Destroy / Inhibit Primary Tumor that Cannot be Resected
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Yosef Landesman
- Admin
- Posts: 50
- Joined: Tue Jul 11, 2006 8:23 pm
- Location: Brookline, MA
Destroy / Inhibit Primary Tumor that Cannot be Resected
Here we will discuss cases of primary tumors that due to their location or size cannot be removed by a surgery.
Yosef Landesman PhD
President & Cancer Research Director
Cure Alveolar Soft Part Sarcoma International
President & Cancer Research Director
Cure Alveolar Soft Part Sarcoma International
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Fictional
Our tumor wasn't exactly non-resectable, but because our daughter's tumor was pelvic, we were confronted with a resection with safe margins (e.g. 1 cm) that could require her to have a colostomy and urostomy (bladder). As a result (and not without our doctors' blessings), we are currently on a course of anti-angiogenic medications. I will post under that different topic heading in the forum, but thought I should also post here in case our experience might help someone else in the same boat.
There is some promise that medication may shrink the tumor sufficiently to make the surgical resection easier...and that is helpful to know. Our early information (not yet confirmed with scans) suggests that we are getting some tumor shrinkage with Sutent. Scans aren't planned until the end of the 2nd course. I'll add more detail about our experiences under the topic of Anti-Angiogenic Meds. 'F'
There is some promise that medication may shrink the tumor sufficiently to make the surgical resection easier...and that is helpful to know. Our early information (not yet confirmed with scans) suggests that we are getting some tumor shrinkage with Sutent. Scans aren't planned until the end of the 2nd course. I'll add more detail about our experiences under the topic of Anti-Angiogenic Meds. 'F'
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Fictional
I wanted to post an addendum to share any information with others who have to confront the issues of a non-resectable or difficult to resect tumor.
Since our initial visit out to Dana Farber, we have learned that there are controversies about extensive pelvic resections for sarcoma and definitions of surgical margins. Some surgery groups have even questions whether extensive pelvic resections for sarcoma should be done. As for ASPS, we really don't know because it is too rare a tumor.
At a recent CTOS meeting (http://www.ctos.org/meeting/2006/program06.asp), surgeons found that recurrence free survival was surprisingly good for patients with low grade sarcomas that had positive margins. Metastases seem to be more deadly than primary tumors because they may be more likely to acquire DNA mutations that may make them more resistant to therapy. From this review of tissue sarcomas (http://caonline.amcancersoc.org/cgi/con ... ll/54/2/94), the following part caught my eye: "However negative margins cannot be attained in some anatomic areas beause of the tumor's proximity to vital structures. In addition, because neither a positive surgical margin nor local recurrence has been shown to clearly adversely affect overall survival, this should be taken into consideration if achieving clear surgical margins would require amputation or substantial functional compromise of an extremity."
Because ASPS is an "early metastasizing" tumor, we decided to go on the generally well-tolerated drug Sutent (anti-angiogenesis medication). We also wonder about the possibility that surgery can increase the likelihood of metastases (small bits of tumor break off as the surgeon removes it), and although we are primarily trying Sutent to shrink the tumor to improve the chance for better margins, we also think it may inhibit the chance for metastases. Based on experience with the vascular sarcomas known as GIST, Sutent can be taken up to the day before surgery; and resumed at the first post-operative visit, without any significant additional complications.
Currently we are headed into another 3 months on Sutent and then check scans. If the tumor doesn't shrink more by then, we may consider another agent or cryoablation or proton irradiation. The latter would be better than conventional radiation therapy because it can precisely limit where the radioactivity goes (reducing harm to the colon and other pelvic structures), but it has been said that primary ASPS can be relatively radio-resistant. Interestingly, though it is thought that Sutent might increase sensitivity to RT.
Since our initial visit out to Dana Farber, we have learned that there are controversies about extensive pelvic resections for sarcoma and definitions of surgical margins. Some surgery groups have even questions whether extensive pelvic resections for sarcoma should be done. As for ASPS, we really don't know because it is too rare a tumor.
At a recent CTOS meeting (http://www.ctos.org/meeting/2006/program06.asp), surgeons found that recurrence free survival was surprisingly good for patients with low grade sarcomas that had positive margins. Metastases seem to be more deadly than primary tumors because they may be more likely to acquire DNA mutations that may make them more resistant to therapy. From this review of tissue sarcomas (http://caonline.amcancersoc.org/cgi/con ... ll/54/2/94), the following part caught my eye: "However negative margins cannot be attained in some anatomic areas beause of the tumor's proximity to vital structures. In addition, because neither a positive surgical margin nor local recurrence has been shown to clearly adversely affect overall survival, this should be taken into consideration if achieving clear surgical margins would require amputation or substantial functional compromise of an extremity."
Because ASPS is an "early metastasizing" tumor, we decided to go on the generally well-tolerated drug Sutent (anti-angiogenesis medication). We also wonder about the possibility that surgery can increase the likelihood of metastases (small bits of tumor break off as the surgeon removes it), and although we are primarily trying Sutent to shrink the tumor to improve the chance for better margins, we also think it may inhibit the chance for metastases. Based on experience with the vascular sarcomas known as GIST, Sutent can be taken up to the day before surgery; and resumed at the first post-operative visit, without any significant additional complications.
Currently we are headed into another 3 months on Sutent and then check scans. If the tumor doesn't shrink more by then, we may consider another agent or cryoablation or proton irradiation. The latter would be better than conventional radiation therapy because it can precisely limit where the radioactivity goes (reducing harm to the colon and other pelvic structures), but it has been said that primary ASPS can be relatively radio-resistant. Interestingly, though it is thought that Sutent might increase sensitivity to RT.