A prospective randomized trial of adjuvant chemotherapy with bolus versus continuous infusion of doxorubicin in patients with high-grade extremity soft tissue sarcoma and an analysis of prognostic factors

Article Abstract:

In the past, amputation was the preferred treatment for many soft-tissue sarcomas that had not yet spread. In recent years, however, it has become possible to save the limbs of many patients with these forms of cancer. Unfortunately, one of the most effective drugs in the treatment of soft-tissue sarcoma may cause very serious side effects. Doxorubicin can cause significant damage to the heart muscle in a substantial fraction of patients. Studies were therefore conducted to determine if altering the schedule of doxorubicin might preserve the anticancer effectiveness while reducing the risk of heart muscle damage. Some studies have suggested that continuous infusion of doxorubicin might cause less heart damage than a large bolus given at once. It is important to establish, however, that the partial protection against heart damage obtained through continuous infusion is not gained at the cost of decreased effectiveness against the cancer. In a prospective comparison, 38 patients with soft tissue sarcoma were randomly assigned to receive a bolus dose and 44 were randomly assigned to receive a continuous infusion. Heart function was monitored; heart toxicity was defined as a decrease in the left ventricular ejection fraction (LVEF) of at least 10 percent. By this definition, cardiac toxicity was seen in 61 percent of the patients receiving bolus doses, in contrast with 42 percent receiving continuous infusion. The total dose of the patients experiencing cardiac toxicity was higher in the continuous infusion group. Two patients in each group developed heart failure and one in each group died. Patients receiving the bolus dose had a significantly lower death rate from cancer, however. When all prognostic indicators were taken into account, the difference in survival between the bolus and the continuous infusion groups was not statistically significant. Curiously, one of the factors that indicated a poor prognosis was receiving a blood transfusion within 24 hours of surgery, a prognostic factor which has been identified in other cancer studies as well. How this factor is related to eventual death from cancer is not yet understood, but it may be related to effects on the immune system. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Chemotherapy, Doxorubicin

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Malignant soft-tissue tumors of the anterior abdominal wall

Article Abstract:

The surgeon's main goal in treating cancer of the soft tissue of the abdominal wall is to control the tumor locally so that it does not recur and does not cross through the abdominal wall and invade vital internal abdominal organs. Malignant soft tissue tumors include sarcoma (malignant tumor beginning in fibrous, fatty, muscular, vascular, or nerve tissue usually first noticed as painless swelling) and desmoid tumors. Desmoid tumors are firm, circumscribed rubbery masses that infiltrate the fibrous sheaths and muscle fibers of the abdominal muscle. Sometimes called aggressive fibromatosis, they are infiltrative and prone to recur; many pathologists consider them to be low-grade malignant tumors. A review of surgical technique and the results of treatment of 55 patients treated for desmoid tumors or nondesmoid sarcoma is presented. Patients were treated over a 32-year period; there were 20 desmoid tumors and 35 nondesmoid sarcomas. Almost all of the patients with desmoid tumors were women of childbearing age; four of the men and two of the women were over the age of 50. The sarcomas did not show a particular preference for sex or age. The most common complaint was presence of a painless mass, although pain was noted in about half of the sarcoma patients. Except for small superficial masses, removal of the full depth of the abdominal wall with wide margins provides the best chance of local control of the tumor. If adequate tumor-free margin cannot be obtained, postoperative radiotherapy can be given. Local tumor control was achieved in 45 patients (86 percent). Twenty-four patients died of their disease; 23 had sarcoma and only 1 had desmoid tumor. Death was almost always due to metastasis (spread) to the lung. Metastasis often developed in patients with high-grade sarcomas. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Pelvic cancer, Fibrosarcoma

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The prognostic value of histologic subtypes in primary extremity liposarcoma

Article Abstract:

Liposarcomas are tumors of fat cells that tend to occur in the arms and legs. According to one classification system, there are five subtypes of liposarcomas; the behavior, relapse rate, and survival rate associated with these subtypes were studied. Well-differentiated liposarcoma (WDL) is a low-grade malignancy, with characteristics closest to normal cells. Myxoid liposarcoma (ML) is also low-grade, while fibroblastic and lipoblastic liposarcomas (FL; LL) have cells like those of fibroblasts (the basic connective tissue cells) and fat cell precursors, respectively. Pleiomorphic liposarcoma (PL) has a variety of cell types. The five-year survival rates for each of these cancers were: WDL, 100 percent; ML, 88 percent; FL, 58 percent; LL, 40 percent; and PL, 56 percent. The recurrence rates were 30, 25, 60, 100, and 64 percent, respectively. Local recurrence occurred more in higher-grade liposarcomas (FL, LL, and PL) than in low-grade liposarcomas. Distant metastasis rarely occurred with low-grade liposarcomas, but occurred in 50 percent of patients with FL, LL, or PL. The study concludes that subtyping can predict the outcome of liposarcoma, but further extension of this study is needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Surveys, Cancer, Married people

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