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Connective Tissue Oncology Society 11th Annual Meeting Boca Raton, November 19-21 2005
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Transcript of Connective Tissue Oncology Society 11th Annual Meeting Boca Raton, November 19-21 2005
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Connective Tissue Oncology Society
11th Annual MeetingBoca 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
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Background
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• R0 = clear margin = Wide ?
• R1 = tumour at margin = Marginal or intralesional ?
• R2 = residual macroscopic disease = Intralesional
Do we all speak the same language ?
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• Intralesional
• Marginal
• Wide
• Radical
Do we all speak the same language ?
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Kawaguchi et al 2004, Clin Orthop 419
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
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• 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
Japanese orthopedic surgeons…
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This is a time for a redefinition of our “activity”…
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You have heard medical oncoloGIST claiming…
We should DESIST using RECIST at least in GIST
CTOS Barcelona
2003
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You have also heard surgical oncologist and orthopaedic
oncologist talking…
… about surgical marginsConsensus Meeting
Trieste 2005
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What is “safe” in STS
surgery?
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• An intact fascial layer ?
• 5 cm of muscle longitudinally ?
• 1cm of muscle radially ?
• Periosteum ?
• Adventitia over vessels ?
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One example
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7 mm.
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How would you have done it ?
• Much better…
• Same…
• Other
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What would you call it ?• Wide ?
• Inadequately wide ?
• Close ?
• Marginal ?
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Do we know what is “safe”?
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AIM OF THE PROJECT
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To have one form for a
prospective data base
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Details of closer margins
•Width
•Quality (fascia, muscle, periosteum….)
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Details of histology
• Subtype
• Grade
• Vascular invasion (Y/N)
• Nature of margin (pushing or infiltrative)
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Details of adjuvant/neoadjuvant
treatments•CT
•RT
•Other
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Margins depend on….
• The type of tumour
• The grade
• The location
• Response to neoadjuvant therapies (CT different from RT ?)
• The surgeon
• The patient
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OUR EXAMPLE
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Participating groups
•EORTC - STBSG
ISG BSG FSG SSG
NWWDT PSG GEIS
+ YOU ?
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End Point
•Local recurrence free survival
• Metastasis free survival
• Disease specific survival
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… and eventually know
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How close we should dare go to this !