Analysis of potential risk factors in the survival of patients with primary retroperitoneal liposarcoma / Análisis de los potenciales factores de riesgo en la supervivencia de pacientes con liposarcoma retroperitoneal primario

Introduction: The present work is an observational study of a series of variables regarding overall survival and disease-free survival in patients diagnosed with primary liposarcoma.Methods: The study is prospective with retrolective data collection that includes all patients with primary liposarcoma referred to Hospital Son Espases University Hospital, Palma de Mallorca, Spain from January 1990 to December 2019.Results: The study includes 50 patients and the compartment surgery was performed in 18 patients (36%) of cases. The mean overall survival of the sample was 15.57 years (95% CI: 12.02–19.12) and the mean disease-free survival was 6.70 years (95% CI: 4.50–8.86). Conclusion: Compartment surgery has not shown benefits in terms of overall survival and disease-free survival. The ASA classification (≥3) predicts a poor prognosis in both overall survival and disease-free survival. Resection with free margins, described on the pathological results and defined in this work as R0, show better disease-free survival. (AU)

Introducción: El presente trabajo es un estudio observacional de una serie de variables relacionadas con la supervivencia global y la supervivencia libre de enfermedad en pacientes diagnosticados de liposarcoma primario. Métodos: Este es un estudio prospectivo con recolección de datos retrolectiva que incluye a todos los pacientes con liposarcoma primario remitidos al Hospital Son Espases en Palma de Mallorca, desde enero de 1990 hasta diciembre de 2019. Resultados: El estudio incluye 50 pacientes y la cirugía compartimental se realizó en 18 (36%) de ellos. La supervivencia global media de la muestra fue de 15,57 años (IC 95% 12,02-19,12) y la supervivencia libre de enfermedad media fue de 6,70 años (IC 95% 4,50-8,86). Conclusiones: La cirugía compartimental no ha mostrado beneficios en términos de supervivencia general y supervivencia libre de enfermedad. La clasificación ASA (≥3) predice un mal pronóstico tanto en la supervivencia global como en la supervivencia libre de enfermedad. La resección con márgenes libres, descrita en los resultados patológicos y definida en este trabajo como R0, muestra una mejor supervivencia libre de enfermedad. (AU)

Analysis of potential risk factors in the survival of patients with primary retroperitoneal liposarcoma.

INTRODUCTION: The present work is an observational study of a series of variables regarding overall survival and disease-free survival in patients diagnosed with primary liposarcoma. METHODS: The study is prospective with retrolective data collection that includes all patients with primary liposarcoma referred to Hospital Son Espases University Hospital, Palma de Mallorca, Spain from January 1990 to December 2019. RESULTS: The study includes 50 patients and the compartment surgery was performed in 18 patients (36%) of cases. The mean overall survival of the sample was 15.57 years (95% CI: 12.02-19.12) and the mean disease-free survival was 6.70 years (95% CI: 4.50-8.86). CONCLUSION: Compartment surgery has not shown benefits in terms of overall survival and disease-free survival. The ASA classification (≥3) predicts a poor prognosis in both overall survival and disease-free survival. Resection with free margins, described on the pathological results and defined in this work as R0, show better disease-free survival.

Analysis of potential risk factors in the survival of patients with primary retroperitoneal liposarcoma.

INTRODUCTION: The present work is an observational study of a series of variables regarding overall survival and disease-free survival in patients diagnosed with primary liposarcoma. METHODS: The study is prospective with retrolective data collection that includes all patients with primary liposarcoma referred to Hospital Son Espases University Hospital, Palma de Mallorca, Spain from January 1990 to December 2019. RESULTS: The study includes 50 patients and the compartment surgery was performed in 18 patients (36%) of cases. The mean overall survival of the sample was 15.57 years (95% CI: 12.02-19.12) and the mean disease-free survival was 6.70 years (95% CI: 4.50-8.86). CONCLUSION: Compartment surgery has not shown benefits in terms of overall survival and disease-free survival. The ASA classification (≥3) predicts a poor prognosis in both overall survival and disease-free survival. Resection with free margins, described on the pathological results and defined in this work as R0, show better disease-free survival.

Role of structures in the masticator space in selecting patients with resectable T4b oral cancer: findings from a survival analysis.

Oral squamous cell cancers involving the masticatory space are staged as unresectable cancers and their treatment is difficult. Curative treatment with extensive surgery followed by adjuvant therapy is one of the treatment options. In this retrospective study, the survival of 123 patients (93 with T4a cancers, 30 with T4b cancers), treated during the period August 2009 to August 2015, was evaluated. The majority had bucco-alveolar cancers (62.6%), were male (61.8%), and were tobacco users (76.4%). The select group of T4b oral cancer patients were treated with surgery, which included infratemporal fossa clearance in all 30 patients, followed by adjuvant therapy. The masseter was the most commonly involved masticatory muscle, and 24 patients had fewer than three involved structures. Free margins were obtained in 90.2% of cases; 41.5% of cases were node-positive. One hundred and four patients (84.6%) completed adjuvant treatment. The median follow-up was 42 months. For node-negative patients with T4a and T4b cancers, the 5-year overall survival was 59% and 50.2%, respectively (P= 0.62), and 5-year disease-free survival was 64.6% and 53.5%, respectively (P= 0.01). In conclusion, the select group of patients with T4b oral cancers and less than three masticatory space structures involved had comparable outcomes to those with T4a cancers after treatment with surgery and adjuvant radiotherapy.

