Clinical outcomes of a comprehensive treatment approach centered on surgery for the treatment of paraspinal soft-tissue sarcoma

English Keywords:Paraspinal soft-tissue sarcoma  Surgical resection  Comprehensive therapy  Outcome

English Abstract:

  【Abstract】 Objectives: To investigate the clinical outcomes of paraspinal soft-tissue sarcoma treated with a comprehensive treatment approach with surgical operation as the main. Methods: 18 patients with paraspinal soft-tissue sarcoma treated at Sun Yat-sen University Cancer Center from April 2017 to October 2022 were retrospectively analyzed. There were 12 males and 6 females with a median age of 36 years(11-58 years). The pathological diagnoses were synovial sarcoma(5 cases), fibrosarcoma(2 cases), undifferentiated pleomorphic sarcoma(2 cases), malignant solitary fibrous tumor(2 cases), not otherwise specified-type high grade sarcoma(2 cases), osteosarcoma(1 case), Ewing sarcoma(1 case), alveolar soft part sarcoma(1 case), dedifferentiated liposarcoma(1 case), and low grade myofibrosarcoma(1 case). According to the modified classification of paraspinal soft-tissue sarcoma, 10 patients were of class 1, 3 were of class 2 and 4 were of class 3, and 1 patient was of class 2+3. All of the patients received surgery. Among them, 11 patients had preoperative chemotherapy and 1 patient had immunotherapy and targeted therapy. The surgical plans for class 1-3 paraspinal soft-tissue sarcoma were: class 1, wide resection; class 2, en-bloc resection by pedicle osteotomy; class 3, wide resection by partial vertebral resection. 8 patients with spinal instability after tumor resection underwent artificial vertebral body reconstruction and pedicle screw-rod system fixation. 6 patients received intensity-modulated radiation therapy(IMRT) with 55-63Gy/25-30F after operation. After surgery, 11 patients had chemotherapy and 1 patient had immunotherapy and targeted therapy. The patients were followed up for wound complication, recurrence and metastasis. Results: For class 1 patients, 7 received wide resection and 3 received marginal resection; For class 2 patients, 2 received wide resection and 1 received marginal resection; For class 3 patients, wide resection or marginal resection were obtained in 2 patients respectively. Marginal resection was obtained in the class 2+3 patients. The median follow-up time was 16 months(1-50 months). 2 patients, who had wound infection 9d and 23d after surgery respectively, were successfully treated by debridement and antibiotics; 2 patients, who developed muscle weakness after surgery, improved after rehabilitation and neurotrophic treatment. 3 patients experienced local recurrence(3-10 months after surgery), all of which didn′t receive postoperative radiotherapy. 1 patient died from brain metastasis within 3 months after surgery; 4 patients who developed lung metastases at 3-38 months after surgery and received medical treatment and resection of pulmonary metastases lived with tumors; The remaining 13 patients was alive without tumors. Conclusions: On the basis of precise pathological diagnosis, treating paraspinal soft-tissue sarcoma with comprehensive treatment approach centered on surgical operation can yield satisfactory clinical outcomes.