ISSN:8756-0437    

DOI:10.1002/ssu.2980040102

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractGrading methodology for soft‐tissue tumors is not yet unequivocally established. The authors use a system that is an elaboration upon that of the National Cancer Institute: grade 1 or low‐grade lesions are malignant lesions with minimal risk of metastases with a tendency for local recurrence if not totally excised, and with a capability for progression to a higher grade with recurrence; grades 2 and 3 are high‐grade lesions with a significant risk of metastases; grade 2 are lesions with intermediate aggressiveness, and grade 3 are highly malignant lesions with dissemination early in the course of the disease. Whereas the great majority of grade 3 lesions recur within 24 months of the initial diagnosis, patients with grade 2 lesions may go recurrence‐free beyond 36 months. Although more experience is needed in grading soft‐tissue sarcomas, it is hoped that grading will continue to contribute to the management of patients with malignant tumors of the soft tissue. It represents an adjunct to histological typing, which is useful in conveying the degree of biological aggressiveness as judged by histological features. Histologically 80% of the lesions can be classified on the basis of hematoxylin and eosin‐stained sections and other conventional special stains. In some instances electron microscopy and immunohistochemistry are necessary for histotyping. The most challenging area for histopathological differential diagnosis remains the distinction of tumor‐like reactive conditions, and pleomorphic benign tumors

ISSN:8756-0437    

DOI:10.1002/ssu.2980040103

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractMost nerve tumors (benign and malignant) do not arise from the nerves per se, but from the supporting cells; tumors arising from the cells of Schwann are termed schwannoma or neurilemmoma—benign or malignant. Surgical extirpation is the most effective treatment for these tumors. Radiation therapy can offer significant palliation and prolongation of life, but no cures have been observed. Benign tumors can be treated by local surgical extirpation; malignant tumors must be radically resected, including major amputation where indicated. Neurofibromatosis (von Reckling‐hausen's disease) is a genetic error of metabolism with a proclivity to produce multiple neurofibromas and, in about 10% of the patients, malignant neurilemmomas. Of 100 patients with malignant neurilemmomas treated by the author, 74 were considered determinate; among them, the 10‐year “cure” rate was 32%. Patients with von Recklinghausen's disease had almost as good a 10‐year survival rate as those with solitary malignant schwannoma (3

ISSN:8756-0437    

DOI:10.1002/ssu.2980040104

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractFive hundred and sixty‐five patients with soft‐tissue sarcoma were admitted to Memorial Sloan‐Kettering Cancer Center from July 1, 1982 to July 1, 1985. Clinical and pathologic factors were analyzed to identify initial characteristics and to determine factors associated with prognosis and the development of metastasis. In decreasing order of frequency, the most common sites of primary tumor were the extremity (51.1%), retroperito‐neum/viscera (28.8%), trunk (15.9%), head and neck (3.7%) and breast (0.4%). The most common histologie types were liposarcoma (21.4%), malignant fibrous histiocytoma (20.2%), leiomyosarcoma (20.0%), fibrosarcoma (11.0%), and tendosynovial sarcoma (9.6%). One hundred and twenty‐eight patients (22.7%) had metastases in a median follow‐up period of 19 months. Metastasis was more common in patients with retroperito‐neal and visceral sarcomas than in patients with extremity sarcomas. Patients with leiomyosarcomas were more likely to develop metastases than those with other histologie types. Fibrosarcoma and liposarcomas were the least likely to develop metastases in this time frame. Tumors greater than 5 cm in diameter occurred more frequently in patients with metastases. Actuarial survival was related to the site of primary tumor and the histologie type and grade of malignancy. Multivariate analysis indicated that patients with low‐grade sarcomas, extremity sarcomas, and fibrosarcomas and patients without metastatic disease demonstrated significantly improved survival. In patients with metastases, disease‐free interval (365 days) was significantly related to overall survival. Thus the development of metastatic disease and prognosis in patients with soft‐tissue sarcoma is significantly associated with specific clinical and pathologic factors, including site of primary tumor, histologie type, histologie grade, and di

ISSN:8756-0437    

DOI:10.1002/ssu.2980040105

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractThis study examines recurrence patterns in 255 patients with soft‐tissue sarcoma treated with preoperative chemotherapy and radiation, followed by limb‐sparing surgery. Eighty‐five patients developed metastatic disease: 13 had isolated local recurrence, 43 had isolated pulmonary metastases, 11 had metastases to lung and elsewhere, and 18 had metastases to multiple sites. Of the patients with isolated pulmonary metastases, 19/43 had resection of the metastases, and 9 are disease free. All 13 patients with local recurrences had resection of the recurrence, and 9 remain disease‐free. Patients with multiple sites of recurrence had a 2‐year survival of less than 10%. Resection of metastases is beneficial to a small number of patients who develop metastati

