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.
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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.
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.
Brenner D, Hall E. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357;2277–2284.
Cheng EY, Springfield DS, Mankin HJ. Frequent incidence of extrapulmonary sites of initial metastasis in patients with liposarcoma. Cancer. 1995;75:1120–1127.
Clark MA, Fisher C, Judson I, Thomas JM. Soft-tissue sarcomas in adults. N Engl J Med. 2005;353:701–711.
Cormier JN, Pollock, RE. Soft tissue sarcomas. CA Cancer J Clin. 2004;54:94–109.
Haaga JR. Radiation dose management: weighing risk versus benefit. AJR Am J Roentgenol. 2001;177:289–291.
Kane III JM. Surveillance strategies for patients following surgical resection of soft tissue sarcomas. Curr Opin Oncol. 2004;16:328–332.
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.
Mettler FA Jr, Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology. 2008;248:254–263.
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.
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.
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.
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.
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.
Radiation-Emitting Products: What are the Radiation Risks from CT. Available at: http://www.fda.gov/Radiation-EmittingProducts. Accessed June 8, 2009.
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.
Simon MA, Springfield D. Surgery for Bone and Soft-Tissue Tumors. 1st ed. Philadelphia, PA: Lippincott-Raven; 1998.
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.
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.
Acknowledgments
We thank Heather Billington, PA-C, Lori Hollingsworth-Burds, PA-C, and Barb Rogowski for their substantial efforts and contribution to this study.
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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
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King, D.M., Hackbarth, D.A., Kilian, C.M. et al. Soft-tissue Sarcoma Metastases Identified on Abdomen and Pelvis CT Imaging. Clin Orthop Relat Res 467, 2838–2844 (2009). https://doi.org/10.1007/s11999-009-0989-1
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DOI: https://doi.org/10.1007/s11999-009-0989-1