1 / 25

Adductor Compartment STS - Does method of treatment affect outcome?

Adductor Compartment STS - Does method of treatment affect outcome?. Anup Pradhan, Yiu-Chung Cheung Birmingham Medical School, UK Supervisors: Mr Robert J Grimer Royal Orthopaedic Hospital, Birmingham, UK Dr Peter Ferguson Mount Sinai Hospital, Toronto, Canada. Background.

massimo
Download Presentation

Adductor Compartment STS - Does method of treatment affect outcome?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Adductor Compartment STS- Does method of treatment affect outcome? Anup Pradhan, Yiu-Chung Cheung Birmingham Medical School, UK Supervisors: Mr Robert J Grimer Royal Orthopaedic Hospital, Birmingham, UK Dr Peter Ferguson Mount Sinai Hospital, Toronto, Canada

  2. Background • Presents late • Often large • Neurovascular bundle close

  3. Surgical challenge!

  4. Marginal close to femoral vessels

  5. Vessels preserved Big hole !

  6. 14 days later… 7 days later…

  7. Aim of the project • To assess outcomes at ROH Birmingham • Survival • Local control • Complications • Function • To compare with a major North American Centre • To determine if different treatment methods affected above outcomes

  8. Treatment philosophies in the two Specialist Regional Centres • ROH, Birmingham, UK • Surgery followed by RT (most cases) • MSH, Toronto • Surgery preceded by RT (most cases) • Frequent use of flaps

  9. Method • Prospective databases • Study period (Jan 1990 – Jan 2001) • Collection of basic data and outcomes • demographic data • Size, grade (tumour) • Treatment methods • Survivorship for LR, OS • Wound complications • TESS for function

  10. Exclusions • Metastases at diagnosis • Previous treatment elsewhere • Patients lost to follow up • Unfit for surgery

  11. ROH MSH Median Age 55yrs Median Age 56.5yrs Patient age distribution P = 0.98

  12. ROH MSH Median = 9.5cm Median = 13cm Tumour size at diagnosis P = 0.11

  13. Factor ROH (n = 64) MSH (n = 62) P-value Mean (median) Age 55 (57) 55 (56.5) 0.98 Mean (median) Size (cm) 13.2 (12.8) 11.4 (9.5) 0.11 Proportion > 10cm 38 (59%) 25 (40%) 0.03 Proportion of high grade tumours 36 (56%) 35 (56%) 0.98 Adequate margins 46 (72%) 44 (71%) 0.91 Pre-operative radiotherapy NIL 26 (42%) Post-operative radiotherapy 60 (94%) 30 (48%) Use of muscle flaps NIL 26 (42%) Patient and Treatment Factors

  14. Factor ROH (n = 64) MSH (n = 62) P-value Length of stay 10.4 11.6 0.50 Wound complications 27 (42%) 14 (23%) 0.019 Local Recurrence (5 Year) 28% 10% 0.015 Metastases (5 Year) 51.5% 38.8% 0.48 Overall survival (5 Year) 58% 74% 0.13 TESS score 72% 79% 0.18 Outcomes Oncological and Functional Outcomes

  15. Comparing OS between the 2 centres P = 0.13 5yr OS = 74% MSH 5yr OS =57% ROH

  16. Overall survival by grade Low/Intermediate grade P < 0.001 High grade

  17. Overall survival by size P = 0.015 Size ≤ 10cm Size > 10cm

  18. Comparison of OS between pre and post RT groups (combined data from both centres) Postop RT Preop RT P = 0.55

  19. Comparing LR between the 2 centres P = 0.0145 5YLR = 10% 5YLR = 28%

  20. Factors associated with LR

  21. Summaryof Overall Findings • OS rate = 66% at 5 yrs • Significant factors • High Grade [HR 5.6, CI 2.3 – 13.5] • Size (< 10cm) [HR 0.41, CI 0.21 – 0.81] • LR rate = 21% at 5yrs • Significant factors • Margin • Functional outcome • Average TESS score – 76% • Worse TESS - wound complications(65% vs.79%) - high grade (70% vs. 84%) • No association with RT timing

  22. Conclusion • OS – unaffected by treatment strategies • RT Timing – no affect on OS, LR, and function • LR – Higher rate in ROH • Positive margins (28%) • quality of RT

  23. Acknowledgements • Supervisors Mr Rob Grimer Dr Peter Ferguson • Mr Seggy Abudu • Dr Anthony Griffin • Medical Records, ROH, Birmingham • Orthopaedic Oncology Team, MSH, Toronto

  24. References • O’Sullivan et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet 2002; 359(9325): 2235-2241 • Grainger MF, Grimer RJ, Carter SR, Tillman RM. Wound complications following resection of adductor compartment tumours. Sarcoma 5 2001: 203-207 • Davis AM, O’Sullivan B, Bell RS, et al. Function and Health Status Outcomes in a Randomized Trial Comparing Preoperative and Postoperative Radiotherapy in Extremity Soft Tissue Sarcoma. J Clin Oncol 2002; 20: 4472-4477 • Bell RS, O’Sullivan B, Davis A, Langer F, Cummings B, Fornasier VL. Functional Outcome in Patients Treated With Surgery and Irradiation for Soft Tissue Tumours. J Surg Oncol 1991; 48: 224-231 • Gerrand CH, Wunder JS, Kandel RA, O’Sullivan B, Catton CN, Bell RS, Griffin AM, Davis AM. Classification of positive margins after resection of soft-tissue sarcoma of the limb predicts the risk of local recurrence. J Bone Joint Surg Br 2001; 83-B(8): 1149-1155

  25. Thank You

More Related