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Purpose: To identify quantitative perfusion parameters that are best associated with tumor grade and tumor necrosis at magnetic resonance (MR) imaging at 3-Tesla., Methods: MR perfusion studies of 31 patients with a musculoskeletal sarcoma were retrospectively evaluated by two readers. There were 18 men and 13 women with a mean age of 34.9±24.4 (standard deviation [SD] years) (range: 6-87 years). All patients underwent carcinologic tumor resection less than 3 months after MR imaging. For all patients six perfusion parameters (three semi-quantitative and three permeability parameters) were analyzed. The percentage of tumor necrosis was estimated using MR imaging. Perfusion data were compared between groups of tumors with different grades and necrosis ratios. Interobserver variability was calculated using intraclass correlation coefficient (ICC)., Results: Interobserver variability among the perfusion parameters was good to excellent (ICC: 0.72-0.9). The area under the curve and maximum slope values showed a significant association with the degree of tumor necrosis (P=0.02-0.04). When tumors with low necrosis ratios were compared to those with high ratios the former parameter was 80% lower. In the same groups, the imaging necrosis index was 56.9-59.8% higher in patients with grade 2 necrosis (P=0.01). Extracellular space volume (V e ) was 31.4% to 55.8% lower in tumors with high grade while the backflow constant (K ep ) was 33.6% to 40.1%% higher in tumors with high grade., Conclusion: Semi-quantitative MR perfusion parameters have an excellent reproducibility and are associated with the degree of histologic tumor necrosis in musculoskeletal sarcomas. The utility of permeability parameters for determining tumor grade needs further investigations., (Copyright © 2018 Soci showét showé françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.)

Superficial soft-tissue sarcomas are malignant mesenchymal tumors located within the cutaneous and/or subcutaneous layers. Most superficial soft-tissue sarcomas are low-grade tumors; yet, the risk of local recurrence is high, and initial wide surgery is the main prognostic factor. Some of these superficial sarcomas may grow, following an infiltrative pattern, and their real extent may be underestimated clinically. Imaging techniques are useful to determine precisely the real margins of the tumor, especially in cases of clinically doubtful or recurrent or large superficial lesions. Imaging tools enable one to determine the relationship with the superficial fascia separating the subcutaneous layer from the underlying muscle. In our institution ultrasonographic examination is followed by magnetic resonance (MR) imaging when the size of the lesion exceeds 3-5 cm. Imaging assessment is performed prior to biopsy, enabling optimal surgical management. Imaging features of the main superficial sarcomas are detailed in the following article, according to their major locations: those arising in the epidermis and/or dermis, which are most often diagnosed by dermatologists, and the subcutaneous sarcomas.

Background: Case reports of primary pulmonary artery sarcomas are very rare., Methods: We described herein eight new cases diagnosed between December 2000 and December 2004., Results: There were four men and four women, with median age of 52 years. Presenting symptoms mimicked pulmonary emboli in all cases. There were six "intimal sarcomas" and two leiomyosarcomas. In six cases, we observed initial metastasis in lung (six cases), in bone (two cases), and in brain (two cases), and adrenal gland (one case). The palliative treatments included surgical desobstruction (six cases), conformational radiotherapy (four cases), and chemotherapy (seven cases). Doxorubicin-based regimen failed in seven cases. All patients died (median survival: 8 months, extremes 5-20 months)., Conclusion: Those eight cases illustrate the high incidence of initial metastasis and the very poor outcome of primary pulmonary artery sarcomas despite classic doxorubicin-based chemotherapy.

The optimal management of adult soft-tissue sarcomas is not clearly established. To assess prognostic factors and survival, the experience of 45 recent successive cases was reviewed. Data were collected from a retrospective database (1993-2005) and statistically analyzed. Rhabdomyosarcomas were excluded. The mean age was 50.1 years; there were 24 men and 21 women. The main histological subtypes were undifferentiated sarcoma (14) and angiosarcoma (10); 21 tumours were grade 3 (46%). The most frequent primary sites were neck muscles (15, 33%) and scalp (11, 24%). At presentation, 5 (20%) cases with lymph-node involvement and another 11 cases (24%) with distant metastasis were observed. The treatment was with curative intent in 33 cases (73%). This entailed surgery, with adjuvant radiotherapy in 15 cases and adjuvant chemotherapy in 5 cases. The 5-year overall survival was 52% (+/-8%). In univariate analysis, the poor prognostic factors were high grade, initial metastasis or lymph nodes, absence of surgery, and number of surgical procedures. In multivariate analysis, two factors remained significant: grade (P=0.006) and absence of surgery (P=0.005). After taking into account grade and metastasis at presentation, quality of surgery has prognostic value. The primary aim of a multidisciplinary approach to these tumours must favour complete resection.

Systematic follow-up of patients after initial treatment of cancer is stressful with heavy cost. The aim of such follow-up is to detect asymptomatic lesions in viewing to increase global survival and quality of life. For an individual patient, the issue of cancer recurrence is a binary event. However, when developing surveillance strategies for large groups of patients, knowledge of the risks (tumor biology, natural history of the disease), the benefits (potential efficacy of salvage therapy) and diagnosis test performances is necessary to formulate a rationale and resource effective follow-up algorithm. The Bayes'nomogram is useful to assess diagnosis test. Soft tissue sarcoma is a example of such demonstration.

After treatment of primary soft tissue sarcoma, a third of patients will develop local or distant (lung in 90% of cases) recurrence. For an individual patient, the issue of cancer recurrence is a binary event. However, when developing surveillance strategies for large groups of patients, knowledge of the risks (tumor biology, natural history of the disease), the benefits (potential efficacy of salvage therapy) and diagnosis test performances is necessary to formulate a rationale and resource effective follow-up algorithm.

Soft tissue sarcomas are uncommon heterogeneous group of tumour derived from mesenchym. The most common location is the lower extremity, but they can occur in the upper extremity, and abdominal and chest walls. The first radiological evaluation may include plain films and ultrasonography in viewing to assess the probability of soft tissue sarcomas. MRI with contrast is the main modality to evaluate these lesions and choose which part of tumour must be biopsied. Computer tomography (CT) is secondary used to perform core needle biopsy and detect lung metastases. The role of PET begins to be more clear in case of need global assessment before radical surgery. A multidisciplinary approach is essential to perform rational treatment planning and avoid partial surgery.

Purpose: We describe clinical and pathological aspects and survival of 12 recent of radio-induced soft tissue sarcoma., Method: We performed a single center case-control study, with 23 control matched by grade (according to Federation nationale des centres de lutte contre le cancer Grading) and by location. Survival comparison used Log Rank test., Results: The development of these 12 cases was a result of 12 previous cancer treatment (including 4 breast cancers and 2 cervix cancers) with radiotherapy (median dose of 58 Grays). The median latency period was 10 years. There were nine women and three men. The median age was 68.5 years. The main location was chest wall (5 cases). The two main histologic subtypes were malignant histiocytofibromas (6 cases) and angiosarcomas (3 cases). Five cases were high grade. Treatments were performed with curative intent in 9 cases, including complete resection in six cases. Clinical and pathological aspects and treatments of controls were similar, but postoperative radiotherapy was most frequent and malignant histiocytofibroma was less common. Median overall survival (47 months vs. 30 months, P = 0.6), median metastatic disease-free survival (37 vs. 15 m., P = 0.6) and median locoregional disease-free survival (14 vs. 24 m., P = 0.07) were similar for cases and control., Conclusion: This study suggests that prognosis of radio-induced soft-tissue sarcomas is similar as other soft tissue sarcoma of same grade and same location.

Little is known about epidemiology of adults soft tissue and visceral sarcomas (ASTS). The frequency of previous cancers and associated genetic diseases has been analyzed out of 493 ASTS, treated between 1997 and 2002 at Oscar Lambret Cancer Center. Median age is 51, sex ratio is close to 1. Liposarcomas and malignant fibrous histiocytofibromas are the two main types (respectively 104 and 86 cases). Upper and lower limbs are the two main locations (respectively 176 and 75 cases). Fifteen patients had associated genetic disease, including 12 cases of Recklinghausen diseases. 7 out of those 15 patients have neurosarcoma. 30 patients have previous cancers, including 7 breast cancers, 3 lymphomas and 3 chronic lymphocytic leukemias. Four out of those 30 patients have two different previous cancers. 13 patients have radiation-induced sarcomas, after an average 10-year-period, and an average dose of 53 Gy. Undifferenciated sarcomas are the main histologic type (8/13), followed by angiosarcomas (2/13). Radiation-induced sarcomas are located in the chest wall (7/13), in pelvis (2/13) and head and neck (2/13). Those sarcomas are high grade (10 grade III tumours). ASTS epidemiology is complex with different risk factors depending on histologic type.

Aim of the Study: Primary thoracic soft tissue sarcomas (PTSTS) include parietal, pulmonary and mediastinal tumors. Management and prognostic factors of these rare tumors are poorly known. The aim of the study was to report a series of 40 patients with PTSTS, with analysis of their clinico-pathological characteristics, management, and prognostic factors., Design: Data were collected from a prospective database. Survival were analyzed by Kaplan-Meier method and compared with log-rank test. Prognostic factors were identified with a Cox model., Results: The median age was 48 years. The male/female ratio was 15/25. The most common subtype was malignant histiocytofibroma (11 cases). Twenty-one tumors were high-grade sarcomas. The commonest location was chest wall (26 cases). Thirty-two sarcomas were treated surgically, including 22 who had radical resections (free margins). Associated treatments were neoadjuvant (n = 8) or adjuvant (n = 8) chemotherapy, and postoperative radiotherapy (n = 17). The 5-year overall survival was 45%. In univariate analysis, prognostic factors were age (p = 0.05), Karnofsky index (p = 0.008), absence of metastases at initial presentation (p = 0.0003), radical resection (p = 0.043), and adjuvant chemotherapy (p = 0.04). The tumor location had no prognostic value., Conclusions: Management of PTSTS needs a multidisciplinary approach, and is mainly based on radical resection. Prognosis of pulmonary, chest wall and mediastinal sarcomas is similar.

Soft tissue sarcomas of the extremities are currently treated with more conservative and functional approaches, combining surgery, radiotherapy and chemotherapy. The role of external beam radiotherapy and brachytherapy has been defined through randomised studies performed in the 80's and 90's. However, the ubiquity of tumour location for these tumours makes difficult a systematic definition of local treatments. Tumour volume definition is based on pre and post surgical imaging (MRI) and on described pathological report. The clinical target volume will take into account quality of the resection and anatomical barriers and will be based on an anatomy and not only on safety margins around the tumour bed. General rules for this irradiation (doses, volumes) and principal results will be presented.