected from the archives of Zhejiang Provincial People's Hospital from January 2014 to December 2019. The clinical features, histomorphology, immunohistochemistry, molecular genetics and prognosis were analyzed and the relevant literature was reviewed. Results: There were three male and four female patients ranging from 32 to 67 years. Locations included the pleura (three cases), pelvic cavity, vagina, parotid gland, and nasal cavity(one each). Tumor size ranged from 2.7 to 13.5 cm. Histologically, all cases were characterized predominantly by the presence of myxoid stroma comprising 55% to 90% of the tumor (mean 72%). The tumors were composed of predominantly stellated, spindled or ovoid cells disposed haphazardly, in loose fascicles, or in anastomosing strands imparting a microcystic/reticular appearance in a extensively myxoid, richly vascularized stroma. Staghorn-shaped branching vessels and thin strands of collagen were commonly seen between tumors cells amidst the myxoid background. These myxoid areas were punctuated by small cellular areas showing diagnostic features of classical SFT, which were present in all seven cases. Areas showing giant cell angifibroma-like change were noted in 2 cases and focal lipomatous metaplasia was identified in 1 case. Atypical features suggestive of aggressive behavior were present in 2 cases and in one of the cases myxoid SFT with high-grade sarcomatous overgrowth was noted. Immunohistochemically, tumor cells in all cases stained positively for STAT6 and CD34. Polymerase chain reaction technique showed in both the examined cases the characteristic NAB2ex4-STAT6ex2 fusion gene. According to the Demicco's risk assessment model, four cases were classfied as low, one was classified as moderate and 2 was classified as high. Follow-up information was obtained in 4 cases. One tumor recurred 3 times within 48 months after operation, and the other 3 cases had no tumor recurrence and metastasis. Conclusions: Myxoid SFT represents a rare morphologic variant of SFT with biological behaviors ranging from indolent to aggressive. Myxoid SFT should be included in the differential diagnostic spectrums of soft tissue tumors with significantly myxoid change. Carefully searching for the typical SFT histomorphology with the use of immunohistochemistry and if necessary, molecularly testing for NAB2-STAT6 fusion can help to distinguish myxoid SFT from its many mimickers.


Assuntos
Sarcoma , Neoplasias de Tecidos Moles , Tumores Fibrosos Solitários , Biomarcadores Tumorais , Feminino , Humanos , Imuno-Histoquímica , Masculino , Prognóstico , Fator de Transcrição STAT6
2.
Surg Oncol ; 34: 182-185, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32891326

RESUMO

In the midst of the coronavirus disease 2019 (COVID-19) pandemic, governmental agencies, state medical boards, and healthcare organizations have called for restricting "elective" operations to mitigate the risk of transmission of the virus amongst patients and healthcare providers and to preserve essential resources for potential regional surges of COVID patients. While the fear of delaying surgical care for many of our patients is deeply challenging for us as cancer care providers, we must balance our personal commitment to providing timely and appropriate oncologic care to our cancer patients with our societal responsibility to protect our patients (including those on whom we are operating), co-workers, trainees, families, and community, from undue risks of contracting and propagating COVID-19. Herein, we present guidelines for surgical decision-making and case prioritization developed among all adult disease specialties in the MD Anderson Cancer Center Departments of Surgical Oncology and Breast Surgical Oncology in Houston, Texas.


Assuntos
Tomada de Decisão Clínica , Infecções por Coronavirus/epidemiologia , Neoplasias/cirurgia , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Betacoronavirus , Neoplasias da Mama/cirurgia , Neoplasias do Sistema Digestório/cirurgia , Neoplasias das Glândulas Endócrinas/cirurgia , Humanos , Melanoma/cirurgia , Tumores Neuroendócrinos/cirurgia , Pandemias , Equipe de Assistência ao Paciente , Neoplasias Peritoneais/cirurgia , Sarcoma/cirurgia , Oncologia Cirúrgica
3.
Rev Med Liege ; 75(7-8): 532-536, 2020 Jul.
Artigo em Francês | MEDLINE | ID: mdl-32779906

RESUMO

The superior vena cava (SVC) syndrome associates a series of signs and symptoms caused by an obstruction of the superior vena cava. The etiologies are multiple, but the most common cause is external compression of this vein by a tumor process. The present report concerns a young female with SVC syndrome. The etiology has been shown to be extra-skeletal Ewing's sarcoma extending from the right atrium to the left brachiocephalic trunk and right humeral vein. This diagnosis of tumor was delayed in the present clinical case and the patient developed serious iatrogenic complications during the early hospital management.