Update in pelvic and retroperitoneal sarcoma management: The role of compartment surgery. / Actualización en el manejo de sarcomas retroperitoneales y pélvicos; el papel de la cirugía compartimental.

Surgery for retroperitoneal sarcomas should be "en bloc" compartmental, which involves resection of unaffected organs. Its upfront use is key, providing a high percentage of resections with negative margins, resulting in a better local control and increased survival in many patients. Preservation of organs should be done in an individualized manner, especially in the pelvic location, and adapted to the histological aggressiveness of the tumor. Preoperative biopsy is able to establish the diagnosis of sarcoma subtype and consequently an adequate perioperative strategy. These patients should be managed by expert surgeons at referral centers with multidisciplinary units and oncology committees. The use of chemotherapy and radiotherapy is not yet well defined, so it is only recommended at referral centers with clinical trials. Currently, this is the only option to offer the best morbidity and mortality rates, as well as possible improvements in the survival of these patients.

Compartmental tongue surgery / 中国癌症杂志

Despite the evolution in cancer management and the introduction of multidisciplinary treatment modalities, 5-year overall survival rate of oral cancer remained to be 45-50%. Retrospectively, one patient's prognosis, relapse pattern and survival were determined by clinicopathological parameters. Nevertheless, radical resection with adequate safe margins is crucial for local control in treatment strategy for oral cancer. However, orthogonally muscle orientation of tongue with enriched neurovascular bundles and lymphatic network make it disadvantaged for progressive deep tumor invasion and regional metastasis. Tumor spread along the muscle fibers following the path of least resistance, this thereby reflected the shortcomings of conventional 1-2cm circumferential wide excision. Compartment resection is removal of entire primary lesion along with its entire potential spreading path with an advantage in removing the potential spreading path. Contrary, lymphatic drainage of tongue cancer is outstanding, there is overtly existence of lymphatic vessels and lingual lymph node which occult lymph node metastasis might easily being overshadowed. Routine neck dissection is disadvantaged for unable to reach. Nevertheless, compartmental surgery can overcome it by bringing lingual lymphatic system into surgical ifeld. Compartment resection is more appreciable than conventional 1-2cm wide resection in fuliflling oncological radicality criteria. In summary, we need to explore the characteristic pattern of tumor invasion and metastasis for other subtypes of oral cancer, thereby establishing a location orientated compartment resection, subsequently enhance the radicality of surgical management and strive to improve the survival rate.

Surgical resection with adjuvant brachytherapy in soft tissue sarcoma of the extremity - a case report.

PURPOSE: Surgery is the major therapeutic method in soft tissue sarcomas of the extremity (E-STS). Treatment of large high-grade tumours, which resection cannot be performed with a wide safe margin, should include complementary radiation and/or chemo-therapy. Hopefully, the use of adjuvant brachytherapy will improve the prognosis of E-STS. CASE DESCRIPTION: After a long process of diagnosing a tumour in the medial compartment of the thigh, a 65-year-old woman with diagnosed synovial sarcoma underwent a surgery. Compartment resection was performed and the tumour was removed with a 10 mm safety margin of healthy tissue. Adjuvant brachytherapy was delivered with (192)Ir (MicroSelectron, Nucletron Electa Group, Stockholm, Sweden(®)) with 10 Ci of nominal activity to a dose of 55 Gy in 16 days because of large tumour size (99 × 78 × 73 mm) and its proximity to the neurovascular bundle. No complications were reported. The patient was discharged from the hospital on the 28(th) day after the surgery. The wound healed without any complications and the outpatient follow-up is being continued. DISCUSSION: Adjuvant brachytherapy is rarely used after surgical treatment due to its limited accessibility in hospitals with surgical and orthopaedic departments. There are numerous publications proving positive influence of brachytherapy on local control and decreased number of recurrences. The recurrence-free survival time also increased significantly, however no direct impact on the number of distant metastases was found. Treatment is well tolerated and short. The complication rate varies between centres from 5 to 30%. The most common adverse effects include: peripheral neuropathy, skin necrosis and osteonecrosis of the long bones. CONCLUSIONS: Treatment of large soft tissue sarcomas of the extremity (E-STS) should include combination of surgical intervention and external beam radiotherapy or brachytherapy. Adjuvant brachytherapy improves local control rate up to 78%, is well tolerated and rarely causes complications. We couldn't determine which type of adjuvant radiation therapy is more effective.