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Milano, Italy

Gronchi A.,Sarcoma Service | Casali P.G.,Adult Mesenchymal Tumor Medical Oncology Unit
Current Treatment Options in Oncology | Year: 2013

Opinion statement: Adult-type soft tissue sarcomas (STS) are curable in roughly one half of cases. Surgery is the treatment mainstay in patients with localized STS and should be performed in centers that have specific expertise with the disease. Radiation therapy complements surgery in several cases, improving the local control. The value of adjuvant chemotherapy is still debated. There is some evidence, however, backing the notion that adjuvant chemotherapy may add to the systemic control of the disease, and thereby overall survival, in the subgroup of patients with high-risk STS. These patients are those with a high-grade, large, and deep tumor. Unfortunately, benefit is apparent when merging all data generated by several trials performed throughout decades, but it was not confirmed by the largest trials, including one that was recently reported. A confounding factor for large clinical trials is that STS are a family of 50-plus different histological subtypes. It is difficult to perform studies that focus on each of them separately, and subgroup analyses suffer from many limitations. Indeed, some histological types are more sensitive to standard chemotherapy and other are less. Furthermore, some histologies are specifically sensitive to some agents that may be completely inactive in others. A prospective, randomized trial is underway to compare standard neoadjuvant chemotherapy in high-risk STS versus a neoadjuvant regimen that is tailored to different histologies. Some rare histological subtypes (alveolar soft part sarcoma, clear cell sarcoma, extraskeletal myxoid chondrosarcoma, solitary fibrous tumor) have shown promising sensitivity to molecular target agents in the metastatic setting, but the value of these therapies in the adjuvant one has not been studied yet. It is probable that in the future the biological background of the different soft tissue sarcoma subtypes will guide the selection of therapies as well as the setting to deliver them. © 2013 Springer Science+Business Media New York.

Imatinib is a standard of care in the adjuvant treatment of patients with resected gastrointestinal stromal tumour (GIST). Two important trials have shown a reduction in GIST recurrence rates for patients treated with imatinib 400 mg daily for 1 year; one of these trials also demonstrated a significant improvement in overall survival for patients with GIST at high risk of recurrence who were treated for 3 years. However, not all patients will benefit from adjuvant treatment. Considering the patient types in both trials, treatment decisions must take into account a number of factors including risk of recurrence and mutational status. Tumour characteristics including tumour size, location and mitotic index are the main prognostic factors of recurrence-free survival (RFS) after surgical resection of GISTs. Research, much of it in the advanced/metastatic setting, shows that mutational analysis is definitely predictive of treatment efficacy and probably prognostic of RFS. Patients on imatinib whose tumours harbour mutations in exon 11 of the KIT gene tend to have superior RFS compared with patients with exon 9 mutations. In contrast, patients with wild-type GIST often have disease that follows an indolent course and has limited sensitivity to imatinib in most cases. As such, increased use of existing risk-stratification schemes and mutational analysis will be essential for optimising tailored treatment approaches. In this review, the development and prognostic/predictive utility of key risk stratification tools and mutational analysis of GIST are discussed herein with the goal of facilitating adjuvant treatment decisions for patients with GIST. © 2012 Elsevier Ltd. All rights reserved.

Gronchi A.,Sarcoma Service | Raut C.P.,Dana-Farber Cancer Institute
Hematology/Oncology Clinics of North America | Year: 2013

Surgery remains the only potentially curative therapy in the management of localized adult soft tissue sarcomas and gastrointestinal stromal tumors. There are over 50 different unique histologic types of soft tissue sarcomas, with different patterns of recurrence and prognosis. Surgical principles and sensitivity to locoregional and systemic treatments vary considerably based on the histologic type and anatomic location, as discussed in detail in this review. © 2013 Elsevier Inc.

Previtali P.,Fondazione Istituto Nazionale Dei Tumori | Fumagalli L.,Fondazione Istituto Nazionale Dei Tumori | Ammatuna M.,Fondazione Istituto Nazionale Dei Tumori | Materazzo C.,Fondazione Istituto Nazionale Dei Tumori | And 3 more authors.
Experimental and Clinical Cardiology | Year: 2014

Although some intra-operative conditions, such as hypotension, catecholaminergic drugs and inadequate depth of anesthesia, may have an intense vasoconstrictive effect, that could eventually induce coronary artery spasm, they have rarely been reported as cause of myocardial ischemia, leading to mechanical or electrical complications, including cardiac arrest. We report the case of a 67-year-old caucasic female who developed a ventricular arrhythmia followed by cardiac arrest, during uneventful abdominal surgery, in combined general-epidural anesthesia. A marked ST elevation, associated with a wide area of left ventricular dyssynchrony and severe mitral regurgitation, was observed during the cardiopulmonary resuscitation maneuvers and disappeared at recovery, after 35 minutes of CPR. A normal coronary angiography, performed ten days after the event, supported the hypothesis of an intra operative coronary spasm.

Duranti L.,Fondazione Istituto Nazionale Dei Tumori | Gronchi A.,Sarcoma Service | Stacchiotti S.,Adult Mesenchymal Tumor Medical Oncology Unit | Fiore M.,Sarcoma Service | And 4 more authors.
European Journal of Cancer | Year: 2013

Purpose To assess changes in survival over time in patients affected by thoracic soft tissue sarcomas treated at a single institution. Patients and Methods Patients with localised adult-type deep thoracic soft tissue sarcoma surgically treated at our institution between 1980 and 2012 were retrospectively reviewed. Patients were categorised into two groups according to timing of their first operation, i.e. surgery done before or after 31st December 2001 (so called 'early years' and 'recent years' groups, respectively), since a more extended surgery was used in the second interval. Overall survival (OS) and crude cumulative incidence (CCI) of local recurrence (LR) and distant metastases (DM) were calculated for each time period. Results Three-hundred-thirty-seven patients were identified. Median follow-up was 4.7 years. Tumour size and rate of critical site involvement were larger in 'recent years', while the distribution of all other tumour- and patient-related factors was identical in the two periods. Despite this, OS and CCI of LR were significantly better in 'recent years' as compared to 'early' ones, the 5-year OS increasing from 58% to 72% and the CCI of LR dropping from 22% to 11%. CCI of DM was equal in the two periods. Conclusion Reference institutions for sarcomas may have improved their outcome in the last years. Although biases of retrospective analyses need to be discounted, it is possible that optimal exploitation of a series of subtle improvements in sarcoma treatment may make a difference in results achievable today. © 2013 Elsevier Ltd. All rights reserved.

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