Primary reexcision for patients with 'microscopic residual' tumor following initial excision of sarcomas of trunk and extremity sites

Daniel M. Hays, Walter Lawrence, Moody Wharam, William Newton, Frederick B. Ruymann, Mohan Beltangady, Harold Maurice Maurer

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Abstract

Among 404 patients with primary tumors of extremity-trunk sites entered in the intergroup Rhabdomyosarcoma Study (IRS) (1972 to 1984), 154 were placed in clinical group lla, ie, with negative nodes but with "microscopic residual" (MR) disease, following the initial excisional (not biopsy) procedure. An elective reexcision of the area of the primary tumor (PRE) was performed in 41 of these patients within 35 days (mean interval, 14 days; SE, 0.9) with no intervening therapy. These procedures consisted of wider excision of the tumor "bed", resulting in a technical transfer of these patients from group lla to group l, ie, complete excision. This reduced intensity of nonsurgical therapy (irradiation and chemotherapy). Among the 41 patients who underwent PRE, the 3-year survival estimate (Kaplan-Meier) was 91% (SE, 4%). This may be compared with the results in 113 patients who remained in group lla, in which the 3-year survival estimate was 74% (SE, 4%). A second group for comparison consisted of the 73 patients with trunk/extremity tumors who were placed in group I after a single excisional procedure, ie, no PRE, in whom the 3-year survival estimate was 74% (SE, 5%). Recognized prognostic factors influencing survival in these groups were comparable, with the exception of tumor size, ie, the largest tumors (≥10 cm in diameter) were concentrated in groups I and lla. When patients with tumors ≥10 cm in diameter (9.7% of the total) were removed from all three study groups, patients undergoing PRE had longer survival duration estimates than patients in the control groups.

Original languageEnglish (US)
Pages (from-to)5-10
Number of pages6
JournalJournal of Pediatric Surgery
Volume24
Issue number1
DOIs
StatePublished - Jan 1 1989

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Residual Neoplasm
Sarcoma
Extremities
Survival
Neoplasms
Patient Transfer
Rhabdomyosarcoma
Kaplan-Meier Estimate
Biopsy
Drug Therapy
Control Groups
Therapeutics

Keywords

  • Rhabdomyosarcoma

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Primary reexcision for patients with 'microscopic residual' tumor following initial excision of sarcomas of trunk and extremity sites. / Hays, Daniel M.; Lawrence, Walter; Wharam, Moody; Newton, William; Ruymann, Frederick B.; Beltangady, Mohan; Maurer, Harold Maurice.

In: Journal of Pediatric Surgery, Vol. 24, No. 1, 01.01.1989, p. 5-10.

Research output: Contribution to journalArticle

Hays, Daniel M. ; Lawrence, Walter ; Wharam, Moody ; Newton, William ; Ruymann, Frederick B. ; Beltangady, Mohan ; Maurer, Harold Maurice. / Primary reexcision for patients with 'microscopic residual' tumor following initial excision of sarcomas of trunk and extremity sites. In: Journal of Pediatric Surgery. 1989 ; Vol. 24, No. 1. pp. 5-10.
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abstract = "Among 404 patients with primary tumors of extremity-trunk sites entered in the intergroup Rhabdomyosarcoma Study (IRS) (1972 to 1984), 154 were placed in clinical group lla, ie, with negative nodes but with {"}microscopic residual{"} (MR) disease, following the initial excisional (not biopsy) procedure. An elective reexcision of the area of the primary tumor (PRE) was performed in 41 of these patients within 35 days (mean interval, 14 days; SE, 0.9) with no intervening therapy. These procedures consisted of wider excision of the tumor {"}bed{"}, resulting in a technical transfer of these patients from group lla to group l, ie, complete excision. This reduced intensity of nonsurgical therapy (irradiation and chemotherapy). Among the 41 patients who underwent PRE, the 3-year survival estimate (Kaplan-Meier) was 91{\%} (SE, 4{\%}). This may be compared with the results in 113 patients who remained in group lla, in which the 3-year survival estimate was 74{\%} (SE, 4{\%}). A second group for comparison consisted of the 73 patients with trunk/extremity tumors who were placed in group I after a single excisional procedure, ie, no PRE, in whom the 3-year survival estimate was 74{\%} (SE, 5{\%}). Recognized prognostic factors influencing survival in these groups were comparable, with the exception of tumor size, ie, the largest tumors (≥10 cm in diameter) were concentrated in groups I and lla. When patients with tumors ≥10 cm in diameter (9.7{\%} of the total) were removed from all three study groups, patients undergoing PRE had longer survival duration estimates than patients in the control groups.",
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