case management, presentation, discussion and sharing of information on extremity sarcomas by...
TRANSCRIPT
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CASE MANAGEMENT, CASE MANAGEMENT, PRESENTATION, DISCUSSION PRESENTATION, DISCUSSION
AND SHARING OF AND SHARING OF INFORMATION ON INFORMATION ON
EXTREMITY SARCOMASEXTREMITY SARCOMAS
byMichael Angelo L. Suñaz, M.D.
Department of SurgeryOspital ng Maynila Medical Center
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CASE MANAGEMENT, CASE MANAGEMENT, PRESENTATION, DISCUSSIONPRESENTATION, DISCUSSION
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E.A., 63/ME.A., 63/MBINAN, LAGUNABINAN, LAGUNA
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CHIEF COMPLAINT: NON-HEALING WOUND ON THE RIGHT GLUTEAL
AREA
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HISTORY OF PRESENT ILLNESS:HISTORY OF PRESENT ILLNESS:
4 months PTA, the patient noted a pimple-like lesion on his right gluteal area. No other associated signs and symptoms were noted.
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HISTORY OF PRESENT ILLNESS:HISTORY OF PRESENT ILLNESS:
3 ½ months PTA, the mass was noted to have increased in size. Consultation of a private physician was done and he was prescribed with unrecalled medications which afforded no relief.
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HISTORY OF PRESENT ILLNESS:HISTORY OF PRESENT ILLNESS:
2 weeks PTA, the mass persisted and was now associated with occasional pain and undocumented fever.
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HISTORY OF PRESENT ILLNESS:HISTORY OF PRESENT ILLNESS:
Persistence of his condition prompted consultation and subsequent admission.
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PAST MEDICAL Hx:
unremarkable
FAMILY Hx:
HPN - paternal side
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PERSONAL/SOCIAL Hx:
- no history of smoking or alcoholic beverage intake
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PHYSICAL EXAMINATION:PHYSICAL EXAMINATION:
G/S: conscious, coherent, not in cardiorespiratory distress
BP= 120/70 CR=83 RR= 19 T=38.20C
SHEENT: no jaundice; pink palpebral cojunctiva,anicteric sclera, No NAD, No CLAD, No TPC
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PHYSICAL EXAMINATION:PHYSICAL EXAMINATION:
C/L: SCE, no retractions, clear BS
CVS: adynamic precordium, NRRR, no murmur
Abdomen: flat; soft; no palpable masses
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PHYSICAL EXAMINATION:PHYSICAL EXAMINATION:
Extremities: 10 x 13 cm firm, slightly movable, ulcerating mass, tender only upon deep palpation towards the right gluteal area
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SALIENT FEATURES:SALIENT FEATURES:63 y/o, M10x13 cm firm, slightly movable,
rapidly growing ulcerating mass tender only upon deep palpation towards the right gluteal area
Occasional pain on the affected area Fever (38.20C)
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10x13 cm firm, nontender, slightly movable, rapidly growing ulcerating
mass on the right gluteal area
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10x13 cm firm, nontender, slightly movable, rapidly growing ulcerating
mass on the right gluteal area
•Rapidly growing
•With associated fever
•Tenderness only upon deep palpation in the direction of the gluteal area
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10x13 cm firm, nontender, slightly movable, rapidly growing ulcerating
mass on the right gluteal area
•Rapidly growing
•With associated fever
•Tenderness only upon deep palpation in the direction of the gluteal area
Infectious Neoplastic
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Clinical Diagnosis:Clinical Diagnosis:
Diagnosis Certainty Treatment
Neoplastic Disease
75% Surgical
Infectious Disease
25% Surgical/
Medical
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BASES:BASES:63 y/o, M10x13 cm firm, slightly movable,
rapidly growing ulcerating mass tender only upon deep palpation towards the right gluteal area
Occasional pain on the affected areaFever (38.20C)
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Do I need a para-clinical diagnostic Do I need a para-clinical diagnostic procedure?procedure?
YES
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Paraclinical Diagnostic ProceduresParaclinical Diagnostic Procedures
Benefit Risk Cost Availability
Biopsy
Can provide a histopathologic diagnosis to determine the primary treatment of the lesion.
