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Background/aim: The present study aimed to assess the relationship between the maximum standardized uptake value (SUVmax) on 18 F-fluorodeoxyglucose positron emission tomography computed tomography ( 18 F-FDG-PET/CT) and the geriatric nutritional risk index (GNRI) in patients with soft-tissue sarcomas (STSs)., Patients and Methods: The present single-center retrospective observational study included patients who underwent 18 F-FDG-PET/CT and for whom serum albumin levels, height, and body weight were measured prior to therapeutic intervention., Results: A total of 81 patients were included in the study. The mean SUVmax was 11.1±9.9. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 79.7% and 52.4%, respectively, for the higher SUVmax group (≥11.1) and 91.0% and 73.0%, respectively, for the lower SUVmax group (<11.1). For the GNRI, the 5-year OS and DFS rates were 89.6% and 64.3%, respectively, for the negative-risk group, and 73.3% and 77.1% for the positive-risk group, respectively, with no significant differences. The mean SUVmax was 9.7±8.1 and 19.1±14.9 for the negative- and positive-risk groups, respectively. The positive-risk group had a significantly higher SUVmax than the negative-risk group (p=0.03). Furthermore, there was a negative correlation between the SUVmax and GNRI (r=-0.48, p<0.05)., Conclusion: A higher SUVmax and lower GNRI in patients with STS may contribute to a poor prognosis. The deregulatory elevation of tumor glucose metabolic activity may affect serum albumin levels and weight loss in patients with STS, resulting in a decrease in the GNRI., (Copyright © 2025 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: Almost half of all patients with soft-tissue sarcoma are over 65 years of age, and the proportion of older patients is increasing. Despite this, they have been underrepresented in clinical trials and only limited data are available to guide treatment decisions. The aim of this study was to investigate treatment patterns and outcomes in older patients with soft-tissue sarcoma., Patients and Methods: Patients over 50 years old treated for advanced soft-tissue sarcoma at the Helsinki University Hospital between January 2000 and July 2020 were included. Data on patient and tumor characteristics, treatment, and survival were retrospectively collected. A total of 152 patients were included: 14.5% (n=22) were over 75 years old, 34.2% (n=52) were 65-74 and 51.3% (n=78) were 50-64 years old., Results: The outcomes of the oldest group differed from those of younger patients; they were more likely to receive single-agent treatment as first-line therapy (90.9% vs. 28.8% and 24.4%, p<0.001) and had the lowest relative dose-intensity (70% vs. 88% and 95%, p<0.05). They experienced grade three to four hematological adverse events less frequently (38.1%, 56.9% and 72.7%, respectively, p=0.031), and received fewer lines of treatment (median of 1, 2 and 2, respectively, p=0.01). In patients aged ≥75 years, there was no association between further lines of therapy and improved survival. Compared to the youngest group, the oldest patients had a greater risk of dying (hazard ratio=1.7, 95% confidence interval=1.0-2.8, p=0.041) and their median overall survival was only 7.4 months, compared to 14.3 and 12.9 months in the two younger groups., Conclusion: These findings suggest that older patients tolerate chemotherapy when treatment is tailored to their needs but may not benefit as much as younger patients., (Copyright © 2024 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: The effect of multidisciplinary therapy conducted at the sarcoma center of our hospital was examined to determine whether therapy undertaken here improved the prognosis of patients with soft-tissue sarcoma., Patients and Methods: The clinical findings and prognoses of patients treated before the establishment of the sarcoma center (72 patients from April 2016 to March 2018) and those treated after (155 patients from April 2018 to March 2021) were compared., Results: The mean number of patients increased from 36.0 to 51.7 per year after the establishment of the sarcoma center. The proportion of patients with stage IV disease also increased from 8.3% to 12.9% after establishment of the sarcoma center. The 3-year survival rate of patients, considering all stages, decreased from 80.0% to 78.3% after establishment of the sarcoma center rather than showing an increase. The 3-year survival rate of patients with stage II and III disease increased from 78.6% to 84.7%, and that of stage III patients with retroperitoneal sarcoma increased from 70.0% to 86.7% after establishment of the sarcoma center. However, no statistically significant difference was observed in the survival curves., Conclusion: The establishment of a sarcoma center has contributed to centralizing treatment for soft-tissue sarcoma. Multidisciplinary therapy at sarcoma centers may improve the prognosis of patients with soft-tissue sarcomas., (Copyright © 2023 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: Leiomyosarcomas account for 2-10% of all extremity soft tissue sarcomas. The role of intraoperative brachytherapy as an additive booster therapy is not clearly defined. This study focused on the additive value of brachytherapy in the treatment of leiomyosarcomas on the extremities., Patients and Methods: This retrospective multicenter study compared treatment outcomes of 94 patients diagnosed with a primary leiomyosarcoma in their extremities. Patients were divided into three groups according to their radiotherapy protocol: a) adjuvant radiotherapy (aRT), b) neoadjuvant radiotherapy (nRT) and c) intraoperative brachytherapy combined with adjuvant radiotherapy (IOBTaRT). These three treatment groups were compared for local control, time to metastasis, and overall survival., Results: Eleven patients were treated with IOBTaRT, 35 patients with aRT, and seven patients with nRT only. The survival time was 157.6 months for patients in the IORTaRT group, and 111.3 months for patients treated with aRT only. The time to local recurrence was 141.5 months for patients treated with IOBTaRT and 106.1 months for patients treated with aRT. The estimated time to metastasis was 34.6 months for patients in the IOBTaRT group and 69.7 months for patients treated with aRT alone. No significant differences were observed between these treatment groups concerning overall survival, local recurrence, or metastasis., Conclusion: Additive brachytherapy did not provide a significant advantage in the treatment of leiomyosarcomas. However, this study was limited by the number of patients per group., (Copyright © 2022 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: Eribulin is widely used for the treatment of breast cancer and soft-tissue sarcoma (STS). Previous studies identified the pre-treatment absolute lymphocyte count, baseline neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein concentration as potential prognostic markers in patients with breast cancer treated with eribulin. However, prognostic factors for eribulin treatment in patients with STS have not been identified., Patients and Methods: This was a retrospective analysis of data collected prospectively from 53 patients who were treated with eribulin for recurrent or metastatic STS between March 2016 and August 2019. Univariate and multivariate analyses were performed to determine the predictive factors of durable clinical benefit, progression-free survival, and overall survival., Results: L-Sarcoma histology [hazard ratio (HR)=28.20, 95% confidence intervaI (CI)=1.67-476.00; p=0.021] and pre-treatment NLR <3.0 (HR=9.96, 95% CI=1.28-77.7; p=0.028) were independent factors predictive of durable clinical benefit. In addition, pre-treatment NLR <3.0 (HR=0.34, 95% CI=0.16-0.74; p=0.0059) and male sex (HR=0.23, 95% CI=0.10-0.52; p<0.001) were independent factors predictive of better progression-free survival., Conclusion: This retrospective study found that baseline NLR predicts the efficacy of eribulin for STS., (Copyright© 2021, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: The delayed initiation of treatment is associated with poor clinical outcomes in patients with malignancies. However, few previous studies have investigated prognostic factors, including the delayed initiation of treatment, in soft-tissue sarcoma., Patients and Methods: One hundred and fifty-three patients with soft-tissue sarcoma were enrolled. Univariate and multivariate analyses were performed to identify factors predicting metastasis, including factors that delay the initiation of treatment., Results: The multivariate analysis revealed that high histological grade (p<0.01), tumor located in the trunk (p=0.04), >5-month delay from symptom initiation to consultation of general practitioner (p=0.02), and >29-day delay in referral to a specialized hospital by general practitioners (p=0.03) were independently associated with metastasis of soft tissue sarcoma., Conclusion: Early consultation of a general practitioner and early referral to a specialized hospital might be essential for preventing metastasis of soft-tissue sarcoma., (Copyright © 2020 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: Soft-tissue sarcomas (STS) of the distal extremities are a rare disease entity, hence proper treatment strategy is not well established. We evaluated the local control, survival and complications of treating sarcomas in the wrist, hand, ankle and foot with limb-sparing surgery (LSS) and postoperative radiotherapy (PORT)., Patients and Methods: Seventeen patients with STS in wrist, hand, ankle and foot who received PORT after LSS from August 2008 to November 2015 were retrospectively reviewed. Primary outcome was 5-year local recurrence-free survival (LRFS). Secondary outcomes were 5-year distant metastasis-free survival (DMFS) and toxicities., Results: The median age was 32 (range=12-78) years. The most frequent STS location was the foot in 11 patients (64%) followed by two patients each in the wrist, hand and ankle, respectively. Fourteen patients (82%) underwent wide resection with flap