bluuebunny/crossref_metadata_2025_split huggingface dataset:
High-dose ifosfamide (HDI) in metastatic synovial sarcoma: The Institut Gustave Roussy experience.
Authors: Rahal Arslane Skander , Cioffi Angela , Rahal Chahinez , Domont Julien , Blesius Aurore , Patrikidou Anna , Bonvalot Sylvie , Le Pechoux Cécile , Terrier Philippe , Vilcot Laurence , Lanoy Emilie , Le Cesne Axel 
Published: March 2020

10044 Background: Synovial sarcoma (SS) is one of the most chemo-sensitive histological subtypes of sarcoma but with a dismal prognosis. In metastatic setting, Anthracyclin/ifosfamide-containing chemotherapy (CT) regimen is the gold standard of treatment in front-line therapy. Patients (pts) with resistant diseases are candidates to investigational drugs or higher dose ifosfamide regimen in selected pts. Methods: Pts treated in our institution, with histological confirmation of advanced SS, adequate organ function and in good condition (PS≤2) were included in this retrospective analysis. Pts who progressed after 1–2 chemotherapy lines received High-dose ifosfamide (HDI) in the form of 4 g/m2 daily (over 24 hours CI) for 3 days for a total dose of 12 g/m2; cycles were given with growth factor support and were repeated every 3 weeks. The primary endpoints were PFS and overall response rate (ORR); the secondary endpoints OS and toxicity profile. AE were assessed by NCI-CTC v. 3.0. Results: 34 pts (21 males) with a median age of 39 years (range 19-66) received this HDI regimen. PS was 0-1 in 90%. 95% of pts received prior doxorubicin, ifosfamide or both, 7 patients had 2 prior lines. Grade III monophasic pattern was seen in 21 patients, grade II in 13. 171 cycles were delivered, median number of cycles was 4 (2-10). The objective responses were CR 0; PR 15; SD 14; PD 2; and NE 3, resulting in an ORR of 44%. The clinical benefit rate was 85%. Median PFS: 11.6 months (95% CI: 9-14). Eleven pts were amenable to a subsequent resection of residual disease. Common adverse events included grade III/IV neutropenia: 47%, febrile neutropenia: 12%, thrombocytopenia: 12%, cystitis: 3%, neurologic: 3%. There was no treatment related death. Conclusions: HDI demonstrated clinically meaningful efficacy with manageable toxicity in pts who failed previous standard Ifosfamide dose. Ifosfamide remains the most active agents in SS and high dose regimen have to be considered in pts previously treated with ifosfamide.
Does combined dose intensification radiotherapy improve disease control in resectable retroperitoneal sarcoma? Long-term results of a phase I/II trial.
Authors: Smith Myles JF , Ridgway Paul F , Catton Charles N , Cannell Amanda , O'Sullivan Brian , Mikula Lynn A , Jones Julia J , Swallow Carol Jane 
Published: March 2020

10050 Background: Late failure is a challenging problem in retroperitoneal sarcoma (RPS) and reported 10 yr overall survival (OS) rates range from 20-30%. Use of preoperative external beam radiotherapy (XRT) in the management of RPS remains controversial. No RCT and very few prospective trials of any type have been completed. We investigated the effects of preop XRT plus dose escalation with early postop brachytherapy (BT) on long term survival and recurrence in RPS. Methods: From 06/96 to 10/00, 40 patients (25 female) with resectable RPS were entered onto a phase I/II trial of preop XRT (50 Gy) plus postop BT (20-25 Gy). As previously reported, BT to the upper abdomen was associated with significant grade III-V postop toxicity, and from 12/98 on, BT was applied only to cases where the “field at risk” excluded the upper abdomen. Kaplan Meier survival curves were constructed; OS and recurrence free survival (RFS) were compared by log rank (SPSS 19.0). Results: Median age at study entry was 58 (38-70) yrs. Twenty nine patients presented to our center with primary disease (73%), and 22 (55%) had high grade tumors. All patients had preop XRT and total gross resection, while half (n=19) received BT. As of 12/2011, median follow-up time is 108 mos. For the entire study cohort, OS at 5 and 10 yrs were 70% and 65%, respectively; RFS at 5 and 10 yrs were 65% and 58%, respectively. RFS at 5 yrs was reduced in high vs. low grade RPS (50% vs. 83%, p=0.028), but by 10 yrs. was similar in high and low grade tumors (50% vs. 67%, p=ns). RFS was reduced in patients who presented with recurrent vs. primary disease (27% vs. 69% at 10 yrs., p=0.018), as was OS (36% vs. 76% at 10 yrs., p=0.034). Neither OS nor RFS was improved in the cohort of patients who received BT compared to the cohort who did not: at 10 yrs. RFS was 53% +BT and 62% -BT, while OS was 53% and 76%, respectively, p=ns. Conclusions: In this prospective study with mature follow-up, long term OS and RFS in patients who underwent combined preop XRT plus resection of RPS compare favorably with those reported in retrospective institutional and population-based series. Postoperative BT did not contribute to disease control.
Risk factors leading to grading changes within 300 low-grade soft tissue sarcomas.
Authors: Koshrawipour Tanja , Stricker Ingo , Tannapfel Andrea , Steinstraesser Lars , Langer Stefan , Ring Andrej 
Published: March 2020

