|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 1 | Page : 119-120
Addressing the unmet need of improving survival outcomes of bone and soft tissue tumors
Arvind Krishnamurthy, V Karthik
Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
|Date of Submission||06-Jan-2020|
|Date of Decision||06-Jan-2020|
|Date of Acceptance||16-Jan-2020|
|Date of Web Publication||24-Feb-2020|
Department of Surgical Oncology, Cancer Institute (WIA), 38, Sardar Patel Road, Adyar, Chennai - 600 036, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Krishnamurthy A, Karthik V. Addressing the unmet need of improving survival outcomes of bone and soft tissue tumors. Cancer Res Stat Treat 2020;3:119-20
|How to cite this URL:|
Krishnamurthy A, Karthik V. Addressing the unmet need of improving survival outcomes of bone and soft tissue tumors. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Mar 30];3:119-20. Available from: http://www.crstonline.com/text.asp?2020/3/1/119/279094
The previous issue of Cancer Research, Statistics, and Treatment featured two articles addressing the larger issue of the oncological outcomes of bone and soft tissue tumors, which, despite the limited numbers and retrospective design, added to the limited available published Indian literature.,, The rarity and, more importantly, the heterogeneity of these tumors make an in-depth study of their clinical behavior difficult.
The article by Pareekutty et al. interestingly demonstrated a better survival in the cohort of patients who had undergone unplanned excisions (uP), and the authors have attributed this to a combination of multiple adverse factors though none of the individual factors studied, i.e., tumor size, grade, and histology, were found to be statistically significant between the two groups (planned versus the uP groups). The mean tumor size in the uP group was >9 cm, which is much more than the traditional believed 5 cm thumb size rule of suspecting a soft tissue tumor to be a possible sarcoma. This understanding among surgeons managing soft tissue tumors would go a long way in bringing down the number of unplanned excisions, and further, this sound clinical practice could definitely save the patients the psychological trauma and the resultant additional costs of having to undergo a repeat surgery to achieve clear margins, among other benefits. The reasons for the better outcomes in the 'uP' excision group, other than a 'pattern of referral' bias, are definitely worth exploring.
Further, the authors passingly mentioned that the patients in the 'uP' group had limited metastases and could be salvaged by a metastatectomy. However, the authors have not elaborated much on the same. It is worthwhile to mention that an important determinant of overall survival for any cancer is the ability to potentially salvage such recurrences.
The other article in the issue by Ankalkoti et al. audits the life and limb salvage outcomes in a tertiary care center. Nearly a third of the recurrences in that series could be salvaged, which included three cases of pulmonary metastasis. It is important to note that about 30%–40% of the patients with extremity osteosarcoma relapse and >80% of these localize in the lungs; there is a need for consideration of pulmonary metastasectomy in carefully selected patients of extremity osteosarcomas.
Further improvements in the survival outcomes in bone and soft tissue sarcomas could possibly stem from the use of novel systemic therapies through predictive biomarker development., While there are hardly any robust choices of second-line systemic therapies in extremity osteosarcomas, histology-directed therapies have shown promise in the management of metastatic soft tissue sarcomas., There is, thus, a huge unmet need pertaining to the development of precision medicine and targeted therapies (both patient-specific biomarker driven and tumor-agnostic) in the population of patients of soft tissue as well as bony sarcomas.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Pareekutty NM, Kattepur AK, Alapett JJ, Satheesan B. Unplanned excision in soft-tissue sarcomas – Is it the unkindest cut of all? Cancer Res Stat Treat 2019;2:152-7. [Full text]
Ankalkoti B, Pareekutty NM, Kattepur AK, Kumbakara R, Vazhayil R, Balasubramanian S. Life and limb after limb salvage surgery for osteosarcoma in an Indian tertiary cancer center. Cancer Res Stat Treat 2019;2:145-51. [Full text]
Tiwari A. Management of bone and soft-tissue sarcomas: From state of practice to state of art. Cancer Res Stat Treat 2019;2:215-6. [Full text]
Sidappa KT, Krishnamurthy A. Adult soft-tissue sarcomas of the head and neck. Indian J Cancer 2011;48:284-8.
] [Full text]
Harrison DJ, Geller DS, Gill JD, Lewis VO, Gorlick R. Current and future therapeutic approaches for osteosarcoma. Expert Rev Anticancer Ther 2018;18:39-50.
Haddox CL, Riedel RF. Individualizing systemic therapy for advanced soft tissue sarcomas based on tumor histology and biology. Expert Rev Anticancer Ther 2020;20:5-8.
Turkar S. Current treatment landscape and emerging management options for extremity sarcoma. Cancer Res Stat Treat 2018;1:121-38. [Full text]