Soft Tissue Sarcoma with Jonathan C. Trent, MD, PhD and Shreyaskumar R. Patel, MD: Case 2 - Episode 2
What are the principle treatment goals for this patient with advanced, invasive myxoid liposarcoma?
When this patient first presented, they had a very large 20 centimeter radiographical tumor located within the lower extremity. It appears, while not specified, that the staging workup would have not picked up any metastatic disease. In this patient, who would otherwise be classified as AGCC stage III tumor, the goal is always cure. This is more of a general statement, that the intent or the goal is always cure. That’s what the patient wants and that’s what the treating team wants. What varies is the probability with which you can achieve it.
For stage III tumors, if you look at the data, there is a 50/50 probability that the patient will do well for three to five years and beyond. This is clearly a very heterogeneous group because what determines stage III is a tumor size that’s greater than 5 centimeters in size alongside high-grade and the location to the investing fascia. In a patient with a 20 centimeter tumor, clearly the probability of recurrence is much higher than just 50%.
The intent would always be cure and this is where the debate about multimodality therapy, should one incorporate neoadjuvant or adjuvant systemic chemotherapy, continues on. The patient obviously was treated with what’s accepted universally as the standard of care which would be a combination of radiation therapy and surgery to extirpate the local disease.
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 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.