Assuntos
Doenças do Tecido Conjuntivo , Neoplasias do Mediastino , Sarcoma , Síndrome da Veia Cava Superior , Feminino , Humanos , Veia Cava Superior
4.
Bone Joint J ; 102-B(8): 1088-1094, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731827

RESUMO

AIMS: The existing clinical guidelines do not describe a clear indication for adjuvant radiotherapy (RT) in the treatment of superficial soft tissue sarcomas (STSs). We aimed to determine the efficacy of adjuvant RT for superficial STSs. METHODS: We retrospectively studied 304 patients with superficial STS of the limbs and trunk who underwent surgical resection at a tertiary sarcoma centre. The efficacy of RT was investigated according to the tumour size and grade: group 1, ≤ 5 cm, low grade; group 2, ≤ 5cm, high grade; group 3, > 5 cm, low grade; group 4, > 5 cm, high grade. RESULTS: The five- and ten-year local recurrence-free survival (LRFS) for all patients was 88% and 81%, respectively. While the efficacy of adjuvant RT was not proven in local control of all patients (five-year LRFS; RT+, 90% versus RT-, 83%; p = 0.074), the LRFS was significantly improved by adjuvant RT in group 2 (five-year LRFS; RT+, 96% versus RT-, 82%; p = 0.019), and group 4 (five-year LRFS; RT+, 87% versus RT-, 73%; p = 0.027). In groups 2 and 4, adjuvant RT significantly reduced the LR risk if the resection margin was clear but less than 5 mm; the LR rate was 7% with adjuvant RT compared with 26% with surgery alone (p = 0.003). There was no statistical relationship with the use of adjuvant RT and survival in every group. CONCLUSION: Adjuvant RT reduces the risk of local recurrence in patients with superficial high-grade STS regardless of tumour size, especially when resection margin is less than 5 mm. Cite this article: Bone Joint J 2020;102-B(8):1088-1094.


Assuntos
Recidiva Local de Neoplasia/epidemiologia , Sarcoma/radioterapia , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/radioterapia , Neoplasias de Tecidos Moles/cirurgia , Adulto , Institutos de Câncer , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Prognóstico , Radioterapia Adjuvante , Estudos Retrospectivos , Medição de Risco , Papel (figurativo) , Sarcoma/mortalidade , Sarcoma/patologia , Neoplasias de Tecidos Moles/mortalidade , Neoplasias de Tecidos Moles/patologia , Análise de Sobrevida , Adulto Jovem
5.
Zhonghua Bing Li Xue Za Zhi ; 49(8): 816-820, 2020 Aug 08.
Artigo em Chinês | MEDLINE | ID: mdl-32746549

RESUMO

Objective: To investigate the clinicopathological characteristics, genetic features, diagnosis and differential diagnosis of pulmonary artery intimal sarcoma (PAIS). Methods: Three cases of PAIS were collected from Jiangsu Province People's Hospital (from February 2016 to November 2019). The clinical data, imaging examination, morphology, immunostaining, and molecular changes were retrospectively analyzed. Results: There were 1 male and 2 females (age: 32, 50, 60 years), who had symptoms of cough, asthma or chest tightness. Imaging findings indicated low density filling defects which were suspected as thrombus, embolism or myxoma. Grossly, the main tumor was located in the elastic arteries and their lobar branches, also extended into the atrium and ventricle, with lung parenchymal infiltration focally. Microscopically, tumor cells were predominantly composed of abundant spindle cells with obvious atypia and myxoid background, resembling fibroblastic or myofibroblastic differentiation. Active mitotic figures and necrosis could be seen in some areas. Immunohistochemical staining of vimentin was strongly positive, while pan-cytokeratin, S-100, desmin, Fli-1, CD31, SMA and ERG etc were variably positive only in focal areas. FISH detection showed amplification of MDM2 gene in three cases and EGFR gene in two cases. Metastatic lesions were found in one case by 18, 32 and 42 months after surgery respectively. There was no recurrence or metastasis in the other two cases. Conclusions: PAIS is one of exceptionally poor differentiated mesenchymal tumor that arises from the arterial intima of elastic pulmonary arteries. There was no definite differention in morphology. Gene detection shows amplification of MDM2 and EGFR gene. This tumor often has poor prognosis with aggressive behavior. Complete resection is the only effective therapeutic option. There is disagreement as to whether chemotherapy and radiotherapy can improve survival.


