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? -


Infiltrative Growth of STS

How should I resect?

Overall Survival


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


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


Does radiological infiltration pattern represent histological tumor infiltration?


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?


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


Patients and MethodsMeasurement of tumor infiltrationRadiographic infiltration (R-inf )- Length of high-intensity tail-like extension

GdFS STIR

R-inf R-inf

H-inf


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


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


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


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


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%


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%)


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.


Thank you for your

attention.

chiba cancer center, chiba, japan

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