Skip to main content
PMC home page
British Journal of Cancer logoLink to British Journal of Cancer
. 1985 Mar;51(3):301–318. doi: 10.1038/bjc.1985.43

Combined modality management of local and disseminated adult soft tissue sarcomas: a review of 257 cases seen over 10 years at the Christie Hospital & Holt Radium Institute, Manchester.

V H Bramwell, D Crowther, D P Deakin, R Swindell, M Harris
PMCID: PMC1976948  PMID: 3970810

Abstract

Over a 10 year period, between 1974-1984, 257 adult cases of tissue sarcoma have been evaluated in the Department of Medical Oncology, Christie Hospital, Manchester. At registration locally advanced or metastatic diseases was present in 162 (63%). The male/female ratio was 1.5:1 and median age 54 years (range 14-85). The commonest sites were lower limb (33%), visceral (21%), trunk (13%), retroperitoneum (12%) and upper limb (10%). Leiomyosarcoma (27%), liposarcoma (14%) malignant fibrous histiocytoma (10%) and neuro plus fibrosarcomas (15%) were the most frequent histological subtypes. A high proportion of uterine sarcomas (17%) is a point of distinction from many other series. Histological grade was specified in 72% of cases and the distribution (Grade I--27%; II--6%; III--67%) reflected a referral bias towards advanced disease. Local resection of the primary tumour was performed in 76% of cases. In many instances this only amounted to 'shelling out' and true compartmental excisions were rare. Amputation was performed in 31% of patients with limb sarcomas. Ninety-eight patients (38%) had experienced one or more local recurrences prior to referral and the overall local recurrence rate was 56%. Suitable patients (78%) received chemotherapy, 50% entering multicentre trials in collaboration with the EORTC. The commonest regime used in patients with advanced disease was CYVADIC which produced an overall response rate of 37%. Ifosfamide, used as a single agent in 16 patients, induced 3CR and 5PR for an overall response rate of 50%. When used in combination with MTX and VADIC, there was no difference in response rate, but numbers in these pilot studies were small. Seventeen high risk patients received adjuvant chemotherapy with VAC, but the results (11 relapses) were disappointing. An EORTC trial, comparing adjuvant CYVADIC chemotherapy with control has accrued 307 patients, 49 of these from the Christie Hospital. Preliminary results within this centre - 13/25 relapses in the control arm, 5/23 in the chemotherapy arm-suggest an advantage for chemotherapy but the data are statistically not significant. Post-operative radical radiotherapy after resection of the primary tumour or local recurrence was performed in 51 patients, with local control in 65% of cases, although metastases developed in 41%. At the time of analysis (1st April 1984) 98 (38%) were alive, of whom 72 showed no evidence of disease and 52 had never relapsed. Malignant disease was the cause of death in 92%. Overall survival was not influenced by sex, but patients less than 40 years of age fared significantly better (P less than 0.001).(ABSTRACT TRUNCATED AT 400 WORDS)

