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Epithelioid Sarcoma: Need for a Multimodal Approach to Maximize the Chances of Curative Conservative Treatment
Authors:Antonin Levy MD  Cécile Le Péchoux MD  Philippe Terrier MD  Ryan Bouaita MD  Julien Domont MD  Olivier Mir MD  Sarah Coppola MD  Charles Honoré MD  Axel Le Cesne MD  Sylvie Bonvalot MD   PhD
Affiliation:1. Department of Radiation Oncology, Institut Gustave-Roussy, Université Paris Sud, Villejuif, France
2. Department of Soft Tissue and Bone Sarcoma Multidisciplinary Unit, Institut Gustave-Roussy, Villejuif, France
3. Department of Pathology, Institut Gustave-Roussy, Villejuif, France
4. Department of Medical Oncology, Institut Gustave-Roussy, Villejuif, France
5. Department of Surgery, Institut Gustave-Roussy, Villejuif, France
Abstract:

Objective

This study was designed to evaluate the impact of multimodal management on a series of epithelioid sarcoma (ES) patients treated with curative intent.

Methods

Data were collected on 69 consecutive patients treated from 1982 to 2012. Univariate and multivariate analyses were performed for tumor control and overall survival (OS).

Results

In total, 54 (78 %) patients had localized ES (M0 group). In the M0 group, 85 % of patients received multimodal management (surgery n = 50, radiotherapy n = 37, chemotherapy n = 30). Among 42 patients with limb ES, 9 (21 %) underwent amputation, and isolated limb perfusion (ILP) was required in 17 (40.5 %) to allow conservative management. Among the 45 patients who underwent conservative surgery, flap reconstructions were required in 13 (28.8 %). The median follow-up was 5.7 years. The 5-year actuarial OS rates were 54, 62, and 24 % in the entire group and the M0 and M1 groups, respectively. In the M0 group, the 5-year actuarial distant control, local control (LC), and locoregional control rates were 67, 75, and 66 %, respectively. Prognostic factors for poor OS in the multivariate analysis were tumors that were deep to the fascia (p = 0.04) and grade 3 (p = 0.005). In the univariate analysis, age <30 years (p = 0.04), the T2 stage (p = 0.04), and mass presentation (p = 0.03) correlated with decreased LC, whereas patients who underwent ILP had a significantly higher LC rate (hazard ratio 3; 95 % confidence interval 0.9–9.4; p = 0.05).

Conclusions

Multimodal management including ILP and flap reconstruction is necessary to achieve optimal conservative LC. High rates of metastasis and lymphatic spread require innovative systemic treatments.
Keywords:
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