Bleeding
Pain+
Readily available
MRI
Accurately delineates muscle groups and distinguishes between bone, vascular structures, and tumor. Sagittal and coronal views allow 3D evaluation of anatomical compartments.1
none ++++Not readily available
CT SCAN
Provide detailed survey of the abdomen and pelvis and delineate adjacent organs and vascular structures.1
Radiation Exposure
+++Not readily available
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Paraclinical Diagnostic ProceduresParaclinical Diagnostic Procedures
CT Scan of the Pelvis (9/29/08)– A mixed density mass with areas of
necrosis is seen arising from the right gluteus maximus muscle infiltrating into the subcutaneous fat measuring about 14 x 12.25 x 9.26 (CC x W x AP). The mass displaces the anal opening to the left.
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Paraclinical Diagnostic ProceduresParaclinical Diagnostic Procedures
CT Scan of the Pelvis (9/29/08)– There are no enlarged lymph nodes.– No osteolytic nor blastic changes seen.
Osteophytes are noted along the iliac margins and vertebral endplates.
– The included bowel loops, prostate and urinary bladder are unremarkable.
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Paraclinical Diagnostic ProceduresParaclinical Diagnostic Procedures
CT Scan of the Pelvis (9/29/08)
IMPRESSION: – Right gluteal mass, consider
sarcoma.– Tissue correlation suggested.– Degenerative osseous changes,
pelvis.
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10x13 cm firm, nontender, slightly movable, rapidly growing ulcerating
mass on the right gluteal area
•Rapidly growing
•With associated fever
•Tenderness only upon deep palpation in the direction of the gluteal area
Infectious Neoplastic
Sarcoma
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Paraclinical Diagnostic ProceduresParaclinical Diagnostic Procedures
CXR (9/3/08)
Both lungs are clear.
The aorta is sclerotic.
The heart is not enlarged.
Diaphragm and sulci are intact.
IMPRESSION: Atheromatous Aorta .
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Paraclinical Diagnostic ProceduresParaclinical Diagnostic Procedures
Liver Ultrasound (9/3/08)
The liver is not enlarged. The ducts are not dilated. The echo pattern is homogenous. No focal mass lesion is seen.
IMPRESSION: Negative study.
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Paraclinical Diagnostic ProceduresParaclinical Diagnostic Procedures
Histopathology result (8/15/08)
GrossThe specimen consists of several
dark brown irregular soft and friable tissues, 4.0 cm in agrregate. The entire specimen is taken for study
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Paraclinical Diagnostic ProceduresParaclinical Diagnostic Procedures
Histopathology result (8/15/08)
Microscopic Microsections disclose loose aggregates of
malignant round cells exhibiting marked hyperchromasia, anisoneuclosis and prominent nucleoli. These have marked eosinophilia and moderate polymorphism. Some tumor giant cells are seen. These are admixed with necrotic and inflammatory material.
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Paraclinical Diagnostic ProceduresParaclinical Diagnostic Procedures
Histopathology result (8/15/08)
MALIGNANT ROUND CELL TUMOR, fragments of, admixed with abscess material.
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10x13 cm firm, nontender, slightly movable, rapidly growing ulcerating
mass on the right gluteal area
•Rapidly growing
•With associated fever
•Tenderness only upon deep palpation in the direction of the gluteal area
Infectious Neoplastic
Sarcoma
Malignant Round Cell Liposarcoma
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Pretreatment Diagnosis:Pretreatment Diagnosis:
Diagnosis Certainty Treatment
Malignant Round Cell Liposarcoma
95% Surgical/ Neoadjuvant,
Adjuvant Therapy
Gluteal Abscess 5% Surgical/ Medical
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TREATMENTTREATMENT
PRETREATMENT DIAGNOSIS:
MALIGNANT ROUND CELL LIPOSARCOMA, RIGHT GLUTEAL
AREA
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TREATMENTTREATMENT
GOALS OF TREATMENT:– Curative extirpation of the tumor
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TREATMENT OPTIONSTREATMENT OPTIONSTREATMENT BENEFIT RISK COST AVAIL
En bloc Surgical Resection
Removal of the gross tumor.
Primary treatment modality.2
Local recurrence if done with inadequate margins.
Bleeding.
May require contiguous organ resection.2
++ Available
Pre-operative Radiation Therapy
Allows early multidiscipli-
nary planning while the tumor is in place.1
Allows lower doses to be delivered to an undisturbed tissue bed that is better oxygenated.1
Difficulty with pathological assessment of margins and increased incidence of wound complications.1
++++ Not readily available
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TREATMENT OPTIONSTREATMENT OPTIONSTREATMENT BENEFIT RISK COST AVAIL
Pre-operative Radiation Therapy
Size of the pre-operative radiation fields and the number of joints included in the field are significantly smaller which may result in an improved functional outcome.1
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TREATMENT OPTIONSTREATMENT OPTIONSTREATMENT BENEFIT RISK COST AVAIL
Post-operative Radiation Therapy
Lower wound complication rate.
Larger radiation field.
++++ Not readily avalable
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TREATMENT OPTIONSTREATMENT OPTIONSTREATMENT BENEFIT RISK COST AVAIL
Brachytherapy Less radiation scatter and much shorter duration of therapy.2
Indicated only in the setting of high-grade lesions.2
Rates of wound complications similar to those of postoperative external beam radiotherapy.2
++++ Not readily avalable
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TREATMENT OPTIONSTREATMENT OPTIONSTREATMENT BENEFIT RISK COST AVAIL
Adjuvant systemic chemotherapy
Statistically significant improvements in local recurrence, distal recurrence,and disease-free survival rates ranging from 6%-10%. 4% improvement in overall survival.2
Potential toxicity.2
++++ Available
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TREATMENT OPTIONSTREATMENT OPTIONSTREATMENT BENEFIT RISK COST AVAIL
Neoadjuvant systemic chemotherapy
Ability to assess tumor responsiveness to the give chemo-therapeutic agents, early treatment of metastatic disease, and downstaging of primary tumor.2
Potential toxicity ++++ Available
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TREATMENT OF CHOICETREATMENT OF CHOICE
WIDE RESECTION AND POST-OPERATIVE RADIATION THERAPY
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PREOPERATIVE PREPARATIONPREOPERATIVE PREPARATION
Informed consentPsychosocial supportOptimize patient’s healthScreen for any condition that will
interfere with treatmentPrepare materials
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OPERATIVE TECHNIQUEOPERATIVE TECHNIQUE
Patient supine under CLEA Asepsis/Antisepsis Sterile drapes placed Intraoperative findings noted: Mass noted
to have extended partially to the serosal layer of the rectum and outermost layer of the sphincter muscle. Gluteus maximus muscle mass and sciatic nerve intact.
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OPERATIVE TECHNIQUEOPERATIVE TECHNIQUE
Wide excision with 1 cm margin; flap created.
HemostasisPlacement of drainCorrect sponge and instrument
countApposition of flap with silk 2-0Dry sterile dressing
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OPERATION DONE:OPERATION DONE:
WIDE RESECTION OF RIGHT GLUTEAL MASS
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POST OPERATIVE DIAGNOSISPOST OPERATIVE DIAGNOSIS
Malignant round cell tumor (liposarcoma), right gluteal area
*Final histopathology report still pending
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SHARING OF INFORMATIONSHARING OF INFORMATION
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SARCOMASSARCOMAS
Refer to tumors that show evidence of mesenchymal differentiation.
1% of adult malignancies 15% of pediatric malignancies
• Singer S, Canter RJ: Soft-tissue sarcoma, in Cameron JL (ed): Current Surgical Therapy 9th Ed. Philadelphia, Mosby, 2008, pp 1101-1105
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EXTREMITY SARCOMASEXTREMITY SARCOMAS
Account for nearly 50% of adult sarcomas.