Full text

PDF
304

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BRAUND R. R., PIGOTT J. D. Soft tissue sarcomas of the head and neck. Am J Surg. 1962 Nov;104:732–736. doi: 10.1016/0002-9610(62)90428-2. [DOI] [PubMed] [Google Scholar]
  2. Bramwell V. H., Mouridsen H. T., Mulder J. H., Somers R., Van Oosterom A. T., Santoro A., Thomas D., Sylvester R., Markham D. Carminomycin vs adriamycin in advanced soft tissue sarcomas: an EORTC randomised phase II study. Eur J Cancer Clin Oncol. 1983 Aug;19(8):1097–1104. doi: 10.1016/0277-5379(83)90034-2. [DOI] [PubMed] [Google Scholar]
  3. Bryant B. M., Wiltshaw E. Central nervous system involvement in sarcoma. A presentation of 12 cases, a review of the literature, and a discussion of possible changing patterns with the use of chemotherapy, placing special emphasis on embryonal tumours. Eur J Cancer. 1980 Nov;16(11):1503–1507. doi: 10.1016/0014-2964(80)90062-6. [DOI] [PubMed] [Google Scholar]
  4. CADE S. Soft tissue tumours: their natural history and treatment. Proc R Soc Med. 1951 Jan;44(1):19–36. [PMC free article] [PubMed] [Google Scholar]
  5. Cody H. S., 3rd, Turnbull A. D., Fortner J. G., Hajdu S. I. The continuing challenge of retroperitoneal sarcomas. Cancer. 1981 May 1;47(9):2147–2152. doi: 10.1002/1097-0142(19810501)47:9<2147::aid-cncr2820470907>3.0.co;2-z. [DOI] [PubMed] [Google Scholar]
  6. Coe M. A., Madden F. J., Mould R. F. The role of radiotherapy in the treatment of soft tissue sarcoma: a retrospective study 1958--73. Clin Radiol. 1981 Jan;32(1):47–51. doi: 10.1016/s0009-9260(81)80247-4. [DOI] [PubMed] [Google Scholar]
  7. Das Gupta T. K., Patel M. K., Chaudhuri P. K., Briele H. A. The role of chemotherapy as an adjuvant to surgery in the initial treatment of primary soft tissue sarcomas in adults. J Surg Oncol. 1982 Mar;19(3):139–144. doi: 10.1002/jso.2930190306. [DOI] [PubMed] [Google Scholar]
  8. España P., Chang P., Wiernik P. H. Increased incidence of brain metastases in sarcoma patients. Cancer. 1980 Jan 15;45(2):377–380. doi: 10.1002/1097-0142(19800115)45:2<377::aid-cncr2820450231>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
  9. Gerner R. E., Moore G. E. Synovial sarcoma. Ann Surg. 1975 Jan;181(1):22–25. doi: 10.1097/00000658-197501000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Gerson R., Shiu M. H., Hajdu S. I. Sarcoma of the buttock: a trend toward limb-saving resection. J Surg Oncol. 1982 Apr;19(4):238–242. doi: 10.1002/jso.2930190413. [DOI] [PubMed] [Google Scholar]
  11. Hart W. R., Billman J. K., Jr A reassessment of uterine neoplasms originally diagnosed as leiomyosarcomas. Cancer. 1978 May;41(5):1902–1910. doi: 10.1002/1097-0142(197805)41:5<1902::aid-cncr2820410535>3.0.co;2-k. [DOI] [PubMed] [Google Scholar]
  12. Kearney M. M., Soule E. H., Ivins J. C. Malignant fibrous histiocytoma: a retrospective study of 167 cases. Cancer. 1980 Jan 1;45(1):167–178. doi: 10.1002/1097-0142(19800101)45:1<167::aid-cncr2820450127>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
  13. Lindberg R. D., Martin R. G., Romsdahl M. M., Barkley H. T., Jr Conservative surgery and postoperative radiotherapy in 300 adults with soft-tissue sarcomas. Cancer. 1981 May 15;47(10):2391–2397. doi: 10.1002/1097-0142(19810515)47:10<2391::aid-cncr2820471012>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  14. Lindberg R. D., Martin R. G., Romsdahl M. M. Surgery and postoperative radiotherapy in the treatment of soft tissue sarcomas in adults. Am J Roentgenol Radium Ther Nucl Med. 1975 Jan;123(1):123–129. doi: 10.2214/ajr.123.1.123. [DOI] [PubMed] [Google Scholar]
