Recurrent Soft Tissue Research Articles

Natural history of fibrodysplasia ossificans progressiva: cross-sectional analysis of annotated baseline phenotypes

BackgroundFibrodysplasia Ossificans Progressiva (FOP; OMIM#135100) is an ultra-rare, severely disabling genetic disease characterized by congenital malformation of the great toes and progressive heterotopic ossification (HO) in muscles, tendons, ligaments, fascia, and aponeuroses often preceded by painful, recurrent soft tissue swelling (flare-ups). The formation of HO leads to progressive disability, severe functional limitations in joint mobility, and to a shortened life-span. In this prospective natural history study, we describe the baseline, cross-sectional disease phenotype of 114 individuals with FOP.MethodsAll subjects underwent protocol-specified baseline assessments to determine their disease status. Cross-sectional analyses were performed using linear regression in which functional evaluations (Cumulative Analogue Joint Involvement Scale [CAJIS] and the FOP-Physical Function Questionnaire [FOP-PFQ]) and the burden of HO as measured by low-dose whole body CT (volume of HO and number of body regions with HO) were assessed.ResultsFindings from 114 subjects (age range 4 to 56 years) were evaluated. While subject age was significantly (p < 0.0001) correlated with increased CAJIS (r = 0.66) and FOP-PFQ scores (r = 0.41), the estimated mean increases per year (based on cross-sectional average changes over time) were small (0.47 units and 1.2%, respectively). There was also a significant (p < 0.0001) correlation between baseline age and HO volume (r = 0.56), with an estimated mean increase of 25,574 mm3/year. There were significant (p < 0.0001) correlations between the objective assessment of HO volume and clinical assessments of CAJIS (r = 0.57) and FOP-PFQ (r = 0.52).ConclusionsBased on the cross-sectional analysis of the baseline data, functional and physical disability as assessed by CAJIS and the FOP-PFQ increased over time. Although longitudinal data are not yet available, the cross-sectional analyses suggest that CAJIS and FOP-PFQ are not sensitive to detect substantial progression over a 1- to 2-year period. Future evaluation of longitudinal data will test this hypothesis. The statistically significant correlations between HO volume and the functional endpoints, and the estimated average annual increase in total HO volume, suggest that the formation of new HO will be measurable over the relative short-term course of a clinical trial, and represents an endpoint that is clinically meaningful to patients.Trial registrationThis study (NCT02322255) was first posted on 23 December, 2014.

Resection margins obtained with patient-specific instruments for resecting primary pelvic bone sarcomas: A case-control study

BackgroundLimb salvage surgery for pelvic bone sarcoma carries a very high risk of local recurrence. Patient-specific instruments (PSIs) have shown promise for obtaining tumour-free resection margins. However, no data are available on medium-term outcomes including local recurrence rates after PSI-guided resection. The objectives of this case-control study were to determine whether PSI-guided resection: 1) was associated with a lower local recurrence rate, 2) allowed a shorter operative time, 3) was associated with better-quality allograft reconstruction. HypothesisPSI-guided resection decreases the local recurrence rate by improving the resection margins in patients with primary pelvic bone sarcomas. Patients and methodsPSI-guided resection was performed in 9 consecutive patients (cases) with primary pelvic sarcomas (chondrosarcoma, n=3; Ewing's sarcoma, n=3; osteosarcoma, n=1; fibrosarcoma, n=1; and radiation-induced sarcoma, n=1). Age ranged from 11 to 63 years. Outcomes were compared to those in a historical control group of 19 patients with primary bone sarcomas who underwent resection surgery in the same hospital without PSI guidance. The case and control groups were similar regarding age, sex distribution, and follow-up duration. The local recurrence rate and operative time were compared between the two groups. Resection margins were classified as R0, R1, or R2. The quality of allograft reconstruction, which was performed in 7 of the 9 cases, was assessed. ResultsAfter a mean follow-up of 52 months (range, 30–90 months), none of the cases had experienced local bone or soft-tissue recurrences, compared to 7 of the 19 controls (p=0.03), in whom mean follow-up was 62 months (range, 24–134 months). Bone resection margins were R0 in 8 cases; in the remaining patient, R1 resection was performed deliberately to preserve an S1 root. All 9 cases had R0 soft-tissue resection margins. In the control group, bone resection margins were R0 in 13 patients, R1 in 5 patients, and R2 in 1 patient (p=0.47). Mean operative time was similar in the cases (612 minutes [range, 435–854 minutes]) and controls (633 minutes [range, 420–990 minutes]) (p=0.87). In the 7 patients who underwent pelvic allograft reconstruction, allograft contact in the defect and osteosynthesis stability were deemed satisfactory by the surgeon. DiscussionThe lower local recurrence rate in the cases demonstrates that the improved resection accuracy provided by PSIs directly influences the risk of local recurrence. In addition, the R0 bone margins in 8 cases establishes that PSIs are effective in improving resection accuracy. Level of evidenceIII, case-control study.

