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

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

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  1. 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

  2. Background

  3. Do we all speak the same language ? • R0 = clear margin = Wide ? • R1 = tumour at margin = Marginal or intralesional ? • R2 = residual macroscopic disease = Intralesional

  4. Do we all speak the same language ? • Intralesional • Marginal • Wide • Radical

  5. 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

  6. 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

  7. This is a time for a redefinition of our “activity”…

  8. We should DESIST using RECIST at least in GIST You have heard medical oncoloGIST claiming… CTOS Barcelona 2003

  9. …about surgical margins You have also heard surgical oncologist and orthopaedic oncologist talking… Consensus Meeting Trieste 2005

  10. What is “safe” in STS surgery?

  11. An intact fascial layer ? • 5 cm of muscle longitudinally ? • 1cm of muscle radially ? • Periosteum ? • Adventitia over vessels ?

  12. One example

  13. 7 mm.

  14. Much better… Same… Other How would you have done it ?

  15. Wide ? Inadequately wide ? Close ? Marginal ? What would you call it ?

  16. Do we know what is “safe”?

  17. AIM OF THE PROJECT

  18. To have one form for a prospective data base

  19. Width Quality (fascia, muscle, periosteum….) Details of closer margins

  20. Subtype Grade Vascular invasion (Y/N) Nature of margin (pushing or infiltrative) Details of histology

  21. CT RT Other Details of adjuvant/neoadjuvant treatments

  22. The type of tumour The grade The location Response to neoadjuvant therapies (CT different from RT ?) The surgeon The patient Margins depend on….

  23. OUR EXAMPLE

  24. EORTC - STBSG Participating groups ISG BSG FSG SSG NWWDT PSG GEIS + YOU ?

  25. Local recurrence free survival Metastasis free survival Disease specific survival End Point

  26. … and eventually know

  27. How close we should dare go to this !

  28. … alessandro.gronchi@istitutotumori.mi.it