• Singer S, Canter RJ: Soft-tissue sarcoma, in Cameron JL (ed): Current Surgical Therapy 9th Ed. Philadelphia, Mosby, 2008, pp 1101-1105
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EXTREMITY SARCOMASEXTREMITY SARCOMAS
Most common types :– Liposarcoma– Malignant Fibrous Histiocytoma (MFH)
• Singer S, Canter RJ: Soft-tissue sarcoma, in Cameron JL (ed): Current Surgical Therapy 9th Ed. Philadelphia, Mosby, 2008, pp 1101-1105
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EXTREMITY SARCOMASEXTREMITY SARCOMAS
Liposarcomas:– Well-differntiated– Myxoid/ round-cell– Pleomorphic
• Singer S, Canter RJ: Soft-tissue sarcoma, in Cameron JL (ed): Current Surgical Therapy 9th Ed. Philadelphia, Mosby, 2008, pp 1101-1105
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EXTREMITY SARCOMASEXTREMITY SARCOMAS
Diagnosis– Comprehensive history and PE– Mass is the most common presenting
complaint– Frequently, a trivial traumatic event draws
attention to the area (although there is probably no causal relation between a history of trauma and the development of a sarcoma).
• Singer S, Canter RJ: Soft-tissue sarcoma, in Cameron JL (ed): Current Surgical Therapy 9th Ed. Philadelphia, Mosby, 2008, pp 1101-1105
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EXTREMITY SARCOMASEXTREMITY SARCOMAS
Diagnosis– Core needle biopsy
Typically performed as the first step Can diagnose the presence of a sarcoma
and grade it in 80% of the cases. For histologic type, it has an accuracy of
75%.
• Singer S, Canter RJ: Soft-tissue sarcoma, in Cameron JL (ed): Current Surgical Therapy 9th Ed. Philadelphia, Mosby, 2008, pp 1101-1105
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EXTREMITY SARCOMASEXTREMITY SARCOMAS
Staging– Primary Tumor (T)
Tx – primary tumor cannot be assessed T0 – no evidence of primary tumor T1 – tumor is < or equal to 5 cm in its
greatest dimension• T1a – tumor is above the superficial fascia• T1b – tumor invading or deep to the superficial
fascia
• Delamn KA, Cormier JN: Soft-tissue and bone sarcoma, in Feig BW, Berger DH, Fuhrman GM (ed): The M.D. Anderson Surgical Oncology Handbook 4th ed . Philadelphia, Lippincott Williams and Wilkins, 2006, pp 125
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EXTREMITY SARCOMASEXTREMITY SARCOMAS
Staging– Primary Tumor (T)
T1 – tumor is > 5 cm in its greatest dimension
• T2a – tumor is above the superficial fascia• T2b – tumor invading or deep to the
superficial fascia
• Delamn KA, Cormier JN: Soft-tissue and bone sarcoma, in Feig BW, Berger DH, Fuhrman GM (ed): The M.D. Anderson Surgical Oncology Handbook 4th ed . Philadelphia, Lippincott Williams and Wilkins, 2006, pp 125
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EXTREMITY SARCOMASEXTREMITY SARCOMAS
Regional Lymph Nodes (N)– Nx – regional lymph nodes cannot be
assessed– N0 – no regional lymph node
metastasis– N1 – Regional lymph node metastasis
• Delamn KA, Cormier JN: Soft-tissue and bone sarcoma, in Feig BW, Berger DH, Fuhrman GM (ed): The M.D. Anderson Surgical Oncology Handbook 4th ed . Philadelphia, Lippincott Williams and Wilkins, 2006, pp 125
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EXTREMITY SARCOMASEXTREMITY SARCOMAS
Distant Metastasis (M)– Mx – distant metastasis cannot be
assessed– M0 – no distant mmetastasis– M1 – distant metastasis
• Delamn KA, Cormier JN: Soft-tissue and bone sarcoma, in Feig BW, Berger DH, Fuhrman GM (ed): The M.D. Anderson Surgical Oncology Handbook 4th ed . Philadelphia, Lippincott Williams and Wilkins, 2006, pp 125
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EXTREMITY SARCOMASEXTREMITY SARCOMAS
Histopahological Grade (G)– Gx – Grade cannot be assessed– G1 – well-differentiated– G2 – Moderately differentiated– G3 – poorly differentiated– G4 - undifferentiated
