RESUMEN
BACKGROUND: Solitary fibrous tumor (SFT) is a rare mesenchymal malignancy. Although surgery is potentially curative, the local relapse risk is high after marginal resections. Given the lack of prospective clinical trial data, the objective of the current study was to better define the role of perioperative radiotherapy (RT) in various SFT presentations by location. METHODS: This was retrospective study performed across 7 sarcoma centers. Clinical information was retrieved from all adult patients with extrameningeal, primary, localized SFT who were treated between 1990 and 2018 with surgery alone (S) compared with those who also received perioperative RT (S+RT). Differences in treatment characteristics between subgroups were tested using analysis of variance statistics and propensity score matching. Local control and overall survival rates were calculated from the start of treatment until progression or death from any cause. RESULTS: Of all 549 patients, 428 (78%) underwent S, and 121 (22%) underwent S+RT. The median follow-up was 52 months. After correction for mitotic count and surgical margins, S+RT was significantly associated with a lower risk of local progression (hazard ratio, 0.19: P = .029), an observation further confirmed by propensity score matching (P = .012); however, this association did not translate into an overall survival benefit. CONCLUSIONS: The results from this retrospective study investigating perioperative RT in patients with primary extrameningeal SFT suggest that combining RT with surgery in the management of this patient population is significantly associated with a reduced risk of local failures, especially in patients who have less favorable resection margins and in those who have tumors with a high mitotic count.
Asunto(s)
Tumores Fibrosos Solitarios/radioterapia , Tumores Fibrosos Solitarios/cirugía , Análisis de Varianza , Terapia Combinada/estadística & datos numéricos , Progresión de la Enfermedad , Extremidades , Femenino , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/radioterapia , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Masculino , Persona de Mediana Edad , Índice Mitótico , Supervivencia sin Progresión , Puntaje de Propensión , Neoplasias Retroperitoneales/mortalidad , Neoplasias Retroperitoneales/radioterapia , Neoplasias Retroperitoneales/cirugía , Estudios Retrospectivos , Tumor Fibroso Solitario Pleural/mortalidad , Tumor Fibroso Solitario Pleural/radioterapia , Tumor Fibroso Solitario Pleural/cirugía , Tumores Fibrosos Solitarios/mortalidad , Tasa de Supervivencia , TorsoRESUMEN
Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms that usually arise in the pleura or less commonly in relation to other serosal surfaces. Infrequent case reports of extra-pleural SFTs have been described at various sub sites within the head and neck area. We report a case of recurrent sino-nasal SFTs treated with surgery followed by re-excision and adjuvant radiation on recurrence and then salvage chemotherapy on progression. Further discussed are the challenges associated with accurate histological and immunohistochemical diagnosis, the difficulty in assessing the aggressiveness and malignant potential of these lesions and the appropriate treatment and follow-up duration that these neoplasms require. To the best of our knowledge this is the first reported case of recurrent malignant sino-nasal SFT in available scientific literature in English language.
Asunto(s)
Recurrencia Local de Neoplasia/radioterapia , Radioterapia Adyuvante , Tumor Fibroso Solitario Pleural/radioterapia , Femenino , Humanos , Imagen por Resonancia Magnética , Mesodermo/diagnóstico por imagen , Mesodermo/patología , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/patología , Senos Paranasales/diagnóstico por imagen , Senos Paranasales/patología , Radiografía , Tumor Fibroso Solitario Pleural/diagnóstico por imagen , Tumor Fibroso Solitario Pleural/patologíaRESUMEN
PURPOSE: The aim of this prospective, phase II clinical study is to evaluate the activity of gemcitabine and cisplatin in comparison to pemetrexed and carboplatin in patients with malignant pleural mesothelioma. PATIENTS AND METHODS: The patients were recruited from May 2008 to May 2011. One group included 21 cases who received cisplatin and gemcitabine. The other group included 19 cases who received pemetrexed and carboplatin. RESULTS: Response is superior in the pemetrexed group (p = 0.041). The median follow-up was 18 months (range 6-30 months). Cumulative survival at 1.5 years was 57.8 % for the pemetrexed carboplatin group. For the gemcitabine cisplatin group, the cumulative survival proportion at 1.5 years was 41 % (p = 0.0599). CONCLUSIONS: Pemetrexed plus carboplatin are a step forward in the treatment of mesothelioma, the prognosis for these patients remains poor. Cheaper combinations as gemcitabine and cisplatin may be considered sufficient to treat cases with advanced mesothelioma (AU)
Asunto(s)
Humanos , Animales , Masculino , Femenino , Tumor Fibroso Solitario Pleural/tratamiento farmacológico , Tumor Fibroso Solitario Pleural/metabolismo , Tumor Fibroso Solitario Pleural/radioterapia , Tumor Fibroso Solitario Pleural/diagnóstico , Supervivencia/psicologíaRESUMEN
Solitary fibrous tumor (SFT) of the pleura is an uncommon neoplasm with non-specific symptoms and non-pathognomonical radiological findings. Surgery allows establishment of a definitive diagnosis as well as a cure of the disease. The role of radiotherapy or chemotherapy in the management of the disease is unclear because of the rarity of the disease and the successful results of the surgical treatment. Long-term clinical follow-up may be useful for the patients with SFT because of the potential adverse biological behavior of this tumor, which may lead to repeated recurrences and/or malignant transformation. We reported a 66-year-old woman with recurrence of SFT in the right lung, which had significant response to external thoracic radiotherapy.
Asunto(s)
Recurrencia Local de Neoplasia/radioterapia , Tumor Fibroso Solitario Pleural/radioterapia , Anciano , Disnea/etiología , Femenino , Humanos , Inmunohistoquímica , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/fisiopatología , Cuidados Paliativos , Tumor Fibroso Solitario Pleural/patología , Tumor Fibroso Solitario Pleural/fisiopatología , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Localized malignant pleural mesothelioma is very rare tumor disease. There are sporadic reports in the literature showing that this entity has a different biologic behavior compared with diffuse pleural mesothelioma. We report two cases of radically resected localized pleural malignant mesothelioma, with a previous history of asbestos exposure. Both cases showed a microscopic and immunohistochemical findings of malignant mesothelioma, biphasic and sarcomatoid lympho-histiocitoid variant type, respectively, without evidence of diffuse pleural spread. The first is very peculiar case of bilateral localized malignant pleural mesothelioma with complete response to chemotherapy and localized late recurrence, radically resected and treated with adjuvant radiotherapy. The second case revealed as a solitary localized mass, underwent a complete en bloc resection and adjuvant radiotherapy. Both cases demonstrate that the localized malignant mesothelioma should be distinguished from diffuse form and that complete resection is associated with good prognosis.