10059 Background: Soft tissue sarcomas (STS) are rare, mesenchymal derived tumors. Based on malignancy, three grades are distinguished with G1 equaling low grade, G2 intermediate grade and G3 high grade, respectively. Studies have shown that some G1 tumors which underwent complete surgical resection reoccurred as lesions with a grading shift from G1 to higher malignancy. This grading change is referred to as up grading. Patients with grading changes were thoroughly examined in our study. Our aim was to find possible risk factors for up gradings, such as age, localization of tumor and tumor type. Methods: This retrospective case control study evaluated 333 Patients, who, between 1996 to 2011 were treated for G1 STS at Bergmannsheil Bochum, university clinic. These patients received complete initial surgical resection. Among our 333 patients, 9.9% (n=33) developed up gradings of their STS. These were then reviewed more closely in the aim of finding possible risk factors. We did not exclude any patients from our data or deliberately pick any grading changers and regard our collective as randomly sampled. The processed data includes age, gender, tumor type, tumor localization, occurrence of recidive and grading change. Results: Patients with up gradings were found to have a higher mean age of 4, 5 years than reference collective. The tumor type has a strong, statistically significant effect on grading change as patients with fibrosarcomas have a threefold risk of developing up gradings when compared to patients with other G1 STS. Conclusions: Our results indicate that age and tumor type play the key role in the development of up gradings in low malignant STS .Patients aged 60 and above diagnosed with fibrosarcomas are at a 3 times higher risk of developing a grading change as opposed to patients younger than 60 with other low grade STS than fibrosarcoma. We discussed the significance of these risk factors and argued whether, in addition to wide tumor resection, a short term postoperative radiotherapy should be applied for these patients to improve therapeutical outcome.
Treatment outcomes of primary mediastinal and intrathoracic great vessels sarcoma: Royal Marsden Hospital experience.
Authors: Lu Shir Kiong , Benson Charlotte , Ganguli Sushila , Scurr Michelle R. , Fisher Cyril , Khabra Komel , Al-Muhaderis Omar , Dunlop Alison , Saran Frank , Ross Gillian , Miah Aisha , Judson Ian Robert 
Published: March 2020