Muscle group excision is an effective and safe surgical treatment for soft tissue sarcoma of thigh

Objective To evaluate the local recurrence rate, limb function and complications of soft tissue sarcoma of thigh after muscle group resection. Methods Between January 2009 and August 2016, twenty-threepatients who were diagnosed as soft tissue sarcoma for the first time in our hospital, receiving thigh quadriceps muscle group resection, adductor muscle group resection or posterior compartment of the thigh resection were incorporated into this study. Patients who had received surgery of this lesion before, suffered from recurrent soft tissue tumor, had tumor involved multiple muscle groups which could not be resected completely, had sciatic nerve or femoral artery or vein affected by tumor or had distal metastasis were excluded. This retrospective study consisted of 12 male and 11 female. The age ranged from 20-80 with the average of 52. All the patients received CT and MRI of thigh to figure out the size of tumor, the invaded extension of the lesion and the specific muscle group involved. Chest CT scan and ultrasound of bilateral inguinal lymph nodes were arranged to exclude the tumor metastases. After all these examinations were done, needle biopsy with the guidance of CT scan was performed for the pathological diagnosis. The pathology included undifferentiated pleomorphic sarcoma (7 cases), rhabdomyosarcoma (2 cases), primitive neurotodermal tumor (1 case), synovial sarcoma (1 case), leiomyosarcoma (3 cases), fibrosarcoma (5 cases) and liposarcoma (4 cases). Sixpatients received quadriceps muscle group resection, eightpatients received adductor muscle group resection and the other 9 patients received posterior compartment of the thigh resection. Patients with undifferentiated pleomorphic sarcoma, leiomyosarcoma, primitive neurotodermal tumor and synovial sarcoma received postoperative adjuvant chemotherapy. None of patients received radiotherapy. After surgery, drainage tube of negative pressure was placed until the volume of drainage was less than 50 ml within 24 h. The affected thigh was bound up tightly. Intravenous antibiotics were used for 3 days to prevent from postoperative infections. Patients received quadriceps muscle group resection stayed in the bed for 4 weeks. After that they could walk with the protection of orthosis with unbending position. Other patients got out of bed after 2 weeks. All the complications after surgery were recorded. Reexaminations were arranged in 3, 6, 12 and 24 months after surgery separately. After that, reexamination was arranged every half a year. Chest CT scan was used to detect lung metastasis and ultrasound or MRI was arranged for local recurrence. Lower limb function after surgery was evaluated by MSTS scores. Results All the surgeries of muscle group excision were successfully completed. The duration of surgery ranged 1.5-3.5 h with the average of 2.2 h. The bleeding volume during surgery ranged 100-1 100 mL with the average of 313 mL. The follow-up was a mean of 41 months (range, 17-108 months). None was lost to follow-up. The local recurrence rate was 4.3% (1/23). One patient with undifferentiated pleomorphic sarcoma had positive surgical margin, who received posterior compartment of the thigh resection. Local recurrence occurred 6 months after surgery. Then he received expanded resection. Six patients had distant metastases, five patients for lung metastases, one patient for lung and inguinal lymph node metastases. Of these, five patients had died and one lived with the metastasis. The median MSTS score was 26.3 points (range, 14-30 points). Specifically, the median musculoskeletal tumor society (MSTS) score was 28 points (range, 21-30 points) for 9 patients with posterior compartment of the thigh resection, twenty-nine points (range, 27-30 points) for 8 patients with adductor muscle group resection, and 20.3 points (range, 14-24 points) for 6 patients with quadriceps muscle group resection. Five patients had complications, including local recurrence (1 case), hematoma (2 cases) and cutaneous necrosis (2 cases), all of which were settled by reoperation. The rate of complication was 21.7%. Conclusion Muscle group resection is an effective surgical treatment for soft tissue sarcoma of thigh, which could reduce the risk of local recurrence, apart from quadriceps muscle group resection, the other two muscle group resections have limited impact on lower limb function, additionally, thigh muscle group resection is a safe procedure with few complications. Key words: Sarcoma; Pathology, surgical; Neoplasm recurrence, local; Treatment outcome