Assuntos
Artéria Pulmonar , Sarcoma , Neoplasias Vasculares/patologia , Adulto , Feminino , Humanos , Hibridização in Situ Fluorescente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sarcoma/patologia , Vimentina
6.
PLoS One ; 15(7): e0236097, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32673360

RESUMO

Soft tissue sarcomas (STS) is a set of rare malignant tumor originated from mesoderm. For the prognosis of sarcoma, early diagnosis is important, however, currently no mature and non-invasive method for diagnosis exists. MicroRNAs (miRNAs) are a class of noncoding RNAs and their expression varies greatly, especially during tumor activity. The purpose of this study was to construct a predictive model for the diagnosis of sarcomas based on the relative expression level of miRNA in serum. miRNA array expression data of 677 samples including 402 malignant sarcoma samples and 275 healthy samples was used to construct the prediction model. Based on 6 gene pairs, random generalized linear model (RGLM) was constructed, with an accuracy of 100% in the internal test dataset and of 74.3% in the merged external dataset in prediction whether a serum sample was obtained from a sarcoma patient, with a specificity of 100% in the internal test dataset and 90.5% in the external dataset. In conclusion, our serum miRNA-pair classifier has the potential to be used for the screening of sarcoma with high accuracy and specificity.


Assuntos
Biologia Computacional , MicroRNAs/sangue , MicroRNAs/genética , Sarcoma/sangue , Sarcoma/diagnóstico , Adulto , Feminino , Perfilação da Expressão Gênica , Redes Reguladoras de Genes , Humanos , Masculino , Programas de Rastreamento , Sarcoma/genética
7.
Rev Med Chil ; 148(3): 327-335, 2020 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-32730377

RESUMO

BACKGROUND: Primary cardiac tumors have a low incidence, and their presentation form and clinical course are not well known. AIM: To describe the characteristics, treatment, follow up and survival of patients with primary cardiac tumors (PCT). MATERIAL AND METHODS: Review of all surgical procedures for PCT performed between 1984 and 2019 in a regional general hospital. The information was obtained from surgical protocols, surgical and pathology databases, medical records and registries of the Chilean National Identification Service. The clinical features of patients, immediate and long term outcomes are described. RESULTS: Seventy-two surgical procedures for PCT were reviewed. Patients' age was 55 ± 15 years and 60% were women. The most common histological types were myxoma in 49 patients (68%), papillary fibroelastoma in 13 (18%) and sarcoma in 6 (8.3%). Forty-nine (68.1%) were symptomatic and all tumors were found on echocardiography. Fifty-one (71%) were in the left atrium, 10 (14%) in the aortic valve and eight (11%) in the right atrium. The surgical procedures were tumor resection in 48 patients (67%) and resection and repair with patch in 23 (32%). Mean postoperative stay was 6.6 ± 4.4 days, eight patients (11%) had complications and no patient died in the immediate postoperative period. Long term survival was higher in patients with benign PCT as compared with those with malignant tumors. CONCLUSIONS: Most PCTs in this group of patients were benign neoplasms and the most common tumors were myxomas. The main diagnostic method is echocardiography and the prognosis of surgical treatment is excellent when the tumors are benign. (Rev Med Chile 2020; 148: 327-335).


Assuntos
Neoplasias Cardíacas , Chile , Feminino , Humanos , Masculino , Mixoma , Estudos Retrospectivos , Sarcoma
10.
Gan To Kagaku Ryoho ; 47(7): 1012-1015, 2020 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-32668841

RESUMO

Although the incidence of each rare cancer is low, the estimated annual incidence rate of all rare cancers added together reportedly corresponded to 22% of all cancer diagnoses in Europe. To cope with most rare cancers, each physician is burdened with literature search and consultation through private relationships to find how the patients should be diagnosed and treated. Treatment guidelines will be of huge assistance in such situations, and should preferably be compiled for selected rare cancers for which information is more often sought after. The author established a research team funded by the Ministry of Health, Labor and Welfare, Japan, under the title of "Improvement of quality in medical support system for rare cancer through compilation of guidelines". This research team is a joint force of several experts from various fields of oncology, and guidelines on rare cancer of various categories, such as brain tumors, retroperitoneal sarcomas, penile cancer and duodenal cancer are currently on the way to publication. This manuscript describes the footsteps of the members of this research team who concentrates on a project to compile guidelines for the diagnosis and treatment of duodenal cancer, which is expected to go to print by the end of 2020.


