Annual Meeting Proceedings Part 1 - American Society of Clinical ...

10068 General Poster Session (Board #50E), Sun, 8:00 AM-12:00 PM
Whole-body PET/MR in soft tissue sarcoma (STS) patients. Presenting
Author: Stephan Richter, Medizinische Klinik und Poliklinik I, University
Hospital Carl Gustav Carus Dresden, Dresden, Germany
Background: PET/MR (positron emission tomography/magnetic resonance
imaging) is a new whole-body hybrid imaging technique that combines
metabolic and cross-sectional diagnostic imaging. To date the only available
clinical data are drawn from feasibility studies in small series of head
and neck cancers and intracranial tumors. Imaging by combined PET and
computed tomography (PET/CT) has been investigated in STS for biopsy
guidance, response assessment and grading. Methods: This exploratory
analysis evaluated the outcomes of PET/MRI in 21 patients with STS in
different treatment settings: (a) neoadjuvant setting, (b) metabolic-driven
local therapy in metastatic sarcoma, and (c) palliative treatment. For
examination we used an Ingenuity PET/MR system (Philips Healthcare). It
combines a 3-Tesla MRI and a PET scanner with time-of-flight technology.
Results: PET/MR shows a high contrast imaging without significant artifacts
or distortions. (a) Four patients with high-risk sarcoma (3 rhabdo, 1
pleomorphic) completed the planned neoadjuvant therapy. Change in
tumor size did not correlat with pathologic response, whereas surgical
outcome was well predicted by metabolic changes. Due to this finding the
preplanned course of chemotherapy for one patient was changed. (b) To
prolong disease stabilization of 3 patients with a remnant metabolic activity
in a single spot they underwent a surgical resection of a single metastatic
lesion or had a local radiotherapeutic approach. (c) In 3 patients with stable
disease after first-line treatment with combination of anthracyline and
ifosfamide persisting metabolic activity indicated a switch to another
alternative 2nd line regime. Trabectedin as 2nd line therapy decreased
metabolic activity that finally resulted in a tumor regression. Conclusions:
To our knowledge this is the first report on patients with STS examined with
whole-body-PET/MR. PET/MR is feasible in STS and may provide valuable
information in treatment, monitoring and prognosis of patients with STS.
This technique may help to choose accurate and on-time treatment option
without unnecessary time delay. Further prospective studies to evaluate
PET/MR in STS are warranted.
10070 General Poster Session (Board #50G), Sun, 8:00 AM-12:00 PM
Multimodality therapy for pulmonary metastasis in sarcoma patients:
Results of a single institution. Presenting Author: Nasreen A Vohra, H. Lee
Moffitt Cancer Canter & Research Institute, Tampa, FL
Background: Pulmonary metastasectomy (PM) for sarcoma can result in
significant long term survival in carefully selected patients (pts). We report
our experience with pulmonary metastasectomy. Methods: After IRB approval,
120 pts who underwent PM for sarcoma at Moffitt Cancer Center
from 1999 to 2011 were reviewed. Survival was calculated according to the
Kaplan-Meier method with Cox proportional hazard univariate (UV) and
multivariate (MV) models used to analyze relationships between clinicopathologic
variables and overall survival (OS). P-value � 0.05 was
considered significant. Results: Median age was 51 yrs, 95(79%) pts had
soft tissue sarcomas with pleomorphic being most common. Of the
25(21%) osseous sarcomas, osteosarcoma was most common. 20(15%)
had synchronous metastasis (mets); of the pts with local disease only,
median time to recurrence from primary resection was 13 months (mo). OS
from initial resection was 55 mo for pts with local disease only vs. 27 mo for
pts with synchronous mets. On UV analysis, use of radiation, number of
index lesions, presence of synchronous mets and time to recurrence
achieved significance. On MV analysis, only shorter time to recurrence
(p�.03) and presence of synchronous mets (p�.04) were independent
predictors of poor survival. 63(52%) pts [26(22%) neoadjuvant, 19(16%)
adjuvant, 18(15%) both] received chemotherapy for the primary tumor,
while 57(48%) did not. There was a trend towards poor survival in pts
receiving chemotherapy compared to pts receiving no chemotherapy
(p�0.06, HR 1.59). In addition 40(34%) pts received chemotherapy prior
to PM with no difference in OS compared to pts who did not get
chemotherapy (p�0.1, HR 1.55). 71(59%) had 1 PM, 32(27%) had 2 and
17(14%) had 3 or more PM with OS being 17 mo, 37 mo and 34 mo in
each group, respectively. A higher number of PM was associated with
improved survival (p�.01). Conclusions: Pts with a shorter disease free
interval have a decreased OS as do pts with synchronous mets. Pts
undergoing multiple PM have a survival benefit likely resulting from
favorable disease biology. Failure of chemotherapy to show a survival
benefit may be a result of selection bias for patients with aggressive disease
being treated with chemotherapy.