  15. Markhede G., Angervall L., Stener B. A multivariate analysis of the prognosis after surgical treatment of malignant soft-tissue tumors. Cancer. 1982 Apr 15;49(8):1721–1733. doi: 10.1002/1097-0142(19820415)49:8<1721::aid-cncr2820490832>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
  16. McNeer G. P., Cantin J., Chu F., Nickson J. J. Effectiveness of radiation therapy in the management of sarcoma of the soft somatic tissues. Cancer. 1968 Aug;22(2):391–397. doi: 10.1002/1097-0142(196808)22:2<391::aid-cncr2820220217>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
  17. Mettlin C., Priore R., Rao U., Gamble D., Lane W., Murphy P. Results of the national soft-tissue sarcoma registry. J Surg Oncol. 1982 Apr;19(4):224–227. doi: 10.1002/jso.2930190410. [DOI] [PubMed] [Google Scholar]
  18. Pinedo H. M., Vendrik C. P., Bramwell V. H., van Slooten E. A., Deakin D. P., van Unnik J. A., Staquet M., Sylvester R., Bonadonna G. Evaluation of adjuvant therapy in soft tissue sarcoma. A collaborative multidisciplinary approach. E.O.R.T.C. protocol 62771. Eur J Cancer. 1979 May;15(5):811–820. doi: 10.1016/0014-2964(79)90158-0. [DOI] [PubMed] [Google Scholar]
  19. Presant C. A., Lowenbraun S., Bartolucci A. A., Smalley R. V. Metastatic sarcomas: chemotherapy with adriamycin, cyclophosphamide, and methotrexate alternating with actinomycin D, DTIC, and vincristine. Cancer. 1981 Feb 1;47(3):457–465. doi: 10.1002/1097-0142(19810201)47:3<457::aid-cncr2820470306>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]
  20. Pritchard D. J., Soule E. H., Taylor W. F., Ivins J. C. Fibrosarcoma--a clinicopathologic and statistical study of 199 tumors of the soft tissues of the extremities and trunk. Cancer. 1974 Mar;33(3):888–897. doi: 10.1002/1097-0142(197403)33:3<888::aid-cncr2820330339>3.0.co;2-c. [DOI] [PubMed] [Google Scholar]
  21. Reszel P. A., Soule E. H., Coventry M. B. Liposarcoma of the extremities and limb girdles. A study of two hundred twenty-two cases. J Bone Joint Surg Am. 1966 Mar;48(2):229–244. [PubMed] [Google Scholar]
  22. Rosenberg S. A., Tepper J., Glatstein E., Costa J., Baker A., Brennan M., DeMoss E. V., Seipp C., Sindelar W. F., Sugarbaker P. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg. 1982 Sep;196(3):305–315. doi: 10.1097/00000658-198209000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Rosenberg S. A., Tepper J., Glatstein E., Costa J., Young R., Baker A., Brennan M. F., Demoss E. V., Seipp C., Sindelar W. F. Prospective randomized evaluation of adjuvant chemotherapy in adults with soft tissue sarcomas of the extremities. Cancer. 1983 Aug 1;52(3):424–434. doi: 10.1002/1097-0142(19830801)52:3<424::aid-cncr2820520307>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
  24. Rosenberg S. A., Tepper J., Glatstein E., Costa J., Young R., Seipp C., Wesley R. Adjuvant chemotherapy for patients with soft tissue sarcomas. Surg Clin North Am. 1981 Dec;61(6):1415–1423. doi: 10.1016/s0039-6109(16)42595-8. [DOI] [PubMed] [Google Scholar]
  25. Russell W. O., Cohen J., Enzinger F., Hajdu S. I., Heise H., Martin R. G., Meissner W., Miller W. T., Schmitz R. L., Suit H. D. A clinical and pathological staging system for soft tissue sarcomas. Cancer. 1977 Oct;40(4):1562–1570. doi: 10.1002/1097-0142(197710)40:4<1562::aid-cncr2820400428>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  26. SPIRO R. H., KOSS L. G. MYOSARCOMA OF THE UTERUS; A CLINICOPATHOLOGICAL STUDY. Cancer. 1965 May;18:571–588. doi: 10.1002/1097-0142(196505)18:5<571::aid-cncr2820180506>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  27. Salazar O. M., Bonfiglio T. A., Patten S. F., Keller B. E., Feldstein M. L., Dunne M. E., Rudolph J. H. Uterine sarcomas: analysis of failures with special emphasis on the use of adjuvant radiation therapy. Cancer. 1978 Sep;42(3):1161–1170. doi: 10.1002/1097-0142(197809)42:3<1161::aid-cncr2820420320>3.0.co;2-c. [DOI] [PubMed] [Google Scholar]
