肉瘤

Nonrhabdomyosarcoma soft-tissue sarcomas (STSs) are a class of 50+ cancers arising in muscle and soft tissues of children, adolescents, and adults. Rarity of each subtype often precludes subtype-specific preclinical research, leaving many STS patients with limited treatment options should frontline therapy be insufficient. When clinical options are exhausted, personalized therapy assignment approaches may help direct patient care. Here, we report the results of an adult female STS patient with relapsed undifferentiated pleomorphic sarcoma (UPS) who self-drove exploration of a wide array of personalized Clinical Laboratory Improvement Amendments (CLIAs) level and research-level diagnostics, including state of the art genomic, proteomic,离体活细胞化疗药物敏感性试验，患者来源的异种移植模型，immunoscoring。她的治疗选择也多种多样，包括新辅助化疗，放疗和手术。佐剂和复发的策略包括关闭标签和天然药物，免疫疗法的几个，和N-的-1的方法。经鉴定的治疗方案，特别是在验证体内study, were not introduced into the course of clinical treatment but did provide plausible treatment regimens based on FDA-approved clinical agents.

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目的。几个研究已经评估的时间长度从诊断到治疗开始在骨肉瘤的预后意义。这项研究的目的是确定的时间来治疗开始（TTI）影响诊断为原发性骨肉瘤的成年人总生存期。方法。美国国立癌症数据库的回顾性分析确定2122例谁诊断为2004年和2012年之间的TTI定位，高品位的骨瘤满足被定义为天的时间长度从诊断到治疗开始纳入标准。患者，疾病特异性，和医疗保健相关的因素进行了评估其与总生存期的关联。秩和检验分析，用于单因素分析和Cox回归模型与总体生存相关的鉴定协变量。结果。Any 10-day increase in TTI was not associated with decreased overall survival (hazard ratio (HR) = 1.00; ).No differences in survival were detected at 1 year, 5 years, and 10 years, when comparing patients with TTI = 14, 30, 60, 90, and 150 days. Decreased survival was significantly associated with patient ages of 51–70 years (HR = 1.66; )and > 71 years (HR = 2.89; ),Charlson/Deyo score ≥2 (HR = 2.02; ),pelvic tumor site (HR = 1.58; ),tumor size >8 cm (HR = 1.52; ),radiation (HR = 1.81; )as index treatment, and residing a distance of 51–100 miles from the treatment center (HR = 1.30; ).增加存活显著相关 with chordoma (HR = 0.27; ),chondrosarcoma (HR = 0.75; ),treatment at an academic center (HR = 0.64; ),and a private (HR = 0.67; )or Medicare (HR = 0.71; )insurer. A transition in care was not associated with a survival disadvantage (HR = 0.90; ).结论。Longer TTI was not associated with decreased overall survival in localized, high-grade primary bone sarcoma in adults. This is important in counseling patients, who may delay treatment to receive a second opinion or seek referral to a higher volume sarcoma center.

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目的。Osteosarcoma is a rare cancer and a third of patients who have completed primary treatment will develop osteosarcoma recurrence. The Src pathway has been implicated in the metastatic behavior of osteosarcoma; about 95% of samples examined express Src or have evidence of downstream activation of this pathway. Saracatinib (AZD0530) is a potent and selective Src kinase inhibitor that was evaluated in adults in Phase 1 studies. The primary goal of this study was to determine if treatment with saracatinib could increase progression-free survival (PFS) for patients who have undergone complete resection of osteosarcoma lung metastases in a double-blinded, placebo-controlled trial.患者与方法。复发性骨肉瘤主题定位于肺和谁了完整手术切除整个肺结节手术完全切除后的六周内被随机分配。Saracatinib, or placebo, was administered at a dose of 175 mg orally, once daily, for up to thirteen 28-day cycles.结果。三十七个科目被列入分析;18名受试者随机接受saracatinib和19接受安慰剂。意向性治疗分析显示的saracatinib治疗组19.4个月和8.6个月，安慰剂治疗组的中位PFS（ ).中位OS未在ARM达成。结论。Although saracatinib was well tolerated in this patient population, there was no apparent impact of the drug in this double-blinded, placebo-controlled trial on OS, and Src inhibition alone may not be sufficient to suppress metastatic progression in osteosarcoma. There is a suggestion of potential clinical benefit as evidenced by longer PFS in patients randomized to saracatinib based on limited numbers of patients treated.

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Background。In relapsed osteosarcoma, the 5-yr postrelapse disease-free survival (PRDFS) rate after the second relapse is <20%. In June 2007, a randomized study was started comparing oral etoposide vs槲寄生fermentatum皮尼（来自寄生植物的提取物槲寄生L.，欧洲槲寄生）作为治疗转移性骨肉瘤手术完全缓解的第二次复发后的维持治疗。主要终点是在12个月的PRDFS率（相对于历史对照率）。这是一个长期的更新结果。患者与方法。10 patients received oral etoposide 50 mg/m²daily for 21 days every 28 days for 6 months, and 9 patients received槲寄生fermentatum Pini 3 times/wk subcutaneously for 1 year. The study closed early in July 2011 due to insufficient recruitment. Lymphocyte subpopulations were analyzed at T0, T3, T6, T9, and T12 months.结果。On 30 June 2019, at a median follow-up ITT of 83 months (range 3–144 ms), a median PRDFS of 106 ms (2–144) was observed in the槲寄生arm with 5/9 patients who never relapse vs a PRDFS of 7 months (3–134) in the etoposide arm (all patients in the Etoposide arm relapsed) (hazard ratio HR = 0.287, 95% CI: 0.076–0.884, ).模型预测10年总生存率为64％槲寄生臂和在臂依托泊苷33％。淋巴细胞亚群计数（CD3，CD4，和CD56）显示出在槲寄生臂的增加而在依托泊苷臂治疗过程中观察到的降低。结论。之后，从试验开始12年，患者在槲寄生武装继续表现出相当长的PRDFS相比，口服依托泊苷，并在OS的优势趋势是明显的，即使治疗的患者数量太小，无法得出结论。槲寄生as maintenance treatment after complete surgical remission in relapsed osteosarcoma should be further investigated and compared with other drugs.

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软组织肉瘤（STS）是具有不同的形态和临床行为间充质起源的癌症的高度异质组。虽然手术切除是主要的STS的标准治疗，晚期和转移性STS患者不符合手术条件。全身性治疗，包括化疗的标准和新的化学药剂，在疾病的管理仍然发挥最相关的作用。在不同的STS亚型特异基因变异的发现允许更好的驾驶他们的发病机理和治疗优化机制的理解。这次审查的重点可用的靶向药物或药物组合基础上参与STS开发，包括染色体易位，致癌突变，基因扩增，以及它们在STS治疗观点遗传畸变。此外，在本文中，我们讨论了治疗个体患者的调整可能使用化疗敏感性和耐药性测定（CSRA）的。综上所述，在晚期和转移性STS个性化管理目前的趋势是基于两个基因检测和CSRA的组合。

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Background and Objectives。骨关节体外照射的自体移植是一种替代操作的技术来修复装置或同种异体移植物用于切除骨恶性肿瘤后重建。本研究的目的是评估并发症，放射线的变化，和骨关节ECIA的功能性结果。方法。我们回顾33例谁接受骨关节骨ECIA肿瘤切除后从1988年到2014年，我们根据肌肉骨骼肿瘤协会的评分系统研究了并发症，通过肢体的国际社会救助移植评价标准X线改变，以及功能的结果。结果。15例患者因后再次手术进行了感染（ñ = 9), protruding fixation implant (ñ = 4), or fracture of the grafted bone (ñ = 2). The average radiographic evaluation score was 66.4%, and the median functional score was 23 (77%). The radiographic score for the proximal humerus or proximal tibia was lower than that for the other locations. The functional score was not different among the autograft sites but was related to the radiographic score.结论。Although osteoarticular ECIA is one of the reasonable surgical options for patients with tumors for which reliable prostheses are not available, we do not recommend osteoarticular ECIA as a routine procedure because of high complication rate.

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