Patterns of recurrence in patients with high-grade soft-tissue sarcomas

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J - 25 Feb 2006 21:24 GMT

http://www.jco.org/cgi/content/abstract/3/3/353
Patterns of recurrence in patients with high-grade soft-tissue sarcomas
Journal of Clinical Oncology, Vol 3, 353-366, Copyright © 1985 by American
Society of Clinical Oncology

DA Potter, J Glenn, T Kinsella, E Glatstein, EE Lack, C Restrepo, DE
White, CA Seipp, R Wesley and SA Rosenberg

From July 1975 to December 1982, 563 patients were referred to the Surgery
Branch of the National Cancer Institute with the diagnosis of soft-tissue
sarcoma. T

hree hundred and seven of these patients had fully resectable, localized
high-grade soft-tissue sarcomas and were treated at the National Cancer
Institute using standard protocols with surgery alone, or in combination
with chemotherapy and/or radiotherapy.

An aggressive surgical approach was undertaken in the management of
patients who subsequently developed recurrent disease.

These 307 cases have been reviewed, with a median duration of follow-up of
30 months, to determine the frequency of recurrent disease, the patterns
of recurrence, and the impact of surgery on the survival of patients who
developed recurrent disease.

Disease recurred in one hundred seven patients (107/307, 35%), with a
median disease-free interval of 18 months (range, 0.5 to 72.0 months).

The frequency of recurrence by site of primary sarcoma was extremity, 31%
(65/211); head and neck, 33% (4/12); trunk, 40% (17/42); retroperitoneum,
47% (17/36); and breast, 67% (4/6).

Isolated pulmonary metastatic disease was the most common pattern of
initial recurrence (56/107, 52%) followed by isolated local recurrence
(21/107, 20%).

Single other sites of recurrence and multiple concurrent sites of
recurrence each accounted for 14% (15/107) of all initial recurrences.

The relative frequency of each of these four patterns of recurrence varied
with the site of the primary sarcoma.

The outcome for patients with recurrent disease depended on the site of
recurrence, rather than on the site of the primary sarcoma.

Sixty-six patients (66/107, 62%) with recurrent disease were rendered
surgically disease-free with the first recurrence, including 40 (40/56,
72%) patients with isolated pulmonary metastases, 20 patients (20/21, 96%)
with isolated local recurrences, five patients (5/15, 33%), with isolated
other sites of recurrence and one patient (1/15, 7%) with multiple sites
of initial recurrence.

Following surgical resection, the actuarial three-year survival for the 66
patients rendered disease-free was 51%. The median survival for the 41
patients not rendered surgically disease-free with the first recurrence
was only 7.4 months.

Thirty of the sixty-six patients (30/66, 45%) rendered disease-free with
the first recurrence remained disease-free at follow-up, with a median
follow-up of 28 months from the time of resection of the first recurrence.

The remaining 36 patients (36/66, 55%) subsequently recurred, with a
median disease-free interval of 7.3 months.(ABSTRACT TRUNCATED AT 400
WORDS)

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J - 25 Feb 2006 21:34 GMT

http://www.meb.uni-bonn.de/cancer.gov/CDR0000062820.html

Treatment of recurrent soft tissue sarcomas depends on the type of initial
presentation and treatment. Patients who develop a local recurrence often can
only be salvaged by aggressive local therapy: local excision plus radiation
therapy after previous minimal therapy or amputation after previous aggressive
treatment. [1] [2] For selected patients who received radiation therapy,
preoperative radiation therapy and wide local excision may avoid the need for
amputation. [3] [4] [5] Metastases to the lung as first recurrence usually
occur within 2 to 3 years of initial diagnosis and should be treated as
described under treatment for stage IV disease. [6] [7] [8] A 30% survival
rate at 3 years is noted if limited pulmonary metastases are resectable.

Doxorubicin alone or with dacarbazine is one of the most frequently used
chemotherapeutic regimens for advanced sarcoma. [9] [10] [11] When used as
single agents, only doxorubicin and ifosfamide show response rates >20%; less
active drugs include dacarbazine, cisplatin, methotrexate, and vinorelbine.
[12] Pegylated liposomal doxorubicin has shown similar activity to
doxorubicin, with fewer toxic effects, in a small study. [13][Level of
evidence: 3iiiDiii] A randomized trial of 340 patients with advanced sarcoma
showed a higher response rate (32% vs. 17%, P<.002) and longer
time-to-progression (6 vs. 4 months, P<.02) for doxorubicin, dacarbazine,
ifosfamide, and mesna versus doxorubicin and dacarbazine alone. [14][Level of
evidence: 1iiDii] Sequential use of doxorubicin followed by ifosfamide or
other drugs with each subsequent recurrence is frequently preferred. Clinical
trials of phase I and II agents should be considered for subsequent
recurrences. High-dose chemotherapy (with or without transplantation) has not
influenced disease-free or overall survival in published studies, but it
remains under clinical evaluation for patients with metastatic disease in
first complete remission, after resection of pulmonary metastases, or for
inoperable large primaries. [15] [16] [17] Information about ongoing clinical
trials is available from the NCI Web site.

http://www.clinicaltrials.gov/ct/gui/screen/Browse Sarcoma &recruiting
ClinicalTrials.gov 152 studies were found

http://www.acor.org/cnet/62820.html
Visceral disease
Adult Soft Tissue Sarcoma
Document Last Modified:05/05/2005

With distant metastases, surgery with curative intent is possible for patients
with limited pulmonary metastases who are also undergoing or have undergone
complete resection of the primary tumor.[10][11][12] The role of adjuvant
therapy for pulmonary nodules is under clinical evaluation.[13]

The value of resection of hepatic metastases is unclear.

Doxorubicin alone or with dacarbazine is considered one of the most frequently
used chemotherapeutic regimens for advanced sarcoma.[14][15][16] When used as
single agents, only doxorubicin and ifosfamide show >20% response rates; less
active drugs include dacarbazine, cisplatin, methotrexate, and
vinorelbine.[17]

A randomized trial of 340 patients with advanced sarcoma showed a higher
response rate (32% vs. 17%, P<.002) and longer time-to-progression (6 vs. 4
months, P<.02) for doxorubicin, dacarbazine, ifosfamide, and mesna versus
doxorubicin and dacarbazine alone.[18][Level of evidence: 1iiDii]

For older patients, sequential use of single agents with each recurrence is a
better strategy for palliation.

High-dose chemotherapy (with or without transplantation) has not influenced
disease-free or overall survival in published studies so far, but it remains
under clinical evaluation for patients with metastatic disease in first
complete remission, after resection of pulmonary nodules, or for inoperable
large primaries.[19]

For GISTs, preliminary evidence indicates that imatinib mesylate, a tyrosine
kinase inhibitor, induced sustained tumor response in patients with
unresectable or metastatic tumors.[2][3][4][Level of evidence: 3iiiDiii]

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