Stergiopoulos, Georgios M.

Background: Localized soft tissue sarcoma (STS) is primarily treated with surgical resection with or without radiotherapy (RT), while the role of chemotherapy (CT) as a radiosensitizer remains unclear. We report our single-institution experience with combined chemoradiotherapy (CCRT) in treating localized STS. Methods: We conducted a retrospective analysis of patients with localized STS treated at Mayo Clinic with mitomycin, cisplatin, and doxorubicin (MitoAP) concurrently with RT between 1/1/85 and 12/12/19. Results: We identified 179 patients (median age 58 years; median tumor size 9.5 cm), with 83.8% of tumors located in the extremities or trunk. Among them, 77.1% received perioperative CT in addition to CCRT, with 95% of those treated in the neoadjuvant setting. Median RT dose was 50 Gray. The 5-year disease-specific survival (DSS) was 77.9% (95% confidence interval, CI: 70.8–83.4%). The addition of perioperative CT to CCRT was associated with improved DSS compared with CCRT alone (p = 0.01, Hazard Ratio, HR: 0.48, 95% CI: 0.27–0.85). Median post-CCRT tumor viability was 30% and did not differ by CT use (p = 0.39), but varied significantly by histology (p < 0.001). Conclusions: Our institutional protocol utilizing two cycles of MitoAP with RT was well tolerated. DSS in our cohort was similar to historical data using perioperative RT alone, suggesting no clear benefit from CCRT. However, the majority of patients in our cohort were classified as high risk, which may have attenuated a potential survival benefit in the absence of appropriate comparative controls. Furthermore, additional perioperative CT to CCRT was associated with improved DSS and differential histology-specific responses in tumor viability, suggesting that a more aggressive neoadjuvant and perioperative approach may be beneficial in selected patients.

Background: Liposarcoma, one of the most prevalent sarcoma histologies, is recognized for its tendency for extra-pulmonary metastases. While oligometastatic cardiac disease is rarely reported, it poses a unique challenge as oligometastatic sarcomas are often managed with surgical resection. Case Report: We present a case of a 62-year-old man diagnosed with an oligometastatic myxoid liposarcoma (MLPS) to the heart 19 years after the primary tumor resection from the lower limb. The metastatic mass, situated in the pericardium adjacent and infiltrating the left ventricle, was not managed surgically but with a combination of chemotherapy and radiotherapy. The patient’s disease remains stable to date, for more than 10 years. Literature Review: We conducted a review of the literature to determine the preferred management approach for solitary cardiac metastases of sarcomas. We also conducted an in-depth analysis focusing on reported cases of MLPS metastasizing to the heart, aiming to extract pertinent data regarding the patient characteristics and the corresponding management strategies. Conclusions: Although clinical diagnoses of solitary or oligometastatic cardiac metastases from sarcomas are infrequent, this case underscores the significance of aggressive management employing chemotherapy and radiotherapy for chemosensitive and radiosensitive sarcomas, especially when surgical removal is high-risk. Furthermore, it challenges the notion that surgery is the exclusive therapeutic option leading to long-term clinical benefit in patients with recurrent sarcomas.

Abstract Background Hospital readmissions pose a challenge for modern healthcare systems. Our aim was to assess the efficacy of telemedicine incorporating telemonitoring technologies in decreasing hospital readmissions with a focus on specific patient populations particularly prone to rehospitalization: patients with heart failure (HF) and/ or chronic obstructive pulmonary disease (COPD) through a systematic review. Methods Three major electronic databases, including PubMed, Scopus, and ProQuest’s ABI (Abstracted Business Information)/INFORM Global, were searched for trials employing telemedical technologies and quantifying the effect on the readmission rates in the HF and/or COPD populations. Our search was limited to English-language articles published between 2012 and 2022. Results Eighteen scientific articles referencing seventeen different clinical trials were isolated. Most studies were randomized controlled trials and the readmission related outcome most studied was all-cause readmissions followed by HF and acute exacerbation of COPD readmissions. 47% of the studies suggested that telemedicine might decrease the readmission related burden, while most of the remaining studies suggested that telemedicine had a neutral effect on hospital readmissions. Comparative analysis of studies focusing on the COPD or HF populations resulted in the observation of a clearer association in the reduction of the readmission-related burden in patients with COPD compared to patients with HF (83% vs 27%). Data regarding other relevant outcomes often assessed including all-cause mortality emergency department visits, healthcare costs, quality of life, medication adherence and reconciliation were extracted and qualitatively assessed. Conclusion This systematic review highlights the uncertainty surrounding the effectiveness of telemedicine in reducing the readmission rates of high-risk patients with chronic illnesses, with much of the uncertainty linked to the variability of the deliverable of telemedicine. Nonetheless, the fact that almost all trials found that patients receiving telemedicine benefited to some extent and the strong association in the reduction of readmissions in the COPD population are encouraging. Conduction of more high-quality studies is necessary to draw definitive conclusions.