• Delamn KA, Cormier JN: Soft-tissue and bone sarcoma, in Feig BW, Berger DH, Fuhrman GM (ed): The M.D. Anderson Surgical Oncology Handbook 4th ed . Philadelphia, Lippincott Williams and Wilkins, 2006, pp 125
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EXTREMITY SARCOMASEXTREMITY SARCOMAS
Stage Grouping– Stage 1
A – G1-2, T1a-1b, N0, M0 B – G1-2, T2a, N0,M0
• Delamn KA, Cormier JN: Soft-tissue and bone sarcoma, in Feig BW, Berger DH, Fuhrman GM (ed): The M.D. Anderson Surgical Oncology Handbook 4th ed . Philadelphia, Lippincott Williams and Wilkins, 2006, pp 125
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EXTREMITY SARCOMASEXTREMITY SARCOMAS
Stage Grouping– Stage II
A – G1-2, T2b, N0, M0 B – G3-4, T1a-1b, N0,M0 C – G3-4, T2a, N0,M0
• Delamn KA, Cormier JN: Soft-tissue and bone sarcoma, in Feig BW, Berger DH, Fuhrman GM (ed): The M.D. Anderson Surgical Oncology Handbook 4th ed . Philadelphia, Lippincott Williams and Wilkins, 2006, pp 125
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EXTREMITY SARCOMASEXTREMITY SARCOMAS
Stage Grouping– Stage III
G3-4, T2b, N0,M0
• Delamn KA, Cormier JN: Soft-tissue and bone sarcoma, in Feig BW, Berger DH, Fuhrman GM (ed): The M.D. Anderson Surgical Oncology Handbook 4th ed . Philadelphia, Lippincott Williams and Wilkins, 2006, pp 125
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EXTREMITY SARCOMASEXTREMITY SARCOMAS
Stage Grouping– Stage IV
Any G, Any T, N1, M0 Any G, Any T, N0, M1
• Delamn KA, Cormier JN: Soft-tissue and bone sarcoma, in Feig BW, Berger DH, Fuhrman GM (ed): The M.D. Anderson Surgical Oncology Handbook 4th ed . Philadelphia, Lippincott Williams and Wilkins, 2006, pp 125
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TREATMENT OPTIONSTREATMENT OPTIONSTREATMENT BENEFIT RISK COST AVAIL
En bloc Surgical Resection
Removal of the gross tumor.
Primary treatment modality.2
Local recurrence if done with inadequate margins.
Bleeding.
May require contiguous organ resection.2
++ Available
Pre-operative Radiation Therapy
Allows early multidiscipli-
nary planning while the tumor is in place.1
Allows lower doses to be delivered to an undisturbed tissue bed that is better oxygenated.1
Difficulty with pathological assessment of margins and increased incidence of wound complications.1
++++ Not readily available
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TREATMENT OPTIONSTREATMENT OPTIONSTREATMENT BENEFIT RISK COST AVAIL
Pre-operative Radiation Therapy
Size of the pre-operative radiation fields and the number of joints included in the field are significantly smaller which may result in an improved functional outcome.1
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TREATMENT OPTIONSTREATMENT OPTIONSTREATMENT BENEFIT RISK COST AVAIL
Post-operative Radiation Therapy
Lower wound complication rate.
Larger radiation field.
++++ Not readily avalable
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TREATMENT OPTIONSTREATMENT OPTIONSTREATMENT BENEFIT RISK COST AVAIL
Brachytherapy Less radiation scatter and much shorter duration of therapy.2
Indicated only in the setting of high-grade lesions.2
Rates of wound complications similar to those of postoperative external beam radiotherapy.2
++++ Not readily avalable
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TREATMENT OPTIONSTREATMENT OPTIONSTREATMENT BENEFIT RISK COST AVAIL
Adjuvant systemic chemotherapy
Statistically significant improvements in local recurrence, distal recurrence,and disease-free survival rates ranging from 6%-10%. 4% improvement in overall survival.2
Potential toxicity.2
++++ Available
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TREATMENT OPTIONSTREATMENT OPTIONSTREATMENT BENEFIT RISK COST AVAIL
Neoadjuvant systemic chemotherapy
Ability to assess tumor responsiveness to the give chemo-therapeutic agents, early treatment of metastatic disease, and downstaging of primary tumor.2
