DOS 2016

DOS Kongressen 2016 ·

211

Surveillance for development of lung metastases

after primary surgical excision of soft tissue

sarcomas of the extremities and trunk wall

Thea Hovgaard, Tine Nymark, Michael Mørk Petersen

Orthopaedic Department, Rigshospitalet; Orthopaedic Department, Odense

University Hospital; Orthopaedic Department, Rigshospitalet

Background:

Current routine follow-up policy for soft tissue sarcomas (STS)

lacks evidence. Early detection and surgical removal of lung metastases (LM) is

associated with improved survival. In Jan. 2010 we introduced a new follow-up

program in which intermediate- and high-grade malignant STS the first 2 years

post surgery were followed 4 times a year alternating between clinical examina-

tion (CE) preceded by focal MRI plus low-dose chest CT-scan without contrast

(CT) and a CE with regular chest X-ray (XR).

Purpose / Aim of Study:

To evaluate the new surveillance program for iden-

tification of LM in intermediate- and high-grade STS within the first 2 years

postoperatively.

Materials and Methods:

We retrospectively assessed the medical files of all

patients (n=116, mean age 59 (18-87) years, F/M=57/59) with STS of the

extremities and trunk wall, who underwent surgery from 2010-2013. We ex-

tracted information on how LM were detected during the first 25 months post-

surgery. Statistics: Kaplan Meier survival analysis and 2x2 contingency table

with chi2-test.

Findings / Results:

19/116 patients experienced LM within the first 25

months post-surgery (25 months-LM free rate 87%). Compared to XR, CT

led to a larger amount of suspicions of LM (23/285 versus 6/278, p<0.002).

Furthermore the suspicions on CT seemed more accurate than on XR (16/23

affirmed versus 2/6 affirmed, p<0.103). The only cases where an XR finding of

LM was correct were in 2 cases where an XR was the first chest examination af-

ter surgery and radiotherapy. CT (n=285) found a larger number of LM than XR

(n=278) did (16 (5.6%) versus 2 (0.7%), p<0.001). Three patients suspected

LM themselves, 1 of them was affirmed.

Conclusions:

Bi-annual CT the first 2 postoperative years after surgical treat-

ment of STS, seemed to detect LM better than plain WR, and therefore render

regular WR between these CT unnecessary.

No conflicts of interest reported

162.