A Contemporary Large Single-Institution Evaluation of Resected Retroperitoneal Sarcoma

Purpose

Retroperitoneal sarcomas (RPS) are rare malignancies, comprising just 10–15 % of all soft-tissue sarcomas. These are challenging tumors to treat, with surgical resection being the only modality capable of providing a cure. This study analyzed the management and survival of patients resected at a large academic institution.

Methods

A retrospective study of all patients with primary localized RPS referred to the University of Washington between January 2000 and January 2013 was performed. Univariate and multivariate Cox regression models were used to analyze progression-free survival (PFS) and overall survival (OS) by patient, tumor, and treatment variables.

Results

The study identified 132 patients. Median follow-up was 31.8 months. Median PFS was 33 months, and median OS was 111 months. Sixty patients (45.5 %) underwent a margin-negative resection (R0), 59 (44.7 %) had a microscopic margin-positive resection (R1), and 7 (5.3 %) had a macroscopic margin-positive resection (R2). Forty (30.3 %) patients received preoperative radiation, 28 (21.2 %) received neoadjuvant chemotherapy, and 7 (5.3 %) received both. Tumor grade and microscopic margin status emerged as statistically significant predictors for both PFS and OS. Tumor size was also found to correlate with PFS. No significant difference in OS or PFS was observed for histologic subtype, neoadjuvant chemotherapy, or neoadjuvant radiation.

Conclusions

Complete surgical resection should remain the mainstay of management for RPS, with emphasis on achieving negative microscopic margins. Neither neoadjuvant chemotherapy nor radiation was shown to significantly improve survival, and their unclear role in the management of RPS requires evaluation in a prospective setting.     

The mandible-C2 angle: a new radiographic assessment of occipitocervical alignment

BACKGROUND CONTEXTOccipitocervical fusion is a rare and often challenging surgical procedure. Significant morbidity can result if care is not taken to achieve physiologic alignment. This is especially true for patients needing occipitocervical fusion in the setting of trauma where preoperative alignment is unknown.PURPOSETo assess the radiographic angles normally subtended between the C2 body and the mandible ramus, in a series of patients with neutral physiologic alignment and no pathology, and to assess its validity as a possible intraoperative radiographic tool to determine a neutral craniocervical alignment.DESIGNValidation and reliability study of radiographic parameters.PATIENT SAMPLEHundred lateral, neutral, cervical radiographs from patients with “normal” radiographic findings.OUTCOME MEASURESRadiographic parameters of occipital-cervical alignment with assessment of reliability and correlation in data.METHODSOne hundred neutral lateral cervical spine radiographs in the upright position of patients with no complaints or known pathology were obtained from two medical clinics between December of 2014 and January of 2017. Three physicians, at different levels of spine surgery training, took measurements of radiographic parameters. The new technique used four different angles measured between the C2-body/dens complex and the mandibular ramus (anterior/posterior C2 body and anterior/posterior mandible lines angles), and compared these with the Occipito-C2 angle, which is a validated assessment of occipitocervical alignment. Statistical analysis was performed to assess correlation in data and measure reproducibility.RESULTSBetween the three reviewers, the mean±standard deviation were 18.0°±6.5° for Occipito-C2 angle (O-C2A), ?4.2°±5.4° for anterior C2-body/anterior mandible line angle (AB/AM), ?4.2°±5.9° for anterior C2-body/posterior mandible line angle (AB/PM), 5.1°±5.8° for posterior C2 body/anterior mandible line angle (PB/AM) and 5.6°±6.2° for posterior C2 body/ posterior mandible line angle (PB/PM). Overall the measurements obtained were correlative with an appropriate range for the standard deviation. Mean intraclass correlation coefficient were 0.889 for O-C2A, 0.795 for AB/AM, 0.859 for AB/PM, 0.876 for PB/AM, and 0.750 for PB/PM, showing high interobserver reliability for all the radiographic measures. Across the five techniques, 87%–92% of measurements fell within 10° of the median, 76%–83% fell within 7.5°, and 55%–66% within 5°.CONCLUSIONSThe mandible-C2 angle offers a reproducible alternative to the validated O-C2A technique for determining appropriate intraoperative occipitocervical alignment, which may be especially useful when preoperative radiographic alignment is unknown, such as occurs with trauma patients, with the goal of decreasing alignment-related complications in the setting of occipitocervical stabilization.