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1488P ORGANISATION OF SARCOMA PATIENT MANAGEMENT IN
REFERENCE CENTERS IN NETSARC NETWORK: ANALYSIS
OF THE QUALITY OF RESECTION
S. Bonvalot 1 , P. Meeus 2 , E. Stoeckle 3 , B. Bui 4 , A. Le Cesne 5 , N. Penel 6 ,I.
L. Ray-Coquard 7 , J. Coindre 8 , C. Chemin 9 , J. Blay 7 , On Behalf of The Netsarc
National Network (www.netsarc.org)
1 Department of Surgery, Institut Gustave Roussy, Villejuif, FRANCE, 2 Surgery,
Centre Léon Bérard, Lyon, FRANCE, 3 Surgery, Institute Bergonie, Bordeaux
Cedex, FRANCE, 4 Medical Oncology, Institute Bergonie, Bordeaux Cedex,
FRANCE, 5 Dept. Medical Oncology, Institut Gustave Roussy, Villejuif, FRANCE,
6 Medical Oncology, Centre Oscar Lambret, Lille, FRANCE, 7 Medical Oncology,
Centre Léon Bérard, Lyon Cedex, FRANCE, 8 Anatomopathology, Institute
Bergonie, Bordeaux Cedex, FRANCE, 9 Medical Evaluation, Centre Léon Berard,
Lyon, FRANCE
The French National Cancer Institute suggested the improvement of sarcoma
management when performed in a multidisplinary expert team. Since 2009, a
network of 26 reference multidisciplinary boards has been created to improve the
quality of care of sarcoma patients in France. All patient cases presented are
uploaded in the NetSarc network collecting patient characteristics, clinical situation
at the time of the discussion, medical decision, and patient outcome (survival and
relapse).
Patients and methods: From January 2010 to April 2012, 8934 patients were
included on this database. Patients were presented from centers within (N = 5911,
66%) or outside (N = 2343, 26%) the Netsarc Network (parameter unknown in N =
679, 8% patient). Patient and disease characteristics and treatment results are
described.
Results: There were 4662 women (52%) and 4272 men (48%). Median size of the
sarcoma was 95mm (range2- > 400). Soft tissue, visceral, and bone represented 6381
(71%) 1285 (14%) and 1264 (14%) of patients respectively. In soft tissue tumours,
grade 1, 2, 3 were reported in 44%, 33%, 23% of patients. The most frequent
histological subtypes were leiomyosarcomas (all sites) (n = 769, 9%), GIST (558, 6%),
dedifferentiated liposarcomas (n = 439, 5%). Most frequent primary sites were thigh
(1268, 14%), retroperitoneal (796, 9%), thoracic wall (460, 5%), uterus (405, 4.5%),
legs (325, 4%). 1052 (11%) patients were reported to have metastases. Clinical and
disease status at the time of discussion was prior to: biopsy (N = 824, 9%), first
surgery (N = 1751, 20%), adjuvant treatment (N = 2806, 31%). 6161 (67%) patients
had a surgery, n = 1472 (24%) in the Netsarc network and outside n = 1843 (30%); in
n = 2846 (46%) this information is not still documented. Patients whose primary
surgery was performed in Netsarc centers had R0, R1, R2, and fragmented primary
surgery in 61%, 31%, 5%, 2% vs 37%, 40%, 16%, 7% in primary care centers
non-Netsarc centers (p < 0.000001).
Conclusions: This first analysis of the NetSarc database shows that more patients
had optimal surgery in reference centers than in primary care centers. This tool will
ensure the monitoring of dedicated action to improve the management of sarcoma
patients in the future.
Disclosure: All authors have declared no conflicts of interest.
1489P FINAL RESULTS OF A FRENCH SARCOMA GROUP (FSG)
RETROSPECTIVE REVIEW OF 110 PATIENTS WITH PRIMARY
LOCALIZED GASTROINTESTINAL STROMAL TUMORS (GIST)
OF THE DUODENUM
F. Duffaud 1 , T. Huynh 1 , P. Cassier 2 , E. Boucher 3 , O. Bouché 4 , A. Le Cesne 5 ,
B. Landi 6 , J. Mancini 7 , F. Marchal 8 , J. Blay 2
1 Medical Oncology, C.H.U. La Timone Adultes, Marseille Cedex, FRANCE,
2 Medical Oncology, Centre Léon Berard, Lyon, FRANCE, 3 Medical Oncology,
Centre Eugène Marquis, Rennes, FRANCE, 4 Gastroenterology, University
Hospital, Reims, FRANCE, 5 Dept. Medical Oncology, Institut Gustave Roussy,
Villejuif, FRANCE, 6 Gastroenterology, Hopital Européen Georges Pompidou,
Paris, FRANCE, 7 Biostatistics, la Timone University Hospital, Marseille, FRANCE,
8 Surgery, Centre Alexis Vautrin, Nancy, FRANCE
Background: Duodenal GISTs represent 3-5% of all GISTs, with limited
understanding of patient outcomes from small series. We conducted a retrospective
analysis of localized duodenal GISTs over the past 18 years.
Methods: Patients (pts) were identified in 2 ways: a group of 101 pts reported via
survey from 20 FSG centers, and a group of 9 pts included in the BFR14 trial.
Results: Pts were: 55 females, 55 males, with a median age of 57 years (30-84), and
median ECOG 0 (0-3). Abdominal pain, anemia, and overt GI bleeding were the
most common symptoms. Tumors (T) originated mainly in D2 (41%), or D3 (27%),
with a median size of 5 cm (1.5-30). All pts except four had resection of the primary
T. Surgical procedures were: local resection (LR) [segmental duodenectomy (n = 31),
wedge local resection (n = 31), local excision (n = 6)], and duodenopancreatectomy
(DP, n = 20). Resections were R0 in 84 pts (79%), R1 in 6 pts (6%). T characteristics
included: KIT+ (n = 100), CD34 + (n= 54), mitoses/50 HPF ≤ 5 (n= 70), or > 5 (n =
24), Miettinen low-risk (n = 37), and high-risk (n = 19), necrosis (n = 29), spindle cell
(n = 84). Genotype was evaluated in 36 cases: KIT exon 11 mutant (n = 30), no
mutation (n = 4), and KIT exon 9 mutant (n = 2). 12 pts received neoadjuvant
Annals of Oncology
imatinib (IM) therapy resulting in 6 PR, 3 SD, 1 PD. 17 pts received adjuvant IM
therapy. With a median FU of 32 months (1-250), 95 pts (86%) are alive.
Twenty-eight (26%) pts relapsed: 6 LR, and 26 metastases. The 4-year OS and EFS
rates were 89.5% and 68.2 %. The 6-year OS and EFS rates were 89.5% and 36.5%.
Univariate analysis showed that: age and ECOG PS have an impact on OS (p= 0.008,
p