Feig.Manual MD Anderson_7ed

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Capítulo 6 / Sarcoma de tejidos blandos y huesos

Lecturas recomendadas American Joint Committee on Cancer. AJCC Cancer Staging Manual . 8th ed. Lippincott-Raven; 2017. Bonvalot S, Gronchi A, Le Péchoux C, et al. Preoperative radiotherapy plus surgery versus surgery alone for patients with primary retroperitoneal sarcoma (EORTC-62092: STRASS): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol . 2020;21(10):1366–1377. Burgoyne, Adam M, et al. “Duodenal-jejunal flexure GI stromal tumor frequently heralds somatic NF1 and notch pathway mutations.” JCO precision oncology. 2017;1:1–12. Coindre JM, Terrier P, Guillou L, et al. Predictive value of grade for metastasis development in the main histologic types of adult soft tissue sarcomas: a study of 1240 patients from the French Federation of Cancer Centers Sar coma Group. Cancer . 2001;91(10):1914–1926. Demetri GD, von Mehren M, Blanke CD, et al. Efficacy and safety of imatinib mesulate in advanced gastrointestinal stromal tumors. N Engl J Med . 2002;347(7):472–480. Dickson MA, Schwartz GK, Keohan ML, et al. Progression-free survival among patients with well-differentiated or dedifferentiated liposarcoma treated with CDK4 inhibitor palbociclib: a phase 2 clinical trial. JAMA Oncol . 2016;2:937–940. Dineen SP, Roland CL, Feig R, et al. Radiation-associated undifferentiated pleomorphic sarcoma is associated with worse clinical outcomes than sporadic lesions. Ann Surg Oncol . 2015;22:3913–3920. Eilber FC, Eilber FR, Eckardt J, et al. The impact of chemotherapy on the survival of patients with high-grade primary extremity liposarcoma. Ann Surg . 2004;240:686–695. Eisenberg BL, Harris J, Blanke CD, et al. Phase II trial of neoadjuvant/adjuvant imatinib mesylate (IM) for advanced primary and metastatic/recurrent operable gastrointestinal stromal tumor (GIST): early results of RTOG 0132/ ACRIN 6665. J Surg Oncol . 2009;99:42–47. Gounder MM, Mahoney MR, Van Tine BA, et al. Sorafenib for advanced and refractory desmoid tumors. N Engl J Med . 2018;379(25):2417–2428. Gronchi A, Ferrari S, Quagliuolo V, et al. Histotype-tailored neoadjuvant chemotherapy versus standard chemother apy in patients with high-risk soft-tissue sarcomas (ISG-STS 1001): an international, open-label, randomised, controlled, phase 3, multicentre trial. Lancet Oncol . 2017;18(6):812–822. Gronchi A, Palmerini E, Quagliuolo V, et al. Neoadjuvant chemotherapy in high-risk soft tissue sarcomas: final results of a randomized trial from Italian (ISG), Spanish (GEIS), French (FSG), and Polish (PSG) Sarcoma Groups. J Clin Oncol . 2020;38(19):2178–2186. Gronchi A, Stacchiotti S, Verderio P, et al. Short, full-dose adjuvant chemotherapy (CT) in high-risk adult soft tissue sarcomas (STS): long-term follow-up of a randomized clinical trial from the Italian Sarcoma Group and the Span ish Sarcoma Group. Ann Oncol . 2016;27(12):2283–2288. Grunhagen DJ, de Witt JHW, Graveland WJ, Verhoef C, van Geel AN, Eggermont AM. Outcome and prognostic fac tor analysis of 217 consecutive isolated limb perfusions with tumor necrosis factor-alpha and melphalan for limb-threatening soft tissue sarcoma. Cancer . 2006;106(8):1775–1784. Guillou L, Coindre JM, Bonichon F, et al. Comparative study of the National Cancer Institute and French Federation of Cancer Centers Sarcoma Group grading systems in a population of 410 adult patients with soft tissue sarcoma. J Clin Oncol . 1997;15:350–362. Issels RD, Lindner LH, Verweij J, et al; European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group (EORTC-STBSG). Neo-adjuvant chemotherapy alone or with regional hyperthermia for localised high-risk soft-tissue sarcoma: a randomised phase 3 multicentre study. Lancet Oncol . 2010;11:561–570. 4. C. Justificación: en los casos de tumores grandes en ubicaciones difíciles, debe considerarse la terapia preope ratoria con un ITC para reducir el tamaño del tumor, lo que puede permitir una resección más pequeña. En este caso, el paciente presenta múltiples factores de alto riesgo, como una tasa mitótica elevada, un tumor de gran tamaño y un tumor primario duodenal. La ubicación del tumor del paciente puede requerir una duo denopancreatectomía, pero, si se reduce de tamaño, puede requerir una duodenectomía lateral que tendría menos morbilidad a largo plazo. Por lo tanto, en esta situación se prefiere el imatinib neoadyuvante. 5. D. Justificación: el sarcoma epitelioide, el sarcoma de células claras, el rabdomiosarcoma y el SPI presentan mayor riesgo de enfermedad metastásica en los ganglios linfáticos regionales. Los otros tipos histológicos enumerados presentan un riesgo menor de metástasis en los ganglios linfáticos en relación con estos grupos.

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