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Connective Tissue Oncology Society 11th Annual Meeting Boca Raton, November 19-21 2005

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Connective Tissue Oncology Society 11th Annual Meeting Boca Raton, November 19-21 2005 A European project for surgical margins assessment in STS of the extremities and superficial trunk.

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slide1

Connective Tissue Oncology Society

11th Annual Meeting

Boca Raton, November 19-21 2005

A European project for surgical margins assessment in STS of the extremities and superficial trunk

Gronchi A, Grimer R, Hoogendoorn PCW, Van Coevorden F, Bauer H, Kindblom LG, Bonvalot S, Coindre JM, Hohenberger P, Wardelman E, Ruka W, Rutkowski P, Collini P, Dei Tos AP

slide3

Do we all speak the same language ?

  • R0 = clear margin = Wide ?
  • R1 = tumour at margin = Marginal or intralesional ?
  • R2 = residual macroscopic disease = Intralesional
slide4

Do we all speak the same language ?

  • Intralesional
  • Marginal
  • Wide
  • Radical
slide5

Japanese orthopaedic surgeons…

Quantify the concept of “barrier”

Joint cartilage = 5cm

Thick barrier = 3cm

Young periosteum

Tendon

Thick fascia (ie fascia lata, presacral fascia)

Thin barrier = 2cm

Adult periosteum

Vascular adventitia

Perineural sheath

Normal muscular fascia

Adherent tumour = – 1cm

Kawaguchi et al 2004, Clin Orthop 419

slide6

Japanese orthopedic surgeons…

  • 5 cm. margin = Curative
  • >2 cm margin = Adequately wide
  • <1 cm margin = Inadequately wide
  • “reacting zone” = Marginal
  • Tumour at the margin = Intralesional

Kawaguchi et al 2004, Clin Orthop 419

slide9
…about surgical margins

You have also heard surgical oncologist and orthopaedic oncologist talking…

Consensus Meeting Trieste 2005

slide11

An intact fascial layer ?

  • 5 cm of muscle longitudinally ?
  • 1cm of muscle radially ?
  • Periosteum ?
  • Adventitia over vessels ?
what would you call it
Wide ?

Inadequately wide ?

Close ?

Marginal ?

What would you call it ?
details of closer margins
Width

Quality (fascia, muscle, periosteum….)

Details of closer margins
details of histology
Subtype

Grade

Vascular invasion (Y/N)

Nature of margin (pushing or infiltrative)

Details of histology
margins depend on
The type of tumour

The grade

The location

Response to neoadjuvant therapies (CT different from RT ?)

The surgeon

The patient

Margins depend on….
participating groups
EORTC - STBSGParticipating groups

ISG BSG FSG SSG

NWWDT PSG GEIS

+ YOU ?

end point
Local recurrence free survival

Metastasis free survival

Disease specific survival

End Point
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