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Intraoperative Localization Using an Implanted Radar Reflector Facilitates Resection of Non-Palpable Trunk and Extremity Sarcoma

  • Sarcoma
  • Published:
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Abstract

Background

Resecting non-palpable soft tissue tumors presents a unique challenge, particularly with recurrent disease in which surrounding tissue has been surgically manipulated and often irradiated. SAVI SCOUT® is a radar-based localization device that was developed for breast tumor localization and was recently FDA-approved for localization of soft tissue tumors. Application of this technology to soft tissue sarcoma has not been previously reported.

Methods

We assembled a single-institution retrospective case series of patients with trunk and extremity sarcomas resected by five sarcoma surgeons using SAVI SCOUT® from December 2018 to May 2020. Reflectors were placed preoperatively using image-guidance, and the radar detector was used intraoperatively to localize the target lesion. Clinical variables were abstracted from the electronic medical record including treatment history, pathology, and early oncologic outcomes. Using a focused review, we compared margin status and recurrence rates with previously published cohorts.

Results

Ten SAVI SCOUT®-localized sarcoma resections were performed. Eight were for locally recurrent disease, of which seven (83%) had prior radiation. The remaining lesions became non-palpable after neoadjuvant chemotherapy. SAVI SCOUT® facilitated resection in all cases with a margin-negative resection rate (77%) comparable to prior cohorts. In this high-risk population with a median follow-up of 14 months, only one patient recurred locally 7.5 months after SAVI SCOUT®-localized resection, requiring re-resection.

Conclusion

SAVI SCOUT® technology facilitated resection of non-palpable recurrent sarcoma of the trunk and extremities in all ten cases attempted. In a high-risk patient population, the pattern of recurrence has been primarily distant with one instance of local tumor recurrence.

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References

  1. Zagars G K et al. Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy: an analysis of 1225 patients. Cancer 2003;97: 2530–2543, https://doi.org/10.1002/cncr.11365.

    Article  PubMed  Google Scholar 

  2. Trovik CS et al. Surgical margins, local recurrence and metastasis in soft tissue sarcomas: 559 surgically-treated patients from the Scandinavian Sarcoma Group Register. Eur J Cancer. 2000;36:710–716, https://doi.org/10.1016/s0959-8049(99)00287-7.

    Article  CAS  PubMed  Google Scholar 

  3. Stojadinovic A et al. Analysis of the prognostic significance of microscopic margins in 2084 localized primary adult soft tissue sarcomas. Ann Surg. 2002;235:424–434, https://doi.org/10.1097/00000658-200203000-00015.

    Article  PubMed  PubMed Central  Google Scholar 

  4. United States Food and Drug Administration. 510(k) Premarket Notification Database. Accessed on April 29, 2020 via https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm.

  5. Hayes MK. Update on Preoperative Breast Localization. Radiol Clin North Am. 2017;55: 591–603, https://doi.org/10.1016/j.rcl.2016.12.012.

    Article  PubMed  Google Scholar 

  6. Flynn N. Merit Medical. Electronic communication. August 31, 2020.

  7. Cox CE et al. A prospective, single arm, multi-site, clinical evaluation of a nonradioactive surgical guidance technology for the location of nonpalpable breast lesions during excision. Ann Surg Oncol 2016;23: 3168–3174, https://doi.org/10.1245/s10434-016-5405-y.

    Article  PubMed  Google Scholar 

  8. Srour M K, Kim S, Amersi F, Giuliano A E, Chung A. Comparison of wire localization, radioactive seed, and Savi Scout(®) radar for management of surgical breast disease. Breast J.2020; 26:406–413, https://doi.org/10.1111/tbj.13499.

    Article  PubMed  Google Scholar 

  9. Trovik CS et al. Consequences of local recurrence of soft tissue sarcoma: 205 patients from the Scandinavian Sarcoma Group Register. Acta Orthop Scand. 2000;71:488–495, https://doi.org/10.1080/000164700317381199.

    Article  CAS  PubMed  Google Scholar 

  10. Moureau-Zabotto L et al. Management of soft tissue sarcomas (STS) in first isolated local recurrence: a retrospective study of 83 cases. Radiother Oncol. 2004;73: 313–319, https://doi.org/10.1016/j.radonc.2004.05.008.

    Article  PubMed  Google Scholar 

  11. Eilber FC et al. Prognostic factors for survival in patients with locally recurrent extremity soft tissue sarcomas. Ann Surg Oncol. 2005;12: 228–236, https://doi.org/10.1245/aso.2005.03.045.

    Article  PubMed  Google Scholar 

  12. Liu C Y et al. Soft tissue sarcoma of extremities: the prognostic significance of adequate surgical margins in primary operation and reoperation after recurrence. Ann Surg Oncol. 2010;17: 2102–2111, https://doi.org/10.1245/s10434-010-0997-0.

    Article  PubMed  Google Scholar 

  13. Torres, M. A. et al. Management of locally recurrent soft-tissue sarcoma after prior surgery and radiation therapy. Int J Radiat Oncol Biol Phys. 2007;67:1124–1129, https://doi.org/10.1016/j.ijrobp.2006.10.036.

    Article  PubMed  Google Scholar 

  14. Daigeler A et al. Long-term outcome after local recurrence of soft tissue sarcoma: a retrospective analysis of factors predictive of survival in 135 patients with locally recurrent soft tissue sarcoma. Br J Cancer. 2014;110: 1456–1464, https://doi.org/10.1038/bjc.2014.21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Sugiura H, Tsukushi S, Yoshida M, Nishida Y. What is the success of repeat surgical treatment of a local recurrence after initial wide resection of soft tissue sarcomas? Clin Orthop Relat Res. 2018;476 1791–1800, https://doi.org/10.1007/s11999.0000000000000158.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Abatzoglou S, Turcotte R E, Adoubali A, Isler M H, Roberge D. Local recurrence after initial multidisciplinary management of soft tissue sarcoma: is there a way out? Clin Orthop Relat Res. 2010;468: 3012–3018, https://doi.org/10.1007/s11999-010-1481-7.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Pouw B et al. Heading toward radioactive seed localization in non-palpable breast cancer surgery? A meta-analysis. J Surg Oncol. 2015;111:185–191, https://doi.org/10.1002/jso.23785.

    Article  PubMed  Google Scholar 

  18. Jadeja P H et al. Utilization of multiple SAVI SCOUT surgical guidance system reflectors in the same breast: a single-institution feasibility study. Breast J. 2018;24: 531–534, https://doi.org/10.1111/tbj.12979.

    Article  PubMed  Google Scholar 

  19. Falcon S, Weinfurtner RJ, Mooney B, Niell BL. SAVI SCOUT® localization of breast lesions as a practical alternative to wires: outcomes and suggestions for trouble-shooting. Clin Imaging. 2018;52:280–286, https://doi.org/10.1016/j.clinimag.2018.07.008.

    Article  PubMed  Google Scholar 

  20. Zagars G K. et al. Prognostic factors for disease-specific survival after first relapse of soft-tissue sarcoma: analysis of 402 patients with disease relapse after initial conservative surgery and radiotherapy. Int J Radiat Oncol Biol Phys. 2003;57:739–747, https://doi.org/10.1016/s0360-3016(03)00714-4.

    Article  PubMed  Google Scholar 

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Acknowledgments

There were no sources of funding for this study.

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Authors and Affiliations

  1. Sarcoma Department, H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA

    Kristy Kummerow Broman MD, MPH, David Joyce MD, Odion Binitie MD, G. Douglas Letson MD, Ricardo J. Gonzalez MD & John E. Mullinax MD

  2. Radiology Department, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33629, USA

    Junsung Choi MD

Authors
  1. Kristy Kummerow Broman MD, MPH
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  2. David Joyce MD
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  3. Odion Binitie MD
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  4. G. Douglas Letson MD
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  5. Ricardo J. Gonzalez MD
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  6. Junsung Choi MD
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  7. John E. Mullinax MD
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Corresponding author

Correspondence to John E. Mullinax MD.

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Douglas Letson—Stryker Orthopaedics—Consultant.

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Broman, K.K., Joyce, D., Binitie, O. et al. Intraoperative Localization Using an Implanted Radar Reflector Facilitates Resection of Non-Palpable Trunk and Extremity Sarcoma. Ann Surg Oncol 28, 3366–3374 (2021). https://doi.org/10.1245/s10434-020-09229-4

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  • DOI: https://doi.org/10.1245/s10434-020-09229-4

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