Feasibility of surgical salvage combined with intraoperative radiation therapy (IORT) for recurrent soft tissue sarcoma after multimodality treatment

Feasibility of surgical salvage combined with intraoperative radiation therapy (IORT) for recurrent soft tissue sarcoma after multimodality treatment

Mazabraud's Syndrome - A Diagnosis Commonly Missed.

Introduction:Mazabraud’s syndrome is a rare benign disorder characterized by the association of single or multiple intramuscular myxomas with monostotic or polyostotic form of fibrous dysplasia. Around 80 cases have been described till date; however, a higher incidence may be expected due to silent nature of the disease and missed diagnosis. The authors report one such case of a missed diagnosis.Case Report:A 39-year-old lady presented with recurrent soft tissue myxomas in thigh. A thorough evaluation with radiographs and magnetic resonance imaging (MRI) and a clinical suspicion of this rare entity helped in making the diagnosis of Mazabraud’s syndrome. The patient was treated with wide excision of the recurrent thigh swelling and watchful observation of two other asymptomatic swelling detected on MRI examination. Bisphosphonate therapy was given for fibrous dysplasia. At latest follow-up after 2 years, the patient was asymptomatic with no recurrence.Conclusion:The report highlights the importance of a high degree of suspicion of this clinical entity in patients treated for recurrent soft tissue swelling as both myxomas and fibrous dysplasia behave differently than their isolated counterparts.

Functional outcome of wide resection and autologous avascular proximal fibular graft arthroplasty in distal radius GCT

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Giant cell tumor (GCT) of distal radius usually presents in late stages with aggressive progression. Extended curettage alone is usually inadequate and wide resection is the most common surgery performed. Reconstruction of the resulting defect poses significant challenges.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 11 patients with distal radius GCT treated with wide resection and autologous avascular proximal fibular graft arthroplasty were studied retrospectively. One patient was Campanacci grade II and the rest 10 were Campanacci grade III. All patients underwent a standard preoperative workup and underwent a standard procedure. Patients were followed up for a mean period of 33 months (range: 1 year–7 years). Wrist movements were documented and functional outcome was scored using revised musculoskeletal tumor society scoring (MSTS).&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Of the 11 patients, eight had excellent outcome, two had good outcome and one had satisfactory outcome according to MSTS scoring. Mean dorsiflexion, palmar flexion, supination and pronation was 44 degrees (range 10-80), 34 degrees (range 10-70), 60 degrees (range 20-80), 54 degrees (range 15-70) respectively. The complications encountered were fibulo-ulnar diastasis in 3 patients, fibulo-carpal subluxation in 2 patients, soft tissue recurrence in 1 patient and graft site non-union in 1 patient. Despite fibula-ulnar and fibula-carpal instability functional outcomes were seen to be excellent (4 patients) or good (1 patient).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Avascular autologous proximal fibular arthroplasty provides for excellent to good functional outcomes after wide resection in distal radius GCT even if radiological appearances are suboptimal.&lt;/p&gt;

Effective palliative treatment of recurrent soft tissue sarcoma in a dog using imatinib mesylate (Gleevec&lt;sup&gt;®&lt;/sup&gt;)

A 14-year-old neutered female Yorkshire terrier presented with a rapidly growing gluteal mass. There was a history of surgical resection of a mass diagnosed as a grade two soft tissue sarcoma in the same region a year earlier. The second mass was surgically excised and histopathologically diagnosed as grade two soft tissue sarcoma. A further relapse occurred six months after the second surgery. On that occasion, the dog was treated with metronomic chemotherapy consisting of cyclophosphamide and piroxicam, which failed to adequately control the disease and the mass increased 2.5-fold in size in three weeks. Imatinib treatment was started, after which there was a 62% reduction in the size of the mass. The patient has remained in partial remission for five months. To the authors’ knowledge, this is the first report on the use of imatinib to treat canine soft tissue sarcoma. Imatinib might be a useful treatment for soft tissue sarcoma that recurs after surgical resection.