Potential toxicity ++++ Available
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MCQMCQ
1. Sarcomas comprise how much of adult malignancies?
a. 1%
b. 3%
c. 15%
d. 20%
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MCQMCQ
1. Sarcomas comprise how much of adult malignancies?
a. 1%
b. 3%
c. 15%
d. 20%
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MCQMCQ
2. Sarcomas comprise how much of pediatric malignancies?
a. 1%
b. 3%
c. 15%
d. 20%
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MCQMCQ
2. Sarcomas comprise how much of pediatric malignancies?
a. 1%
b. 3%
c. 15%
d. 20%
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MCQMCQ
3. Extremity sarcomas comprise how much of adult sarcomas?
a. 10%
b. 30%
c. 50%
d. 20%
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MCQMCQ
3. Extremity sarcomas comprise how much of adult sarcomas?
a. 10%
b. 30%
c. 50%
d. 20%
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MCRMCR
A – 1, 2, and 3 are correctB – 1 and 3 are correctC – 2 and 4 are correctD – only 4 is correct E – none are correct
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MCRMCR
I. Which of the following represents stage I soft-tissue sarcoma?1. G1-2, T1a-T1b, N0,M02. G1-2, T2b, N0, M03. G1-2, T2a, N0,M04. Any G, Any T, N1, M0
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MCRMCR
I. Which of the following represents stage I soft-tissue sarcoma?1. G1-2, T1a-T1b, N0,M02. G1-2, T2b, N0, M03. G1-2, T2a, N0,M04. Any G, Any T, N1, M0
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MCRMCR
I. Which of the following represents stage III soft-tissue sarcoma?1. G1-2, T1a-T1b, N0,M02. G1-2, T2b, N0, M03. G3-4, T2a, N0,M04. G3-4, T2b, N0, M0
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MCRMCR
I. Which of the following represents stage III soft-tissue sarcoma?1. G1-2, T1a-T1b, N0,M02. G1-2, T2b, N0, M03. G3-4, T2a, N0,M04. G3-4, T2b, N0, M0
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THANK YOU!!!
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REFERENCESREFERENCES
Delman KA, Cormier JN: Soft-tissue and bone sarcoma, in Feig BW, Berger DH, Fuhrman GM (ed): The M.D. Anderson Surgical Oncology Handbook 4th ed . Philadelphia, Lippincott Williams and Wilkins, 2006, pp 125
Singer S, Canter RJ: Soft-tissue sarcoma, in Cameron JL (ed): Current Surgical Therapy 9th Ed. Philadelphia, Mosby, 2008, pp 1101-1105
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JOURNAL CRITICAL APPRAISALJOURNAL CRITICAL APPRAISAL
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Spinal metastases from myxoid Spinal metastases from myxoid liposarcoma warrant screening with liposarcoma warrant screening with magnetic resonance imagingmagnetic resonance imaging
Joseph H. Schwab, MDJoseph H. Schwab, MD 1 1, Patrick J. Boland, MD, Patrick J. Boland, MD 1 1, Cristina Antonescu, , Cristina Antonescu, MDMD 2 2, Mark H. Bilsky, MD, Mark H. Bilsky, MD 3 3, John H. Healey, MD, John H. Healey, MD 1 * 1 *
11Department of Surgery, Orthopedic Service, Memorial Sloan-Department of Surgery, Orthopedic Service, Memorial Sloan-Kettering Cancer Center, New York, New YorkKettering Cancer Center, New York, New York22Department of Pathology, Memorial Sloan- Kettering Cancer Center, Department of Pathology, Memorial Sloan- Kettering Cancer Center, New York, New YorkNew York, New York33Department of Surgery, Orthopedic and Neurosurgery Services, Department of Surgery, Orthopedic and Neurosurgery Services, Memorial Sloan-Kettering Cancer Center and Medical College of Memorial Sloan-Kettering Cancer Center and Medical College of Cornell University, New York, New YorkCornell University, New York, New York
email: John H. Healey (email: John H. Healey (healeyjhealeyj@@mskccmskcc.org.org))**Correspondence to John H. Healey, Department of Surgery, Correspondence to John H. Healey, Department of Surgery, Orthopedic Service, Memorial Sloan-Kettering Cancer Center, 1275 Orthopedic Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Suite A342, New York, NY 10021York Avenue, Suite A342, New York, NY 10021
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ABSTRACTABSTRACT
Background:– Myxoid liposarcoma (MLS) has an
unusual tendency for extrapulmonary metastasis, particularly to the spine and soft tissues. The objective of this study was to determine the prevalence of spinal metastasis, treatment outcomes, and optimal screening method for spinal metastasis in patients with MLS.
