מאמרים מדעיים בתחום סרקומה

Scientific Articles on SARCOMA

 

1. World J Surg. 2015 Aug;39(8):1895-901. doi: 10.1007/s00268-015-3038-0.

 

Visceral Fat Content Correlates with Retroperitoneal Soft Tissue Sarcoma (STS)

Local Recurrence and Survival.

 

Papoulas M(1), Weiser R, Rosen G, Gerstenhaber F, Merimsky O, Lubezky N, Klausner

JM, Lahat G.

 

Author information:

(1)Department of Surgery, The Sourasky Medical Center, Sackler School of

Medicine, Tel-Aviv University, 6 Weitzman St., Tel-Aviv, Israel,

michail.a.papoulas@gmail.com.

 

BACKGROUND: Our aim was to evaluate the association between visceral fat content

with soft tissue sarcoma (STS) local recurrence and survival.

METHODS: One hundred and one computed tomography imaging studies of primary STS

patients who had complete macroscopic resection at our institution between 2002

and 2012 were reviewed, and retroperitoneal and circumferential fat contents were

measured. Correlations between imaging findings and clinical data were analyzed.

RESULTS: Fifty-seven STS tumors (56.4 %) were retroperitoneal; of them, 65 % were

high grade, median size was 15 cm (range 3-49), and the most common histological

subtype was high grade liposarcoma (31.6 %). Median follow-up length for the

entire cohort was 64 months (range 6-95). High visceral fat (VF) content ≥15

versus <15 mm was identified as a risk factor for retroperitoneal STS local

recurrence; 65.1 versus 26.7 %, respectively (p = 0.04); VF content did not

correlate with distant metastasis. Median overall survival (OS) length of

patients with VF ≥15 versus <15 mm was 57 months (range 2-144) versus not

reached, respectively (p = 0.007). Multivariable analysis identified VF ≥15 mm as

an independent risk factor for decreased OS (HR: 4.2, 95 % CI 1.07-16.67). In

contrast, circumferential fat content did not correlate with retroperitoneal STS

patient outcomes.

CONCLUSION: High VF content is an independent adverse prognosticator associated

with significantly higher rates of retroperitoneal STS local recurrence and

decreased patients survival. Local tumor biology may be affected by the presence

of adipose cells. Further clinical and molecular research is needed to establish

this premise.

 

PMID: 25804549  [PubMed - in process]

 

 

2. Ann Oncol. 2014 Sep;25 Suppl 3:iii21-6. doi: 10.1093/annonc/mdu255.

 

Gastrointestinal stromal tumours: ESMO Clinical Practice Guidelines for

diagnosis, treatment and follow-up.

 

ESMO/European Sarcoma Network Working Group.

 

Collaborators: Casali PG, Blay JY, Bertuzzi A, Bielack S, Bjerkehagen B, Bonvalot

S, Boukovinas I, Bruzzi P, Dei Tos AP, Dileo P, Eriksson M, Fedenko A, Ferrari A,

Ferrari S, Gelderblom H, Grimer R, Gronchi A, Haas R, Hall KS, Hohenberger P,

Issels R, Joensuu H, Judson I, Le Cesne A, Litière S, Martin-Broto J, Merimsky O,

Montemurro M, Morosi C, Picci P, Ray-Coquard I, Reichardt P, Rutkowski P,

Schlemmer M, Stacchiotti S, Torri V, Trama A, Van Coevorden F, Van der Graaf W,

Vanel D, Wardelmann E.

 

PMID: 25210085  [PubMed - indexed for MEDLINE]

 

 

3. Ann Oncol. 2014 Sep;25 Suppl 3:iii113-23. doi: 10.1093/annonc/mdu256.

 

Bone sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and

follow-up.

 

ESMO/European Sarcoma Network Working Group.

 

Collaborators: Casali PG, Blay JY, Bertuzzi A, Bielack S, Bjerkehagen B, Bonvalot

S, Boukovinas I, Bruzzi P, Dei Tos AP, Dileo P, Eriksson M, Fedenko A, Ferrari A,

Ferrari S, Gelderblom H, Grimer R, Gronchi A, Haas R, Hall KS, Hohenberger P,

Issels R, Joensuu H, Judson I, Le Cesne A, Litière S, Martin-Broto J, Merimsky O,

Montemurro M, Morosi C, Picci P, Ray-Coquard I, Reichardt P, Rutkowski P,

Schlemmer M, Stacchiotti S, Torri V, Trama A, Van Coevorden F, Van der Graaf W,

Vanel D, Wardelmann E, Bolle S, Capanna R, Delaney T, Doglietto F, Fossati P,

Jeys L, Kasper B, Leithner A, Radaelli S, Scheipl S, Tamborini E, Uhl M,

Vleggert-Lankamp CL.

 

PMID: 25210081  [PubMed - indexed for MEDLINE]

 

 

4. Ann Oncol. 2014 Sep;25 Suppl 3:iii102-12. doi: 10.1093/annonc/mdu254.

 

Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for

diagnosis, treatment and follow-up.

 

ESMO/European Sarcoma Network Working Group.

 

Collaborators: Casali PG, Blay JY, Bertuzzi A, Bielack S, Bjerkehagen B, Bonvalot

S, Boukovinas I, Bruzzi P, Dei Tos AP, Dileo P, Eriksson M, Fedenko A, Ferrari A,

Ferrari S, Gelderblom H, Grimer R, Gronchi A, Haas R, Hall KS, Hohenberger P,

Issels R, Joensuu H, Judson I, Le Cesne A, Litière S, Martin-Broto J, Merimsky O,

Montemurro M, Morosi C, Picci P, Ray-Coquard I, Reichardt P, Rutkowski P,

Schlemmer M, Stacchiotti S, Torri V, Trama A, Van Coevorden F, Van der Graaf W,

Vanel D, Wardelmann E, Colombo C, Fiore M, Mariani L, Miceli R, Pollock RE, Raut

CP, Strauss D, Swallow CJ.

 

PMID: 25210080  [PubMed - indexed for MEDLINE]

 

 

5. Am J Clin Oncol. 2014 Jul 17. [Epub ahead of print]

 

Single-institution Experience of SBRT for Lung Metastases in Sarcoma Patients.

 

Soyfer V(1), Corn BW, Shtraus N, Honig N, Meir Y, Kollender J, Merimsky O.

 

Author information:

(1)Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.

 

OBJECTIVES:: Lung metastasectomy is regarded as the standard procedure for

improving the prognosis of patients with metastatic sarcoma. Few reports are

available in the literature describing the value of stereotactic body radiation

therapy (SBRT) of lung metastases from primary sarcoma as an alternative to

surgical treatment. We therefore sought to expand the evidence base for this

modality.

MATERIALS AND METHODS:: Twenty-two patients with metastatic sarcoma to lung were

treated by SBRT. The retrospective analysis of overall survival, toxicity, and

local control of 53 treated lesions is presented in the study. Lung lesions were

grouped into 2 categories for follow-up: <10 mm or ≥10 mm diameter.

RESULTS:: Of 34 lesions <10 mm, 24 achieved complete response, 3 partial

response, and 7 stable disease. The results of 18 lesions measuring >10 mm were

as follows: 5 complete response, 5 progressive disease, and 8 stable disease. No

progressive disease of all SBRT treated lesions was found at a median follow-up

of 95 months (SD 32). Five-year overall survival of the entire group was 62% from

the time of diagnosis and 50% from start of treatment. The treatment was well

tolerated with minimal, mainly skin toxicity.

CONCLUSION:: SBRT is an effective tool that might be used as an alternative to

operative treatment of lung metastases in sarcoma patients.

 

PMID: 25036473  [PubMed - as supplied by publisher]

 

 

6. Med Oncol. 2014 May;31(5):936. doi: 10.1007/s12032-014-0936-1. Epub 2014 Apr 10.

 

Is it important to maintain high-dose intensity chemotherapy in the treatment of

adults with osteosarcoma?

 

Kushnir I(1), Kolander Y, Bickels J, Gortzak Y, Flusser G, Issakov J, Merimsky O.

 

Author information:

(1)Division of Oncology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel

Aviv, Israel.

 

Neoadjuvant chemotherapy for osteosarcoma is the standard of care, but there is

still confusion regarding the best chemotherapy regimen and the optimal

intensity. This retrospective study intends to evaluate whether there is a clear

correlation between the chemotherapy dose intensity (DI) and the percentage of

tumor necrosis, the risk of tumor recurrence after surgery and patient survival.

The medical records of all adult patients with localized osteosarcoma that

received treatment between the years of 1998 and 2009 at the Tel Aviv Sourasky

Medical Center were analyzed. We used multiple logistic/linear regression models

to test the effect of the neoadjuvant chemotherapy relative DI (RDI) on

histological response, recurrence and time to recurrence. A Cox regression

analysis was conducted for the effects of neoadjuvant chemotherapy RDI,

histological response, tumor location, gender and age on patient survival. Thirty

medical records were analyzed. Survival, histological response, recurrence and

time to recurrence were not affected by the chemotherapy RDI. The 5-year overall

survival of the patient's population was found to be 63% with a median survival

of 9.4 years. Patients with a good histological response had a longer survival

than those with a bad response (mean survival times 11.0 vs. 6.6 years, log-rank

test, P = 0.046). High DI is not a prognostic factor in osteosarcoma and

maintaining it should not be a prime priority. Histological response is a

prognostic but possibly not a reliable predictive factor, and further research is

needed in order to find other reliable factors.

 

PMID: 24719037  [PubMed - indexed for MEDLINE]

 

 

7. Expert Rev Anticancer Ther. 2014 Jun;14(6):705-10. doi:

10.1586/14737140.2014.895667. Epub 2014 Mar 10.

 

Optimal management of sarcomas of the breast: an update.

 

Nizri E(1), Merimsky O, Lahat G.

 

Author information:

(1)The Department of General Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv,

Israel.

 

Breast sarcomas are rare mesenchymal-derived breast tumors. The small number of

patients, the different histological subtypes, and the variation in clinical

practice impairs the ability to draw firm practice recommendations. Patient

management is often extrapolated from other soft tissue sarcomas, mostly of the

extremities in which more clinical data is available. Surgical resection with

negative margins is the goal of treatment, irrespective of the surgical

procedure; the implication of radiation and chemotherapy is variable. Further

advances in treatment should follow the assembly of breast sarcoma patients in

specific cancer networks in specialized sarcoma referral centers. The

characterization of molecular pathways active in tumorogenesis of these tumors

may pave the way for the application of novel therapeutic agents.

 

PMID: 24611696  [PubMed - indexed for MEDLINE]

 

 

8. Br J Radiol. 2013 Aug;86(1028):20130258. doi: 10.1259/bjr.20130258. Epub 2013 May

24.

 

Hypofractionated adjuvant radiation therapy of soft-tissue sarcoma achieves

excellent results in elderly patients.

 

Soyfer V(1), Corn BW, Kollender Y, Issakov J, Dadia S, Flusser G, Bickels J,

Meller I, Merimsky O.

 

Author information:

(1)Department of Oncology, Tel Aviv Sourasky Medical Center, Ashdod, Israel.

 

OBJECTIVE: Adjuvant radiation therapy (RT) is an essential part of combined

limb-sparing treatment of soft-tissue sarcoma (STS). Elderly or medically unfit

patients often have difficulty in completing 6-7 weeks of standard fractionated

daily treatment. Our aim was to evaluate the efficacy of a hypofractionated

adjuvant approach with RT for STS in elderly and debilitated patients.

METHODS: 21 elderly patients were treated with a short course of adjuvant RT

(39-48 Gy, 3 Gy per fraction) for STS. The medical records of the patients were

retrospectively reviewed for local or distant recurrence and side effects of RT.

RESULTS: At a mean 26 months of follow-up, three local recurrences (14%) were

detected. Eight patients (38%) had lung metastases during the observed period.

Three of them died from metastatic disease. The hypofractionated radiation was

well tolerated with minimum long-term side effects.

CONCLUSION: Hypofractionated adjuvant radiation appears to be an effective

treatment in terms of local control in elderly and debilitated patients.

ADVANCES IN KNOWLEDGE: The results of this study might provide an alternative to

commonly used standard fractionation of radiotherapy in sarcoma patients.

 

PMCID: PMC3745062

PMID: 23709514  [PubMed - indexed for MEDLINE]

 

 

9. Ann Oncol. 2012 Oct;23 Suppl 7:vii92-9.

 

Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for

diagnosis, treatment and follow-up.

 

ESMO / European Sarcoma Network Working Group.

 

Collaborators: Blay JY, Blomqvist C, Bonvalot S, Boukovinas I, Casali PG, De

Alava E, Dei Tos AP, Dirksen U, Duffaud F, Eriksson M, Fedenko A, Ferrari A,

Ferrari S, del Muro XG, Gelderblom H, Grimer R, Gronchi A, Hall KS, Hassan B,

Hogendoorn P, Hohenberger P, Issels R, Joensuu H, Jost L, Jurgens H, Kager L, Le

Cesne A, Leyvraz S, Martin J, Merimsky O, Nishida T, Picci P, Reichardt P,

Rutkowski P, Schlemmer M, Sleijfer S, Stacchiotti S, Taminiau A, Wardelmann E.

 

PMID: 22997462  [PubMed - indexed for MEDLINE]

 

 

10. Ann Oncol. 2012 Oct;23 Suppl 7:vii49-55.

 

Gastrointestinal stromal tumors: ESMO Clinical Practice Guidelines for diagnosis,

treatment and follow-up.

 

ESMO / European Sarcoma Network Working Group.

 

Collaborators: Blay JY, Blomqvist C, Bonvalot S, Boukovinas I, Casali PG, De

Alava E, Dei Tos AP, Dirksen U, Duffaud F, Eriksson M, Fedenko A, Ferrari A,

Ferrari S, del Muro XG, Gelderblom H, Grimer R, Gronchi A, Hall KS, Hassan B,

Hogendoorn P, Hohenberger P, Issels R, Joensuu H, Jost L, Jurgens H, Kager L, Le

Cesne A, Leyvraz S, Martin J, Merimsky O, Nishida T, Picci P, Reichardt P,

Rutkowski P, Schlemmer M, Sleijfer S, Stacchiotti S, Taminiau A, Wardelmann E.

 

PMID: 22997454  [PubMed - indexed for MEDLINE]

 

 

11. Ann Oncol. 2012 Oct;23 Suppl 7:vii100-9.

 

Bone sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and

follow-up.

 

ESMO / European Sarcoma Network Working Group.

 

Collaborators: Blay JY, Blomqvist C, Bonvalot S, Boukovinas I, Casali PG, De

Alava E, Dei Tos AP, Dirksen U, Duffaud F, Eriksson M, Fedenko A, Ferrari A,

Ferrari S, del Muro XG, Gelderblom H, Grimer R, Gronchi A, Hall KS, Hassan B,

Hogendoorn P, Hohenberger P, Issels R, Joensuu H, Jost L, Jurgens H, Kager L, Le

Cesne A, Leyvraz S, Martin J, Merimsky O, Nishida T, Picci P, Reichardt P,

Rutkowski P, Schlemmer M, Sleijfer S, Stacchiotti S, Taminiau A.

 

PMID: 22997441  [PubMed - indexed for MEDLINE]

 

 

12. Cancer Chemother Pharmacol. 2012 Dec;70(6):855-60. doi:

10.1007/s00280-012-1968-x. Epub 2012 Sep 28.

 

Clinical activity of mTOR inhibition in combination with cyclophosphamide in the

treatment of recurrent unresectable chondrosarcomas.

 

Bernstein-Molho R(1), Kollender Y, Issakov J, Bickels J, Dadia S, Flusser G,

Meller I, Sagi-Eisenberg R, Merimsky O.

 

Author information:

(1)The Unit of Bone and Soft Tissue Oncology, Division of Oncology, Tel-Aviv

Sourasky Medical Center, Affiliated with the Sackler School of Medicine, Tel-Aviv

University, Israel.

 

OBJECTIVE: Chondrosarcomas (CS) represent a heterogeneous group of rare sarcomas,

poorly responsive to chemotherapy or radiotherapy. When local therapies in

recurrent or metastatic disease are exhausted, chemotherapy plays a marginal

role. Different molecular pathways have been shown to be activated in CS. In this

retrospective study, we summarize our experience in treating a cohort of patients

with recurrent unresectable CS with a combination of sirolimus (SIR) and

cyclophosphamide (CTX).

PATIENTS AND METHODS: Ten consecutive patients with unresectable CS were offered

off-label treatment with SIR and CTX between 2007 and 2012. Tumor response,

progression-free survival (PFS), adverse events, and other relevant clinical data

were analyzed.

RESULTS: The median patients' age was 49 (range 28-68). Median disease-free

interval since the primary diagnosis was 22.5 months. Median time from the

disease recurrence to initiation of SIR and CTX treatment was 21.7 months due to

additional local surgical treatments, excision of metastases, or slow

asymptomatic progression. One (10 %) objective response was observed, and six (60

%) patients had stabilization of disease for at least 6 months. Three patients

had progressive disease. Median PFS was 13.4 months (range 3-30.3). No

significant adverse events were observed.

CONCLUSIONS: Although advanced CS remains an incurable disease, our experience

suggests that a combination of SIR and CTX is well tolerated and may have

meaningful clinical activity with disease control rate of 70 %. Further

prospective studies are warranted.

 

PMID: 23053256  [PubMed - indexed for MEDLINE]

 

 

13. Sarcoma. 2010;2010:927972. doi: 10.1155/2010/927972. Epub 2010 Mar 8.

 

Radiation therapy for palliation of sarcoma metastases: a unique and uniform

hypofractionation experience.

 

Soyfer V(1), Corn BW, Kollender Y, Tempelhoff H, Meller I, Merimsky O.

 

Author information:

(1)Division of Oncology, Institute of Radiation Therapy, Tel-Aviv Sourasky

Medical Center, 6 Weizmann Street, Tel-Aviv 64239, Israel.

 

Radiotherapy (RT) is our preferred modality for local palliation of metastatic

soft tissue sarcoma (STS). A short and intense course of RT is usually needed for

rapid palliation and local control of metastatic disease. Seventeen patients at a

median age of 61 had symptomatic metastatic sarcoma and required rapid

palliation. The symptoms related to the metastases were either pain or

discomfort. All patients were treated by a short and intensive course of

administration: 39 Gy were given in 13 fractions of 3 Gy/day, 5 times a week.

Median follow-up period was 25 weeks. The treatment was well tolerated. Acute

side effects included grade one skin toxicity. No wound complications were noted

among those undergoing surgery. Late side effects included skin pigmentation and

induration of irradiated soft tissues. Durable pain control was achieved in 12

out 15 cases treated for gross metastases. Tumor progression was seen in the 3

other cases within a period of two to nine months. Among 5 lesions which were

irradiated as an adjunctive treatment following resection, no local recurrence

was observed. The results of this series, although limited in size, point to the

safety and feasibility of hypofractionated RT for palliation of musculoskeletal

metastases from sarcoma.

 

PMCID: PMC2834957

PMID: 20224682  [PubMed]

 

 

14. Int J Gynecol Cancer. 2010 Feb;20(2):255-60. doi: 10.1111/IGC.0b013e3181c9e289.

 

Metastatic uterine leiomyosarcomas: a single-institution experience.

 

Bernstein-Molho R(1), Grisaro D, Soyfer V, Safra T, Merimsky O.

 

Author information:

(1)Division of Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.

rinat.bern@gmail.com

 

BACKGROUND: Uterine leiomyosarcoma (LMS) is a rare disease and, when it recurs or

metastasizes, can rarely be cured. In a retrospective study, we summarized our

experience in treating a large cohort of patients with metastatic uterine LMS.

MATERIALS AND METHODS: Cases of recurrent or metastatic uterine LMS diagnosed

between 2000 and 2008 were analyzed. Survival was determined from the time of

initial diagnosis to last follow-up.

RESULTS: Thirty-three patients (median age, 55 years) were identified. Eighteen

patients were initially diagnosed with localized disease. Median disease-free

interval was 5.25 months, and overall survival (OS) is 43.7 months. Median OS of

15 patients with initially discovered metastatic disease is 31.4 months.

Different chemotherapy regimens produced approximately 30% response rates. Twelve

patients underwent at least 1 surgical resection of pulmonary or extrapulmonary

metastases. In this group, median progression-free survival was 7.9 months

(range, 0-33.9 months), median OS was 45.2 months (range, >8.1-78.8 months),

2-year survival rate was 83%, and 4-year survival rate was 25%.

