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Lymph node status is the most important prognostic factor in extremity sarcoma

The aim of this study was to assess regional lymph node metastasis in extremity sarcoma patients using the

Surveillance, Epidemiology, and End Results database. Of 7,159 patients without distant metastasis, 64 patients had identified regional lymph node metastasis (.9%). Regional lymph node metastasis was associated with younger age, tumor grade, size, invasion, and tumor subtype. Excluding distant metastasis, lymph node status was the strongest prognostic factor (hazards ratio = 5.1, P < .001).

Am J Surg. 2013 Sep;206(3):289-95. doi: 10.1016/j.amjsurg.2012.10.043. Epub 2013 Jun 24.






Specialty bias exists in adjuvant treatment recommendations for soft tissue sarcoma


The aim of the study was to assess if clinical specialty introduces bias in recommendations for multimodality treatment of soft tissue sarcoma (STS). The questionnaire was completed by 320 of 490 potential respondents (65%), including medical (18%), radiation (8%), orthopedic (22%), and surgical oncologists (45%). Respondents concurred on the use of radiation therapy for margins positive for tumor, for high-grade tumors, for improvement in local control, for tumors larger than 10 cm, and for tumors in close proximity to a neurovascular bundle. Respondents diverged on the use of radiation therapy for tumors 5 to 10 cm in size, for low-grade tumors, for radiation-associated STS, and for survival benefit. Only radiation oncologists felt that radiation therapy was underutilized as a treatment modality (mean [SEM] Likert scale score, 2.44 [0.12]; P < .001). There was agreement on the use of chemotherapy for synovial sarcoma, for high-grade tumors, for tumors larger than 10 cm, for patients younger than 50 years of age, and for survival benefit. Medical oncologists were more likely to recommend chemotherapy for margins positive for tumor (mean [SEM] score, 3.12 [0.12]; P = .03) and for improvement in local control (mean [SEM] score, 2.91 [0.12] P = .08). Surgical oncologists placed the least emphasis on chemotherapy in the overall treatment plan (mean [SEM] score, 2.60 [0.07]; P = .001).

JAMA Surg. 2013 Jul;148(7):632-9. doi: 10.1001/jamasurg.2013.113.





Questionable role of SLN biopsy in select patients with sarcoma for tumor staging


This review examines the clinical utility of SLN biopsy in patients with sarcoma. Sixteen studies involving SLN biopsy in patients with sarcoma were identified. Of 114 patients reported, 14 patients had positive SLNs (crude estimate, 12%; meta-analysis estimate, 17%). The meta-analysis false-negative rate was 29% (95% credible interval, 5%-59%). Recurrence and death rates in the SLN-positive group were higher than in the SLN-negative group.

Am J Surg. 2012 Oct;204(4):428-33. doi: 10.1016/j.amjsurg.2011.12.019.








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