Soft-tissue Sarcoma Metastases Identified on Abdomen and Pelvis CT Imaging

  • David M. King
  • Donald A. Hackbarth
  • Chris M. Kilian
  • Guillermo F. Carrera
Symposium: Selected Papers Presented at the 2008 Meeting of the Musculoskeletal Tumor Society

Abstract

The current standard of care for patients with extremity soft-tissue sarcomas is to obtain imaging of the chest for staging and surveillance. Our institutional standard of care has been to obtain CT scans of the chest, abdomen, and pelvis to evaluate for metastatic disease. Cost and radiation risk led us to question the utility of the additional scans. We presumed abdomen and pelvic CT scans would not benefit this patient population. We retrospectively reviewed our sarcoma databases from 2000 to 2008. We included 124 patients with 15 types of extremity soft tissue sarcomas evaluated with CT of the C/A/P. Primary outcomes were (1) location of metastatic disease in relation to (2) sarcoma type. Twenty patients (16%) presented with or developed abdomen/pelvis metastases and 10 of the 15 types of soft tissue sarcomas had abdominal or pelvic metastases. A larger number of patients demonstrated metastatic disease in the abdomen and pelvis than anticipated. We believe routine imaging of the abdomen and pelvic with CT for both staging and surveillance of all types of soft tissue sarcoma should be considered.

Level of Evidence: Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

Notes

Acknowledgments

We thank Heather Billington, PA-C, Lori Hollingsworth-Burds, PA-C, and Barb Rogowski for their substantial efforts and contribution to this study.

References

  1. 1.
    Beitler AL, Virgo KS, Johnson FE, Gibbs JF, Kraybill WG. Current follow-up strategies after potentially curative resection of extremity sarcomas: Results of a survey of the members of the Society of Surgical Oncology. Cancer. 2000;88:777–785.PubMedCrossRefGoogle Scholar
  2. 2.
    Billingsley KG, Lewis JJ, Leung DHY, Casper ES, Woodruff JM, Brennan MF. Multifactorial analysis of the survival of patients with distant metastasis arising from primary extremity sarcoma. Cancer. 1999;85:389–395.PubMedCrossRefGoogle Scholar
  3. 3.
    Brenner D, Hall E. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357;2277–2284.PubMedCrossRefGoogle Scholar
  4. 4.
    Cheng EY, Springfield DS, Mankin HJ. Frequent incidence of extrapulmonary sites of initial metastasis in patients with liposarcoma. Cancer. 1995;75:1120–1127.PubMedCrossRefGoogle Scholar
  5. 5.
    Clark MA, Fisher C, Judson I, Thomas JM. Soft-tissue sarcomas in adults. N Engl J Med. 2005;353:701–711.PubMedCrossRefGoogle Scholar
  6. 6.
    Cormier JN, Pollock, RE. Soft tissue sarcomas. CA Cancer J Clin. 2004;54:94–109.PubMedCrossRefGoogle Scholar
  7. 7.
    Haaga JR. Radiation dose management: weighing risk versus benefit. AJR Am J Roentgenol. 2001;177:289–291.PubMedGoogle Scholar
  8. 8.
    Kane III JM. Surveillance strategies for patients following surgical resection of soft tissue sarcomas. Curr Opin Oncol. 2004;16:328–332.PubMedCrossRefGoogle Scholar
  9. 9.
    Lee CI, Haims AH, Monico EP, Brink JA, Forman HP. Diagnostic CT scans: Assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology. 2004;231:393–398.PubMedCrossRefGoogle Scholar
  10. 10.
    Mettler FA Jr, Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology. 2008;248:254–263.PubMedCrossRefGoogle Scholar
  11. 11.
    NCCN Clinical Practice Guidelines in Oncology. Soft tissue sarcoma. National Comprehensive Cancer Network Web site. Available at: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed June 8, 2009.
  12. 12.
    Pearlstone DB, Pisters PWT, Bold RJ, Feig BW, Hunt KK, Yasko AW, Patel S, Pollack A, Benjamin RS, Pollock RE. Patterns of recurrence in extremity liposarcoma: Implications for staging and follow-up. Cancer. 1999;85:85–92.PubMedCrossRefGoogle Scholar
  13. 13.
    Pisters PWT, Leung DHY, Woodruff J, Shi W, Brennan MF. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol. 1996;14:1679–1689.PubMedGoogle Scholar
  14. 14.
    Pollack R, Brennan M, Lawrence W Jr. Society of Surgical Oncology practice guidelines: soft-tissue sarcoma surgical practice guidelines. Oncology (Williston Park). 1997;11:1327–1332.Google Scholar
  15. 15.
    Potter DA, Glenn J, Kinsella T, Glatstein E, Lack EE, Restrepo C, White DE, Seipp CA, Wesley R, Rosenberg SA. Patterns of recurrence in patients with high-grade soft-tissue sarcomas. J Clin Oncol. 1985;3:353–366.PubMedGoogle Scholar
  16. 16.
    Radiation-Emitting Products: What are the Radiation Risks from CT. Available at: http://www.fda.gov/Radiation-EmittingProducts. Accessed June 8, 2009.
  17. 17.
    Radiation Risks and Pediatric Computed Tomography(CT): A Guide for Health Care Providers. Available at: http://www.cancer.gov/cancertopics/causes/radiation-risks-pediatric-CT. Accessed June 8, 2009.
  18. 18.
    Simon MA, Springfield D. Surgery for Bone and Soft-Tissue Tumors. 1st ed. Philadelphia, PA: Lippincott-Raven; 1998.Google Scholar
  19. 19.
    Stojadinovic A, Leung DHY, Allen P, Lewis JJ, Jaques DP, Brennan MF. Primary adult soft tissue sarcoma: Time-dependent influence of prognostic variables. J Clin Oncol. 2002;20:4344–4352.PubMedCrossRefGoogle Scholar
  20. 20.
    Whooley BP, Gibbs JF, Mooney MM, McGrath BE, Kraybill WG. Primary extremity sarcoma: What is the appropriate follow-up? Ann Surg Oncol. 2000;7:9–14.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  • David M. King
    • 1
  • Donald A. Hackbarth
    • 1
  • Chris M. Kilian
    • 2
  • Guillermo F. Carrera
    • 3
  1. 1.Department of Orthopaedic SurgeryMedical College of WisconsinMilwaukeeUSA
  2. 2.Medical College of WisconsinMilwaukeeUSA
  3. 3.Department of RadiologyMedical College of WisconsinMilwaukeeUSA

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