title: Epithelioid sarcoma: need for a multimodal approach to maximize the chances of curative conservative treatment.
abstract: OBJECTIVE
  This study was designed to evaluate the impact of multimodal management on a series of epithelioid sarcoma (ES) patients treated with curative intent.
  
  
  METHODS
  Data were collected on 69 consecutive patients treated from 1982 to 2012. Univariate and multivariate analyses were performed for tumor control and overall survival (OS).
  
  
  RESULTS
  In total, 54 (78 %) patients had localized ES (M0 group). In the M0 group, 85 % of patients received multimodal management (surgery n = 50, radiotherapy n = 37, chemotherapy n = 30). Among 42 patients with limb ES, 9 (21 %) underwent amputation, and isolated limb perfusion (ILP) was required in 17 (40.5 %) to allow conservative management. Among the 45 patients who underwent conservative surgery, flap reconstructions were required in 13 (28.8 %). The median follow-up was 5.7 years. The 5-year actuarial OS rates were 54, 62, and 24 % in the entire group and the M0 and M1 groups, respectively. In the M0 group, the 5-year actuarial distant control, local control (LC), and locoregional control rates were 67, 75, and 66 %, respectively. Prognostic factors for poor OS in the multivariate analysis were tumors that were deep to the fascia (p = 0.04) and grade 3 (p = 0.005). In the univariate analysis, age <30 years (p = 0.04), the T2 stage (p = 0.04), and mass presentation (p = 0.03) correlated with decreased LC, whereas patients who underwent ILP had a significantly higher LC rate (hazard ratio 3; 95 % confidence interval 0.9-9.4; p = 0.05).
  
  
  CONCLUSIONS
  Multimodal management including ILP and flap reconstruction is necessary to achieve optimal conservative LC. High rates of metastasis and lymphatic spread require innovative systemic treatments.
authors.affiliation: Department of Radiation Oncology, Institut Gustave-Roussy, Université Paris Sud, Villejuif, France, levy.antonin@gmail.com.
authors.forename: Antonin
authors.initials: A
authors.lastname: Levy
authors.forename: Cécile
authors.initials: C
authors.lastname: Le Péchoux
authors.forename: Philippe
authors.initials: P
authors.lastname: Terrier
authors.forename: Ryan
authors.initials: R
authors.lastname: Bouaita
authors.forename: Julien
authors.initials: J
authors.lastname: Domont
authors.forename: Olivier
authors.initials: O
authors.lastname: Mir
authors.forename: Sarah
authors.initials: S
authors.lastname: Coppola
authors.forename: Charles
authors.initials: C
authors.lastname: Honoré
authors.forename: Axel
authors.initials: A
authors.lastname: Le Cesne
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bonvalot
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D055815:Young Adult