Conservative Curative Larynx Preserving Surgery for Subglottic Soft Tissue Recurrence Reinforced with Fascia-Lata and Strap Muscles.

For early cancers of vocal cords, trans oral laryngeal surgery (TOLS) and curative radiotherapy (RT), have remained mainstay of treatment. Soft tissue recurrence in laryngeal cancers is not much documented, leading to absence of guidelines to deal with it, salvage total laryngectomy being the treatment of choice. We present a tailormade surgical procedure for limited soft tissue recurrence of glottic cancer extending into subglottic anterior soft tissue reinforced with fascia lata and strap muscles, previously treated with TOLS and/or RT.

A phase II study of temsirolimus and liposomal doxorubicin for patients with recurrent and refractory bone and soft tissue sarcomas

BackgroundRelapsed and refractory sarcomas continue to have poor survival rates. The cancer stem cell (CSC) theory provides a tractable explanation for the observation that recurrences occur despite dramatic responses to upfront chemotherapy. Preclinical studies demonstrated that inhibition of the mechanistic target of rapamycin (mTOR) sensitizes the CSC population to chemotherapy.MethodsHere we present the results of the Phase II portion of a Phase I/II clinical trial that aimed to overcome the chemoresistance of sarcoma CSC by combining the mTOR inhibitor temsirolimus (20 mg/m2 weekly) with the chemotherapeutic agent liposomal doxorubicin (30 mg/m2 monthly).ResultsFifteen patients with relapsed/refractory sarcoma were evaluable at this recommended Phase 2 dose level. The median progression free survival was 315 days (range 27–799). Response rate, defined as stable disease or better for 60 days, was 53%. Nine of the patients had been previously treated with doxorubicin. Therapy was well tolerated. In a small number of patients, pre- and post- treatment tumor biopsies were available for assessment of ALDH expression as a marker of CSCs and showed a correlation between response and decreased ALDH expression. We also found a correlation between biopsy-proven inhibition of mTOR and response.ConclusionsOur study adds to the literature supporting the addition of mTOR inhibition to chemotherapy agents for the treatment of sarcomas, and proposes that a mechanism by which mTOR inhibition enhances the efficacy of chemotherapy may be through sensitizing the chemoresistant CSC population. Further study, ideally with pre- and post-therapy assessment of ALDH expression in tumor cells, is warranted.Trial registration The trial was registered on clinicaltrials.gov (NCT00949325) on 30 July 2009. http://www.editorialmanager.com/csrj/default.aspx

Patterns of Local Failure after Radical Nephroureterectomy in Upper Tract Urothelial Carcinoma: Association with Primary Tumor Locations and Implications for the Clinical Target Volume Design of Adjuvant Radiation Therapy