ISSN:8756-0437    

DOI:10.1002/ssu.2980040106

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractLymph node metastases occur in an appreciable number of soft‐tissue sarcomas. The histologic subtype plays a most important role. Synovial sarcoma, malignant fibrous histiocytoma, rhabdomyosarcoma, and an‐giosarcoma manifest relatively frequently such metastases, whereas fibrosarcoma, liposarcoma, and malignant schwannoma do so very infrequently. With the use of the newer radiologic techniques, it is expected that this feature will be more clearly defined and taken into account in planning the treatment. For histologic subtypes known frequently to manifest metastases to the regional lymph nodes, the latter should be considered for inclusion in the surgical and/or radiation treatment plan, particularly for primary tumors situated close to a nodal basin; and careful follow‐up of these nodes should be prac

ISSN:8756-0437    

DOI:10.1002/ssu.2980040107

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractThe charts of 423 patients with localized extremity soft‐tissue sarcoma treated at our institution over a 10‐year period (1968–1978) were reviewed. Data were subjected to both univariate and multivariate analysis, with independent variables in the multivariate analysis appearing in capital letters. Factors associated with an increased risk of local recurrence included the following: AGE>53; PRESENTATION WITH RECURRENT DISEASE; HIGH TUMOR GRADE; positive regional nodes; TREATMENT BY LIMB‐SPARING SURGERY (LSS); invasion of vital structures (LSS only); INADEQUATE MARGINS; and biopsy with delayed definitive resection. Survival was adversely affected by the following: AGE>53; PAINFUL MASS; PROXIMAL SITE; SIZE>10 cm; HIGH TUMOR GRADE; POSITIVE NODES; invasion of vital structures; TREATMENT BY AMPUTATION; INADEQUATE MARGINS; and local recurrence after treatment at our institution. Significant variations in both local recurrence and survival according to histopathology were also observed, with EMBRYONAL RHABDOMYOSARCOMA, ANGIOSARCOMA, and MALIGNANT PERIPHERAL NERVE TUMORS emerging as independent predictors of local recurrence. Using the Cox models for local recurrence and survival, patients were stratified into high‐, intermediate‐, and low‐risk categories based on the presence or absence of each variable. Risk factor analysis should be part of the overall evaluation of each patient with extr

ISSN:8756-0437    

DOI:10.1002/ssu.2980040108

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractSoft‐tissue tumors encompass a wide variety of lesions and continue to pose a difficult treatment problem. The outlook, however, is improving, and there have been recent advances in pretreatment assessment, clinico‐pathologic correlation, and adjuvant treatment programs. We retrospectively reviewed our experience in a large series of soft‐tissue tumors treated at the Mayo Clinic as well as recent experience using chemotherapy and radiation trea

ISSN:8756-0437    

DOI:10.1002/ssu.2980040109

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractDespite the low incidence of sarcomas, the Soft Tissue and Bone Sarcoma Group has established itself as one of the more active cooperative groups of the European Organization for Research and Treatment of Cancer. Performing over a 10 yr period three phase III protocols (total entry 750 patients), three randomized phase II studies (464 patients), a pilot combination study (185 patients), and 12 phase II studies (406 patients). The new randomized phase III protocol for advanced soft‐tissue sarcoma will provide an interesting test of the validity of the current membership policy, which has not discouraged the participation of enthusiastic new members. For extremity sarcomas, improved surgical techniques have increased the number of patients retaining functional limbs but have maintained excellent rates of local control. However, systemic metastasis remains a significant problem and presents a challenge for future adjuvant studie

ISSN:8756-0437    

DOI:10.1002/ssu.2980040110

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractThe most active single agents in soft‐tissue sarcomas are doxorubicin (Adriamycin) and ifosfamide, with response rates of 20‐35%. Dacarba‐zine (DTIC) has a response rate of 16%. A randomized trial of 5 g/m2of ifosfamide versus 1.5 g/m2of cyclophosphamide noted a higher response rate for ifosfamide with less myelosuppression. Both randomized studies of doxorubicin with or without DTIC documented an increased response rate for the combination. In contrast, three randomized trials of doxorub‐icin‐based regimens with and without cyclophosphamide have failed to detect an advantage for the addition of cyclophosphamide. Thus, the most active combination for soft‐tissue sarcomas is doxorubicin and DTIC. The role of the addition of ifosfamide is currently under

ISSN:8756-0437    

DOI:10.1002/ssu.2980040111

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY