Epithelioid Sarcoma: Need for a Multimodal Approach to Maximize the Chances of Curative Conservative Treatment
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This study was designed to evaluate the impact of multimodal management on a series of epithelioid sarcoma (ES) patients treated with curative intent.
Data were collected on 69 consecutive patients treated from 1982 to 2012. Univariate and multivariate analyses were performed for tumor control and overall survival (OS).
In total, 54 (78 %) patients had localized ES (M0 group). In the M0 group, 85 % of patients received multimodal management (surgery n = 50, radiotherapy n = 37, chemotherapy n = 30). Among 42 patients with limb ES, 9 (21 %) underwent amputation, and isolated limb perfusion (ILP) was required in 17 (40.5 %) to allow conservative management. Among the 45 patients who underwent conservative surgery, flap reconstructions were required in 13 (28.8 %). The median follow-up was 5.7 years. The 5-year actuarial OS rates were 54, 62, and 24 % in the entire group and the M0 and M1 groups, respectively. In the M0 group, the 5-year actuarial distant control, local control (LC), and locoregional control rates were 67, 75, and 66 %, respectively. Prognostic factors for poor OS in the multivariate analysis were tumors that were deep to the fascia (p = 0.04) and grade 3 (p = 0.005). In the univariate analysis, age <30 years (p = 0.04), the T2 stage (p = 0.04), and mass presentation (p = 0.03) correlated with decreased LC, whereas patients who underwent ILP had a significantly higher LC rate (hazard ratio 3; 95 % confidence interval 0.9–9.4; p = 0.05).
Multimodal management including ILP and flap reconstruction is necessary to achieve optimal conservative LC. High rates of metastasis and lymphatic spread require innovative systemic treatments.
KeywordsOverall Survival Sentinel Lymph Node Biopsy Flap Reconstruction Isolate Limb Perfusion Epithelioid Sarcoma
The authors declare no financial support and no funds received.
- 2.Laskowski J. Sarcoma aponeuroticum. Nowotory. 1961;11:61–7.Google Scholar
- 9.ESMO/European Sarcoma Network Working Group. Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23S:vii92–9.Google Scholar
- 10.Kraybill WG, Harris J, Spiro IJ, et al. Long-term results of a phase 2 study of neoadjuvant chemotherapy and radiotherapy in the management of high-risk, high-grade, soft tissue sarcomas of the extremities and body wall: Radiation Therapy Oncology Group Trial 9514. Cancer. 2010;116:4613–21.PubMedCentralPubMedCrossRefGoogle Scholar
- 12.Bonvalot S, Laplanche A, Lejeune F, Stoeckle E, Le Péchoux C, Vanel D, Terrier P, Lumbroso J, Ricard M, Antoni G, Cavalcanti A, Robert C, Lassau N, Blay JY, Le Cesne A. Limb salvage with isolated perfusion for soft tissue sarcoma: could less TNF-alpha be better? Ann Oncol. 2005;16:1061–8.PubMedCrossRefGoogle Scholar
- 19.Edge SB, Byrd DR, Compton CC, et al. Soft tissue sarcoma. AJCC cancer staging manual, 7th edn. New York: Springer, 2010, pp 291–6.Google Scholar
- 20.Enzinger FM, Weiss SW. Soft tissue tumors, 3rd edn. St. Louis: Mosby, 1994.Google Scholar
- 22.Tumor of bone and soft tissues. R classification. In: Sobin LH, Wittekind Ch. TNM classification of malignant tumours UICC, 6th edn, 2002. New York: Wiley Liss, p 110.Google Scholar
- 23.Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.PubMedCrossRefGoogle Scholar
- 30.Bonvalot S, Dunant A, Le Pechoux C, et al. Quality of surgical margins and local recurrence in primary extremity soft tissue sarcoma (STS). J Clin Oncol. 2010;28:15s (suppl; abstr 10068).Google Scholar
- 31.Pennacchioli E, Deraco M, Mariani L, Fiore M, Mussi C, Collini P, Olmi P, Casali PG, Santinami M, Gronchi A. Advanced extremity soft tissue sarcoma: prognostic effect of isolated limb perfusion in a series of 88 patients treated at a single institution. Ann Surg Oncol. 2007;14:553–9.PubMedCrossRefGoogle Scholar