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Adductor Compartment STS - Does method of treatment affect outcome?

Adductor Compartment STS - Does method of treatment affect outcome?. Anup Pradhan, Yiu-Chung Cheung Birmingham Medical School, UK Supervisors: Mr Robert J Grimer Royal Orthopaedic Hospital, Birmingham, UK Dr Peter Ferguson Mount Sinai Hospital, Toronto, Canada. Background.

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Adductor Compartment STS - Does method of treatment affect outcome?

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  1. Adductor Compartment STS- Does method of treatment affect outcome? Anup Pradhan, Yiu-Chung Cheung Birmingham Medical School, UK Supervisors: Mr Robert J Grimer Royal Orthopaedic Hospital, Birmingham, UK Dr Peter Ferguson Mount Sinai Hospital, Toronto, Canada

  2. Background • Presents late • Often large • Neurovascular bundle close

  3. Surgical challenge!

  4. Marginal close to femoral vessels

  5. Vessels preserved Big hole !

  6. 14 days later… 7 days later…

  7. Aim of the project • To assess outcomes at ROH Birmingham • Survival • Local control • Complications • Function • To compare with a major North American Centre • To determine if different treatment methods affected above outcomes

  8. Treatment philosophies in the two Specialist Regional Centres • ROH, Birmingham, UK • Surgery followed by RT (most cases) • MSH, Toronto • Surgery preceded by RT (most cases) • Frequent use of flaps

  9. Method • Prospective databases • Study period (Jan 1990 – Jan 2001) • Collection of basic data and outcomes • demographic data • Size, grade (tumour) • Treatment methods • Survivorship for LR, OS • Wound complications • TESS for function

  10. Exclusions • Metastases at diagnosis • Previous treatment elsewhere • Patients lost to follow up • Unfit for surgery

  11. ROH MSH Median Age 55yrs Median Age 56.5yrs Patient age distribution P = 0.98

  12. ROH MSH Median = 9.5cm Median = 13cm Tumour size at diagnosis P = 0.11

  13. Factor ROH (n = 64) MSH (n = 62) P-value Mean (median) Age 55 (57) 55 (56.5) 0.98 Mean (median) Size (cm) 13.2 (12.8) 11.4 (9.5) 0.11 Proportion > 10cm 38 (59%) 25 (40%) 0.03 Proportion of high grade tumours 36 (56%) 35 (56%) 0.98 Adequate margins 46 (72%) 44 (71%) 0.91 Pre-operative radiotherapy NIL 26 (42%) Post-operative radiotherapy 60 (94%) 30 (48%) Use of muscle flaps NIL 26 (42%) Patient and Treatment Factors

  14. Factor ROH (n = 64) MSH (n = 62) P-value Length of stay 10.4 11.6 0.50 Wound complications 27 (42%) 14 (23%) 0.019 Local Recurrence (5 Year) 28% 10% 0.015 Metastases (5 Year) 51.5% 38.8% 0.48 Overall survival (5 Year) 58% 74% 0.13 TESS score 72% 79% 0.18 Outcomes Oncological and Functional Outcomes

  15. Comparing OS between the 2 centres P = 0.13 5yr OS = 74% MSH 5yr OS =57% ROH

  16. Overall survival by grade Low/Intermediate grade P < 0.001 High grade

  17. Overall survival by size P = 0.015 Size ≤ 10cm Size > 10cm

  18. Comparison of OS between pre and post RT groups (combined data from both centres) Postop RT Preop RT P = 0.55

  19. Comparing LR between the 2 centres P = 0.0145 5YLR = 10% 5YLR = 28%

  20. Factors associated with LR

  21. Summaryof Overall Findings • OS rate = 66% at 5 yrs • Significant factors • High Grade [HR 5.6, CI 2.3 – 13.5] • Size (< 10cm) [HR 0.41, CI 0.21 – 0.81] • LR rate = 21% at 5yrs • Significant factors • Margin • Functional outcome • Average TESS score – 76% • Worse TESS - wound complications(65% vs.79%) - high grade (70% vs. 84%) • No association with RT timing

  22. Conclusion • OS – unaffected by treatment strategies • RT Timing – no affect on OS, LR, and function • LR – Higher rate in ROH • Positive margins (28%) • quality of RT

  23. Acknowledgements • Supervisors Mr Rob Grimer Dr Peter Ferguson • Mr Seggy Abudu • Dr Anthony Griffin • Medical Records, ROH, Birmingham • Orthopaedic Oncology Team, MSH, Toronto

  24. References • O’Sullivan et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet 2002; 359(9325): 2235-2241 • Grainger MF, Grimer RJ, Carter SR, Tillman RM. Wound complications following resection of adductor compartment tumours. Sarcoma 5 2001: 203-207 • Davis AM, O’Sullivan B, Bell RS, et al. Function and Health Status Outcomes in a Randomized Trial Comparing Preoperative and Postoperative Radiotherapy in Extremity Soft Tissue Sarcoma. J Clin Oncol 2002; 20: 4472-4477 • Bell RS, O’Sullivan B, Davis A, Langer F, Cummings B, Fornasier VL. Functional Outcome in Patients Treated With Surgery and Irradiation for Soft Tissue Tumours. J Surg Oncol 1991; 48: 224-231 • Gerrand CH, Wunder JS, Kandel RA, O’Sullivan B, Catton CN, Bell RS, Griffin AM, Davis AM. Classification of positive margins after resection of soft-tissue sarcoma of the limb predicts the risk of local recurrence. J Bone Joint Surg Br 2001; 83-B(8): 1149-1155

  25. Thank You

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