CONCLUSIONS: Very few patients with recurrent or metastatic uterine LMS can be

curatively treated. Our experience suggests that modern multimodal therapy or

combining chemotherapy with aggressive surgery in selected patients may be

significant in prolonging survival of women with this fatal disease.

 

PMID: 20134269  [PubMed - indexed for MEDLINE]

 

 

15. J Neurooncol. 2009 Sep;94(3):383-8. doi: 10.1007/s11060-009-9862-z. Epub 2009 Mar

28.

 

Expression and significance of EGFR in malignant peripheral nerve sheath tumor.

 

Keizman D(1), Issakov J, Meller I, Maimon N, Ish-Shalom M, Sher O, Merimsky O.

 

Author information:

(1)Unit of Bone and Soft Tissue Oncology, Division of Oncology, Tel Aviv Sourasky

Medical Center (TASMC), Affiliated with Sackler School of Medicine, Tel-Aviv

University, Tel Aviv, Israel.

 

Erratum in

    J Neurooncol. 2009 Sep;94(3):389. Meimon, Natalie [corrected to Maimon, Natalie].

 

Malignant peripheral nerve sheath tumor (MPNST) is an aggressive sarcoma.

Epidermal growth factor receptor (EGFR) may play a putative role in its

pathogenesis, and be targeted for therapeutic purposes. The study was aimed at

investigating the expression and prognostic influence of EGFR in MPNST. Primary

and metastatic MPNSTs were immunostained with antibodies to EGFR. The total EGFR

expression (membranous and cytoplasmic) was analyzed by morphometry, grade of

positivity and the intensity (score 0-3). An EGFR composite score (range 0-300)

was calculated by multiplying the intensity by the grade. A composite score >10

was considered as EGFR overexpression. Score was correlated with clinical

behavior. Forty-three percentage of 46 patients with MPNST overexpressed EGFR in

the primary tumor, and had a higher prevalence of advanced-stage tumors (>or=IIc,

46% vs. 80%, P = 0.011). Patients without overexpression had a higher prevalence

of tumors with a low mitotic rate (31% vs. 0%, P = 0.049). Neurofibromatosis was

more prevalent in patients with EGFR overexpression (75% vs. 42%, P = 0.007).

Five year disease free survival (mean 30.1 vs. 17.4 months, P = 0.048), time to

progression (mean 9.2 vs. 5.2 months, P = 0.005) and 5 year survival (52% vs.

25%, P = 0.041, mean 54 vs. 43 months) were significantly higher among patients

without overexpression. EGFR appeared to play a role in MPNST progression. EGFR

overexpression was correlated with worse prognostic variables and course.

Clinical trials of targeting EGFR in MPNST are warranted.

 

PMID: 19330289  [PubMed - indexed for MEDLINE]

 

 

16. Am J Clin Oncol. 2009 Feb;32(1):34-7. doi: 10.1097/COC.0b013e31817b6087.

 

The co-occurrence of breast cancer and soft tissue sarcoma in a single cohort

series.

 

Geva R(1), Jiveliouk I, Inbar M, Meller I, Friedman E, Merimsky O.

 

Author information:

(1)Unit of Bone and Soft Tissue Oncology, Division of Oncology, Tel-Aviv Sourasky

Medical Center, Tel-Aviv, Israel.

 

BACKGROUND: The incidence of breast cancer (BC) and soft tissue sarcoma (STS) in

the Israeli general population is 97/10 women and 1.5/10 persons. It is expected

that 1.5/10 x 49/10 of the women in the general population will have both BC and

STS.

METHODS: A retrospective search of 1350 adult STS patient files that were

recorded between 1995 and 2005.

RESULTS: One hundred thirty-four patients with STS had multiple primary

malignancies. BC was observed in 27/64 patients (42%) before/after the STS:

BC-first in 19/27, BC-later in 8/27. Of 19 with BC-first the STS was related to

radiotherapy in 2, and to lymphedema in 1. Of 8 STS-first, only 1 got

chemotherapy before BC. Median interval between first to second malignancies was

6.9 years for BC-first, and 3.8 for BC-later. The incidence of BC among all

patients with STS-first followed by a second malignancy is 8/58 (14%), or 27/890

(3%) of all women STS-patients in the registry. The incidence of STS among the BC

patients was low, and most of our cases were therapy unrelated. Median survival

for BC-first was 305 months, versus 213 for STS-first.

CONCLUSIONS: BC and STS may naturally occur in the same individual. The etiology

for this phenomenon is unclear. Practically, BC screening in patients with STS is

warranted.

 

PMID: 19194122  [PubMed - indexed for MEDLINE]

 

 

17. Anticancer Drugs. 2008 Nov;19(10):1019-21. doi: 10.1097/CAD.0b013e328312c0e5.

 

Targeting the mammalian target of rapamycin in myxoid chondrosarcoma.

 

Merimsky O(1), Bernstein-Molho R, Sagi-Eisenberg R.

 

Author information:

(1)Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv

University, Tel-Aviv, Israel. merimsky@zahav.net.il

 

Myxoid chondrosarcoma is a slow-growing sarcoma poorly responsive to chemotherapy

and radiation therapy. Translational research has validated several proteins as

optional therapeutic targets. Significant responses are, however, rare. In this

paper we report an extraordinary response of myxoid chondrosarcoma to targeted

therapy by rapamycin in combination with cyclophosphamide. Our case points to a

possible novel therapeutic approach towards myxoid chondrosarcoma, by targeting

the mammalian target of rapamycin protein, and probably protein kinase C-alpha,

mitogen-activated protein kinase, and Jun N-terminal kinase too, by rapamycin.

 

PMID: 18827568  [PubMed - indexed for MEDLINE]

 

 

18. Sarcoma. 2000;4(1-2):7-10. doi: 10.1155/S1357714X00000025.

 

Gemcitabine in bone sarcoma resistant to Doxorubicin-based chemotherapy.

 

Merimsky O(1), Meller I, Kollender Y, Issakov J, Flusser G, Inbar M.

 

Author information:

(1)Department of Oncology The Tel-Aviv Sourasky Medical Center Affiliated with

Sackler Faculty of Medicine Tel-Aviv University Tel-Aviv Israel.

 

SUBJECTS AND METHODS: Seven patients with progressive localized or metastatic

chemo-resistant osteosarcoma were treated by gemcitabine.The protocol included

gemcitabine 1000 mg/m2/w for 7 consecutive weeks, followed by 1 week rest. If no

progression was observed,maintenance by gemcitabine 1000 mg/m2/w for 3 weeks

every 28 days was given until failure was clinically or radiologically

evident.Results. The true objective response rate was 0%. However, disease

stabilization and clinical benefit response were observed in five patients (70%)

for 13-96 weeks.Discussion. Postponing the inevitable death with a relatively

non-toxic treatment, is, in our opinion, an important issue especially in young

patients.Thus it may be justified and warranted to investigate the activity of

gemcitabine in a larger group of patients with bone sarcomas.

