ONCAlert | 2017 San Antonio Breast Cancer Symposium
Soft Tissue Sarcoma Case Studies

Jonathan C. Trent, MD, PhD: Principle Treatment Goals for This Patient

Jonathan C. Trent, MD, PhD
Published Online:Feb 18, 2016
Michael C is a 59-year-old social worker from Los Angeles California; his medical history is notable for obesity, COPD, and mild hypertension

Soft Tissue Sarcoma with Jonathan C. Trent, MD, PhD and Shreyaskumar R. Patel, MD: Case 2

Soft Tissue Sarcoma with Jonathan C. Trent, MD, PhD and Shreyaskumar R. Patel, MD: Case 1
Soft Tissue Sarcoma with Jonathan C. Trent, MD, PhD and Shreyaskumar R. Patel, MD: Case 2


What are the principle treatment goals for this patient with advanced, invasive myxoid liposarcoma?

Overall, the goals of treatment in a patient with mixoid liposarcoma is curative. When a patient has a primary mixoid liposarcoma, we evaluate the aggressiveness of the tumor by looking at the grade as well as the round cell component. Patients with a high-grade aggressive tumor, close margins, higher round cell component will be treated with chemotherapy, radiation therapy, and surgery. A smaller size tumor with very low round cell component may be treated with surgery alone plus or minus radiation therapy.

When these tumors spread to distant sites, in my practice, I still approach these patients with a curative intent, although one has to realize that the probability of curing a patient with mixoid liposarcoma that is metastatic is, in reality, quite low, probably less than 10%. Occasionally, these patients can have very robust responses in their metastatic disease. They may have oligometastatic disease that can be consolidated with radiation therapy or surgical resection.

CASE: Soft-Tissue Sarcoma Case 2

Michael C is a 59-year-old social worker from Los Angeles California; his medical history is notable for obesity, COPD, and mild hypertension.

  • In January of 2014, he presents to his PCP with complaints of right lower leg pain of several weeks’ duration
  • Physical exam was unremarkable except for swelling of the lower right calf; x-ray of the affected leg was negative for fracture
  • MRI scan of the lower right calf showed a 20 cm well defined lobular mass arising between the gastrocnemius and soleus
  • Biopsy of the mass showed myxoid liposarcoma with round cell component. Patient underwent en bloc resection of the tumor following preoperative radiotherapy
  • Gross examination showed the tumor to be 10 × 8 × 15 cm with gelatinous brownish appearance

In September of 2014, Michael returns for follow up and his CT scan shows a 4 cm posterior mediastinal mass, and a 6 cm perinephric mass suspicious for metastatic disease. He initiates treatment with anthracycline and ifosfamide chemotherapy (6 cycles) for recurrent disease and shows a partial response.

  • In May of 2015, he returns for follow up with intermittent chest and lower back pain; CT scan is consistent with progression of the mediastinal and perinephric masses, and bone scan shows new lesions occurring in the L2 and L3 lumbar vertebrae
  • At recurrence, liver and renal function and CBC are within normal limits, and his ECOG performance status is 1
  • He received treatment with trabectedin (1.5 mg/m2 24-hr infusion given every 3 week)
  • At the 2nd cycle he develops febrile neutropenia (ANC< 500 cells/mm3) requiring hospitalization
  • The oncologist reduces his trabectedin dose to 1.2 mg/m2; he continues therapy
  • Within 1 week, he shows clinical improvement and CT scan shows slight improvement
Publications
Copyright © TargetedOnc 2017 Intellisphere, LLC. All Rights Reserved.