Say Hi Japan Issue 23-2 Chiba Part 2 by Checktour Magazine 55
Chiba Cancer Center, Chiba, Japan
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Transcript of Chiba Cancer Center, Chiba, Japan
Chiba Cancer Center, Chiba, Japan
Shintaro Iwata Tsukasa Yonemoto Yoko Hagiwara Takeshi Ishii Division of Orthopedic Surgery
Akinobu Araki Dai Ikebe Division of Surgical Pathology
Hiroyuki Funatsu Division of Diagnostic Imaging, Chiba Cancer Center, Chiba, Japan
CTOS 18th Annual Meeting 1st Nov. 2013
Infiltrative Soft Tissue Sarcoma- Should We Excise Beyond Radiological Infiltration? -
Chiba Cancer Center, Chiba, Japan
Infiltrative Growth of STS
How should I resect?
Overall Survival
Chiba Cancer Center, Chiba, Japan
Infiltrative Growth on MRI Significantly Correlated withPoor Local Control Rate and Overall Survival for MFH
FocalInfiltrative
Infiltrative
Focal
Infiltrative
Focal
P=.014 P=.04
- Iwata et al. CTOS 2011 meeting
Local Control Rate
Chiba Cancer Center, Chiba, Japan
Adjuvant Radiotherapy was Not Beneficial for Patients with Infiltrative Growth and Positive Surgical Margins
FocalInfiltrative
- Iwata et al. CTOS 2011 meeting
Infiltrative Focal
RT(+)
RT(-) RT(+)
RT(-)
P=.38 P=.08
Chiba Cancer Center, Chiba, Japan
Does radiological infiltration pattern represent histological tumor infiltration?
Chiba Cancer Center, Chiba, Japan
Q1: Do tumor cells actually exist in the radiographic infiltration?
Clinical questionsAim of this study
Q2: Should surgery be planed to include resecting the radiographic infiltration?
Chiba Cancer Center, Chiba, Japan
Patients and MethodsInclusion criteria1) Diagnosed with MFS, UPS, or LMS2) Treated initailly at our institution between 2007 and 2011
Total: 41 patientsFollow-up for survivals: 18 - 77 months (median 48 months)
Histological infiltration (H-inf )- Distance from the tumor edge to the end of the atypical tumor cells
Chiba Cancer Center, Chiba, Japan
Patients and MethodsMeasurement of tumor infiltrationRadiographic infiltration (R-inf )- Length of high-intensity tail-like extension
GdFS STIR
R-inf R-inf
H-inf
Chiba Cancer Center, Chiba, Japan
Result 1 Correlation with H-inf and other factors
Factor n H-inf(+) H-inf(-) PAge (mean, years) 76 60 .016
LocationSuperficial 11 7 4 .25
Deep-seated 30 13 17Size (mean, cm) 8 7 .83
GradeGrade 2 23 10 13 .44Grade 3 18 10 8
Surgical margin
Adequate 31 13 18 .12Inadequate 10 7 3
(+) (-)H-inf
Age
(yea
rs)
(Fisher’s exact test, Mann-Whitney’s U-test)
(P<.0001, Fisher’s exact test)
H-inf (+) H-inf (-) TotalR-inf (+) 17 2 19R-inf (-) 3 19 22
Total 20 21 41
Chiba Cancer Center, Chiba, Japan
Leng
th (c
m)
R-inf STIR
R-inf GdFS
H-inf
0.8-5.3 0.4-6.7 0.1-6.0Range (cm)
Median 2.4 2.0 1.5
P=.59 (Kruskal-Wallis test)
Result 2 Relationship between H-inf and R-inf
Chiba Cancer Center, Chiba, Japan
R-inf GdFS
H-inf=0.81xR-inf+0.25
R2=.59
R-inf STIR
H-inf=0.47x R-inf+0.25
R2=.28
H-in
f (cm
)
(Pearson’s correlation coefficient)
Result 2 Relationship between H-inf and R-inf
Chiba Cancer Center, Chiba, Japan
Result 4 Prognostic factor analysisFactor OAS P LCR P
SiteExtremity 78 .57 85 .28
Trunk 89 100
LocationSuperficial 82 .89 100 .16
Deep-seated 80 84
Size<8cm 87 .31 100 .042*≧8cm 75 77
FNCLCC Grade
Grade 2 83 .76 100 .033*Grade 3 79 76
Surgical margin
Wide 85 .19 100 .0017*Intra-infiltrate 100 56Intra-tumor 50 67
H-infYes 78 .79 76 .047*No 84 100
(Log-rank test)Time (months)
H-inf
Pro
babi
lity
Yes
No
P=.047
Time (months)
Surgical margin
Pro
babi
lity
Wide
Intra-tumor
Intra-infiltrate P=.0017
Chiba Cancer Center, Chiba, Japan
DiscussionQ1: Do tumor cells actually exist in the radiographic infiltration?
Actually tumor lesion, not edema!
A1: YES, we should think so, at least on UPS and MFS.
R-inf reflects H-inf.Sensitivity: 89%Specificity: 86%
Chiba Cancer Center, Chiba, Japan
DiscussionQ2: Should surgery be planed to include resecting the radiographic infiltration?
If you ignore, tumor recur.
A2: YES, we propose 2cm margin from the edge of the infiltration in GdFS MRI.
H-inf
R-inf (H-inf - R-inf) < 2cm - 13/14 (93%)
Chiba Cancer Center, Chiba, Japan
Conclusion
• Radiographic infiltration of MFS and UPS as assessed by GdFS MRI correlated with histological infiltration.
• Wide resection with an “infiltration”-free margin would improve local control of these tumors.
Chiba Cancer Center, Chiba, Japan
Thank you for your
attention.