 

PMCID: PMC2408365

PMID: 18521428  [PubMed]

 

 

19. Sarcoma. 1999;3(2):85-8. doi: 10.1080/13577149977695.

 

Kollender Y(1), Shabat S, Nirkin A, Issakov J, Flusser G, Merimsky O, Meller I.

 

Author information:

(1)The National Unit of Orthopedic Oncology The Tel-Aviv Sourasky Medical Center

Tel Aviv Israel.

 

Background. The origin of Ewing's sarcoma in a periosteal location is rare and

not clearly documented. Other malignant bone tumors appear to have a somewhat

better prognosis when confined between periosteum and bone. Is it the same for

periosteal Ewing's sarcoma?Methods. We describe two new cases and comprehensively

review the literature consisting of 18 documented cases since the condition was

first described in 1986 (S.M. Bator.Cancer 58:1781- 4).Results. Periosteal

Ewing's sarcoma differs from the other forms of Ewing's sarcoma in terms of sex

predominance, location of tumor, surgical stage at presentation and typical

imaging studies. Eighteen out of the 20 patients were reported to be alive with

no evidence of disease.Conclusions. It seems that the prognosis of this rare

variant of Ewing's sarcoma family of tumors might be better but the small number

of cases precludes such a firm conclusion.

 

PMCID: PMC2395413

PMID: 18521268  [PubMed]

 

 

20. Sarcoma. 1998;2(3-4):205-7. doi: 10.1080/13577149877993.

 

Primary liposarcoma of the mediastinum.

 

Greif J(1), Marmor S, Merimsky O, Kovner F, Inbar M.

 

Author information:

(1)Pulmonary Division Tel-Aviv Sourasky Medical Center and the Sackler Faculty of

Medicine Tel-Aviv University Tel-Aviv Israel.

 

Patient. A 62-year-old man presented with effort dyspnea, non-productive cough

and weakness of 4 month duration. He had no findings on physical

examination.Discussion. Chest X-ray revealed a large mass in the left anterior

mediastinum. Computerized tomography of the chest showed a well-delineated

homogeneous mediastinal mass with fat-equivalent density and a small pleural

effusion. Fiberoptic bronchoscopy revealed narrowing of the left main bronchus,

secondary to external compression. The bronchial mucosa was normal and brush

cytology was negative. A CT-guided fine needle aspiration (FNA) of the mass

yielded fragments of cells embedded in myxoid background material and closely

packed atypical lipoblasts, compatible with liposarcoma. The patient underwent a

left lateral thoracotomy and margibnal resection of the mass. The

histopathological examination confirmed the diagnosis of mixed-type liposarcoma,

consisted of myxoid and pleomorphic liposarcoma. Postoperative two-field

radiation therapy was delivered to the mediastinum for a total midplane dose of

40 Gy. After a disease-free interval of 8 months the disease recurred in the

mediastinum and pleura. Palliative chemotherapy achieved a short duration partial

response but the patient succumbed to local recurrence 2 years after the

diagnosis.

 

PMCID: PMC2395397

PMID: 18521256  [PubMed]

 

 

21. Sarcoma. 2008;2008:825093. doi: 10.1155/2008/825093.

 

Targeting mTOR in HIV-Negative Classic Kaposi's Sarcoma.

 

Merimsky O(1), Jiveliouk I, Sagi-Eisenberg R.

 

Author information:

(1)Unit of Bone and Soft Tissue Oncology, Division of Oncology, Tel-Aviv Sourasky

Medical Center, 6 Weitzman Street, Tel-Aviv 64239, Israel.

 

A 66-year old female with HIV-negative classic Kaposi's sarcoma responded to mTOR

targeting by rapamycin. The response was well documented by PET-CT. This case

provides supporting evidence that the mTOR pathway may be important in the

tumorigenesis of KS and that rapamycin may have activity in this disease.

 

PMCID: PMC2391286

PMID: 18509482  [PubMed]

 

 

22. Eur J Surg Oncol. 2009 Feb;35(2):209-14. doi: 10.1016/j.ejso.2008.01.007. Epub

2008 Mar 4.

 

Efficacy of high vs low dose TNF-isolated limb perfusion for locally advanced

soft tissue sarcoma.

 

Nachmany I(1), Subhi A, Meller I, Gutman M, Lahat G, Merimsky O, Klausner JM.

 

Author information:

(1)Department of Surgery B, Tel Aviv Sourasky Medical Center, Sackler School of

Medicine, Tel Aviv University, Tel Aviv, Israel. ido.nachmany@gmail.com

 

AIMS: The administration of a high dose of rTNF-alpha (3-4 mg) and Melphalan via

isolated limb perfusion (ILP) for patients with locally advanced limb STS was

shown to be effective. Reports that a low dose of TNF (1mg) is as effective, led

to the adoption of the low dose regimen as the treatment of choice. The purpose

of this study was to compare two groups of patients with locally advanced limb

STS, that was treated with high and low dose TNF-ILP, in terms of limb

preservation.

METHODS: Retrospective study of 41 patients who underwent ILP, with "high dose"

(HD) and "low dose" (LD) TNF. ILP/TNF was performed on candidates to either

amputation or significantly mutilating surgery without this treatment. In both

groups, all patients, with the exception of three in each group, underwent

resection of the residual tumor or tumor bed or limb 8-12 weeks after the

procedure.

RESULTS: In the HD group, marked tumor softening occurred within 48 h, and in

tumors protruding through the skin, hemorrhagic necrosis was evident within 24h.

The overall response rate was 65.2%. Five patients achieved a CR and 10 had a PR;

in five of these patients >90% necrosis of the tumor occurred. In eight patients,

only minimal regression was observed (stabilization of disease). The rate of limb

sparing was 69.5%. In the LD group, the overall response rate was 30.7%. CR was

achieved in one patient. PR was observed in two. Two patients were lost to follow

up. Of the remaining 15 patients, limb preservation was achieved in 53.3%.

CONCLUSION: Despite the retrospective comparison and possible selection bias, it

is possible to raise the concern that at least some patients may benefit from a

higher TNF dose perfusion in ILP for advanced limb STS.

 

PMID: 18295442  [PubMed - indexed for MEDLINE]

 

 

23. Isr Med Assoc J. 2007 Nov;9(11):810-2.

 

A histopathological review of gastrointestinal related mesenchymal tumors: the

hidden GIST.

 

Issakov J(1), Jiveliouk I, Nachmany I, Klausner J, Merimsky O.

 

Author information:

(1)Unit of Bone and Soft Tissue Pathology, Tel Aviv Sourasky Medical Center, Tel

Aviv, Israel.

 

BACKGROUND: The diagnosis of gastrointestinal stromal tumors is based on

documentation of c-KIT and platelet-derived growth factor-alpha receptors or

specific c-KIT mutations. Before the diagnosis of GIST was possible, all cases

had been classified as sarcomas or benign tumors.

OBJECTIVES: To identify cases of GIST formerly diagnosed as abdominal or

retroperitoneal mesenchymal tumors.