10060 Background: Sarcoma of the mediastinum and great vessels remain a rare subgroup of soft tissue sarcoma and prognosis remains poor with patients (pts) often presenting with advanced disease. There is no standard treatment due to paucity of data hence its management relies on case series. To date this is the largest series of pts reported. Methods: Retrospective analysis of pts identified anonymously from a prospectively maintained database of the sarcoma unit. Results: 46 pts were included in the analysis. The median age at diagnosis was 45.9 with a male: female ratio of 1.2: 1. 60% of pts presented with localised disease. The most common histological subtype was spindle cell sarcoma followed by angiosarcoma. The heart (n=21), majority in the atria, was the commonest primary site. 28 pts presented with localised disease of which 21 had surgery and 16 received chemotherapy (CT). 4 pts received multi-modality treatment. 83% of pts with metastases had CT. 6 of them attained stable disease, 1 had partial response and 4 (Ewing’s, rhabdomyosarcoma and angiosarcoma) had complete response. 31 pts developed disease recurrence of which 58% had initial localised disease. 6 pts had metastectomy, 19 received palliative CT and 11 had palliative radiotherapy (RT). RT of 50-60Gy to the heart or mediastinum was delivered to 61% of pts with initial localized disease and 33% of pts with metastases. 2 pts had documented post-treatment cardiac complication. After a median follow up of 2.16 years, the median event-free survival was 0.97 years (95%CI 0.65-1.30), median overall survival (OS) was 1.7 years (95% CI 0.70-2.71) and 5 year OS was 17.9%. Conclusions: The optimal management in this disease is unclear. In this study, surgery was frequently implemented in both localised and metastatic settings but challenges remain in achieving clear margins. Chemotherapy has a role and it is key to identify chemosensitive subtypes. RT is offered as an adjunct following suboptimal resection. Despite aggressive treatments, this group of young pts had high recurrence rate and poor prognosis. Multi-modality treatment may have a role in selected pts but its efficacy and long-term cardiac sequelae need to be evaluated prospectively.
Bone metastases in soft tissue sarcoma patients: A survey of natural, prognostic value, and treatment.
Authors: Vincenzi Bruno , Santini Daniele , Schiavon Gaia , Frezza Anna Maria , Dileo Palma , Silletta Marianna , Bertoldo Francesco , Badalamenti Giuseppe , Baldi Giacomo G. , Zovato Stefania , Berardi Rossana , Tucci Marco , Whelan Jeremy , Tirabosco Roberto , Dei Tos Angelo Paolo , Tonini Giuseppe 
Published: March 2020

10063 Background: Given the limited data currently available, we surveyed the natural history of bone metastases in patients affected by soft tissue sarcoma (STS). Methods: This retrospective, multicenter, observational study evaluated data from 135 patients with STS metastatic to the bone who presented between 2001 and 2011. For all patients, we recorded the primary tumor histological subtype, bone metastases characteristics (onset, site), type of treatment received (surgery, radiotherapy, zoledronic acid), type and frequency of skeletal related events (SRE) and disease outcome. Results: The most represented histological subtypes among the enrolled patients were leiomyosarcoma (27%), angiosarcoma (13%) and spindle cell sarcoma (8%). The spine was the most common site for bone involvement (51%), followed by hip/pelvis (20%), long bones (15%) and other sites (14%). In 27% of cases, bone metastases were present at the time of diagnosis. Fiftyfour patients (40%) developed SREs and the median time to first SRE (if developed) was 4 months. The most common SRE was the need for radiotherapy occurring in 28% of patients followed by pathologic fracture (22%). Patients survived for a median of 6 months after bone metastases diagnosis. The occurrence of a SRE was associated with a decreased overall survival (P=0.04). A subgroup analysis revealed that zoledronic acid significantly prolonged median time to first SRE (5 versus 2 months; P = 0.002). Conversely, It did not determine an improvement in terms of overall survival, even if favorable trend was identified (median, 7 versus 5 months, respectively; P = 0.105). Conclusions: This study illustrates the burden of bone disease from STS and supports the use of zoledronic acid in this setting.
Use of microRNA (miR) expression profiling to identify distinct subclasses of triple-negative breast cancers (TNBC).
Authors: Shapiro Charles L. , Cascione Luciano , Gasparini Pierluigi , Lovat Francesca , Carasi Stefania , Pulvirenti Alfredo , Ferro Alfredo , Huebner Kay ,   Ohio State University Medical Center and Comprehensive Cancer Center
Published: March 2020