grafts and the same number of patients achieved clear resection margins. The median postoperative radiation dose was 54 (range=46-60) Gy. Five patients also received chemotherapy. At a median follow-up of 39 (range=6-87) months, 5-year LRFS and DMFS were both 100%. Only one patient experienced grade 3 radiation dermatitis and there was no major wound complication. Radiation-induced bone fracture occurred in two patients., Conclusion: PORT after LSS showed excellent local control for STS in the wrist, hand, ankle and foot. Considering the good local control and saving of limb function without any significant toxicity, the combination of LSS followed by PORT could be an appropriate and safe modality for STS of the distal extremities., (Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Background/aim: Superficial myxofibrosarcoma (MFS) and undifferentiated pleomorphic sarcoma (UPS) are highly associated with infiltrative growth (tail sign) and local recurrence, but the impact of preoperative radiotherapy is uncertain., Patients and Methods: Eight consecutive superficial MFS and 10 superficial UPS cases treated with preoperative radiotherapy and surgery were reviewed. Pathological response, surgical margin and magnetic resonance imaging (MRI) were retrospectively evaluated. Oncological events were reported in a descriptive form., Results: Pathologically, nearly-complete response was observed in six UPS cases. Tail sign was pathologically detected in 13 cases, eight of which remained viable. Among the eight cases with viable tail, three cases, including two with positive margin, locally recurred. No major discrepancy was observed between tail length on pre-treatment T1-weighted post-contrast, fat-saturated MRI and pathological tail length., Conclusion: Tail of superficial MFS and UPS can retain viability even after radiotherapy and cause local recurrence unless they respond to radiotherapy well. Wider resection including the tail on MRI is recommended., (Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Background: Given the immune-mediated mechanisms of radiotherapy (RT), we hypothesized that age would affect response to RT in patients with soft-tissue sarcoma (STS) undergoing surgery., Materials and Methods: Using the Surveillance, Epidemiology, and End Results Program (1990-2011), we identified 15,380 patients with non-metastatic STS. Stratified by age (≥65 years) and histological subtype, we assessed predictors of overall (OS) and disease-specific survival (DSS)., Results: Treatment with RT was associated with improved OS and DSS compared to surgery alone (p<0.05). Multivariate analysis also demonstrated that older patients obtained significant improvements in OS following RT, while younger patients did not. Results for DSS were similar, with older patients with leiomyosarcoma, sarcoma not otherwise specified, and myxoid liposarcoma, in particular, showing greater improvements in DSS after RT than younger patients (p<0.05). Interaction testing demonstrated an impact of year of diagnosis on outcomes but not receipt of RT., Conclusion: Among patients with STS undergoing surgery, age appears to impact oncological outcomes after RT., (Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

A patient with a pleural epitheloid hemangio-endothelioma (EHE) who failed to respond to six cycles of initial chemotherapy with iphosphamide and epirubicine was treated with pazopanib in second-line. A significant subjective and objective metabolic response on (18)F-fluoro-deoxyglucose positron-emission tomography-computed tomography was noted. Based on this observation, the role of vasculoendothelial growth factor receptor inhibitors such as pazopanib (or other tyrosine kinase inhibitors), in the treatment of pleural EHE should be established through prospective collaborative studies as upfront medication and in combination with chemotherapy., (Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Aim: Soft-tissue sarcomas are a group of rare mesenchymal carcinomas that include approximately 50 histological types, and account for 1% of all adult cancer cases. The yearly incidence of soft-tissue sarcomas in the USA is approximately 11,280 cases, with an overall mortality of 3,900 deaths per year., Materials and Methods: In this study, we established a patient-derived orthotopic xenograft (PDOX) from a patient with a soft-tissue sarcoma of the retroperitoneum in nude mice and compared it to a subcutaneous patient-derived model of the same tumor for histology., Results: In the PDOX model, a bulky tumor grew in the left retroperitoneum in the same manner as the patient's tumor. Upon histological examination, the majority of the PDOX tissue section comprised sarcomatous high-grade spindle cells of varying sizes, similar to the original patient tumor. In contrast, the majority of the subcutaneously-implanted tumor comprised round to oval cells., Conclusion: These results indicate that the PDOX recapitulated the histology of the original tumor more than the subcutaneous model., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)