Annals of Surgical Oncology

, Volume 21, Issue 1, pp 269–276 | Cite as

Epithelioid Sarcoma: Need for a Multimodal Approach to Maximize the Chances of Curative Conservative Treatment

  • Antonin Levy
  • Cécile Le Péchoux
  • Philippe Terrier
  • Ryan Bouaita
  • Julien Domont
  • Olivier Mir
  • Sarah Coppola
  • Charles Honoré
  • Axel Le Cesne
  • Sylvie Bonvalot
Bone and Soft Tissue Sarcomas

Abstract

Objective

This study was designed to evaluate the impact of multimodal management on a series of epithelioid sarcoma (ES) patients treated with curative intent.

Methods

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).

Results

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).

Conclusions

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.

Supplementary material

10434_2013_3247_MOESM1_ESM.doc (26 kb)
Supplementary material 1 (DOC 26 kb)
10434_2013_3247_MOESM2_ESM.doc (28 kb)
Supplementary material 2 (DOC 27 kb)

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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Antonin Levy
    • 1
    • 2
  • Cécile Le Péchoux
    • 1
    • 2
  • Philippe Terrier
    • 2
    • 3
  • Ryan Bouaita
    • 1
    • 2
  • Julien Domont
    • 2
    • 4
  • Olivier Mir
    • 2
    • 4
  • Sarah Coppola
    • 2
    • 5
  • Charles Honoré
    • 2
    • 5
  • Axel Le Cesne
    • 2
    • 4
  • Sylvie Bonvalot
    • 2
    • 5
  1. 1.Department of Radiation Oncology, Institut Gustave-RoussyUniversité Paris SudVillejuifFrance
  2. 2.Department of Soft Tissue and Bone Sarcoma Multidisciplinary UnitInstitut Gustave-RoussyVillejuifFrance
  3. 3.Department of PathologyInstitut Gustave-RoussyVillejuifFrance
  4. 4.Department of Medical OncologyInstitut Gustave-RoussyVillejuifFrance
  5. 5.Department of SurgeryInstitut Gustave-RoussyVillejuifFrance

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