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Chiba Cancer Center, Chiba, Japan

CTOS 18 th Annual Meeting. 1 st Nov. 2013. Infiltrative Soft Tissue Sarcoma - Should We Excise Beyond Radiological Infiltration? -. Shintaro Iwata Tsukasa Yonemoto Yoko Hagiwara Takeshi Ishii Division of Orthopedic Surgery Akinobu Araki Dai Ikebe Division of Surgical Pathology

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Chiba Cancer Center, Chiba, Japan

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  1. CTOS 18th Annual Meeting 1st Nov. 2013 Infiltrative Soft Tissue Sarcoma - Should We Excise Beyond Radiological Infiltration? - Shintaro IwataTsukasa 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 Chiba Cancer Center, Chiba, Japan

  2. Infiltrative Growth of STS How should I resect? Chiba Cancer Center, Chiba, Japan

  3. Infiltrative Growth on MRI Significantly Correlated with Poor Local Control Rate and Overall Survival for MFH • Iwata et al. • CTOS 2011 meeting Focal Infiltrative Infiltrative Local Control Rate Overall Survival Focal Infiltrative Focal P=.014 P=.04 Chiba Cancer Center, Chiba, Japan

  4. Adjuvant Radiotherapy was Not Beneficial for Patients with Infiltrative Growth and Positive Surgical Margins • Iwata et al. • CTOS 2011 meeting Infiltrative Focal Focal RT(+) Infiltrative RT(-) RT(-) RT(+) P=.38 P=.08 Chiba Cancer Center, Chiba, Japan

  5. Does radiological infiltration pattern represent histological tumor infiltration? Chiba Cancer Center, Chiba, Japan

  6. Clinical questions • Aim of this study Q1: Do tumor cells actually exist in the radiographic infiltration? Q2: Should surgery be planed to include resecting the radiographic infiltration? Chiba Cancer Center, Chiba, Japan

  7. Patients and Methods Inclusion criteria Diagnosed with MFS, UPS, or LMS Treated initailly at our institution between 2007 and 2011 Total: 41 patients Follow-up for survivals: 18 - 77 months (median 48 months) Chiba Cancer Center, Chiba, Japan

  8. Patients and Methods Measurement of tumor infiltration Radiographic infiltration (R-inf) - Length of high-intensity tail-like extension GdFS STIR R-inf R-inf Histological infiltration (H-inf) - Distance from the tumor edge to the end of the atypical tumor cells H-inf Chiba Cancer Center, Chiba, Japan

  9. Result 1 Correlation with H-infand other factors (P<.0001, Fisher’s exact test) (Fisher’s exact test, Mann-Whitney’s U-test) Chiba Cancer Center, Chiba, Japan Age (years) (-) (+) H-inf

  10. Result 2 Relationship between H-infand R-inf Length (cm) R-inf GdFS R-inf STIR H-inf 0.8-5.3 0.1-6.0 0.4-6.7 Range (cm) Median 2.4 2.0 1.5 P=.59 (Kruskal-Wallis test) Chiba Cancer Center, Chiba, Japan

  11. Result 2 Relationship between H-infand R-inf H-inf(cm) R-inf STIR R-inf GdFS R2=.59 R2=.28 (Pearson’s correlation coefficient) H-inf=0.47x R-inf+0.25 H-inf=0.81xR-inf+0.25 Chiba Cancer Center, Chiba, Japan

  12. Result 4 Prognostic factor analysis P=.0017 H-inf Probability Yes P=.047 (Log-rank test) Time (months) No Chiba Cancer Center, Chiba, Japan Surgical margin Wide Probability Intra-tumor Intra-infiltrate Time (months)

  13. Discussion Q1: Do tumor cells actually exist in the radiographic infiltration? A1: YES, we should think so, at least on UPS and MFS. R-inf reflects H-inf. Sensitivity: 89% Specificity: 86% Actually tumor lesion, not edema! Chiba Cancer Center, Chiba, Japan

  14. Discussion Q2: Should surgery be planed to include resecting the radiographic infiltration? A2: YES, we propose 2cm margin from the edge of the infiltration in GdFS MRI. (H-inf - R-inf) < 2cm - 13/14 (93%) R-inf If you ignore, tumor recur. H-inf Chiba Cancer Center, Chiba, Japan

  15. 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. Chiba Cancer Center, Chiba, Japan

  16. Thank you for your attention. Chiba Cancer Center, Chiba, Japan

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