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ABSTRACTABSTRACT
Methods:– Data from patients with had spinal metastases
were obtained from the authors' institutional soft tissue sarcoma database. The accuracy with which positron emission tomography (PET) scans and bone scans identified metastatic lesions was compared with the accuracy of magnetic resonance imaging (MRI). Clinical response to treatment was based on pain, neurologic scores, and survivorship analysis.
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ABSTRACTABSTRACT
Results:– There were 33 patients who developed
spinal metastasis after a median 36 months of follow-up (range, from 7.5 months to 33 years). Known spinal metastases were detected by bone scans in 16% of patients and by PET scans in 14% of patients.
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ABSTRACTABSTRACT
Results:– Patients who underwent surgery had high-
grade spinal cord compression more often than patients who did not undergo surgery (72% vs 19%, respectively; P = .002). Pain and neurologic function were improved or maintained in all patients who received radiation alone (n = 8 patients) and in all but 1 patient who underwent surgery (n = 18 patients). The median overall survival was 51.4 months from the time of primary diagnosis and 21.9 months from the time of first metastasis.
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ABSTRACTABSTRACT Conclusions:
– Bone scans and PET scan lack sufficient sensitivity to detect spinal metastasis from MLS. Treatment of metastasis is palliative, but local treatment can yield long-term disease control in select patients. Screening with whole-spine MRI may lead to the earlier detection of spinal metastasis. Cancer 2007. © 2007 American Cancer Society.
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Appraisal Guide: Appraisal Guide: THERAPY OR PREVENTIONTHERAPY OR PREVENTIONAre the results of the study valid?
Primary Guides:
Was the assignment of patients to treatments randomized?
– NO. Data from patients with had spinal metastases were obtained from the authors' institutional soft tissue sarcoma database.
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Appraisal Guide: Appraisal Guide: THERAPY OR PREVENTIONTHERAPY OR PREVENTIONAre the results of the study valid?
Primary Guides:
Were all patients who entered the trial properly accounted for and attributed at its conclusion?
YES. All 33 MLS patients with spinal metastasis were accounted for.
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Appraisal Guide: Appraisal Guide: THERAPY OR PREVENTIONTHERAPY OR PREVENTIONAre the results of the study valid?
Primary Guides:
Was followup complete?
YES.
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Appraisal Guide: Appraisal Guide: THERAPY OR PREVENTIONTHERAPY OR PREVENTION
Are the results of the study valid?
Primary Guides:
Were patients analyzed in the groups to which they were randomized?
YES.
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Appraisal Guide: Appraisal Guide: THERAPY OR PREVENTIONTHERAPY OR PREVENTIONAre the results of the study valid?
Secondary Guides:
Were patients, health workers, and study personnel "blind" to treatment?
NO.
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Appraisal Guide: Appraisal Guide: THERAPY OR PREVENTIONTHERAPY OR PREVENTIONAre the results of the study valid?
Secondary Guides:
Were the groups similar at the start of the trial?
YES.
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Appraisal Guide: Appraisal Guide: THERAPY OR PREVENTIONTHERAPY OR PREVENTIONAre the results of the study valid?
Secondary Guides:
Aside from the experimental intervention, were the groups treated equally?
YES.