  28. Salazar O. M., Bonfiglio T. A., Patten S. F., Keller B. E., Feldstein M., Dunne M. E., Rudolph J. Uterine sarcomas: natural history, treatment and prognosis. Cancer. 1978 Sep;42(3):1152–1160. doi: 10.1002/1097-0142(197809)42:3<1152::aid-cncr2820420319>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
  29. Schoenfeld D. A., Rosenbaum C., Horton J., Wolter J. M., Falkson G., DeConti R. C. A comparison of adriamycin versus vincristine and adriamycin, and cyclophosphamide versus vincristine, actinomycin-D, and cyclophosphamide for advanced sarcoma. Cancer. 1982 Dec 15;50(12):2757–2762. doi: 10.1002/1097-0142(19821215)50:12<2757::aid-cncr2820501211>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  30. Shiu M. H., Castro E. B., Hajdu S. I., Fortner J. G. Surgical treatment of 297 soft tissue sarcomas of the lower extremity. Ann Surg. 1975 Nov;182(5):597–602. doi: 10.1097/00000658-197511000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Simon M. A., Enneking W. F. The management of soft-tissue sarcomas of the extremities. J Bone Joint Surg Am. 1976 Apr;58(3):317–327. [PubMed] [Google Scholar]
  32. Sordillo P. P., Magill G. B., Shiu M. H., Lesser M., Hajdu S. I., Golbey R. B. Adjuvant chemotherapy of soft-part sarcomas with ALOMAD (S4). J Surg Oncol. 1981;18(4):345–353. doi: 10.1002/jso.2930180404. [DOI] [PubMed] [Google Scholar]
  33. Spittle M. F., Newton K. A., Mackenzie D. H. Liposarcoma. A review of 60 cases. Br J Cancer. 1970 Dec;24(4):696–704. doi: 10.1038/bjc.1970.83. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Suit H. D., Proppe K. H., Mankin H. J., Wood W. C. Preoperative radiation therapy for sarcoma of soft tissue. Cancer. 1981 May 1;47(9):2269–2274. doi: 10.1002/1097-0142(19810501)47:9<2269::aid-cncr2820470928>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  35. Suit H. D., Russell W. O., Martin R. G. Sarcoma of soft tissue: clinical and histopathologic parameters and response to treatment. Cancer. 1975 May;35(5):1478–1483. doi: 10.1002/1097-0142(197505)35:5<1478::aid-cncr2820350537>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]
  36. Suit H. D., Russell W. O. Radiation therapy of soft tissue sarcomas. Cancer. 1975 Aug;36(2):759–764. doi: 10.1002/1097-0142(197508)36:2+<759::aid-cncr2820360821>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
  37. Weisenburger T. H., Eilber F. R., Grant T. T., Morton D. L., Mirra J. J., Steinberg M., Rickles D. Multidisiciplinary "limb salvage" treatment of soft tissue and skeletal sarcomas. Int J Radiat Oncol Biol Phys. 1981 Nov;7(11):1495–1499. doi: 10.1016/0360-3016(81)90077-8. [DOI] [PubMed] [Google Scholar]
  38. Weiss S. W., Enzinger F. M. Malignant fibrous histiocytoma: an analysis of 200 cases. Cancer. 1978 Jun;41(6):2250–2266. doi: 10.1002/1097-0142(197806)41:6<2250::aid-cncr2820410626>3.0.co;2-w. [DOI] [PubMed] [Google Scholar]
  39. Windeyer B., Dische S., Mansfield C. M. The place of radiotherapy in the management of fibrosarcoma of the soft tissues. Clin Radiol. 1966 Jan;17(1):32–40. doi: 10.1016/s0009-9260(66)80117-4. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES