الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Soft tissue sarcomas are rare cancers that account for less than 1% of all adult malignancies and involve more than 50 distinctive histologic subtypes that differ in pathogenesis and outcomes. They are diverse, non-epithelial extraskeletal tumors that can originate in muscle, nerves, fat or fibrous tissue. The aim of the present work was to review medical records of all patients diagnosed with soft tissue sarcoma and to identify the incidence of cases presenting to Alexandria main university hospital, stand on treatment modalities applied and survival outcome.
To achieve this aim, medical records of patients who presented to ACOD between January 2003 and December 2012 were reviewed. Epidemiological data, clinicopathological data and details of variously administered treatment regimens were retrieved and tabulated. Overall survival (OS) and disease free survival (DFS) of patients who were estimated using Kaplan-Meier method.
The total number of cases along the 10 years was 121 patients constituted 0.48% of total cancer cases. There was a slight female predominance, with about 53% of the studied cases being females. About 41% of cases aged from 30 to 50 years, 33.9% aged from 50 to 70 years, while 19% of cases were less than 30 years with the mean age was 44.5 years.
The majority of studied cases presented with painless swelling, while 9% presented with painful mass. Around 10% of cases presented with abdominal discomfort and distension (retroperitoneal sarcomas). The most common sites of primary tumors were the extremities (73.6%), the trunk (12.4%), retroperitoneal (10.7%) and head and neck (3.3%).
The most common pathological subtype was liposarcoma (more than ¼ of cases). About 28% of cases were grade I while the percentage of grade II and III were 19.8% each. Regarding the size of the tumor, about 1/3 of cases were more than 10 cm while 41.7% were 5-10 cm in maximum diameter. Surgical margins were free in about 60% of cases and were involved in about 36%. About 15% of the studied cases were metastatic at presentation; most of them had lung metastasis.
Around 80% of the non-metastatic cases underwent radical surgery while 18.4% of them underwent incomplete excision of the tumor ”with gross residual”. Only two patients underwent amputation. About 2/3 of the non-metastatic cases received radiotherapy with the dose ranging from 50 to 59 Gy as an adjuvant treatment. About 37% of non-metastatic cases received chemotherapy. The most common adjuvant chemotherapy regimen was ifosfamide plus adriamycin.
About 1/3 of the studied cases developed recurrence after finishing their treatment. 9 with local recurrence underwent surgery, while 9 patients received radiotherapy. None of them received radiotherapy in the treatment of the primary tumor. About 57% of recurrent cases received chemotherapy. All metastatic STS patients received chemotherapy. Most common first line regimen was ifosfamide plus adriamycin while gemcitabine with either docetaxel or vinorelbine were the most common regimens as a second line. Out of 18 metastatic STS patients, only 5 patients received palliative radiotherapy.
In the present study, a total of 121 STS patients were included in survival outcomes analysis. The median overall survival (OS) time was 32 months, the overall survival at 1,3 and 5 years was 69.9%, 37% and 34.4% respectively. The DFS of the non-metastatic cases was 63.1%, 33.5% and 16.8% at 1, 3 and 5 years respectively with median time was 28 months. The median progression free survival of the metastatic and recurrent cases was around 12 months.
Age, pathological grade, tumor size, status of surgical margin, use of adjuvant radiotherapy, use of adjuvant and palliative chemotherapy were tested in relation to survival analysis.
Patients younger than 50 years had better OS and DFS compared with patients older than 50 years, but this difference was not statistically significant [ P value = 0.17 and 0.94 respectively]. The OS and DFS of patients with grade I and II were significantly better than grade III [ P value = 0.03 and 0.014 respectivley]. Tumors less than 10 cm had better OS compared with tumors more than 10 cm. But this difference was not statistically significant [ P value = 0.16], while tumors less than 10 cm had better DFS compared with tumors more than 10 cm [ P value = 0.02] which was statistically significant.
Patients who underwent surgery with negative margin had better OS and DFS than patients underwent surgery with involved surgical margin, this difference was statistically significant [P value = 0.024 and 0.003 respectively]. There were no statistically significant differences in OS and DFS with the use of adjuvant radiotherapy in tumors less than 5 cm and with p value = 0.06, while there were statistically significant differences in OS and DFS with adjuvant radiotherapy in tumors more than 5 cm with p value = 0.029. There were no statistically significant differences in OS and DFS with the use of adjuvant radiotherapy in low grade tumors with p value = 0.07 while there were statistically significant differences in OS and DFS with the use of adjuvant radiotherapy in high grade tumors with p value = 0.002.
There were no statistically significant differences in OS and DFS in patients who received adjuvant chemotherapy [P value = 0.09 and 0.14 respectively]. There were no statistically significant differences in OS and PFS in patients who received palliative chemotherapy [ p value = 0.17 and 0.36 respectively].
At the end of the study, we recommend that a multidisciplinary team should be involved in treatment decisions of cases of STS to achieve optimal oncological and functional outcomes. Enhancing awareness of the early signs and symptoms of soft tissue sarcoma at primary health care level will help early detection of malignancies and result in better prognosis and quality of life. Establishment of electronic patient data entry is a necessity to help proper follow up for the patients for a better outcome. Adopting an institutionally based management guidelines for each stage of STS. Establishment of a national cancer registry for the whole country is mandatory to stand on cancer incidence in all Egypt and to identify possible risk factors.