Assuntos
Neoplasias Duodenais , Neoplasias Duodenais/terapia , Humanos , Incidência , Guias de Prática Clínica como Assunto , Sarcoma
11.
Gan To Kagaku Ryoho ; 47(7): 1016-1019, 2020 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-32668842

RESUMO

Challenges in the treatment of sarcoma as a rare cancer include(1)inexperience of sarcoma physicians due to the small number of patients,(2)insufficient information due to the lack of evidence,(3)lack of opportunities to provide information to non-specialists and to educate young physicians,(4)low adherence to standard treatments presented in clinical practice guidelines,(5)insufficient number of researchers engaged in basic research on rare cancers and their research funds, and(6) low number of clinical trials for the development of orphan drugs. This paper describes the current status and future prospects for the centralization and networking of sarcoma treatment, problems in pathological diagnosis, clinical evidence creation, information provision and human resource development, and information dissemination and consultation support to sarcoma patients.


Assuntos
Sarcoma , Antineoplásicos/uso terapêutico , Ensaios Clínicos como Assunto , Humanos , Médicos , Encaminhamento e Consulta , Sarcoma/tratamento farmacológico , Neoplasias de Tecidos Moles
12.
Gan To Kagaku Ryoho ; 47(7): 1093-1095, 2020 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-32668859

RESUMO

A 83-year-old female presented with a painful, palpable mass of the breast, which had been growing rapidly for the past few months. The physical examination revealed a 5×5 cm, elastic, hard, mobile mass with a smooth surface in the right breast. Ultrasound confirmed a 6×4 cm hypoechoic mass with regular borders in the inferior lateral quadrant of the right breast, which required core-needle biopsy to establish diagnosis. The histopathological result reported stromal neoplasm, suggestive of sarcoma or phyllodes tumor. CT scans of the chest and abdomen were negative for metastases. She underwent simple mastectomy and axillary node sampling. The postoperative course was uneventful, and she hoped no adjuvant therapies to be recommended. She is currently receiving outpatient follow-up care. Breast stromal sarcomas are rare and malignant tumors, hence, treatment protocols are not well-established. Early diagnosis of primary stromal sarcomas is essential, as they tend to spread very rapidly and are known to have poor prognosis.


Assuntos
Neoplasias da Mama , Sarcoma , Idoso de 80 Anos ou mais , Biópsia com Agulha de Grande Calibre , Feminino , Humanos , Mastectomia
13.
Lancet Oncol ; 21(8): 1110-1122, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32702309

RESUMO

BACKGROUND: Outcomes for children and adults with advanced soft tissue sarcoma are poor with traditional therapy. We investigated whether the addition of pazopanib to preoperative chemoradiotherapy would improve pathological near complete response rate compared with chemoradiotherapy alone. METHODS: In this joint Children's Oncology Group and NRG Oncology multicentre, randomised, open-label, phase 2 trial, we enrolled eligible adults (aged ≥18 years) and children (aged between 2 and <18 years) from 57 hospitals in the USA and Canada with unresected, newly diagnosed trunk or extremity chemotherapy-sensitive soft tissue sarcoma, which were larger than 5 cm in diameter and of intermediate or high grade. Eligible patients had Lansky (if aged ≤16 years) or Karnofsky (if aged >16 years) performance status score of at least 70. Patients received ifosfamide (2·5 g/m2 per dose intravenously on days 1-3 with mesna) and doxorubicin (37·5 mg/m2 per dose intravenously on days 1-2) with 45 Gy preoperative radiotherapy, followed by surgical resection at week 13. Patients were randomly assigned (1:1) using a web-based system, in an unmasked manner, to receive oral pazopanib (if patients <18 years 350 mg/m2 once daily; if patients ≥18 years 600 mg once daily) or not (control group), with pazopanib not given immediately before or after surgery at week 13. The study projected 100 randomly assigned patients were needed to show an improvement in the number of participants with a 90% or higher pathological response at week 13 from 40% to 60%. Analysis was done per protocol. This study has completed accrual and is registered with ClinicalTrials.gov, NCT02180867. FINDINGS: Between July 7, 2014, and Oct 1, 2018, 81 eligible patients were enrolled and randomly assigned to the pazopanib group (n=42) or the control group (n=39). At the planned second interim analysis with 42 evaluable patients and a median follow-up of 0·8 years (IQR 0·3-1·6) in the pazopanib group and 1 year (0·3-1·6) in the control group, the number of patients with a 90% pathological response or higher was 14 (58%) of 24 patients in the pazopanib group and four (22%) of 18 patients in the control group, with a between-group difference in the number of 90% or higher pathological response of 36·1% (83·8% CI 16·5-55·8). On the basis of an interim analysis significance level of 0·081 (overall one-sided significance level of 0·20, power of 0·80, and O'Brien-Fleming-type cumulative error spending function), the 83·8% CI for response difference was between 16·5% and 55·8% and thus excluded 0. The improvement in pathological response rate with the addition of pazopanib crossed the predetermined boundary and enrolment was stopped. The most common grade 3-4 adverse events were leukopenia (16 [43%] of 37 patients), neutropenia (15 [41%]), and febrile neutropenia (15 [41%]) in the pazopanib group, and neutropenia (three [9%] of 35 patients) and febrile neutropenia (three [9%]) in the control group. 22 (59%) of 37 patients in the pazopanib group had a pazopanib-related serious adverse event. Paediatric and adult patients had a similar number of grade 3 and 4 toxicity. There were seven deaths (three in the pazopanib group and four in the control group), none of which were treatment related. INTERPRETATION: In this presumed first prospective trial of soft tissue sarcoma spanning nearly the entire age spectrum, adding pazopanib to neoadjuvant chemoradiotherapy improved the rate of pathological near complete response, suggesting that this is a highly active and feasible combination in children and adults with advanced soft tissue sarcoma. The comparison of survival outcomes requires longer follow-up. FUNDING: National Institutes of Health, St Baldrick's Foundation, Seattle Children's Foundation.


Assuntos
Antineoplásicos/administração & dosagem , Quimiorradioterapia/métodos , Terapia Neoadjuvante/métodos , Pirimidinas/administração & dosagem , Sarcoma/tratamento farmacológico , Neoplasias de Tecidos Moles/tratamento farmacológico , Sulfonamidas/administração & dosagem , Adolescente , Adulto , Antineoplásicos/efeitos adversos , Quimiorradioterapia/efeitos adversos , Quimioterapia Adjuvante/efeitos adversos , Quimioterapia Adjuvante/métodos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Pirimidinas/efeitos adversos , Radioterapia Adjuvante , Sarcoma/radioterapia , Neoplasias de Tecidos Moles/radioterapia , Sulfonamidas/efeitos adversos , Adulto Jovem
14.
Medicine (Baltimore) ; 99(27): e20715, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629645

RESUMO

To understand the feasibility, clinical effect, and complications related to biological reconstruction techniques for long limb malignant bone tumors after excision.This retrospective study included eighty patients with malignant bone tumors treated at our hospital between January 2007 and January 2019. After tumor resection, 52 cases of intercalary and 28 cases of osteoarticular bone grafts were used. The implanted bone included devitalized recycling bone, fibular, and allograft.The average follow up period was 42.19 months for 80 patients, among whom 15 (18.75%) died. The 5-year EFS and OS were 58% and 69%, respectively. The average length of the replanted bone was 18.57 cm. The MSTS scores of intercalary and osteoarticular bone grafts were 87.24% and 64.00%, respectively. In 23 cases (44.23%) of metaphyseal and 26 cases (32.5%) of the diaphysis, bone graft union was obtained at the first stage. The factors affecting bone union were the patient's gender, age, devitalization bone methods and whether the implanted bone was completely fixed. Postoperative complications included delayed bone union in 15 patients, fractures in 25 cases, nonunion in 22 cases, bone resorption in 14 cases, and postoperative infection in 4 cases. Twenty-eight cases of bone grafting required revision surgery, including replacement of internal fixation, autologous bone graft, debridement, removal of internal fixation, and replacement with prosthetic replacement.Biological reconstructions with massive bone grafts are useful in the reconstruction of certain malignant extremity bone tumors after wide excision.


Assuntos
Neoplasias Ósseas/cirurgia , Transplante Ósseo/métodos , Neoplasias Femorais/cirurgia , Úmero/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Sarcoma/cirurgia , Tíbia/cirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
16.
Medicine (Baltimore) ; 99(29): e21118, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702862

RESUMO

INTRODUCTION: Lipomas are rarely found in primary mesenchymal tumors of the hypopharynx and larynx. When they do appear, they often macroscopically resemble a retention cyst or laryngeal nodule. The laryngeal spindle cell lipoma, a variant, is extremely rare. PATIENT CONCERNS: A 65-year-old woman presented with a 3-month history of pharyngeal paraesthesia. Laryngoscopy revealed the presence of a well-encapsulated, smooth-surfaced, yellowish, pedicled mass on the left epiglottis. Magnetic resonance imaging confirmed the epiglottic mass. DIAGNOSIS: Following excision of the mass, the diagnosis of an spindle cell lipoma was established and confirmed by immunohistochemistry. INTERVENTIONS: Surgical excision of the lesion using a controlled-temperature plasma technique (coblation). OUTCOMES: At the last (4-year) follow-up evaluation, the patient was asymptomatic and without recurrence. CONCLUSION: SLC involvement of the epiglottis is rare. Coblation is an effective means to remove it.


Assuntos
Sarcoma/diagnóstico , Idoso , Feminino , Humanos , Laringoscopia/métodos , Laringe/patologia , Imagem por Ressonância Magnética/métodos , Faringe/anormalidades , Faringe/fisiopatologia , Sarcoma/patologia , Sarcoma/cirurgia
17.
JCO Glob Oncol ; 6: 1046-1051, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32639877

RESUMO

PURPOSE: Many patients with cancer, often those with rare cancers such as sarcomas, travel long distances to access expert care. The COVID-19 pandemic necessitated widespread changes in delivery of cancer care, including rapid adoption of telemedicine-based care. We aimed to evaluate the impact of telemedicine on patients, clinicians, and care delivery at the Royal Marsden Hospital (RMH) Sarcoma Unit during the pandemic. METHODS: Data were extracted from patient records for all planned outpatient appointments at the RMH Sarcoma Unit from March 23 to April 24, 2020. Patients and clinicians completed separate questionnaires to understand their experiences. RESULTS: Of 379 planned face-to-face appointments, 283 (75%) were converted to telemedicine. Face-to-face appointments remained for patients who needed urgent start of therapy or performance status assessment. Patients lived on average > 1.5 hours from RMH. Patient satisfaction (n = 108) with telemedicine was high (mean, 9/10), and only 48% (n = 52/108) would not want to hear bad news using telemedicine. Clinicians found telemedicine efficient, with no associated increased workload, compared with face-to-face appointments. Clinicians indicated lack of physical examination did not often affect care provision when using telemedicine. Most clinicians (n = 17; 94%) believed telemedicine use was practice changing; congruently, 80% (n = 86/108) of patients desired some telemedicine as part of their future care, citing reduced cost and travel time. CONCLUSION: Telemedicine can revolutionize delivery of cancer care, particularly for patients with rare cancers who often live far away from expert centers. Our study demonstrates important patient and clinician benefits; assessment of longer-term impact on patient outcomes and health care systems is needed.


Assuntos
Assistência Ambulatorial/métodos , Infecções por Coronavirus/epidemiologia , Oncologia/métodos , Pandemias , Satisfação do Paciente , Pneumonia Viral/epidemiologia , Sarcoma/terapia , Telemedicina/métodos , Carga de Trabalho , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Assistência à Saúde/métodos , Feminino , Neoplasias Gastrointestinais/terapia , Tumores do Estroma Gastrointestinal/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias de Tecidos Moles/terapia , Viagem , Reino Unido/epidemiologia , Adulto Jovem
18.
Medicine (Baltimore) ; 99(27): e20880, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629676

RESUMO

To determine the value of 3T magnetic resonance imaging (MRI) texture analysis in differentiating high- from low-grade soft-tissue sarcoma.Forty-two patients with soft-tissue sarcomas who underwent 3T MRI were analyzed. Qualitative and texture analysis were performed on T1-, T2- and fat-suppressed contrast-enhanced (CE) T1-weighted images. Various features of qualitative and texture analysis were compared between high- and low-grade sarcoma. Areas under the receiver operating characteristic curves (AUC) were calculated for texture features. Multivariate logistic regression analysis was used to analyze the value of qualitative and texture analysis.There were 11 low- and 31 high-grade sarcomas. Among qualitative features, signal intensity on T1-weighted images, tumor margin on T2-weighted images, tumor margin on fat-suppressed CE T1-weighted images and peritumoral enhancement were significantly different between high- and low-grade sarcomas. Among texture features, T2 mean, T1 SD, CE T1 skewness, CE T1 mean, CE T1 difference variance and CE T1 contrast were significantly different between high- and low-grade sarcomas. The AUCs of the above texture features were > 0.7: T2 mean, .710 (95% confidence interval [CI] .543-.876); CE T1 mean, .768 (.590-.947); T1 SD, .730 (.554-.906); CE T1 skewness, .751 (.586-.916); CE T1 difference variance, .721 (.536-.907); and CE T1 contrast, .727 (.530-.924). The multivariate logistic regression model of both qualitative and texture features had numerically higher AUC than those of only qualitative or texture features.Texture analysis at 3T MRI may provide additional diagnostic value to the qualitative MRI imaging features for the differentiation of high- and low-grade sarcomas.


Assuntos
Imagem por Ressonância Magnética/métodos , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Reconhecimento Automatizado de Padrão , Adulto Jovem
19.
Cancer Treat Rev ; 88: 102058, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32619864

RESUMO

Soft tissue sarcomas constitute 1% of adult malignant tumors. They are a heterogeneous group of more than 50 different histologic types. Isolated limb perfusion is an established treatment strategy for locally advanced sarcomas. Since its adoption for sarcomas in 1992, after the addition of TNFα, few modifications have been done and although indications for the procedure are essentially the same across centers, technical details vary widely. The procedures mainly involves a 60 min perfusion with melphalan and TNFα under mild hyperthermia, achieving a limb preservation rate of 72-96%; with an overall response rates from 72 to 82.5% and an acceptable toxicity according to the Wieberdink scale. The local failure rate is 27% after a median follow up of 14-31 months compared to 40% of distant recurrences after a follow up of 12-22 months. Currently there is no consensus regarding the benefit of ILP per histotype, and the value of addition of radiotherapy or systemic treatment. Further developments towards individualized treatments will provide a better understanding of the population that can derive maximum benefit of ILP with the least morbidity.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Quimioterapia do Câncer por Perfusão Regional/métodos , Sarcoma/tratamento farmacológico , Neoplasias de Tecidos Moles/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Quimioterapia do Câncer por Perfusão Regional/efeitos adversos , Quimioterapia do Câncer por Perfusão Regional/tendências , Ensaios Clínicos Fase II como Assunto , Extremidades/irrigação sanguínea , Extremidades/patologia , Humanos , Hipertermia Induzida/métodos , Melfalan/administração & dosagem , Melfalan/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Sarcoma/patologia , Neoplasias de Tecidos Moles/patologia , Fator de Necrose Tumoral alfa/administração & dosagem , Fator de Necrose Tumoral alfa/efeitos adversos
20.
Asian Cardiovasc Thorac Ann ; 28(5): 282-285, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32483975

RESUMO

Primary pulmonary intimal sarcoma is rare. Differentiating it from pulmonary thromboembolism is difficult because of similarities in clinical symptoms and imaging findings. Positron-emission tomography-computed tomography has been useful for diagnosing primary pulmonary intimal sarcoma. We describe a rare case of primary pulmonary intimal sarcoma that showed no abnormal 18F-fluorodeoxyglucose uptake on positron-emission tomography. We resected the mass and performed right ventricular outflow tract reconstruction. Proper diagnosis is necessary to determine appropriate therapy, Clinicians must consider the possibility of primary pulmonary intimal sarcoma even if imaging findings are inconsistent with the disease.


Assuntos
Fluordesoxiglucose F18/administração & dosagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Artéria Pulmonar/diagnóstico por imagem , Compostos Radiofarmacêuticos/administração & dosagem , Sarcoma/diagnóstico por imagem , Túnica Íntima/diagnóstico por imagem , Neoplasias Vasculares/diagnóstico por imagem , Idoso , Feminino , Humanos , Valor Preditivo dos Testes , Artéria Pulmonar/patologia , Artéria Pulmonar/cirurgia , Sarcoma/patologia , Sarcoma/cirurgia , Resultado do Tratamento , Túnica Íntima/patologia , Túnica Íntima/cirurgia , Neoplasias Vasculares/patologia , Neoplasias Vasculares/cirurgia
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