Local control and survival in soft tissue sarcomas of the limbs, trunk walls and head and neck: a study of 113 cases.

One hundred thirteen patients with soft tissue sarcomas of the limbs, trunk walls, and head and neck have been treated at the Centre François Baclesse since 1972. Of these, 89 histologically confirmed patients were treated with a multimodality treatment protocol. Treatment policy was designed to use each treatment method as efficiently, economically and conservatively as possible: preoperative irradiation at moderate dose to a large volume (6.5 Gy, 2 sessions, 48 hr interval); surgery 48 hr after the last preoperative irradiation; surgical excision was guided and verified intra operatively by the pathologist (with frozen sections); postoperative irradiation aimed at sterilizing all residual isolated and radiosensitive tumor cells, possibly scattered throughout the anatomical region. The total dose is brought to the equivalent of 50 Gy (preoperative dose included). This dose was increased to 60 or even 70 Gy to a restricted volume, when limb conservation was sought, but tumor foci too large for total resection without amputation; actinomycin was added to the first five postoperative irradiations. The results at 5 years were as follows: local recurrence rate, 13.6%; metastatic rate, 28%; survival rate, overall (113 patients,) 65.6%, curative series (89 patients), 75%. When the surgical excision of the primary tumor was histologically complete (54 patients) the local recurrence rate was 1.9%, the metastatic rate 11.6%, and the survival rate 89.6% at 5 years.

Radiation therapy of skin carcinomas: results of a hypofractionated irradiation schedule in 675 cases followed more than 2 years.

Six hundred and seventy-five cases of cutaneous epidermoid carcinomas of the face (excluding the lips, ears and eyelids) were treated with superficial irradiation therapy according to an original dose and time schedule (3 fractions of 1020 R over 14 days), with correction for RBE. The reference dose was always set at the deepest portion of the tumor (100% isodose including the lesion) and surface dose was limited to 125% of the depth dose. The energy used varied according to the thickness of the tumor, and the size of the irradiation fields according to the diameter of the tumor. All other parameters remained constant. The results after a minimum follow-up of 2 years show that the failure rate was low (less than 4%) and could be corrected in 85% of cases. Ninety per cent of recurrences appeared within 3 years; they were central and most frequently observed in nasal locations and basal cell carcinomas. Complications were rare (fewer than 3% of cases), and the majority were cured by medical treatment. Cosmetic results were satisfactory in over 90% of cases. The method used for expression of the dose permits a clear and coherent interpretation of the results: complications and sequelae were closely correlated with the irradiated surface and volume. The hypofractionated irradiation protocol described in this paper offers a simple, ambulatory method for the treatment of cutaneous epidermoid carcinomas of the face which have a particularly high incidence among the elderly. The majority of patients can be treated in this way.(ABSTRACT TRUNCATED AT 250 WORDS)

Radiotherapy as an integrated part of the treatment of soft tissue sarcomas.

A considerable improvement in the prognosis of soft tissue sarcomas in the adult has been obtained with a treatment schedule combining surgery and routine radiation therapy (possibly preoperative and certainly postoperative); local recurrences, the predominant element in the natural history of the disease, have become very rare and limb function is generally maintained. Metastatic risk presents the major problem, and in our series spread of the disease remained uncontrolled in 25% of cases. Further research is required in this area, and a better definition of the risk factors, especially with regard to histology, is needed. We suggest that the possibility of reinforcing treatment of those histological forms at high metastatic risk by the introduction of multidrug therapy after local treatment be investigated. Such studies can only be effectively conducted within the framework of a multicenter collaborative controlled clinical trial.

[Multidisciplinary treatment of soft tissue sarcomas: an improvement in prognosis (author's transl)]. / Sarcomes des tissus mous: progrès thérapeutiques par l'application d'un protocole pluridisciplinaire.