METHODS: We reviewed the archive material on all surgical cases diagnosed as

gastrointestinal related malignant mesenchymal tumors or GIST in our medical

center during the last decade (1995-2004).

RESULTS: Sixty-eight cases of retroperitoneal soft tissue sarcoma were

identified. Thirty-eight were reconfirmed to be GIST, 19 were newly diagnosed as

GIST (the hidden cases), 8 cases were re-diagnosed as mesenchymal tumors, and 3

cases of sarcoma remained sarcomas. Of all the GIST tumors, c-KIT-positive and

PDGFRalpha-positive tumors were more characteristic of primary gastric tumors,

while c-KIT-positive and PDGFRalpha-negative tumors were found in the colorectal

area. The c-KIT-negative and PDGFRalpha-positive cases were of gastric origin.

CONCLUSIONS: Any c-KIT-negative malignant mesenchymal mass located near the

proximal gastrointestinal tract should also be stained for PDGFRalpha to

differentiate between GIST and other soft tissue sarcomas. Practically, formerly

diagnosed abdominal or retroperitoneal soft tissue sarcomas should be reviewed to

identify patients with misdiagnosed GIST and thereby avoid future unnecessary and

ineffective chemotherapy.

 

PMID: 18085040  [PubMed - indexed for MEDLINE]

 

 

24. Oncol Rep. 2007 Dec;18(6):1577-81.

 

Synovial sarcoma of the extremities and trunk: a long-lasting disease.

 

Gofman A(1), Issakov J, Kollender Y, Soyfer V, Dadia S, Jiveliouk I, Flusser G,

Bickels J, Meller I, Merimsky O.

 

Author information:

(1)National Unit of Orthopedic Oncology, Tel-Aviv Sourasky Medical Center,

affiliated with Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 64239,

Israel.

 

Synovial sarcoma (SS) of an extremity or trunk is relatively rare and is

approached by limb sparing surgery (LSS), radiation therapy (RT) and

chemotherapy. We conducted a retrospective analysis of the clinical and

histopathological data of 73 patients with proven SS. At a median follow-up time

of 6 years, local recurrence was seen in 17.8 and systemic recurrence 35.6% of

patients (local-only, 6.8; systemic-only, 24.6; combined, 11%). The 10-year local

recurrence-free survival (LRFS), systemic recurrence-free survival (SRFS) and

overall survival (OS) rates were 78, 68 and 61%, respectively. LRFS was

significantly better in patients treated with isolated limb perfusion (ILP); SRFS

was influenced by the delay until diagnosis. The practical aspects of our

observations are the need for long-term follow-up in order to diagnose

recurrences, the fact that not all local or distant recurrences are necessarily

associated with a shortening of OS time and the important role of induction ILP

with TNF in cases of extremity SS.

 

PMID: 17982647  [PubMed - indexed for MEDLINE]

 

 

25. Gynecol Obstet Invest. 2008;65(2):89-95. Epub 2007 Sep 18.

 

The complexity of management of pregnancy-associated malignant soft tissue and

bone tumors.

 

Molho RB(1), Kollender Y, Issakov J, Bickels J, Flusser G, Azem F, Alon A, Inbar

MJ, Meller I, Merimsky O.

 

Author information:

(1)Unit of Bone and Soft Tissue Oncology, Division of Oncology, Tel-Aviv Sourasky

Medical Center, Tel-Aviv, Israel.

 

OBJECTIVE: The incidence of musculoskeletal tumors during pregnancy is very low.

The aim of this study was to summarize our experience in treating a large cohort

of pregnant patients diagnosed with these rare tumors.

METHODS: Women diagnosed with musculoskeletal tumors during pregnancy or

immediately after delivery were identified retrospectively in our database

between 1996 and 2006. Relevant maternal and neonatal data were collected.

RESULTS: Twenty patients, 8 with bone sarcomas (BS) and 12 with soft tissue

sarcomas (STS) were identified. Two women were treated by wide excision of mass

during pregnancy. In all other cases oncological treatment was delayed until

delivery or termination of pregnancy. Vaginal delivery was possible in 9

patients, cesarean section was performed in 7, spontaneous abortion occurred in

1, and 3 underwent termination of pregnancy. Three newborns were premature, but

normal growth and development were observed. Different techniques of fertility

preservation were used in our patients. Five patients with BS and 5 patients with

STS received preoperative chemotherapy, with different grades of toxicity. The

degree of tumor necrosis tended to correlate with dose-intensity of chemotherapy.

Seven patients with BS received adjuvant chemotherapy. Two patients with STS

received adjuvant chemotherapy, two - radiotherapy, and four - both modalities.

Median disease-free survival was 15.1 months, median overall survival - 25.4

months.

CONCLUSIONS: Musculoskeletal tumors diagnosed during pregnancy, or after

delivery, do not appear to have a significant impact on the prognosis. A

multidisciplinary team should tailor the oncological approach individually.

 

(c) 2008 S. Karger AG, Basel.

 

PMID: 17878735  [PubMed - indexed for MEDLINE]

 

 

26. Int J Oncol. 2007 Jul;31(1):225-32.

 

Molecular impacts of rapamycin-based drug combinations: combining rapamycin with

gemcitabine or imatinib mesylate (Gleevec) in a human leiomyosarcoma model.

 

Merimsky O(1), Gorzalczany Y, Sagi-Eisenberg R.

 

Author information:

(1)Unit of Bone and Soft Tissue Oncology, Division of Oncology, The Tel-Aviv

Sourasky Medical Center, Tel Aviv, Israel.

 

Drug combinations may provide a therapeutic benefit in treating cancer patients.

However when considering a drug combination, it is important to assess how the

molecular impact of the combination relates to the effects manifested by each

drug alone and whether or not it varies depending on the tumor type. In this

study, we have analyzed the molecular impact on a human leiomyosarcoma cell line

(SK-LMS-1) of a combination consisting of the mTOR inhibitor rapamycin and either

the anti-metabolite drug gemcitabine (Gemzar) or the protein tyrosine kinase

inhibitor imatinib mesylate (Gleevec, STI571). We show that imatinib mesylate

depolarizes the mitochondrial membrane potential (DeltaPhim) and inhibits protein

tyrosine phosphorylation, but displays only minor effects on cell proliferation

when added alone or in combin-ation with rapamycin. Gemcitabine or rapamycin,

when added alone, inhibit protein tyrosine phosphorylation as well as

phosphorylation of the MAP kinases ERK1/2. Both drugs also affect the cell cycle,

arresting the cells at the S or G1 phase respectively. Rapamycin elevates

significantly DeltaPhim but produces only a moderate effect on cell growth.

Gemcitabine inhibits considerably cell growth but exerts no effect on DeltaPhim.

Combining gemcitabine and rapamycin produces a major effect on the cell cycle,

elevates the DeltaPhim even further and maintains the molecular impacts exerted

by each single drug. Therefore, consistent with our clinical observation, these

results suggest that combining gemcitabine and rapamycin may be beneficial in

treating leiomyosarcoma patients.

