Chiba Cancer Center, Chiba, Japan Shintaro Iwata Tsukasa Yonemoto Yoko Hagiwara Takeshi Ishii Division of Orthopedic Surgery Akinobu Araki Dai Ikebe Division of Surgical Pathology Hiroyuki Funatsu Division of Diagnostic Imaging, Chiba Cancer Center, Chiba, Japan CTOS 18 th Annual Meeting1 st Nov Infiltrative Soft Tissue Sarcoma - Should We Excise Beyond Radiological Infiltration? -

Chiba Cancer Center, Chiba, Japan Infiltrative Growth of STS How should I resect?

Overall Survival Chiba Cancer Center, Chiba, Japan Infiltrative Growth on MRI Significantly Correlated with Poor Local Control Rate and Overall Survival for MFH Focal Infiltrative Focal Infiltrative Focal P=.014 P=.04 -Iwata et al. CTOS 2011 meeting Local Control Rate

Chiba Cancer Center, Chiba, Japan Adjuvant Radiotherapy was Not Beneficial for Patients with Infiltrative Growth and Positive Surgical Margins Focal Infiltrative -Iwata et al. CTOS 2011 meeting Infiltrative Focal RT(+) RT(-) RT(+) RT(-) P=.38 P=.08

Chiba Cancer Center, Chiba, Japan Does radiological infiltration pattern represent histological tumor infiltration?

Chiba Cancer Center, Chiba, Japan Q1: Do tumor cells actually exist in the radiographic infiltration? Clinical questions Aim of this study Q2: Should surgery be planed to include resecting the radiographic infiltration?

Chiba Cancer Center, Chiba, Japan Patients and Methods Inclusion criteria 1) Diagnosed with MFS, UPS, or LMS 2) Treated initailly at our institution between 2007 and 2011 Total: 41 patients Follow-up for survivals: months (median 48 months)

Histological infiltration (H-inf ) - Distance from the tumor edge to the end of the atypical tumor cells Chiba Cancer Center, Chiba, Japan Patients and Methods Measurement of tumor infiltration Radiographic infiltration (R-inf ) - Length of high-intensity tail-like extension GdFS STIR R-inf H-inf

Chiba Cancer Center, Chiba, Japan Result 1 Correlation with H-inf and other factors FactornH-inf(+)H-inf(-)P Age (mean, years) Location Superficial Deep-seated Size (mean, cm)87.83 Grade Grade Grade Surgical margin Adequate Inadequate1073 (+) (-) H-inf Age (years) (Fisher’s exact test, Mann-Whitney’s U-test) (P<.0001, Fisher’s exact test) H-inf (+)H-inf (-)Total R-inf (+)17219 R-inf (-)31922 Total202141

Chiba Cancer Center, Chiba, Japan Length (cm) R-inf STIR R-inf GdFS H-inf Range (cm) Median P=.59 (Kruskal-Wallis test) Result 2 Relationship between H-inf and R-inf

Chiba Cancer Center, Chiba, Japan R-inf GdFS H-inf=0.81xR-inf+0.25 R 2 =.59 R-inf STIR H-inf=0.47x R-inf+0.25 R 2 =.28 H-inf (cm) (Pearson’s correlation coefficient) Result 2 Relationship between H-inf and R-inf

Chiba Cancer Center, Chiba, Japan Result 4 Prognostic factor analysis FactorOASPLCRP Site Extremity Trunk89100 Location Superficial Deep-seated8084 Size <8cm * ≧ 8cm 7577 FNCLCC Grade Grade * Grade Surgical margin Wide * Intra-infiltrate10056 Intra-tumor5067 H-inf Yes * No84100 (Log-rank test) Time (months) H-inf Probability Yes No P=.047 Time (months) Surgical margin Probability Wide Intra-tumor Intra-infiltrate P=.0017

Chiba Cancer Center, Chiba, Japan Discussion Q1: Do tumor cells actually exist in the radiographic infiltration? Actually tumor lesion, not edema! A1: YES, we should think so, at least on UPS and MFS. R-inf reflects H-inf. Sensitivity: 89% Specificity: 86%

Chiba Cancer Center, Chiba, Japan Discussion Q2: Should surgery be planed to include resecting the radiographic infiltration? If you ignore, tumor recur. A2: YES, we propose 2cm margin from the edge of the infiltration in GdFS MRI. H-inf R-inf (H-inf - R-inf) < 2cm - 13/14 (93%)

Chiba Cancer Center, Chiba, Japan Conclusion Radiographic infiltration of MFS and UPS as assessed by GdFS MRI correlated with histological infiltration. Wide resection with an “infiltration”- free margin would improve local control of these tumors.

Chiba Cancer Center, Chiba, Japan Thank you for your attention.