« a clear cell sarcoma » 2007-11383 fn. 25 year-old male january 2007 3cm mass on the medial side...
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25 year-old male
January 2007 3cm mass on the medial side of the right heel
Early August 20073 cm clinical right inguinal massPreoperative MRI (images unavailable)
End August 2007General hospital: surgical biopsy of the right
heel massPathology (reviewed): clear cell sarcomaNo molecular analysis
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PET-CT
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September 2007 Clinical residual mass (4 cm) on the right
heel with skin infiltration Right inguinal mass (3 cm) Post surgical biopsy PET CT Chest CT: No lung metastases
Amputation?Heel surgery with free flapInduction chemotherapy?ILP?Inguinal lymph node dissection?Radiotherapy?
What do you propose?
Sarcoma board• Metastatic disease (inguinal lymph nodes)• Conservative surgery not feasible
Upfront systemic treatment• Doxorubicin/Dacarbazine - 3 cycles
→ Stable disease (Mass 4 cm heel + Right 3 cm inguinal mass , no lung metastasis)
What next ???
September 2007 2007-11383 FN2007-11383 FN
Isolated limb perfusion
• Melphalan 80 mg and TNF alpha 1 mg
• 1h (38°Celsius)
• + Inguinal lymph node dissection with sartorius
muscular flap
Pathological analysis
• Lymph nodes metastases of clear cell sarcoma
(2 N+ / 9)
2007-11383 FNJanuary 2008
February 2008
RECIST PR: 26mm x 20mmModerate vascularization after dynamic injection = sign of good
response
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March 2008Radiotherapy (45 Gy on the heel, 65 Gy on the inguinal region)Ended in May 2008 RECIST CR
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Doxorubicin/Dacarbazine started in February 2011
Patient deceased in March 2011 (+ 4 years after diagnosis)
March 2011 2007-11383 FN