The results obtained in the treatment of 45 cases of soft tissue sarcomas are presented. All cases were reviewed and classified according to the modern criteria of malignancy. The treatment schedule comprised: (1) preoperative irradiation: 2 sessions of 6.50 Gy in 48 hours, target volume: whole limb segment; (2) surgical excision 48 hours later with systematic intraoperative histologic verification, until healthy tissue margins are obtained; (3) postoperative irradiation: 3 weeks later delivering a cumulative total dose of 50.00 Gy to the preoperative volume and 60.00 - 70.00 Gy to a reduced volume encompassing the surgical region with protection of vascular axes where possible; (4) chemotherapy: Actinomycin D 0.3 mg/m2 half and hour before the first 5 sessions of postoperative irradiation; (5) bilateral lung irradiation: 4 sessions of 3.75 Gy in 7 days to the whole chest. The results were as follows: local recurrence rate was 9.5 per cent at 5 years. In 21 cases in whom surgical excision was deemed histologically adequate, no recurrences was seen at 3 years (minimum follow-up). Survival at 5 years was 77 per cent. Deaths were due to metastatic spread, especially to the lungs. These results show an improvement as compared with historical series. New progress should be sought in combining a more aggressive type of chemotherapy for cases with high metastatic risk.

[Basocellular epitheliomas of the eyelids]. / Les épithéliomas baso-cellulaires palpébraux.

On the basis of a retrospective study of 354 basal-cell epitheliomas of the eyelids, we present a study of the most frequently used treatments: surgery, conventional radiation therapy and curietherapy. The results of treatment, both functional and oncological, are generally satisfactory, whatever the method chosen, but with a set of arguments in favor of surgery. The major therapeutic indications are discussed, without formally ruling out any treatment.

[A systematic radio-surgical combination in the treatment of sarcoma of soft tissues in adults. Results in 106 cases at the Centre François Baclesse]. / Association radio-chirurgicale systématique dans le traitement des sarcomes des tissus mous de l'adulte. Résultats dans 106 cas au Centre François Baclesse.

Based on a series of 143 cases of soft tissue sarcomas, including 106 cases treated curatively, the author stresses the importance of surgical resection with frozen section histological control, systematically combined with radiotherapy. Even when resection is complete, the frequency of loco-regional recurrences in all published series shows that neoplastic cells were already present around the resection site. Consequently, since 1972 at the Centre François Baclesse, whenever possible, surgery is preceded by concentrated regional irradiation (2 sessions of 6.50 Gy at 48 hour's interval) and postoperative complementary radiotherapy is always performed regardless of the quality of the resection 3 weeks after the preoperative irradiation. The dose is limited to a total of 50 Gy when the resection is complete and is increased to 60 to 70 Gy in the zones of doubtful or incomplete resection. This postoperative radiotherapy is associated with 5 injections of actinomycin D during the first sessions, but no adjuvant chemotherapy such as cyvadic is administered routinely. Under the conditions of treatment, the 5-year results obtained in 106 cases were as follows: local recurrences: 12.4%, metastases: 26%, survival rate: 76%. When the surgical resection was complete (62 cases), the 5-year local recurrence rate was 1.5% with 9% metastases and 92% survival. Metastases were related to factors of high malignancy which are beginning to be more clearly defined. These forms may benefit from intensive combination chemotherapy.

The pathologist's role in a multidisciplinary approach for soft part tissue sarcoma: a reappraisal (39 cases).

A combined treatment modality of radiotherapy, surgery, and monochemotherapy in 39 cases of soft tissue sarcomas is presented. The 39 patients presented initially with local disease only, without evidence of metastases. At the end of the surgical procedure the adequacy of the excision had been evaluated by the pathologist. Surgical procedure was complemented by systematic radiation therapy. The overall recurrence rate was 7.7%; the overall incidence of metastases 31%. In the group in which adequate excision had been obtained, no loco-regional recurrences were obtained, survival was significantly better, and the incidence of metastases was lower than in group in whom adequate excision could not be obtained. The importance of two criteria was stress: the depth and the character of the margins of the tumor which cannot be considered separately. The results suggest that there is a correlation between the general and loco-regional malignancy of soft tissue sarcomas.