CLINICAL CHARACTERISTICS AND OUTCOMES FOR BENIGN AND MALIGNANT SOLITARY FIBROUS TUMOR / HEMANGIOPERI...
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CLINICAL CHARACTERISTICS AND OUTCOMES FOR BENIGN AND MALIGNANT SOLITARY FIBROUS TUMOR / HEMANGIOPERICYTOMA (SFT/HPC) – A SINGLE CENTER EXPERIENCE.

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Connective tissue oncology society november 17 th 2012 prague czech republic

CLINICAL CHARACTERISTICS AND OUTCOMES FOR BENIGN AND MALIGNANT SOLITARY FIBROUS TUMOR / HEMANGIOPERICYTOMA (SFT/HPC) – A SINGLE CENTER EXPERIENCE

Nicholas DeVito, M.D.; Evita Henderson, M.D.; Gang Han, Ph.D.; Damon Reed, M.D.; Marilyn Bui, M.D., Ph.D.; Robert Lavey, M.D., M.P.H.; Lary Robinson, M.D.; Jonathan S. Zager, M.D.; Ricardo J Gonzalez, M.D.; Vernon K. Sondak, M.D.; G. Douglas Letson, M.D.; Anthony Conley, M.D.

Moffitt Cancer Center, University of South Florida, Tampa, FL, USA

  • Connective Tissue Oncology Society

  • November 17th, 2012

  • Prague, Czech Republic


Introduction and background
Introduction and Background MALIGNANT SOLITARY FIBROUS TUMOR / HEMANGIOPERICYTOMA (SFT/HPC) –

  • Solitary Fibrous Tumor/Hemangiopericytoma (SFT/HPC) is a ubiquitous mesenchymal tumor of fibroblastic type. SFT/HPC typically affects adults from ages 20 to 70 years

  • Vallat-Decouvelaereet al first distinguished malignant from benign variants on the basis of nuclear atypia, hypercellularity, greater than 4 mitosis/10 HPFs, and necrosis

  • However, the correlation between morphology and aggressiveness is poorly defined

  • Surgery is the treatment of choice for local disease, radiation is an option of unclear benefit, and chemotherapy is often a final effort


Introduction and background1
Introduction and Background MALIGNANT SOLITARY FIBROUS TUMOR / HEMANGIOPERICYTOMA (SFT/HPC) –

  • One recent retrospective study examined the use of temozolomide and bevacizumab to treat SFT/HPC

  • A prospective trial was presented at AACR in 2010 that examined the molecular characteristics and targeted therapeutics for patients with SFT/HPC resistant to conventional chemotherapies. Eleven patients received sunitinibmaleate and figitumumab with favorable response


Our purpose
Our Purpose MALIGNANT SOLITARY FIBROUS TUMOR / HEMANGIOPERICYTOMA (SFT/HPC) –

  • This retrospective chart review was conducted to further define the clinical characteristics and outcomes in patients with benign and malignant SFT/HPC

  • We hope that it will further the understanding of this rare disease and become useful as a reference for future clinical trials


Methods
Methods MALIGNANT SOLITARY FIBROUS TUMOR / HEMANGIOPERICYTOMA (SFT/HPC) –

  • Patients with pathology defined SFT/HPC who were treated at the Moffitt Cancer Center were first identified through the Total Cancer Care database and then through PowerChart database queries from 1993 to 2011

  • Two sarcoma pathologists re-reviewed every case in an un-blinded manner

  • Internal Review Board approval under an umbrella protocol for the purpose of retrospective studies

  • Data collected from PowerChart included age of the patient, patient gender and race, vital status, last follow up, age of presentation, primary tumor site, date and site of metastases, chemotherapeutic, surgical and radiotherapeutic interventions


Our patients
Our Patients MALIGNANT SOLITARY FIBROUS TUMOR / HEMANGIOPERICYTOMA (SFT/HPC) –

  • 82 patients total

  • 47(57%) women

  • 73(89%) Caucasian

  • Median age: 62 years (range, 20 - 89)

  • Thirty-two (39%) pts died as of Nov. 2011

  • The median follow-up was 55.3 months


Disease characteristics
Disease Characteristics MALIGNANT SOLITARY FIBROUS TUMOR / HEMANGIOPERICYTOMA (SFT/HPC) –

  • - Lung/Pleura in 28(34%) - Abdomen/Pelvis in 23(28%)

  • - Extremity in 13(16%) - Head/Neck in 9(11%)


Disease characteristics1
Disease Characteristics MALIGNANT SOLITARY FIBROUS TUMOR / HEMANGIOPERICYTOMA (SFT/HPC) –

  • Benign: 43(52%)

  • Malignant: 39(48%)


Benign
Benign MALIGNANT SOLITARY FIBROUS TUMOR / HEMANGIOPERICYTOMA (SFT/HPC) –

Malignant


Disease characteristics2
Disease Characteristics MALIGNANT SOLITARY FIBROUS TUMOR / HEMANGIOPERICYTOMA (SFT/HPC) –


Disease characteristics3
Disease Characteristics MALIGNANT SOLITARY FIBROUS TUMOR / HEMANGIOPERICYTOMA (SFT/HPC) –

  • Compared to benign SFT/HPC, malignant histology was associated with:

    • larger tumor size

    • higher mitotic counts

    • metastatic disease at diagnosis

    • greater use of chemotherapy and radiation therapy

  • Gender, age, and tumor site were not significantly different between benign and malignant subtypes.


Treatments
Treatments MALIGNANT SOLITARY FIBROUS TUMOR / HEMANGIOPERICYTOMA (SFT/HPC) –


Survival differences between benign and malignant sft hpc
Survival Differences Between Benign and Malignant SFT/HPC MALIGNANT SOLITARY FIBROUS TUMOR / HEMANGIOPERICYTOMA (SFT/HPC) –

By univariate analysis, benign vs. malignant variant

positively impacted overall survival (P=0.02)


Survival differences in surgically and non surgically treated patients
Survival Differences in Surgically and Non-Surgically Treated Patients

By univariate analysis, complete resection positively

impacted overall survival (P<0.0001, HR 0.09)


Univariate survival analysis
Univariate Treated Patients Survival Analysis



Discussion and conclusions
Discussion and Conclusions Treated Patients

  • Malignant SFT/HPC was associated with larger, mitotically active tumors that were more likely to be metastatic at diagnosis compared to benign SFT/HPC

  • Primary site was not associated with tumor behavior

  • Clear survival differences exist between benign and malignant SFT/HPC


Discussion and conclusions1
Discussion and Conclusions Treated Patients

  • Patients treated with chemotherapy had an inferior OS compared to untreated patients, however, this is likely due to the severity of their disease.

  • While surgery is the best treatment option for benign and malignant SFT/HPC, targeted systemic therapies and better understanding of the molecular pathogenesis are needed to improve outcomes for patients with metastatic, malignant SFT/HPC.


Acknowledgements
Acknowledgements Treated Patients

  • Moffitt Cancer Center:

    • Sarcoma Department

    • Our Statistician Gang Han

    • Our Pathologists Dr. Henderson and Dr. Bui

    • Eric Anderson for facilitating funding for this trip

    • My Principal Investigator Dr. Anthony Conley

  • University of South Florida, Morsani College of Medicine for supporting my research

  • The Connective Tissue Oncology Society

  • Tufts Medical Center, for arranging my schedule to allow me to present at CTOS