1007 Background: TNBC is divided into basal and non-basal subclasses. To further subclassify TNBC we performed microRNA (miR) expression profiles and linked them to patient overall survival. Methods: During 1996-2005, 365 consecutive TNBC (phenotypically estrogen, progesterone and HER2 negative by immunohistochemistry [IHC]) were identified from the NCCN Breast Cancer Data Base/Tumor Registry at OSU Medical Center. One hundred fifty-eight (43%) formalin-fixed paraffin embedded (FFPE) breast cancer and 40 normal breast tissue blocks were available and tissue cores were obtained for RNA. RNA was isolated using the Ambion recoverall total nucleic acid isolation kit and the expression of ~700 miRs was assessed for each sample using the nanoString nCounter method. A consensus-clustering algorithm (ConsensusClusterPlus, Bioconductor www.bioconductor.org) was used to identify subclasses of TNBC and Kaplan-Meier overall survival curves were compared using the log-rank test. Censoring occurred at the date of death from causes other than breast cancer or at time of the last known follow-up, whichever occurred first. The median follow-up was 67 mo. (range 4-171 mo.). Results: The median age was 52 yrs. (range 20-84 yrs.); 81% white and 9% African-American; stages I, II, and III were 31%, 54% and 15%, respectively; and most patients received adjuvant anthracycline-based regimens with (25%) or without taxanes (75%). The algorithm identified 5 distinct subclasses; 1 clustering with normal breast miR expression whereas the other 4 each had a unique pattern of deregulated miRs. The median overall survivals were significantly different across the 5 cancer subclasses (log-rank p=0.028) (Table). Conclusions: miR expression profiling identifies and discriminates 5 TNBC subclasses, which do not coincide with those identified as basal and non-basal by IHC. Molecular analyses are ongoing to associate the miR-based subclasses with specific clinical features or the expression of specific pathways. [Table: see text]
Age as a prognostic factor in osteosarcoma: Survival analysis.
Authors: Pallotta Guadalupe Maria , Boggio Gaston Federico , Specterman Sergio , Lastiri Jose Maria , Lopez Lincuez Maria Emilia , Lupinacci Lorena , Makiya Monica , Streitenberger Patricia , Aponte Luis , Farfalli German , Ayerza MIguel Angel 
Published: March 2020

10074 Background: Studies comparing survival between adult and paediatric population with osteosarcoma are scarce and contradictory. Generally adults were excluded from analysis in historical series. End Point: evaluate age as prognostic factor in ostosarcomas IIb treated exclusively by a multidisciplinary group in a single institution. Methods: 132/278 patients with histological diagnosis of osteosarcoma IIb were selected. All were treated exclusively in our hospital from July 1988 until December 2010. Patients 17 years old or younger were considered paediatric. They all received presurgical chemotherapy with the same scheme: ifosfamide + doxorrubicin + high dose methotrexate. Univariate analysis was made (Fischer exact test). Survival was calculated wih Kaplan-Meier actuarial method. Curves were compared with log rank test. Multivariate Cox analysis was made. Results: Median age was 19.6 years (std: 9,1; range 5-58). Adults: 77, children: 55. No differences were detected between the two age groups regarding: elevated alkaline phosphatase, kind of surgery (amputation vs. limb sparing), relapse site (lung, local, other), necrosis greater than 90% or number of lung resections. There was a tendency towards axial localization in adults (p=0.05). No paediatric patient had inadequate medical intervention, but it was present in 14.3% of adults (p=0.002). 5 year Overall survival (5y OS) in children was 85,2% compared with 61,8% in adults (p=0.005); Disease free survival (DFS) had a non significant tendency to be better in children (69.6% vs. 51,3%). Variables associated with worse OS were: axial location (p=0.01), elevated alkaline phosphatase (0.003), amputation (p=0.008), local relapse or systemic non-lung metastasis (p= 0.001), necrosis less than 90% (0.001). Multivariate Cox analysis showed association between OS and paediatric population (p=0.01) and necrosis greater than 90% (p=0.001), while DFS was associated with necrosis greater than 90% (p=0.01) and elevated alkaline phosphatase (p=0.05). Conclusions: Paediatric population presents better survival compared to adults in our institution. Differences in tumour biology and in the mode of presentation related to age may be the explanation.
Multimodality treatment of pediatric and adult patients with Ewing sarcoma: A single-institution experience.
Authors: Lorente David , Diaz Robert , Torres Barbara , Cañete Adela , Aparicio Jorge , Gimenez Alejandra , Reche Encarni , Rodrigo Esteban , Verdeguer Amparo , Montalar Joaquin 
Published: March 2020

