12th Annual CTOS Meeting 2006

POSTER VIEWING OF SESSION 6

12th Annual CTOS Meeting 2006

Introduction: Prognosis of the patients with sacral chordoma is dismal. Surgical treatment with tumor-free margin often results in severe complication, whereas intralesional margin leads to high rate of local recurrence. Recently, carbon ion radiotherapy is being performed for the patients of sacral chordoma. Difference of the clinical outcome of these treatments is still unknown.

Aim: To evaluate the clinical outcome for the patients

of sacral chordoma with surgical treatment or carbon ion radiotherapy as a conservative therapy. To clarify the criteria to determine the treatment modality for the patients with sacral chordoma

Patients: 15 casesSince 1990, No previous treatmentOriginated in sacrum, Diagnosed as a chordoma pathologically

Methods: treatment, pre- or post- operative symptoms, highest level of tumor, complications, walking ability, prognosis

Treatment for sacral chordoma; surgery or carbon ion radiotherapy

ABSTRACT 668

12th Annual CTOS Meeting 2006

Surgery Carbon ion

free gait: 4 casesone cane: 4wheel chair: 1

walkingability

free gait: 3 casesone cane: 3

prognosis NED 5 casesDOD 1

urinary, anorectaldysfunction : 4/6

urinary, anorectaldysfunction : all cases

NED 5 casesAWD 3 DOD 1

complications

Results

Complications, ADL, prognosis

Urinary, anorectal 　 worsen in surgical therapy

Criteria to determine the treatment modality

One S2 root can be preservedWide margin can be obtained

ADL, prognosis 　 surgery

Surgery = Carbon ion

Discussion

surgery

Not otherwise = carbon ion radiotherapy

Conclusion•Clinical outcome for 15 cases with sacral chordomawas analyzed.•Urinary, anorectal function was worsened in cases with surgical treatment•Cabon ion radiotherapy is good therapeutic tool for sacral chordomas with less complications

12th Annual CTOS Meeting 2006

Radiation Induced Pathologic Fractures After Surgery for Soft Tissue Sarcomas

Kevan Saidi, Anthony Griffin, Peter Ferguson, Robert Bell, Jay WunderKevan Saidi, Anthony Griffin, Peter Ferguson, Robert Bell, Jay WunderThe　Musculoskeletal　Oncology　Unit,　Mount　Sinai　Hospital,　The　University　of　Toronto,　Canada

Aim of Study:

• Determine healing rates of radiation induced fractures

• Determine results of surgical management

• Fracture Fixation vs Endoprosthetic Replacement

Background:

• Previous studies established risk factors for fracture

• Helmstedter (CORR 2001) - prophylactic IM nail with periosteal stripping

• Lin (CORR 1998) - Consider primary arthroplasty in proximal & distal femur fractures

Methods:

• Retrospective review 1986 to present

• 32 patients with 34 fractures (2 acetabular fractures - 1o THA)

12th Annual CTOS Meeting 2006

Radiation Induced Pathologic Fractures After Surgery for Soft Tissue Sarcomas

Results: 11 of 34 Fractures Healed (32%)

• Femur: 25% (3/12) proximal 12% (1/8) diaphysis 50% (1/2) distal healed• Tibia: 100% (2/2) proximal 33% (1/3) diaphysis• Others: 60% (3/5) patella, metatarsals

• 5/16 (31%) healed after periosteal stripping• 4/9 (44%) Men & 7/23 (30%) Women Healed

• 2/8 (25%) healed after 50 Gy• 9/24 (38%) healed after 66 Gy

• Risk Factors For Fracture (Holt, JBJS 2005): • Females > 50, High Dose Radiation (60 or 66 Gy), Proximal 2/3 Femur

Conclusion:• Fractures of the proximal 2/3 of the femur and diaphysis of tibia are at high

risk of non-union• Primary endoprosthetic replacement should be considered when treating

pathologic radiation induced fractures of the proximal femur

4.5 yrsOR x 25 yrs

12th Annual CTOS Meeting 2006

A multivariate analysis of a series of 382 primary retroperitoneal sarcomas (RPS) from the French Association of SurgeryCastaing M1, Laplanche A1 (statisticians),

Bonvalot S1, Rivoire M2, Stoeckle E3 (surgeons), for the French Association of Surgery1 Gustave-Roussy Institute, Villejuif, France; 2 Léon Bérard Center, Lyon, France;3 Bergonié Institute, Bordeaux, France.

Introduction: no consensus concerning the precise value of the extent of surgery and the value of additional treatment modalities

Material & methods: retrospective national study

Aim of the study:to define the best surgical technique to achieve clear margins and determine prognostic factors for abdominal recurrences and patient survivalDefinitions of surgery1. Systematic complete resection: complete or partial resection of non-involved contiguous organs to achieve wide margins 2. Contiguously involved organ resection3. Simple complete resection of the tumor with grossly negative margins 4. Re-excision: systematic complete surgery after previous simple resection

12th Annual CTOS Meeting 2006

Results discussion

15111320263649847811182838588514711237991621410172331516695116

0%

20%

40%

60%

80%

100%

0 1 2 3 4 5 6 7 8Years

Ab

do

min

al r

ec

urr

en

ce

ra

te

Simple complete resection (median=2.5 years)Contiguously involved organ resection (median=2.5 years)Re-excision (median not reached)Systematic complete resection (median=9 years)

logrank : p < 0.0001

Patients at risk 2741588211215219525330430456488121165210271335348111622304476

2568142545

0%

20%

40%

60%

80%

100%

0 1 2 3 4 5 6 7 8Years

Su

rviv

al

No spilling of the tumor (median=8.5 years)No macroscopic residual (median=7 years)Spilling of the tumor (median=1.5 years)Macroscopic residual (median=1 year)

Patients at risk

Overall survival

• TUMOR GRADE• SPILLING OF THE TUMOR • MACROSCOPIC RESIDUAL (Yes/No)

Prognostic factors (multivariate)

Abdominal recurrences• TYPE OF SURGERY (1/2/3/4)• TUMOR GRADE (1/2/3)• SPILLING OF THE TUMOR (Yes/No)• PRE OPERATIVE BIOPSY (Percut/Surg/No)• NB OF TREATED PATIENTS PER CENTER (<10, 10-30, >30)

Conclusions: systematic complete surgery, percutaneous pre operative biopsy, no spilling of the tumor. Additional treatment modalities need further investigation.

p < 0.0001 for both

12th Annual CTOS Meeting 2006

Factors Predicting Actual Long-term Survival After Soft Tissue

Sarcoma Pulmonary Metastasectomy

Richard R. Smith M.D.*, Youngji Pak M.S.#, William G. Kraybill M.D.*, and John M. Kane III M.D.*

Department of Surgical Oncology* and Biostatistics#Roswell Park Cancer Institute and State University of

New York at Buffalo

Abstract 707

12th Annual CTOS Meeting 2006

INTRODUCTION AND METHODS

• There were an estimated 9,420 soft tissue sarcomas (STS) in the United States in 2005 with 3490 deaths. Approximately 20-25% of all STS patients will develop pulmonary metastases and 70% of these patients will have disease confined to the lungs. Pulmonary metastasectomy (PM) has been employed as a potentially curative therapy for isolated lung metastases with a reported 3 year overall survival (OS) of 30-42%. Factors predictive of post-PM survival include completeness of resection, number of metastases, tumor doubling time, and disease-free interval. Unfortunately, even with complete resection, recurrence occurs in 45-83% of patients. The purpose of this study was to examine the factors predictive of actual long-term survival in STS patients undergoing PM with greater than 5 years of follow-up.

• The records of all STS patients undergoing PM from January 1976 - December 2000 were identified through a computerized coding search of sarcoma patients who underwent pulmonary resection. Ninety-nine patients were identified and 94 patients had complete follow up information for a minimum of 5 years. The hospital and outpatient records were reviewed for each patient to collect the clinicopathologic variables. For care received outside of the institute, records and correspondence from outside physicians were reviewed.

• Five year actual disease-free survival (DFS) and OS were calculated for all patients. The complete resection (R0) group was also examined as a subgroup. Data analysis was performed by software package SAS, version 9.1. Fisher’s exact test, test, and Cochran-Armitage trend test were used to assess the statistical significance of associations between expressions of resection margin (R) and other clinicopathologic variables. Univariate survival analysis was done using Kaplan-Meier method; difference in survival curves was assessed with the log-rank test. Multivariate survival analysis was done via Cox’s proportional hazard model. Hazard Ratios (HR) and 95 % Confidence Interval were calculated based upon parameters estimates from the finally fitted Cox’s proportional hazard model. P-values less than 0.05 were considered to be significant.

12th Annual CTOS Meeting 2006

Results and Conclusions• RESULTS• Median age for the 94 patients undergoing pulmonary metastasectomy (PM) was 49 years (range 9-75 years).• Median time from diagnosis to metastasis was 15 months (range 0-176 months) .• Median follow-up was 99 months (range 65-206 months).

• The 30 day surgical mortality was 3.7%. • 34 patients (36%) had concomitant extra-pulmonary disease that was resected in a staged fashion with PM. • 73 patients (78%) underwent a complete pulmonary metastasectomy with microscopically negative margins (R0). • 33 patients (35%) underwent subsequent re-resections of recurrent pulmonary metastatic disease.

• The actual 5 year DFS and OS for the entire group were 5% and 15%, respectively.• The actual 5 year DFS and OS for the R0 group were 7% and 18%, respectively.• Median OS of the R0 group was 22 months (range 1-206) vs. 11.5 months (range 5-126) for R1 vs. 9.5 months (range 0-24) for R2

(P < 0.0001).

• On univariate analysis, variables significantly associated with OS included: resection status, disease-free interval ≤ vs. > 15 months, bilateral metastases, and number of metastases.

• On multivariate analysis, only resection status and disease-free interval were significantly associated with OS.

• CONCLUSIONS• Less than 20% of soft tissue sarcoma patients undergoing pulmonary metastasectomy will be alive 5 years after resection of their

metastatic disease and the majority of these patients will have active sites of disease.

• A prolonged disease-free interval (> 15 months from primary diagnosis to metastatic disease) and complete negative margin resection of all pulmonary metastases are the only variables associated with improved overall survival.

• Surgically treatable recurrence at the primary tumor site, extension of lung metastases into the thorax, and re-resection of subsequent pulmonary recurrences do not negatively impact upon overall survival following pulmonary metastasectomy.

• Pulmonary metastasectomy for soft tissue sarcomas remains the primary, potentially curative treatment for patients with lung metastases as long as all known disease can be resected with negative margins.

12th Annual CTOS Meeting 2006

ILP: abstracts 598, 678,684 • AB 598: Efficacy of TNF ILP for locally advanced soft tissue

sarcoma, is it dose dependent? Ido Nachmany et al. • 35 pts with 3-4 mg CR 37% limb preservation 85%• 17 pts low dose CR 1/17, most had amputation

• AB 678: Single agent experience for hyperthermic ILP of extremity sarcoma. M. Moller et al

• 15 pts HILP with melphalan alone: overall initial CR 100%• Overall limb salvage 90%, local recurrence rate 40%

• AB 684: ILP for unresectable extremity sarcoma C. Wray et al.• Study 1: TNF and melphalan: 16 pts 56% PR, 50 % limb salvage• Study 2: Doxorubicine: 12 pts no CR no PR, 8/12 amputations, 6

rhabdomyolisis

12th Annual CTOS Meeting 2006

Cover of soft tissue defect after surgery

• AB 575: Use of human allogenic virus inactivated acellular dermal matrix populated with autologous fibroblasts to close soft tissue defects after sarcoma resection. E Roessner et al.

• Tissue donations, skin was virus inactivated, kinetic of fibroblast demonstrated good cell proliferation. 2 pts successfully treated.

• AB 562: CHEST WALL RESECTIONS FOR SARCOMA - THE NORTH OF ENGLAND EXPERIENCE Craig Gerrand et al.

• AB 609: STABLE AND WELL VASCULARISED COVER AFTER WIDE EN BLOC RESECTION OF THE STERNAL BONE Lene Birk-Soerensen et al.

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FIBROMATOSIS

• [Abstract ID:613] DESMOIDS: INITIAL PRESENTATION DETERMINES OUTCOME Eberhard Stoeckle et al. 95 pts, . A differentiated approach, favoring first-line medical treatment should be done in the shoulder girdle, pelvic girdle, thoracic wall

• [Abstract ID:708]LONG TERM DISEASE CONTROL IN PATIENTS (PTS) WITH DESMOID FIBROMATOSIS MANAGED WITH MULTIMODALITY THERAPY Chandrajit P Raut et al. 57 pts, intra and extra abdominal. In the setting of unresectable DF, treatment with chemotherapy may be associated with disease stability or partial response.

12th Annual CTOS Meeting 2006

AB 723: Prognostic value of unplanned excision of a soft tissue sarcoma on subsequent outcome

H. Wafa et al.

• 316 pts with a previous unplanned surgery• 281 had reexcision, 56% had residual tumor• Factors affecting LR recurrence: High grade,

MPNST, and myxofibrosarcoma• No residual tumor on reexcision affected

survival