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    • Chemotherapy is generally applied for metastatic diseases an

    2018-10-22

    Chemotherapy is generally applied for metastatic diseases and unresectable tumors. However, the role of chemotherapy in the treatment of MFH is not entirely clear. Several clinical trials incorporating the chemotherapy drug doxorubicin have demonstrated trends toward improved event-free survival without a major impact on the OS. The results of a large meta-analysis, which included almost 1600 soft-tissue sarcoma patients, concluded that the addition of chemotherapy improved the OS by <10%. Results were more favorable in patients with extremity tumors than in patients with axial or retroperitoneal tumors. More recently, clinical trials incorporating ifosfamide and doxorubicin have demonstrated an improvement in disease-free survival. One of the major limitations of chemotherapy is the toxicity associated with the doses necessary to have a significant impact on disease-specific survival. In our study, six patients received chemotherapy after resection. The major reason for performing chemotherapy in this group was the distant metastases (Cases 6, 8, 12, and 13). The other reasons for chemotherapy are the tumor being near a neurovascular bundle (Case 1) and the patient\'s preference (Case 4). However, four of the six patients died. Previous studies have shown that the 5-year OS rate in all MFH ranged from 36% to 70%. The general outcomes of extremity MFHs are superior to those of head-and-neck and retroperitoneal MFHs. According to our research, the 5-year survival rate is 76.2%. Clinical outcomes of extremity MFHs are associated with multiple factors. A French multicenter study of 195 MFH patients showed that tumor staging, resection margin, tumor location, histology type, and age of the patients are independent predictors of 5-year survival. However, independent prognostic factors have varied among studies. Sabesan et al. in 2006 stated that, although their results were not consistent with those of previous studies, the primary tumor site may influence the OS. In our study, all patients with distant metastases died, and there was a significantly higher mortality rate than that in the group without droperidol Supplier (p = 0.022).
    Conclusion
    Acknowledgments
    Introduction Dermatofibrosarcoma protuberans (DFSP) is a rare dermal mesenchymal tumor first described by Taylor in 1890; it accounts for < 0.1% of all cutaneous tumors with an annual incidence of approximately 4.2 cases per million per year in the United States. Although DFSP can be found in all parts of the body, the trunk is the most common site (up to 50% of all cases); it is most common in middle-aged males. DFSP is locally aggressive and rarely metastasizes distally or to regional lymph nodes postoperatively. The pathogenesis remains unclear, and no hereditary influence has been identified. According to the guidelines of The National Comprehensive Cancer Network, the standard treatment involves a wide excision with a safety margin to adjacent fascia. Local recurrence remains challenging; adjuvant radiotherapy can be administered after a wide excision to reduce the risk of local recurrence for patients with close or positive margins. An oral tyrosine kinase inhibitor, imatinib, has been approved for inoperable tumors, local recurrences, and metastatic diseases. Skin graft has been widely used after oncologic resections in most studies, but it is associated with complications such as scar contracture, graft ulceration or loss after radiation, movement restriction, and poor esthetic outcomes.
    Materials and methods
    Results The mean age of 14 patients was 41.29 ± 14.01 years (range 18–62 years), and males were more dominant than females at a ratio of 9:5. The peak incidence occurred at approximately the age of 30 years in five patients in this series. Seven patients exhibited DFSP in the trunk, four patients in the head and neck, and three patients in the lower and upper extremities (see Table 1). Because of the possible unfavorable esthetic results and movement restrictions after scar contracture resulting from suboptimal outcomes, we did not consider skin graft as an option of reconstruction. Immediate reconstruction with a pedicled perforator flap was the first option. If no suitable regional flap is available, a free anterolateral thigh (ALT) perforator flap is a versatile option to provide adequate soft-tissue augmentation and re-create anatomical structures after excision. We performed nine pedicled flaps and five free flaps for soft-tissue defect coverage.