There are no standards about the delineation of clinical target volume of upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU).This study aims to explore the high-risk local recurrence areas for UTUC patients stratified by primary tumor locations and in order to provide implications for the CTV design. All the UTUC patients who were followed up in our center after radical nephroureterectomy between 2010 and 2016 were retrospectively enrolled. The patterns of first discovered failure were assessed, and local recurrence sites (soft tissue relapse within the retroperitoneal field of exenteration and regional lymph nodes) were evaluated. All of the local recurrence sites were identified by MRI, CT, or PETCT. Three hundred twenty-nine patients with radical nephroureterectomy were enrolled in our study. The median follow up time was 45m (4-110m). Sixty-five patients experienced local recurrence. The median time from surgery to local relapse was 7m (range 1-48m). Local recurrence was the first event in 26 (57.8%) patients, the other 19 patients (42.2%) also had metastasis. We studied the detailed relapse site images of 45 patients. A total of 152 sites of local relapse were observed in 45 patients. The median relapse sites of each patient was 2 (1-10). The average number of positive nodes per patient was 3.4. Among the 152 relapse sites, lymphatic recurrence was the dominant recurrence type (90.1%, 137 sites), and the others were soft tissue recurrence (9.9%, 15 sites). We stratified all the patients into 3 groups according to their tumor location. Para-aorta lymph node region has the highest recurrence rates in all of the patients. The recurrence rates in this region account for 85% in renal pelvic and upper ureter tumor, 75% and 74% in middle and lower ureter tumor. The distribution of recurrent LN in middle and lower ureter tumors were much lower (below mid level of L2) than renal pelvic and upper ureter tumors (superior bonder of L1). Para-aorta recurrence in patients with left-sided UTUC almost occurred in LPA region. While the right-sided UTUC had higher para-aorta recurrence rate in RPC and AC region. Recurrence of internal and external iliac lymph node region was rare (<10%) in all the UTUC patients. In all of the soft tissue recurrence sites, the kidney fossa relapse accounted for 33.3% (5 sites); urecter tumor bed recurrence accounted for 66.7% (10 sites). Lymph node recurrences were the most common recurrence sites in UTUC patients after surgery. Para-aortic lymph node region was the common recurrence lymph regions in UTUC patients. Right-sided UTUC had different local relapse pattern compared with left-sided UTUC in this region. Recurrence in internal and external iliac lymph node region was rare (<10%) in all the UTUC patients. Delineate CTV according to the primary tumor locations can include more than 90% recurrence regions and decrease the radiation areas compared with conventional CTV.

Efficacy of radio-hyperthermo-chemotherapy as salvage therapy for recurrent or residual malignant soft tissue tumors

Background: Recurrence after wide excision or residual tumor after an unplanned excision of a malignant soft tissue sarcoma (STS) is a complex problem, due to a higher recurrence rate and poorer survival rate compared with primary resection. Regional hyperthermia was used, with the expectation that it will enhance the anti-tumor effects of chemotherapy and radiotherapy. This study aimed to assess the efficacy of neoadjuvant concomitant radiotherapy, hyperthermia, and chemotherapy (RHC) for salvage of recurrent or residual malignant STS.Methods: We identified 64 patients with recurrent or residual STS treated between 1994 and 2013. After excluding those with low-grade malignancy, with recurrent bone tumor in the soft tissues, with truncal STS, and who declined to participate, 23 patients (7 with recurrence and 16 with residual tumor) underwent RHC. The histologic diagnoses were undifferentiated pleomorphic sarcoma (n = 11), synovial sarcoma (n = 3), leiomyosarcoma and myxoid liposarcoma (n = 2 each), and other histologic types. As primary outcomes, the 5-year overall survival (OS), distant metastasis-free survival (D-MFS), and local control (LC) rates were evaluated by Kaplan-Meier analysis.Results: The median follow-up period was 112.3 months. The 5-year OS, D-MFS, and LC were 86.4%, 77.4%, and 86.7%, respectively. In the univariate analysis, tumor depth was considered as a negative prognostic factor for OS and D-MFS, and a positive margin was also a negative prognostic factor for OS, D-MFS LC with retained on Cox proportional hazards model in OS, and D-MFS.Conclusion: RHC is an effective option for salvage treatment of recurrent and residual STS.

Undifferentiated Pleomorphic Sarcoma of the Mandible: a Case Report

Undifferentiated pleomorphic sarcoma (UPS) is a high-grade and aggressive neoplasm, most commonly located in the extremities and retroperitoneum and only rarely diagnosed in the oral cavity. In this report, we describe an original case of mandibular UPS affecting an 88-year-old woman and first diagnosed as a central giant cell granuloma that was surgically removed. After 5 months of follow-up, because of persistent pain and local soft tissue recurrence, new incisional biopsy was performed, and microscopic analysis revealed an aggressive neoplasm with pleomorphic cells, atypical mitotic figures, and areas of necrosis, infiltrating adjacent cortical and medullary mandibular bone. Immunohistochemical analysis revealed only a focal positivity for smooth muscle actin, AE1/AE3, and CD99; thus, microscopic and immunohistochemical findings led to the diagnosis of UPS. The patient was referred for radiotherapy, and 6 months after the UPS treatment, the patient is well, free of tumor.

Periorbital infections and conjunctivitis due to Panton-Valentine Leukocidin (PVL) positive Staphylococcus aureus in children

BackgroundColonisation with Panton-Valentine Leukocidin expressing strains of Staphylococcus aureus (PVL + SA) is characterised by recurrent skin and soft tissue infections. While periorbital and orbital infections are common in children and frequently caused by S. aureus the role of PVL + SA in recurrent eye infections has not been studied.This study aimed to detect and report frequency and recurrence of periorbital or orbital infections as additional symptoms of PVL + SA colonisation in children.MethodsWe conducted a retrospective cohort study of pediatric patients who were treated for PVL + SA skin and soft tissue infection in our in- and outpatient clinics in Berlin, Germany from January 2012 to January 2017. We identified cases with periorbital or orbital infections in the year prior to the first PVL + SA evidence. In these cases, we conducted follow-up interviews by phone to determine recurrence of symptoms after the completion of decolonisation procedures.ResultsFifty pediatric patients (age range: one week to 17 years) were evaluated and treated for PVL + SA infections in the reported time period. 19 patients (38%) reported periorbital infection or conjunctivitis, with recurrent hordeola as the most frequent finding (n = 9; 18%). Reappearance of hordeola (n = 5) was associated with recurrence of skin and soft tissue infections and/or de novo detection of PVL + SA. No further hordeola or other eye infections occurred after successful decolonisation.ConclusionOur findings suggest a frequent involvement of periorbital skin in children with PVL + SA infections. Pediatric patients with recurrent periorbital infections might benefit from PVL + SA screening and consecutive decolonisation procedures.

Chronic active hepatitis induced by Pazopanib mimicking hypervascular liver metastases in a patient with recurrent soft tissue sarcoma: A case report.

Pazopanib is the first multitargeted tyrosine-kinase inhibitor approved for the treatment of patients with advanced non-adipocytic soft tissue sarcoma (STS). It has been demonstrated to improve progression-free survival without impairing health-associated quality of life. However, Pazopanib is associated with several adverse side effects associated with inhibition of the vascular endothelial growth factor receptor. These include hepatotoxicity, as manifested by abnormal liver function tests. To the best of our knowledge, the current study presents the first case of a patient with recurrent STS who developed biopsy proven Pazopanib-induced chronic active hepatitis and whose previous computed tomography examination demonstrated multiple hypervascular liver lesions. These lesions were indistinguishable from metastases and to the best of our knowledge, have not been described previously. These lesions therefore appear to be a novel finding of Pazopanib-induced chronic active hepatitis. It is crucial to be aware of this unusual finding within a clinical setting, to avoid overstaging and early discontinuation of effective treatment.

Efficacy and Clinical Prognostic Factors of Image-guided 125I Seed Implantation for Locally Recurrent Soft Tissue Sarcoma

Efficacy and Clinical Prognostic Factors of Image-guided 125I Seed Implantation for Locally Recurrent Soft Tissue Sarcoma

Efficacy and clinical prognostic factors of image-guided 125I seed implantation for locally recurrent soft tissue sarcoma

Objective To evaluate the outcomes and prognostic factors of image-guided 125I seed implantation for locally recurrent soft tissue sarcoma(RSTS). Methods A total of 60 patients with RSTS who received image-guided 125I seed implantation in Peking University Third Hospital, from September 2002 to December 2015, were retrospectively analyzed. The enrollment criteria: KPS > 60 points, refused or could not tolerate surgery or radiotherapy, the expecting survival time >3 months, relapsed after multiple treatment of soft tissue sarcoma, and underwent CT or ultrasound guided 125I seed implantation treatment. In all, the median activity of seeds was 25.9×106 Bq (range, 11.1×106-29.6×106 Bq), median number of implanted seeds was 58 (range, 3-133), and the median D90 was 120 Gy (range, 36.50-460.97 Gy). The local progression-free survival (LPFS) and overall survival (OS) were calculated using the Kaplan-Meier method . The log-rank test and Cox regression model were used for the univariate and multivariate analyses. Results The median follow-up was 18.75 months (range, 1-146). The median OS was 18.5 months (95% CI 13.1-23.9). The 1-, 3- and 5-year OS rate were 63.3%, 33.0% and 29.5%, respectively. The 1-, 3- and 5-year LPFS rate were 72.5%, 63.7% and 59.7%, respectively. The general rate of pain relieving was 100% (6/6). 8.3% (5/60) presented grade Ⅳ skin toxicity. No fatal complications ocurred. The univariate analysis suggested that tumor size, tumor volume, KPS score, D90 were prognostic factors of OS and LPFS. The multivariate analysis demonstrated that previous chemotherapy history and distant metastases were independent prognostic factors of survival. Conclusions Image-guided 125I seed implantation for recurrent soft tissue sarcoma is a safe treatment option with high efficacy and low morbidity. Tumor size and D90 were the prognostic factors of OS and LPFS. Key words: Recurrence; Soft tissue sarcoma; 125I seed implantation; Prognosis

