Fungating Soft-Tissue Sarcomas

Potter, Benjamin K.; Adams, Sheila C.; Qadir, Rabah; Pitcher, J. David; Temple, H. Thomas
March 2009
Journal of Bone & Joint Surgery, American Volume;Mar2009, Vol. 91-A Issue 3, p567
Academic Journal
Background: Several variables have been reported as being prognostic with regard to the outcomes of soft-tissue sarcomas. Although the tumors are subjectively ominous, no prior study has been performed to evaluate the treatment or prognosis of fungating soft-tissue sarcomas. Methods: We performed a retrospective review of all soft-tissue sarcomas treated at our institution between 1989 and 2004 that had been followed for a minimum of two years or until the death of the patient. Our study group consisted of twenty-four patients with a primary high-grade fungating tumor, and our control group consisted of 146 consecutive patients with a primary high-grade non-fungating tumor. The study cohorts were compared with regard to disease presentation, treatment, and oncologic outcomes. Results: There were no significant differences in tumor size, tumor depth, or histopathologic diagnoses between the cohorts, although the patients with a fungating tumor tended to be older (mean, sixty-five years compared with fifty-five years in the control group; p = 0.004) and have shorter postoperative follow-up (mean, thirty-eight months compared with sixty-five months in the control group; p = 0.03). The proportion of patients presenting with metastases was significantly greater in the group with a fungating tumor (33% compared with 9% in the control group; p = 0.003). Significantly more patients with a fungating tumor underwent amputation (35% compared with 12% in the control group; p = 0.01), while a greater proportion of control patients received radiation therapy (68% compared with 39% in the group with a fungating tumor; p = 0.02). There was no difference in the proportions of patients receiving chemotherapy or in the local recurrence rates between the two cohorts. The Kaplan-Meier five-year overall survival estimates were 20% in the group with a fungating tumor compared with 63% (p < 0.0001) in the control group. The Kaplan-Meier five-year disease-specific survival estimates for patients presenting with localized disease was 58% in the group with a fungating tumor and 74% in the control group (p = 0.05). Multivariate analysis demonstrated that disease stage, fungation, and a tumor size of ≥10 cm were significant independent negative prognostic factors for disease-specific survival. Conclusions: Malignant tumor ulceration is an independent predictor of a poor prognosis for patients with a high-grade soft-tissue sarcoma. Despite the discouraging overall prognosis, aggressive multidisciplinary treatment can lead to long-term survival in an important subgroup of patients with fungating lesions. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Nonreferral of Possible Soft Tissue Sarcomas in Adults: A Dangerous Omission in Policy. Abellan, Juan F.; Lamo de Espinosa, José M.; Duart, Julio; Patiño-García, Ana; Martin-Algarra, Salvador; Martínez-Monge, Rafael; San-Julian, Mikel // Sarcoma;2009, Vol. 2009, Special section p1 

    Introduction. The aim of this study is to compare outcomes in three groups of STS patients treated in our specialist centre: patients referred immediately after an inadequate initial treatment, patients referred after a local recurrence, and patients referred directly, prior to any treatment....

  • Outcomes of First-Line Chemotherapy in Patients with Advanced or Metastatic Leiomyosarcoma of Uterine and Non-Uterine Origin. Oosten, A. W.; Seynaeve, C.; Schmitz, P. I. M.; Den Bakker, M. A.; Verweij, J.; Sleijfer, S. // Sarcoma;2009, Vol. 2009, Special section p1 

    Although leiomyosarcomas (LMSs) form the largest subgroup of soft tissue sarcomas (STSs), the efficacy of chemotherapy in this group is largely unclear, partly because older studies are contaminated with gastrointestinal stromal tumors (GISTs). In this retrospective study we investigated the...

  • Leiomyosarcomas of Vascular Origin in the Extremity. Abed, R.; Abudu, A.; Grimer, R. J.; Tillman, R. M.; Carter, S. R.; Jeys, L. // Sarcoma;2009, Vol. 2009, Special section p1 

    Between 1996 and 2006 a total of 278 patients with soft tissue Leiomyosarcoma were treated at our centre. We identified 16 patients (5.8%) where the tumour directly arose from the blood vessels. These tumours were studied to determine their prognosis and behaviour. All tumors were in the lower...

  • Primary Adult Renal Ewing's Sarcoma: A Rare Entity. Mukkunda, Ravindra; Venkitaraman, Ramachandran; Thway, Khin; Toon Min; Fisher, Cyril; Horwich, Alan; Judson, Ian // Sarcoma;2009, Vol. 2009, Special section p1 

    Background. Ewing’s sarcoma of extraskeletal origin is uncommon and that is of primary renal origin in adults are rare. There is no consensus on the optimal management of Ewing’s tumors of renal origin. Methods. A retrospective review of the clinical features, treatment, and...

  • The Value of Surgery for Retroperitoneal Sarcoma. Gholami, Sepideh; Jacobs, Charlotte D.; Kapp, Daniel S.; Parast, Layla M.; Norton, Jeffrey A. // Sarcoma;2009, Vol. 2009, Special section p1 

    Introduction. Retroperitoneal sarcomas are uncommon large malignant tumors. Methods. Forty-one consecutive patients with localized retroperitoneal sarcoma were retrospectively studied. Results. Median age was 58 years (range 20–91 years). Median tumor size was 17.5 cm (range 4–41...

  • Population based epidemiology and prognosis of mesothelioma in Leeds, UK.  // Thorax;May2008, Vol. 63 Issue 5, p435 

    Introduction: Malignant mesothelioma is a fatal neoplasm, which is rapidly increasing in incidence throughout Western Europe. To date there have been no studies reporting on the natural history and interventional practices on a comprehensive unselected population, as opposed to reports from...

  • Life expectancy following orbital exenteration. James Chiun Lon Wong; Thampy, Reshma; Cook, Anne // British Journal of Ophthalmology;Jan2015, Vol. 99 Issue 1, p1 

    Orbital exenteration is a physically debilitating procedure that may be a necessity in the management of orbital malignancy. It requires a sensitive multidisciplinary approach, both preoperatively and postoperatively. Providing life expectancy information for patients during preoperative...

  • Impact of Angiotensin-Converting Enzyme Gene Polymorphism on Proteinuria and Arterial Hypertension. Živko, Marijana; Kušec, Rajko; Galešić, Krešimir // Collegium Antropologicum;Sep2013, Vol. 37 Issue 3, p765 

    Proteinuria is the hallmark of renal disease. In essential hypertension the onset of de novo proteinuria is associated with faster rate of progression of disase. Some authors have suggested that the DD genotype of the angiotensin-converting enzyme (ACE) gene would be an adverse renal prognosis...

  • Clinical digest. Trial proves apremilast is effective long-term treatment for psoriasis.  // Nursing Standard;10/10/2012, Vol. 27 Issue 6, p14 

    The article discusses research in the article "Efficacy of Apremilast in the Treatment of Moderate to Severe Psoriasis: A Randomised Controlled Trial" by K. Papp et al. which found that the drug apremilast is effective for the long term treatment of psoriasis.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics