My primary tumor in 1998 was in my left leg. Upper outer thigh.
2002 metastasised to left lung.
2004 " Brain ( temporal lobe)
2005 2nd Brain surgery.
I now have a 13 cm metastasis in my right leg hamstring. I lost 55 pounds in last 14 months. So no telling how long this one had been there .
Biopsy confirmed. Mri shows no bone involvement so far.
From my previous research & consults , I believe no or limited margins are required. Anyone have a differing opinion ?
Leg metastasis
periosteal margins
There is a relevant article - it is about soft tissue sarcoma primaries in contact with bone - in your case it is a soft tissue metastasis but may be it can be used, I do not know and probably nobody does for sure. The purpose of the study was to evaluate the risk of local recurrence for sarcomas adjacent to bone and to determine whether the periosteum provides an adequate margin of resection:
Periosteal margin in soft-tissue sarcoma.
http://www.ncbi.nlm.nih.gov/sites/entre ... d_RVDocSum
pubmed ID is 17183556
The conclusion was that relatively few sarcomas are able to penetrate cortical bone. Composite bone and soft-tissue resections are indicated primarily for frank bone invasion. In the absence of this, the periosteum is an adequate surgical margin for sarcomas treated with wide excision and radiation.
Periosteal margin in soft-tissue sarcoma.
http://www.ncbi.nlm.nih.gov/sites/entre ... d_RVDocSum
pubmed ID is 17183556
The conclusion was that relatively few sarcomas are able to penetrate cortical bone. Composite bone and soft-tissue resections are indicated primarily for frank bone invasion. In the absence of this, the periosteum is an adequate surgical margin for sarcomas treated with wide excision and radiation.
Leg metastasis
Thanks Olga,
Very good article. Great info. Nice to know the periosteum is acceptable as a margin .
So far I have been fortunate , as my tumors have been encapsulated ( or is this the case with all ASPS tumors ?) . Even less reason to justify an overly wide margin. Quality of life is important to me.
Very good article. Great info. Nice to know the periosteum is acceptable as a margin .
So far I have been fortunate , as my tumors have been encapsulated ( or is this the case with all ASPS tumors ?) . Even less reason to justify an overly wide margin. Quality of life is important to me.
to shrink it
Have you talked to a doctor reg. may be to try shrink it before of the resection to make it loose so the contact with the bone will not be that close? I am not sure if it can simplify the surgery and if it adds any security reg. not penetrating periosteal margins. There are a few possible ways to look at
- a cryo for the soft tissue done in Boston
MRI-guided percutaneous cryotherapy for soft-tissue and bone metastases: initial experience.
http://www.ncbi.nlm.nih.gov/sites/entre ... d_RVDocSum
- cryo done in LA - may be it is in your insurance?
Cryoablation and resection influences patient survival for soft tissue sarcomas: impact on survivorship and local recurrence.
http://www.ncbi.nlm.nih.gov/sites/entre ... d_RVDocSum
- some kind of the new radiation therapy, like proton is increasingly used for ASPS but it is avail. in Boston.
- a cryo for the soft tissue done in Boston
MRI-guided percutaneous cryotherapy for soft-tissue and bone metastases: initial experience.
http://www.ncbi.nlm.nih.gov/sites/entre ... d_RVDocSum
- cryo done in LA - may be it is in your insurance?
Cryoablation and resection influences patient survival for soft tissue sarcomas: impact on survivorship and local recurrence.
http://www.ncbi.nlm.nih.gov/sites/entre ... d_RVDocSum
- some kind of the new radiation therapy, like proton is increasingly used for ASPS but it is avail. in Boston.