A Daily Diagnostic Multidisciplinary Meeting to Reduce Time to Definitive Diagnosis in the Context of Primary Bone and Soft Tissue Sarcoma.

The incidence of postoperative venous thromboembolism (VTE)and wound complications is greater after sarcoma resection. We sought to identify differences in postoperative VTE and bleeding complications with direct oral anticoagulants (DOACs)versus low-molecular-weight heparin (LMWH)following resection of lower extremity primary bone or soft tissue sarcoma. We retrospectively identified 2083 patients from the PearlDiver database who underwent resection of primary bone or soft tissue sarcoma of the lower extremity from January 2010 to October 2021 and prescribed LMWH or DOAC within 90-days postoperatively. The primary outcomes were comparison of postoperative incidence and odds of deep venous thrombosis(DVT), pulmonary embolism(PE), and bleeding complications within 90-days following resection. Patients prescribed DOACs had a greater odds of DVT (odds ratio [OR]: 1.60; 95% confidence interval [CI]: 1.06-2.41;p = 0.024) and PE (OR: 3.38;95% CI: 1.96-5.86;p < 0.001) within 90-days following resection of bone sarcoma when compared withthe LMWH cohort. Patients undergoing resection of soft tissue sarcomas also had greater odds DVT (OR: 1.65;95% CI: 1.09-2.49;p = 0.016) and PE (OR: 2.62;95% CI: 1.52-4.54;p < 0.001) in the DOAC cohort. There was no difference in the odds of bleeding complications. This study demonstrated an increased incidence and odds of VTE, but not bleeding complications, when using DOACs versus LMWH after primary bone or soft tissue sarcoma resection. Level III.

The lungs are the commonest site of metastasis for primary high-grade bone and soft tissue sarcoma, but current guidelines on the management of pulmonary nodules do not specifically cater for this group of patients. The current article reviews the literature from the past 20 years that has reported the CT features of pulmonary metastases in the setting of known primary bone and soft tissue sarcoma, with emphasis on osteosarcoma, chondrosarcoma, and trunk and extremity soft tissue sarcoma, the aim being to aid radiologists who report chest CT of musculoskeletal sarcoma patients in deciding which lesions should be considered metastatic, which lesions are indeterminate and require follow-up, and which lesions are of no concern.

Impact of the COVID-19 on the surgical management of bone and soft tissue sarcoma: A systematic review

BackgroundOxidative stress is characterised by an increased level of reactive oxygen species (ROS) that disrupts the intracellular reduction-oxidation (redox) balance and has been implicated in various diseases including cancer. Malignant tumors of connective tissue or sarcomas account for approximately 1% of all cancer diagnoses in adults and around 15% of paediatric malignancies per annum. There exists no information on the alterations of oxidant/antioxidant status of sarcoma patients in literature. This study was aimed to determine the levels of oxidative stress and antioxidant defence in patients with primary bone and soft tissue sarcoma and to investigate if there exists any significant differences in these levels between both the sarcomas.MethodsThe study cohort consisted of 94 subjects; 20 soft tissue sarcoma, 27 primary bone sarcoma and 47 healthy controls. Malondialdehyde (MDA) and protein carbonyls were determined to assess their oxidative stress levels while antioxidant status was evaluated using catalase (CAT), superoxide dismutase (SOD), thiols and trolox equivalent antioxidant capacity (TEAC).ResultsSarcoma patients showed significant increase in plasma and urinary MDA and serum protein carbonyl levels (p < 0.05) while significant decreases were noted in TEAC, thiols, CAT and SOD levels (p < 0.05). No significant difference in oxidative damage was noted between both the sarcomas (p > 0.05).ConclusionsIn conclusion, an increase in oxidative stress and decrease in antioxidant status is observed in both primary bone and soft tissue sarcomas with a similar extent of damage. This study offers the basis for further work on whether the manipulation of redox balance in patients with sarcoma represents a useful approach in the design of future therapies for bone disease.

Objectives: The goal of this meta-analysis was to assess the use of FDG-PET in the diagnosis of primary bone and soft tissue sarcomas. Subjects and Methods: Several databases, including PubMed, Embase, Cochrane Library, and Web of Science, were searched. In addition to sensitivity and specificity, the diagnostic accuracy region for detecting and grading sarcomas were pooled using bivariate and hierarchical summary receiver-operating characteristic (HSROC) models. Subgroup analysis included pooling soft tissue and bone sarcomas separately, and sensitivity analysis included high-quality studies. The quality of eligible studies was assessed using QUADAS-2. Results: Of the 1,258 papers screened, 21 studies satisfied the inclusion criteria. The pooled sensitivity and specificity of FDG-PET combined with CT for the detection of sarcomas were 89.2 and 76.3%, respectively. These diagnostic accuracy measures were higher when combined with CT than those of PDG-PET alone. Diagnostic accuracy for bone and soft tissue lesions were comparable but slightly better for soft tissue tumors. Pooling only the high-quality studies with low risk of bias yielded a sensitivity of 88.5% and specificity reduced to 65.6%. There was no evidence for publication bias, but significant heterogeneity among the studies was apparent. This study also showed that FDG-PET can efficiently differentiate between benign and malignant tumors, with a mean standard uptake value of maximally 2.52 units in benign and 6.81 units in malignant tumors (89.2% sensitivity and 75.1% specificity). Conclusion: Our findings indicate FDG-PET can efficiently differentiate between benign and malignant bone and soft tissue tumors. We also found that FDG-PET improves accuracy in diagnosing soft tissue sarcomas when combined with CT.

Background Primary bone and soft tissue sarcomas are rare tumors requiring wide surgical resection and reconstruction to achieve local control. Postoperative complications can lead to delays in adjuvant therapy, potentially affecting long-term oncologic outcomes. Understanding postoperative complication risks is essential; however, past studies are limited by small sample sizes. Purpose This study uses a large national registry to characterize the incidence of complications and mortality in the first thirty days following surgical management of primary bone and soft tissue sarcomas of the extremities. Methods A retrospective review of patients in the National Surgical Quality Improvement Program database was performed. Cases were identified using diagnosis codes for malignant neoplasm of soft tissue or bone and procedure codes for amputation and radical resection. The cohort was subdivided by bone versus soft tissue sarcoma, upper versus lower extremity, and amputation versus limb salvage. Results One thousand, one hundred eleven patients were identified. The most frequent complications were surgical site infections, sepsis, and venous thromboembolism. The overall incidence of complications was 14.0%. Unplanned readmission and reoperation occurred after 7.0% and 8.0% of cases, respectively. Thirty-day mortality was 0.3%, with one intraoperative death. Patient factors and complication rates varied by tumor location and surgical modality. Lower extremity cases were associated with higher rates of wound complications and infectious etiologies such as surgical site infections, urinary tract infections, and systemic sepsis. In contrast, patients undergoing amputation were more likely to experience major medical complications including acute renal failure, cardiac arrest, and myocardial infarction. Conclusion Approximately 1 in 7 patients will experience a complication in the first thirty days following surgery for primary bone and soft tissue sarcomas of the extremities. The unique risk profiles of lower extremity and amputation cases should be considered during perioperative planning and surveillance.

SELNET clinical practice guidelines for soft tissue sarcoma and GIST

The aim of this study was to examine cases of malpractice litigation in primary sarcoma and metastatic bone disease inorthopedic oncology, to identify the areas in which orthopedic surgeons may be guilty of negligence, and to make them aware of this. A comprehensive examination was conducted on all closed medical malpractice cases involving bone and soft tissue malignant tumors from 2014 to 2024. Patient demographics, histopathological diagnosis, and malpractice claims made in a variety of specialties were recorded. The inclusion and exclusion criteria of the study resulted in the inclusion of 70 cases of primary bone and soft tissue sarcoma and 36 cases of metastatic bone disease. A total of 47 primary tumors were bone sarcoma and 23 were soft tissue sarcoma. A total of 11 patients with primary sarcoma were accepted for malpractice claims, representing 16% of all cases within this category. Nevertheless, no evidence of malpractice was identified among the patients with metastatic bone disease (p = 0.012). Orthopedists (44 of 85 defendants), pathologists (14 of 85 defendants), and radiologists (7 of 85 defendants) were the most common defendants in primary sarcoma malpractice cases. Surgeons other than orthopedists (21 of 49 defendants), medical oncologists (4 of 49 defendants), and radiation oncologists (4 of 49 defendants) were the most common defendants in metastatic bone disease malpractice cases. Analysis of our cases suggests that malpractice claims are more likely filed against orthopedic surgeons for the treatment of primary malignant bone and soft tissue tumors than for metastatic bone disease.

BackgroundChest wall sarcomas are rare and pose significant technical challenges in surgical management, particularly in patients with advanced disease. In this study, we examined the extent of resection, reconstruction techniques, and oncological outcomes of patients with chest wall soft tissue and bone sarcomas.MethodsThis retrospective single-center series included patients who underwent surgery at our center between May 2014 and February 2022 for deep-seated/subfascial primary and recurrent soft tissue or bone sarcomas of the chest wall requiring significant resection and extensive reconstruction. We analyzed clinical and operative data, including extent of resection, reconstruction techniques, and oncological outcomes. Additionally, we compared survival outcomes between patients with primary and recurrent tumors, and examined how these were influenced by clinical factors using Cox proportional hazards regression analysis.ResultsOf the 38 patients included, 22 were treated for primary or recurrent soft tissue sarcoma (STS) and 16 for bone sarcoma. En bloc microscopic radical resection (R0) was achieved in 95.45% and 93.75% of patients with soft tissue and bone sarcomas, respectively. Nonetheless, local recurrence or distant metastases occurred in 40%, 58.33%, and 40% of patients with primary soft tissue, recurrent soft tissue, and bone sarcomas, respectively. Adherence to clinical guidelines and treatment in the reference center was high for bone sarcoma (93.75%), but notably low for STS, resulting in 54.55% of these patients requiring re-resection. Compared with those who underwent only one surgery, patients who underwent re-resection had poorer postoperative outcomes, more severe complications, and longer hospital stay.ConclusionsChest wall sarcomas often require extensive resection and complex reconstruction. Although surgical treatment at reference sarcoma centers has significantly improved oncological and clinical outcomes, the prognosis of these patients remains guarded, necessitating further related research and continued refinement in surgical techniques, adjuvant therapies, and follow-up strategies.

Level III, therapeutic study.

The aim of the present study was to investigate the clinical outcomes of adolescents and young adults with bone and soft tissue sarcomas. Records of seven male and six female patients aged 17-39 years with bone or soft tissue sarcomas were reviewed retrospectively; data on histology, size, location, grade/stage, treatment, recurrence, presence of metastasis, and prognosis were retrieved. Five-year survival rates were estimated using the Kaplan-Meier method and were compared according to age, sarcoma type, histological grade, and location. Seven and six patients had bone and soft tissue sarcomas, respectively. In terms of histology, patients with bone sarcomas included four with osteosarcoma, two with chondrosarcoma, and one with Ewing sarcoma of the bone. Of those with soft tissue sarcomas, three had liposarcomas, two had synovial sarcomas, and one each had Ewing sarcoma and leiomyosarcoma. The five-year survival rate of the cohort was 57.1%. Younger patients with sarcoma had poorer survival than older patients. Patients with high-grade sarcomas also had poorer survival than those with low-grade tumors. In addition, patients with trunk-located tumors had poorer survival than those with tumors in the extremities. These findings suggest that, younger adolescents and young adults with high-grade or trunk-located sarcomas require more aggressive treatment.