DNA-cytometric characteristics of recurrent soft tissue sarcomas

Aim. To determine the content of deoxyribonucleic acid (DNA) and distribution of cells in mitotic phases in patients with recurrent soft tissue sarcomas for the assessment of malignancy of the process. Methods. Tumor tissues of patients with recurrent soft tissue sarcomas were studied. Research methods included histological, DNA-cytometric and statistical methods. Results. Proliferative activity and proliferative index of recurrent sarcomas differed depending on the tumor grade and stage. Differences in the number of diploid, aneuploid and polyploid cells were determined in each group and between the groups depending on the cell cycle phases. Cell cycle parameters were as following: 100% of G1 (well-differentiated) cancer were diploid, as well as 33.3% of G2 (moderately differentiated) and 15% of G3 (poorly differentiated) tumors. Aneuploid tumors prevailed in G2 and G3, the ratio of which was 66.7 and 85%, respectively. The analysis of kinetic parameters of the cell cycle allowed establishing a decrease in the number of cells in G1/G0 phase of the cell cycle from G1 to G3, which was accompanied by a statistically significant increase in the proportion of cells in S-phase (p ˂0.05). Conclusion. The DNA-cytometric study of cell cycle parameters showed high biological potential of recurrent soft tissue sarcomas, which was determined by two indices - the proportion of cells in G2+M-phase and the cell loss factor; 100% of well-differentiated (G1) tumors, 33.3% of moderately differentiated (G2) and 15% of poorly differentiated (G3) tumors were diploid; aneuploid tumors prevailed in G2 and G3.

Hand-foot skin reaction predicts treatment outcome of pazopanib in patients with metastatic soft tissue sarcoma: A multicenter study in the Asian population.

Pazopanib is a multitargeted tyrosine kinase inhibitor used as a standard treatment for chemotherapy-refractory recurrent or metastatic soft tissue sarcoma. This study aimed to evaluate the efficacy and safety of pazopanib for treatment of metastatic soft tissue sarcoma in the Asian population. Fifty patients with chemotherapy-refractory recurrent or metastatic soft tissue sarcoma, who had received pazopanib treatment between 2015 and 2016 were enrolled. We reviewed patients' clinical characteristics and studied survival outcomes following pazopanib treatment. Median follow-up was 5.7 months. Seven patients were still on pazopanib by the end of this study and the disease had progressed in the other 43 patients, leading to 23 deaths. We found that despite treatment more than half the patients experienced disease progression (56% vs 14% partial response and 30% stable disease). The median progression-free survival and overall survival was 3.1 and 11.0 months, respectively. Multivariate analysis identified good Eastern Cooperative Oncology Group performance status (0 or 1) and occurrence of hand-foot skin reaction as independent factors associated with better outcome. Hand-foot skin reaction was 32% in our cohort and the median onset time was 4 (1.00-8.29) weeks. It had dose-dependent effect by clinical observation. Our study showed that the incidence rate of hand-foot skin reaction in Taiwan is higher than western population, and it is an independent predictive factor for better treatment outcomes.

Some immunohistochemical parameters in primary and recurrent soft tissue sarcomas.

e23533Background: The purpose of the study was to reveal some immunohistochemical parameters in primary and recurrent soft tissue sarcomas. Methods: The study included patients with primary (n = 30...

EP-1628: Radiotherapy for high grade late recurrent soft tissue sarcomas: follow up and outcomes

EP-1628: Radiotherapy for high grade late recurrent soft tissue sarcomas: follow up and outcomes