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
Do we all speak the same language ? • R0 = clear margin = Wide ? • R1 = tumour at margin = Marginal or intralesional ? • R2 = residual macroscopic disease = Intralesional
Do we all speak the same language ? • Intralesional • Marginal • Wide • Radical
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
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
We should DESIST using RECIST at least in GIST You have heard medical oncoloGIST claiming… CTOS Barcelona 2003
…about surgical margins You have also heard surgical oncologist and orthopaedic oncologist talking… Consensus Meeting Trieste 2005
An intact fascial layer ? • 5 cm of muscle longitudinally ? • 1cm of muscle radially ? • Periosteum ? • Adventitia over vessels ?
Much better… Same… Other How would you have done it ?
Wide ? Inadequately wide ? Close ? Marginal ? What would you call it ?
Width Quality (fascia, muscle, periosteum….) Details of closer margins
Subtype Grade Vascular invasion (Y/N) Nature of margin (pushing or infiltrative) Details of histology
CT RT Other Details of adjuvant/neoadjuvant treatments
The type of tumour The grade The location Response to neoadjuvant therapies (CT different from RT ?) The surgeon The patient Margins depend on….
EORTC - STBSG Participating groups ISG BSG FSG SSG NWWDT PSG GEIS + YOU ?
Local recurrence free survival Metastasis free survival Disease specific survival End Point