The coronavirus disease (COVID-19) pandemic negatively affected the diagnosis and treatment of several cancer types. However, this pandemic’s exact impact and extent on bone and soft tissue sarcomas need to be clarified. We aimed to investigate the effect of the COVID-19 pandemic and emergency declaration by the local government on consultation behavior and clinical stage at diagnosis of bone and soft tissue sarcoma. A total of 403 patients diagnosed with bone and soft tissue sarcoma who initially visited three sarcoma treatment hospitals between January 2018 and December 2021 were included. The monthly number of newly diagnosed soft tissue sarcoma patients was reduced by 25%, and the proportion of soft tissue patients with stage IV disease at diagnosis significantly increased by 9% during the COVID-19 pandemic compared to before the COVID-19 pandemic. Furthermore, the monthly number of new primary bone and soft tissue sarcoma patients significantly decreased by 43% during the state of emergency declaration. The COVID-19 pandemic had a negative impact on soft tissue sarcoma patients’ consultation behavior and increased the proportion of advanced-stage patients at initial diagnosis. An emergency declaration by the local government also negatively affected primary bone and soft tissue sarcoma patients’ consultation behavior.

The modified Glasgow prognostic score in patients undergoing surgery for bone and soft tissue sarcoma

Bone and soft tissue sarcomas are a rare and diverse family of malignancies. Sarcomas disproportionally impact young patients, and most subtypes have limited therapeutic options. Given the rarity of these tumors and their heterogenous nature, there is a need for developing clinically relevant models to broadly characterize the landscape of drug resistance and sensitivity in sarcoma in order to identify effective therapies. We leverage patient-derived tumor organoids (PDTOs) to create models across an array of bone and soft tissue sarcomas. We have procured n=193 specimens from n=127 patients undergoing biopsies or surgical resections at UCLA Health hospitals and successfully generated PDTOs from over 100 samples so far originating from primary, recurrent, or metastatic bone and soft tissue sarcomas. We performed molecular and histologic characterization to compare the PDTOs with the parent tumor and monitored PDTOs growth using a machine learning-based imaging pipeline (Al Shihabi et al, 2022). Our results show that sarcoma PDTOs closely resemble the tumor of origin in their molecular features and exhibit diverse growth patterns across subtypes. We leveraged our existing organoid high-throughput drug screening pipeline (Phan et al, 2019) to perform functional screenings of chemotherapies, targeted agents, and combination therapies, with results within one week from surgery. By screening a large number of samples, we could identify patterns of response with respect to diagnosis, prior treatment, patient age, lesion type, and disease trajectory. We observe tumor-specific susceptibilities with high heterogeneity both across and within sarcoma subtypes. As an example, we will focus on osteosarcoma, a bone tumor common in the pediatric and AYA population. We characterized PDTOs from n=33 osteosarcoma specimens and observed significant heterogeneity in response to NCCN-recommended therapies, suggesting that some patients may benefit from a personalized selection of approved therapeutic regimens. Finally, we compare functional and genomic screening to show how drug sensitivity and resistance characterization can facilitate optimal drug selection, avoid ineffective therapies, and mirror patient outcomes. Citation Format: Ahmad Al Shihabi, Peyton J. Tebon, Huyen T. Nguyen, Jomjit Chantharasamee, Sara Sartini, Ardalan Davarifar, Alexandra Jensen, Miranda Diaz-Infante, Hannah Cox, Alfredo Gonzalez, Nasrin Tavanaie, Sarah Dry, Arun Singh, Bartosz Chmielowski, Joseph G. Crompton, Anusha Kalbasi, Fritz C. Eilber, Francis J. Hornicek, Nicholas Bernthal, Scott D. Nelson, Paul C. Boutros, Noah Federman, Jane Yanagawa, Alice Soragni. A characterization of drug sensitivity and resistance in sarcoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 203.

Outcomes of a Large Single Institutional Series of Radiation Associated Sarcomas