Sarcoma Science Highlights
Background: Pelvic Chondrosarcomas (CS) have a poor prognosis. The grade is the most important survival predictor; other factors are periacetabular location and Dedifferentiated CS subtype. The aim of the study is to investigate a series of CS of the pelvis, to analyze the prognostic factors that affect outcomes and to demonstrate how the use of intraoperative navigation can reduce the complications without worse outcomes.
Methods: Retrospective study on 35 patients (21 M, 14 F), median age at surgery 54 years (IQR 41-65), with pelvic CS, treated with hemipelvectomy under navigation guidance.
Results: 30 high-grade CS and 5 low-grade CS; mean follow-up 51.4 months. There was a positive linear correlation between the tumor volume and the presence of local recurrence at follow-up. The mean survival time of patients with larger chondrosarcoma volume was lower, but not significantly so. Lower MSTS score was associated with significantly lower survival time (p < 0.001).
Conclusion: in this series overall survival, LR and distant metastasis were comparable with recent literature, while the complication rate was lower compared to similar series without the use of navigation. There was a correlation between tumor volume and local recurrence rate but not with the presence of metastasis at follow-up.
Osteosarcoma: An Evolving Understanding of a Complex Disease
Osteosarcoma is the most common primary bone sarcoma and affects both children and adults. The cornerstone of treatment for patients with localized and oligometastatic disease remains neoadjuvant chemotherapy, surgical resection of all sites of disease, followed by adjuvant chemotherapy. This approach is associated with up to 80% five-year survival. However, the survival of patients with metastatic disease remains poor, and overall, osteosarcoma remains a challenging disease to treat. Advances in the understanding of molecular drivers of the disease, identification of poor prognostic factors, development of risk-stratified treatment protocols, successful completion of large collaborative trials, and surgical advances have laid the groundwork for progress. Advances in computer navigation, implant design, and surgical techniques have allowed surgeons to improve patients' physical function without sacrificing oncologic outcomes. Future goals include identifying effective risk stratification algorithms which minimize patient toxicity while maximizing oncologic outcomes and continuing to improve the durability, function, and patient acceptance of oncologic reconstructions.
The Sarcoma Department at Moffitt is a multispecialty group focused on the treatment and cure of patients with all sarcoma subtype diagnoses. All new patient cases are presented at a weekly Multidisciplinary Tumor Board, and our comprehensive care includes limb preservation surgery, brachytherapy, complex vascular resection/reconstruction, as well as high-risk screening and comprehensive genetic counseling and testing.
Our team has a special interest in the treatment of patients with complex pelvic tumors and retroperitoneal sarcoma. The nature of these tumors often requires a multidisciplinary surgical team to include surgical and orthopaedic oncologists working in tandem for optimal patient outcomes. We employ a limb salvage approach for complex pelvic resections which often requires the use of custom implants or implants used on a compassionate use protocol. This focus lends itself to deep expertise in all domains which is required for optimal outcomes in such rare malignancies.
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