LWBK1006-26 LWW-Govindan-Review December 12, 2011 19:29
372 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology ReviewAnswer 26.12. The answer is C.
Independent predictors of prognosis of patients with nonmetastatic soft
tissue sarcoma include age, histologic subtype, histologic grade, tumor
site, and tumor size. Factors predictive of better disease-specific survival
include younger age, selected histologic subtypes (fibrosarcoma), low his-
tologic grade, smaller (<5 cm) tumor size, and extremity location. Nomo-
grams are available that accurately predict the prognosis of patients with
nonmetastatic soft tissue sarcoma treated with surgery with or without
adjuvant radiation.Answer 26.13. The answer is A.
In this patient, the most likely cause of the new lung nodule is metastases
of the leiomyosarcoma. Retrospective series have observed that 20% to
30% of such patients who undergo complete resection of the lung metas-
tases were alive 5 years later. Factors that predict for a lower success
rate with resection in such patients include more than four lung nodules,
bilateral lung nodules, and a disease-free interval of less than 12 months.
Chemotherapy and radiation provide only palliative intent in this case.Answer 26.14. The answer is D.
For locally recurrent sarcoma without distant metastases, re-resection is
the preferred treatment. For patients with metastatic sarcoma, median
survival is 1 year; however, a subset of these patients live for more than
2 years. It is important to consider complete resection of oligometastases
to the lung because approximately 25% of those patients will be alive 5
years later. Nearly all randomized trials have shown no overall survival
benefit with combination (vs. single agent) chemotherapy, although tumor
response rates were consistently higher. A single, recent randomized trial
demonstrated a modest survival benefit with the addition of docetaxel to
gemcitabine in patients with metastatic sarcoma.Answer 26.15. The answer is D.
Several studies have shown higher tumor response rates (but not improved
survival) with larger doses of doxorubicin and ifosfamide; however, this
does result in greater toxicity. Ifosfamide is an active agent in synovial cell
sarcoma but has little activity in leiomyosarcoma. Paclitaxel appears to
only be effective in the treatment of angiosarcoma and Kaposi’s sarcoma.
Perhaps the first drug identified to be active in adult soft tissue sarcoma,
dacarbazine resulted in tumor response rates of 10% to 30%.Answer 26.16. The answer is D.
In contrast with MFH of soft tissue, which is primarily treated with resec-
tion, MFH of bone is treated like high-grade osteosarcoma with preop-
erative chemotherapy, limb-sparing resection, and adjuvant chemother-
apy. Outcomes of patients with MFH of bone and with osteosarcoma
are similar when treated this way. Limb-sparing resection alone or