10082 Background: Treatment of Ewing sarcoma pts. usually follows pediatric protocols, both in children and in adults. However, older patients fare poorly in most series. We analyze our experience with the 2001 protocol of the Spanish Society of Pediatric Oncology. Methods: Retrospective analysis. Schema: 6 cycles (cy) of VIDE chemotherapy (CT: vincristine, ifosfamide, etoposide, doxorrubicin). If no progression, local treatment (surgery or RT) and consolidation adjusted to risk: VACx8 (vincristine, dactinomycin, ciclophosphamyde) in standard-risk pts; if increased risk (axial, complete response in lung metastases or non-pulmonary metastases) VACx1, high-dose CT (busulphan-melphalan) and autologous transplant (ATSP). Analysis: induction CT toxicity, pathological response rates, consolidation treatment, disease-free (DFS) and overall survival (OS) (Kaplan- Meier). Log-rank and Cox regression analysis of prognostic factors in OS. Results: 35 patients (01.2003-05.2011). 60% male. Median age 16 y (r 7-57). Axial (43%), extremities (34%), extra-osseous (18%) and ribs (9%). Metastases: 54% (lung 58%, bone 26%, others 12%). > 1 location: 29%. Induction CT: 83% received 6 cy. 6% early progressions and 3% toxic deaths. 196 cycles of CT. Dose reduction (etoposide) in 60%. Grade 3-4 toxicity: neutropenia 13%, anemia 14%, neutropenic fever 13%, diarrhoea-stomatitis 7%.Local treatment: surgery (49%), radiotherapy (29%), none (22%). In 17 resections, > 90% necrosis in 53%. Consolidation: VACx8 29%; VACx1-ATSP in 34%; 37% other treatments (progression). No ATSP-related mortality. Median follow-up: 36 m ( 5-101 m). Median DFS 25 m (16-34 m). Median OS 28 m (15-41 m), 3-year OS 40%. Median time to progression 7 m (0.4-15 m). Median OS from progression 7 m (0.4-15 m). Age < 15 years, a non-axial primary and no extra-pulmonary metastases were favourable prognostic factors in the univariate analysis. Conclusions: Induction CT with the VIDE regimen is feasible in most patients, with a low risk of early progression. Hematological toxicity is substantial but manageable. Adults patients have a worse prognosis compared to pediatric patients. Unfortunately, survival after progression is dismal.
Outcomes of multivisceral resection of gastric gastrointestinal stromal tumors.
Authors: Ganai Sabha , Posner Mitchell , Prachand Vivek N. , Alverdy John C. , Choi Eugene A. , Waxman Irving , Patti Marco G. , Roggin Kevin K. 
Published: March 2020

10090 Background: Despite the recent introduction of imatinib and laparoendoscopic techniques to the management of gastric gastrointestinal stromal tumors (GISTs), outcomes remain uncertain in the setting of multivisceral involvement. Methods: We conducted a retrospective review of 73 consecutive patients who underwent resection of gastric GISTs from October 2002 through December 2011. Median follow-up was 22 months (interquartile range [IQR] 6-37). Results: Patients were 51% female, with a mean age of 65 ± 12 years and BMI of 30 ± 8 kg/m2. Patients undergoing multivisceral resection (n=14) had a longer interval from diagnosis to surgery (7.3 [IQR 1.9 – 15.0] vs. 1.3 [IQR 0.7-4.2] months, p<0.01), greater use of neoadjuvant imatinib (64% vs. 3%, p<0.0001), and greater preoperative tumor size (12 ± 8 vs. 4 ± 3 cm, p<0.0001) in comparison to gastric-only resections (n=59). Patients were less likely to be managed laparoscopically (7% vs. 71%, p<0.0001), had a longer operative time (310 ± 117 vs. 145 ± 62 min, p<0.0001), and were less likely to be R0 (71% vs. 98%, p<0.001). While patients undergoing multivisceral resection were more likely to have a pathological complete response to therapy (29% vs. 0, p<0.001), they were also more likely to have metastatic disease present (29% vs. 0, p<0.001). Hospital length of stay was greater (median 8 [IQR 6-9] vs. 3 [IQR 2-6] days, p<0.0001). There were no significant differences in grade or mitotic index between groups. There was greater use of adjuvant imatinib (64% vs. 25%, p<0.05). Overall survival was less in patients undergoing multivisceral resection (64% vs. 87% at 3 years, p<0.05), as was disease-free survival (52% vs. 71% at 3 years, p<0.05). Median overall and disease-free survival were 43 and 22 months after multivisceral resection for gastric GISTs. Controlling for tumor size, grade, resection status, and the use of neoadjuvant imatinib, multivisceral resection and use of adjuvant imatinib were both independent predictors of disease-free survival (p<0.05). Conclusions: Multivisceral involvement is associated with tumors of greater size and, despite an increased use of neoadjuvant imatinib, it is associated with poor outcome for patients with gastric GISTs.