Emanuela Palmerini1, Eric L Staals2, Robert G Maki3, Stefano Pengo4, Angela Cioffi5, Marco Gambarotti6, Piero Picci7, Primo Andrea Daolio8, Antonina Parafioriti8, Carol Morris5, Cristina R Antonescu5, Alessandro Gronchi4, Paolo Giovanni Casali4, Davide M Donati9, Stefano Ferrari1, Silvia Stacchiotti4. 1. Chemotherapy, Musculoskeletal Oncology Department, Istituto Ortopedico Rizzoli, Bologna, Italy. 2. Orthopaedic Surgery, Musculoskeletal Oncology Department, Istituto Ortopedico Rizzoli, Bologna, Italy. Electronic address: eric.staals@ior.it. 3. Departments of Medicine, Pediatrics, and Orthopaedics, Mount Sinai School of Medicine, NY, USA. 4. Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 5. Department of Medicine, Memorial Sloan-Kettering Cancer Center, NY, USA. 6. Surgical Pathology, Musculoskeletal Oncology Department, Istituto Ortopedico Rizzoli, Bologna, Italy. 7. Laboratory of Experimental Oncology, Musculoskeletal Oncology Department, Istituto Ortopedico Rizzoli, Bologna, Italy. 8. Istituto Ortopedico Gaetano Pini, Milano, Italy. 9. Orthopaedic Surgery, Musculoskeletal Oncology Department, Istituto Ortopedico Rizzoli, Bologna, Italy.
Abstract
BACKGROUND: Tenosynovial giant cell tumour/pigmented villonodular synovitis (TGCT/PVNS) is a benign neoplasm of synovium and tendon sheath. We conducted a retrospective pooled analysis in three major referral centers. METHODS: Patients treated between 1998 and 2008 were examined. Only patients presenting with primary disease or first relapse were included. 5-year local failure free survival (5-year-LFFS) was analysed. RESULTS: 294 patients were included: 254 with new diagnosis and 40 in 1st local recurrence (171 F/123 M; median age: 36 years; tumour size ⩽2 cm in 27% of patients, >2 to ⩽5 cm in 41%, and >5 cm in 32%). A diffuse pattern was reported in 69%, localised in 31%. No metastases were documented. Local failure (LF) was reported in 28% of patients: 36% in diffuse pattern, 14% in localised (p = 0.002); median time to LF: 16 months. With a median follow-up of 4.4 years, 5-year-LFFS was 66%, with multiple (up to five) local recurrences in 40% of relapsed patients. Size <2 cm, macroscopically complete resection, female gender and new diagnosis were associated with a better local control. After multivariate analysis, a previous relapse was independently associated with local failure. CONCLUSIONS: This study underlines the propensity of TGCT/PVNS to multiple local recurrences. In absence of clinical factors, biological studies are needed to identify prognostic factors of local failure. After a first local recurrence, surgery does not seem to have a curative potential. In these high risk patients, studies addressing the role of target therapies are needed.
BACKGROUND:Tenosynovial giant cell tumour/pigmented villonodular synovitis (TGCT/PVNS) is a benign neoplasm of synovium and tendon sheath. We conducted a retrospective pooled analysis in three major referral centers. METHODS:Patients treated between 1998 and 2008 were examined. Only patients presenting with primary disease or first relapse were included. 5-year local failure free survival (5-year-LFFS) was analysed. RESULTS: 294 patients were included: 254 with new diagnosis and 40 in 1st local recurrence (171 F/123 M; median age: 36 years; tumour size ⩽2 cm in 27% of patients, >2 to ⩽5 cm in 41%, and >5 cm in 32%). A diffuse pattern was reported in 69%, localised in 31%. No metastases were documented. Local failure (LF) was reported in 28% of patients: 36% in diffuse pattern, 14% in localised (p = 0.002); median time to LF: 16 months. With a median follow-up of 4.4 years, 5-year-LFFS was 66%, with multiple (up to five) local recurrences in 40% of relapsed patients. Size <2 cm, macroscopically complete resection, female gender and new diagnosis were associated with a better local control. After multivariate analysis, a previous relapse was independently associated with local failure. CONCLUSIONS: This study underlines the propensity of TGCT/PVNS to multiple local recurrences. In absence of clinical factors, biological studies are needed to identify prognostic factors of local failure. After a first local recurrence, surgery does not seem to have a curative potential. In these high risk patients, studies addressing the role of target therapies are needed.
Authors: William D Tap; Hans Gelderblom; Emanuela Palmerini; Jayesh Desai; Sebastian Bauer; Jean-Yves Blay; Thierry Alcindor; Kristen Ganjoo; Javier Martín-Broto; Christopher W Ryan; David M Thomas; Charles Peterfy; John H Healey; Michiel van de Sande; Heather L Gelhorn; Dale E Shuster; Qiang Wang; Antoine Yver; Henry H Hsu; Paul S Lin; Sandra Tong-Starksen; Silvia Stacchiotti; Andrew J Wagner Journal: Lancet Date: 2019-06-19 Impact factor: 79.321
Authors: Monique J L Mastboom; Floortje G M Verspoor; Daniël Uittenbogaard; Gerard R Schaap; Paul C Jutte; H W Bart Schreuder; Michiel A J van de Sande Journal: Clin Orthop Relat Res Date: 2018-09 Impact factor: 4.176
Authors: James H Lewis; Hans Gelderblom; Michiel van de Sande; Silvia Stacchiotti; John H Healey; William D Tap; Andrew J Wagner; Antonio Lopez Pousa; Mihaela Druta; Chia-Chi Lin; Hideo A Baba; Youngsook Choi; Qiang Wang; Dale E Shuster; Sebastian Bauer Journal: Oncologist Date: 2020-12-24