1. SPINDLE CELL SARCOMA OF BONE AN ASSESSMENT OF OUTCOME
David PEAKE
Robert J GRIMER, David SPOONER,
Simon R CARTER, Roger M TILLMAN,
Seggy ABUDU, Mark DAVIES

2. THE STUDY
To investigate treatment, outcome and prognostic factors for “spindle cell sarcomas of bone”
Retrospective review of prospective database (1970 – 2001)
Pathology diagnosis as made at the time

3. SPINDLE CELL SARCOMA OF BONE DEFINITION
All primary bone sarcomas that
were NOT
Osteosarcoma
Ewing’s sarcoma
Chondrosarcoma

4. THE DATABASE
Prospective from 1986 (but includes all tumour cases since 1970)
>15,000 patients
Records patient details, diagnosis, treatment, outcome, function etc

5. RESULTS 183 patients - 116 male : 67 Female 179 primary : 4 secondary
3 RT / 1 Paget’s
Stage:
10 low grade
173 high grade
26 metastases at presentation

6. AGE
Mean 45 yrs
76 <40
47 >60

7. 157 limb : 26 axial SITE 78 distal femur 26 pelvis 23 proximal femur
21 proximal tibia
10 humerus
25 other
34 had a pathological fracture at presentation (18%)

8. HISTOLOGY MFH 74 Spindle cell sarcoma 56 Leiomyosarcoma 24
Fibrosarcoma 18
Angiosarcoma 11

9. HISTOLOGY VARIED WITH TIME !

10. MANAGEMENT
As per osteosarcoma
Chemotherapy when appropriate
Surgical excision

11. 131 (71%) received chemotherapy
Doxorubicin / Cisplatin 84
Doxorubicin / HDMTX 10
Doxorubicin / Ifosfamide 10
Others
Unknown 12

12. CHEMOTHERAPY - 2 Chemotherapy dependant on age
84% under age 40
56% aged 40-60
18% over age 60
Neoadjuvant in 83% of those who had it
30% had better than 90% necrosis
No conclusion possible about best regime

13. SURGERY 150 patients had surgery
37 amputation (25%)
113 LSS (75%)
Trend towards increased amputation in older patients and those with pathological fracture

14. OUTCOME
Stage 3 disease
median survival 13 months
High grade, non axial, non metastatic disease (n = 125):
Overall survival
62% at 5 years 58% at 10 years

15. OVERALL SURVIVAL (no mets, limb)
62% at 5 years (+ 4%)
58% at 10 years (+ 4%)

16. PROGNOSTIC FACTORS (p<0.05)
Limb salvage > amputation HR 5.4
Necrosis > 90% HR 5.4
Limb > central HR 1.9
Age < HR 2.0
Not significant
Diagnosis
Type of chemotherapy

17. Survival according to age
< 40 yrs
40 – 60 yrs
> 60 yrs

18. Survival according to histology
LMS
MFH
Fibrosarcoma
Angiosarcoma
Sarcoma
N.S.

19. LOCAL RECURRENCE 15% overall 20% in LSS cases 7% after amputation
Highest in distal femur (28%)
Decreasing risk by decade
Not increased with pathological fracture
73% died after LR
Mean survival 11 months after LR

20. RISK FACTORS FOR LOCAL RECURRENCE
Marginal margins HR 3.5 ( ) p = 0.002
< 90% necrosis HR 11.6 (1.3 – 100) p = 0.026
Univariate

21. COMPARISON (63% at 5 yrs) Huvos, 1985 MFH (n=130) 53%
Little, MFH (n=39) 53%
Yokoyama, 1993 MFH(n=34) 43%
Picci, MFH (n=51) 67%
Bielack, MFH (n=125) 59%
Bramwell,1999 MFH (n=41) 59%

22. “Spindle cell sarcoma of bone”
CONCLUSION
“Spindle cell sarcoma of bone”
describes a heterogeneous group of primary bone sarcomas (cf soft tissue sarcoma)
behaves like, if not better than, osteosarcoma matched for age
should be treated the same as osteosarcoma
why not register for same trials (especially for OS > 40)?