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Fall 2008

Case Study Adult Soft Tissue Sarcoma

In April 2006, while on a family vacation in Arizona, DE, an active 47-year-old man, called his California cardiologist because he felt unusually tired. He also had noticed a small mass in his upper calf.

DE had recently undergone mitral valve repair, and his cardiologist was concerned enough about deep vein thrombosis to suggest that DE go to the local emergency room. Scans and X-rays were negative, but the team there suggested DE get what they believed was a hematoma looked at upon his return to the Bay Area. That process led to his being referred to Richard J. O'Donnell, M.D., chief of orthopaedic oncology at UCSF Medical Center.

Evaluation and Surgical Intervention

After an initial examination, O'Donnell ordered an imaging workup. "A combination of CT and PET scans revealed a mass in the popliteal fossa," says O'Donnell. The subsequent pathology report from an incisional biopsy in May 2006 identified a grade 2 myxoid round cell liposarcoma.

O'Donnell resected the tumor in early June. During the procedure, radiation oncologist Alexander R. Gottschalk, M.D., Ph.D, administered intraoperative radiation therapy to reduce the dose needed for postoperative care.

Unfortunately, when the pathologist's report came back the next time, the tumor had progressed to grade 3.

Postoperative Care: Chemo and Radiation

Concerned about microscopic residual disease, O'Donnell and his team, including medical oncologist Thierry M. Jahan, M.D., believed that a combination of radiation and chemotherapy would be the best option for minimizing the likelihood of recurrence. DE underwent radiation therapy with Gottschalk through January 2007. As for chemotherapy, though, since one of the drugs was associated with cardiac toxicity, the team was concerned its administration might complicate DE's heart condition.

After consultation with DE's cardiologist and with the heart surgeon who had completed the mitral valve repair, the team arrived at a plan to go ahead with the chemo, along with an echocardiogram before each of the six cycles to monitor the drug's effect on DE's heart.

"Throughout the treatment, all the echocardiograms showed the left ventricular ejection fraction consistently above 60 percent," says Jahan.

A Team Approach

DE did, however, incur other common complications during his 18 months of postoperative treatment. Those complications and return trips to the hospital kept him in close contact with many of the staff at the Helen Diller Family Comprehensive Cancer Center.

"Dr. Jahan has kept in close touch with my [community] internist, whom he recommended," says DE, who still undergoes CT and PET scans every three months. As of July 2008, DE remains disease-free.

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