Sarcoma
647s
10069 General Poster Session (Board #50F), Sun, 8:00 AM-12:00 PM
Neoadjuvant chemotherapy for adult soft tissue sarcomas: A phase II trial.
Presenting Author: Samuel Aguiar, A.C. Camargo Cancer Hospital, Sao
Paulo, Brazil
Background: Treatment of soft tissue sarcomas (STS) is characterized by
high rates of local control, but poor overall survival because of distant
relapses and high rates of wound complications, when preoperative
radiation is used. The objective of this study was to test the effectiveness of
a protocol with neoadjuvant chemotherapy for STS. Methods: A phase II
single-arm prospective trial was carried out. Only adult patients with high
grade extremity lesions and tumors deep and larger than 5 cm were
included. A total of four cycles of chemotherapy was administered
pre-operatively. The chemotherapeutic regimen was: ifosfamide – total of
9.0 g/m2 per cycle, infused in 2 hours from Day 1 to Day 5 (1.8
mg/m2/day). Half of the equivalent dose of mesna was infused 15 min
pre-ifosfamide and 4 hours post-ifosfamide. Doxorubicin – total of 60mg/m2
per cycle, was infused in bolus on Day 1. Filgrastima 300 mcg, SC, was
administered after the last dose of chemotherapy for 5 days. Radiation was
given after surgery. Toxicity was classified by the NIH Toxicity Criteria and
response was determined by the RECIST criteria. The others endpoints
were the amputation and the wound-related complication rates. Results:
Between January, 2005 and May, 2011, 42 patients were included.
21(50%) patients have completed the 4 cycles. Nineteen patients (45.2%)
have grade 3 or 4 toxicity, and one (2.3%) death related to treatment had
occurred. Between severe complications, febrile neutropenia was the most
frequent. By using the RECIST criteria, we observed 10(24.5%) cases of
progression, 24(58.5%) cases of stable disease, and 7(17%) partial
responses. No complete clinical or radiological response was observed. In
the pathological analysis of the surgical specimens, 4(9.7%) cases showed
no residual disease (complete pathological response), and a total of 6
(14.6%) showed � 5% of viable residual cells. The amputation rate was
4.8% (2 cases) and complications related to the wound were observed in 9
patients (21.9%). Conclusions: The protocol showed a good rate of
objective and pathological response, low rate of complications related to
the operative wound, and maintained an acceptable amputation rate. On
the other hand, we observed high rate of progression, by RECIST criteria.
10071 General Poster Session (Board #50H), Sun, 8:00 AM-12:00 PM
Atypical vascular neoplasms and risk of development of angiosarcoma.
Presenting Author: Vinod Ravi, University of Texas M. D. Anderson Cancer
Center, Houston, TX
Background: Atypical vascular neoplasms are rare cutaneous lesions that
develop following radiation therapy to the breast that have evidence of
atypia but do not meet all criteria for a diagnosis of angiosarcoma. They
typically have a benign course and are managed by surgical resection.
Histopathological changes consistent with atypical vascular neoplasm are
commonly found adjacent to angiosarcoma and have lead some investigators
to believe that these may be precursor lesions to development of
angiosarcoma. Methods: We performed a retrospective review of all patients
with a diagnosis of atypical vascular neoplasm from 2002 to 2012. Patient
with a prior/concurrent history of angiosarcoma were excluded from the
analysis. Primary objective of the study was to determine the percentage of
patients with atypical vascular neoplasms that progressed to angiosarcoma
on long-term follow-up. Results: 37 patients were identified in the tumor
registry at MD Anderson cancer center with a diagnosis of atypical vascular
neoplasm between 2002 and 2012 with a median follow-up of 24 months.
The median age of the study population was 53. Females represented 89%
of the study population. Atypical vascular neoplasms occurred most
frequently in the breast/chest (70%) and 68% of patients had a prior
history of breast cancer. 54% of patients had prior radiation therapy. The
median time to development of atypical vascular neoplasms from radiation
therapy was 52 months. Among patients who underwent surgical resection
with negative margins, there were no recurrences. We failed to observe any
progression to angiosarcoma in the study population. Conclusions: Patients
with atypical vascular neoplasms may not progress to angiosarcoma and are
best managed with surgical resection.
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