 

PMID: 17549426  [PubMed - indexed for MEDLINE]

 

 

27. J Bone Joint Surg Br. 2006 Dec;88(12):1647-51.

 

Liposarcoma in adult limbs treated by limb-sparing surgery and adjuvant

radiotherapy.

 

Issakov J(1), Soyfer V, Kollender Y, Bickels J, Meller I, Merimsky O.

 

Author information:

(1)Department of Pathology, Tel-Aviv Sourasky Medical Centre, Tel-Aviv, Israel.

 

Between December 1995 and March 2003, 38 adult patients with intermediate or

high-grade liposarcoma in a limb were treated by limb-sparing surgery and

post-operative radiotherapy. The ten-year local recurrence-free survival was 83%,

the ten-year metastasis-free survival 61%, the ten-year disease-free survival 51%

and the ten-year overall survival 67%. Analysis of failure and success showed no

association with the age of the patients, gender, the location of the primary

tumour, the type of liposarcoma and the quality of resection. Our results

indicate that liposarcoma may recur even ten years after the end of definitive

therapy and may spread to unexpected sites as for soft-tissue sarcoma.

 

PMID: 17159180  [PubMed - indexed for MEDLINE]

 

 

28. Radiother Oncol. 2005 Dec;77(3):295-300. Epub 2005 Nov 21.

 

Limb sparing approach: adjuvant radiation therapy in adults with intermediate or

high-grade limb soft tissue sarcoma.

 

Merimsky O(1), Soyfer V, Kovner F, Bickels J, Issakov J, Flusser G, Meller I,

Ofer O, Kollender Y.

 

Author information:

(1)Sackler School of Medicine, Tel-Aviv University, Israel.

oferm@tasmc.health.gov.il

 

BACKGROUND: Limb soft tissue sarcomas (STS) are currently treated with limb

sparing surgery (LSS) followed by radiation therapy (RT).

PATIENTS AND METHODS: Between October 1994 and October 2002, 133 adult patients

with intermediate or high-grade limb STS were approached by LSS+RT.

RESULTS: RT related toxicity was manageable, with a low rate of severe effects.

At 4-year median follow-up, there were 48 recurrences of any type, 23 of isolated

local failure, and 35 of systemic spread w/o local failure. DFS and OS were

influenced by disease stage II vs I, primary site in the upper limb vs lower

limb, MPNST vs other types, induction therapy vs no induction, adequate resection

vs marginal resection or involved margins, and good response to induction therapy

vs bad response. DFS and OS were Patient's age and sex, tumor depth, acute or

late toxicity of RT, or the interval of time between the date of definitive

surgery and the start of RT did not affect DFS and or OS.

CONCLUSIONS: The RT protocol is applicable in the era of complicated, expensive

and time-consuming 3D therapy. Our results of LSS+RT in adults with limb HG STS

are satisfactory.

 

PMID: 16300847  [PubMed - indexed for MEDLINE]

 

 

29. Oncol Rep. 2005 Oct;14(4):1071-6.

 

A single-team experience of limb sparing approach in adults with high-grade

malignant fibrous histiocytoma.

 

Issakov J(1), Kollender Y, Soyfer V, Bickels J, Flusser G, Meller I, Merimsky O.

 

Author information:

(1)Unit of Musculoskeletal Pathology, Tel-Aviv Sourasky Medical Center, Tel-Aviv,

Israel.

 

Malignant fibrous histiocytoma (MFH) is the most common subtype of soft-tissue

sarcoma (STS). When located in a limb, MFH, is currently treated with limb

sparing surgery (LSS) followed by radiation therapy (RT). During 8 years, 42

adult patients with high-grade limb MFH were approached by LSS and RT. Our

results reflect a single-team experience and point to several important

conclusions. High grade MFH, treated by conservative approach, lead to a 10-year

relapse-free survival of 62% and a 10-year overall survival rate of 80%.

Recurrences of MFH tend to occur during the first 2 years. Relapse-free survival

was affected mainly by location in the lower limb vs. the upper limb,

irrespective of the tumor size. Patients who had their diagnostic biopsies in

another medical center had a greater tendency to local and systemic relapse. It

seems that the most important clues for disease-free survival are the team

experience and cooperation. All other factors are tumor-biology dependent, and

thus far are beyond our control.

 

PMID: 16142374  [PubMed - indexed for MEDLINE]

 

 

30. Int J Mol Med. 2004 Nov;14(5):931-5.

 

Targeting metastatic leiomyosarcoma by rapamycin plus gemcitabine: an intriguing

clinical observation.

 

Merimsky O(1).

 

Author information:

(1)Unit of Bone and Soft Tissue Oncology, Division of Oncology, The Tel-Aviv

Sourasky Medical Center, 6 Weizmann Street, Tel-Aviv 64239, Israel.

merimsky@zahav.net.il.

 

The emerging anti-cancer approach is based on combining a 'traditional' cytotoxic

drug with a 'signaling' blocking agent. Such combination, if designed and applied

properly, may increase selectivity towards tumor cells. The use of such

combinations requires smart planning and choice of the drugs to be combined,

their proper dosing as well as correct sequence and schedule of application. The

combination of the anti-metabolite gemcitabine and the mTOR blocker, rapamycin,

has achieved an impressive response in a patient with metastatic leiomyosarcoma.

 

PMID: 15492868  [PubMed - indexed for MEDLINE]

 

 

31. Int J Radiat Oncol Biol Phys. 2004 Apr 1;58(5):1468-73.

 

Radiotherapy for spinal cord compression in patients with soft-tissue sarcoma.

 

Merimsky O(1), Kollender Y, Bokstein F, Issakov J, Flusser G, Inbar MJ, Meller I,

Bickels J.

 

Author information:

(1)Unit of Bone and Soft Tissue Oncology, Tel-Aviv Sourasky Medical Center and

Tel-Aviv University Sackler School of Medicine, Tel-Aviv, Israel.

merimsky@zahav.net.il

 

PURPOSE: Spinal metastases of soft-tissue sarcoma (STS) occur rarely and pose a

therapeutic problem. Although wide resection is warranted for best local control,

it is rarely feasible. A radiotherapy (RT) dose of 70 Gy is usually needed to

treat limb STS, but only 45 Gy can be given to the spine. In the present series,

we report our experience using RT to treat spinal cord compression (SpCC)

associated with STS.

METHODS AND MATERIALS: The medical files of 19 adult patients with STS and SpCC

were reviewed. RT was considered in all the cases, together with steroids and

analgesics. The prescribed dose was 30 Gy in 10 fractions within 12 days. The

effect of treatment was evaluated on a clinical basis.

RESULTS: Twenty-three events of SpCC were found. The prevailing symptom was pain.

The Karnofsky performance status was 40-70% at presentation. RT was given in all

but 1 patient and surgical decompression in 3. Small, but important, improvements

in signs and Karnofsky performance status were noted in 14 of 23 cases of SpCC,

expressed mainly by pain alleviation and restoration of independence. The median

survival after the diagnosis of SpCC was 5 months.

CONCLUSION: Radiotherapy is an important tool in palliating SpCC in patients with

STS.

 

PMID: 15050325  [PubMed - indexed for MEDLINE]

 

 

32. Isr Med Assoc J. 2004 Jan;6(1):34-8.

 

Palliative treatment for advanced or metastatic osteosarcoma.

 

Merimsky O(1), Kollender Y, Inbar M, Meller I, Bickels J.

 

Author information:

(1)Unit of Soft Tissue and Bone Oncology, Tel Aviv Sourasky Medical Center, Tel

Aviv, Israel. oferm@tasmc.health.gov.il

 

PMID: 14740508  [PubMed - indexed for MEDLINE]

 

 

33. Isr Med Assoc J. 2003 Apr;5(4):264-7.

 

Gestation-related malignant musculoskeletal tumors.

 

Merimsky O(1), Inbar M, Issakov J, Kollender Y, Flusser G, Meller I, Bickels J.

 

Author information:

(1)Unit of Bone and Soft Tissue Oncology, Tel Aviv Sourasky Medical Center, Tel

Aviv, Israel. merimsky@zahav.net.it

 

BACKGROUND: The incidence of malignant musculoskeletal tumors during pregnancy is

very low. The paucity of data precludes the drawing of solid conclusions

regarding a standard approach.

OBJECTIVES: To summarize our experience treating 13 pregnant women with malignant

soft tissue or bone tumors.

METHODS: We conducted a retrospective analysis of 13 cases of patients with

either soft tissue or bone sarcoma that developed or progressed during pregnancy

or immediately after delivery.

RESULTS: The clinical presentation of the tumors was a growing mass and/or

increasing pain and disability. Most of the masses were located in the lower part

of the body and were of considerable size. Treatment given during gestation was

limited to wide excision of the mass in the 28th week of gestation in one

patient. All the patients reported disease progression during gestation. Vaginal

delivery was possible in eight patients with no complications, cesarean section

was carried out in three women, spontaneous miscarriage occurred in one and

termination of pregnancy was performed in one patient.

CONCLUSIONS: The diagnostic and therapeutic approaches should be tailored

specifically in every pregnant woman in whom sarcoma is suspected.

 

PMID: 14509131  [PubMed - indexed for MEDLINE]

 

 

34. Oncol Rep. 2003 Sep-Oct;10(5):1593-9.

 

Induction chemotherapy for bone sarcoma in adults: correlation of results with

erbB-4 expression.

 

Merimsky O(1), Kollender Y, Issakov J, Inbar M, Flusser G, Benayahu D, Meller I,

Bickels J.

 

Author information:

(1)Unit of Soft Tissue and Bone Oncology, Division of Oncology, The Tel-Aviv

Sourasky Medical Center, Tel-Aviv 64239, Israel. merimsky@zahav.net.il

 

Tumor response to preoperative chemotherapy is an important prognostic factor for

localized, operable extremity osteosarcoma. Other clinical variables include

tumor size and location, age and sex, and serum enzymes. Advances in molecular

oncology yielded a second group of factors such as multidrug resistance status,

loss of heterozygosity of RB gene, and HER2/erbB-2 expression. The aim of this

study was to investigate the expression and the prognostic value of the newly

described erbB-4 receptor in specimens from adults with bone sarcomas treated by

pre- and postoperative chemotherapy. Thirty-three patients with non-metastatic

bone sarcoma have been treated by two doxorubicin-based induction chemotherapy

regimen, followed by limb sparing surgery and tailored adjuvant chemotherapy.

Pre-chemotherapy tissue specimens were investigated for the expression of erbB-4

receptor and post-induction specimens were assessed for pathological response.

The clinical response rates were 32-36%. The degree of induced necrosis was

correlated with the disease-free survival (DFS). Patients achieving >/=90%

necrosis had an improved DFS over patients with poor histological response.

ErbB-4 expression was significantly associated with poor histologic response and

shorter DFS. ErbB-4 expression may be used for prognostication of adults with

bone sarcomas.

 

PMID: 12883746  [PubMed - indexed for MEDLINE]

 

 

35. Cancer. 2003 Jun 1;97(11):2830-8.

 

Role of adjuvant cryosurgery in intralesional treatment of sacral tumors.

 

Kollender Y(1), Meller I, Bickels J, Flusser G, Issakov J, Merimsky O, Marouani

N, Nirkin A, Weinbroum AA.

 

Author information:

(1)National Orthopedic Oncology Unit, Tel-Aviv Sourasky Medical Center, Sackler

Faculty of Medicine, Tel Aviv University, Israel.

 

BACKGROUND: Cryosurgery is an adjuvant surgical technique for the treatment of

benign aggressive, low-grade malignant and metastatic tumors of long bones. It

has been used rarely to treat sacral tumors, mainly because of potential damage

to nerves, blood vessels, and intrapelvic organs. The authors described their

experience with this procedure and provided medium and long-term follow-up

results.

METHODS: Fifteen procedures of cryosurgery of the sacrum were performed in 14

patients to improve the therapeutic outcome of a variety of tumors. The patient

group included 7 males and 7 females with a mean age of 42 +/- 24 years. Three

patients were younger than 20 years of age. The procedures were performed at the

Tel Aviv Sourasky Medical Center between January 1991 and January 1999. There

were seven benign aggressive lesions (four giant cell tumors and three aneurysmal

bone cysts), one benign schwannoma, one low-grade chondrosarcoma, five metastatic

carcinomas, and one high-grade Ewing sarcoma, all localized at level S(2) or

higher. Eight of the bone tumors also involved significant anterior or posterior

soft tissue. All patients had severe preoperative pain radiating to the buttocks,

perineum, and lower limbs and 9 (64%) patients had bladder and/or rectal

dysfunction. Invasive diagnostic procedures and radiation (if warranted) preceded

surgery. Sacral posterior fenestration and burr drilling were followed by

two-cycle cryosurgery using the open pour technique or the argon-helium-based

heat-freeze system.

RESULTS: All interventions were performed under combined general and regional

anesthesia and concluded uneventfully with moderate blood loss. Thirteen patients

were discharged home after 8 +/- 5 days (one patient remained hospitalized for 30

days). Only two patients experienced local disease recurrence during a 3-11-year

follow-up period: one was retreated successfully by cryosurgery and the other

underwent sacrectomy and radiotherapy elsewhere, with a subsequent loss of

visceral functions. No patient suffered chronic pain, deep wound infections, or

significant neurologic deficits and all were satisfied with the esthetic outcome.

CONCLUSIONS: Cryosurgery is a conservative, feasible, and safe adjuvant technique

in the treatment of sacral tumors. It is associated with minimal permanent

neurologic and vascular injury compared with sacrectomy.

 

Copyright 2003 American Cancer Society.

 

PMID: 12767097  [PubMed - indexed for MEDLINE]