Review

. 2023 May;12(10):11719-11730.

doi: 10.1002/cam4.5671. Epub 2023 Feb 6.

The significance of margins in pediatric Non-Rhabdomyosarcoma soft tissue sarcomas: Consensus on surgical margin definition harmonization from the INternational Soft Tissue SaRcoma ConsorTium (INSTRuCT)

Monika Sparber-Sauer^{1

2}, Andrea Ferrari³, Sheri L Spunt⁴, Christian Vokuhl⁵, Dana Casey⁶, Timothy B Lautz⁷, William H Meyer⁸, David O Walterhouse⁹, Kristian W Pajtler^{10

11

12}, Rita Alaggio¹³, Andreas Schmidt¹⁴, Akmal Safwat¹⁵, Beate Timmermann¹⁶, Patrizia Dall'Igna¹⁷, Sonja Chen¹⁸, Aaron R Weiss¹⁹, Daniel Orbach²⁰

Affiliations

¹ Klinikum der Landeshauptstadt Stuttgart gKAöR, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pädiatrie 5 (Pädiatrische Onkologie, Hämatologie, Immunologie), Stuttgart, Germany.
² Medizinische Fakultät der Universität Tübingen, Tübingen, Germany.
³ Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
⁴ Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States.
⁵ Section of Pediatric Pathology, University of Bonn, Bonn, Germany.
⁶ Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States.
⁷ Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States.
⁸ Jimmy Everest Section of Pediatric Hematology Oncology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.
⁹ Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States.
¹⁰ Hopp-Children's Cancer Center, NCT Heidelberg (KiTZ), Heidelberg, Germany.
¹¹ Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany.
¹² Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany.
¹³ Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
¹⁴ Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany.
¹⁵ Oncology Department and Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.
¹⁶ Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), Germany.
¹⁷ Pediatric Surgery, Department of Emergencies and Organ Transplantation, University of Bari, Bari, Italy.
¹⁸ Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States.
¹⁹ Department of Pediatrics, Maine Medical Center, Portland, Maine, United States.
²⁰ SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), PSL University, Institut Curie, Paris, France.

PMID: 36744538
PMCID: PMC10242312
DOI: 10.1002/cam4.5671

Review

The significance of margins in pediatric Non-Rhabdomyosarcoma soft tissue sarcomas: Consensus on surgical margin definition harmonization from the INternational Soft Tissue SaRcoma ConsorTium (INSTRuCT)

Monika Sparber-Sauer et al. Cancer Med. 2023 May.

. 2023 May;12(10):11719-11730.

doi: 10.1002/cam4.5671. Epub 2023 Feb 6.

Authors

Affiliations

¹ Klinikum der Landeshauptstadt Stuttgart gKAöR, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pädiatrie 5 (Pädiatrische Onkologie, Hämatologie, Immunologie), Stuttgart, Germany.
² Medizinische Fakultät der Universität Tübingen, Tübingen, Germany.
³ Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
⁴ Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States.
⁵ Section of Pediatric Pathology, University of Bonn, Bonn, Germany.
⁶ Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States.
⁷ Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States.
⁸ Jimmy Everest Section of Pediatric Hematology Oncology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.
⁹ Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States.
¹⁰ Hopp-Children's Cancer Center, NCT Heidelberg (KiTZ), Heidelberg, Germany.
¹¹ Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany.
¹² Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany.
¹³ Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
¹⁴ Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany.
¹⁵ Oncology Department and Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.
¹⁶ Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), Germany.
¹⁷ Pediatric Surgery, Department of Emergencies and Organ Transplantation, University of Bari, Bari, Italy.
¹⁸ Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States.
¹⁹ Department of Pediatrics, Maine Medical Center, Portland, Maine, United States.
²⁰ SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), PSL University, Institut Curie, Paris, France.

PMID: 36744538
PMCID: PMC10242312
DOI: 10.1002/cam4.5671

Abstract

Background: Margin status following surgery in children, adolescents, and young adults with soft tissue sarcomas is controversial and has been defined differently by various specialties, with definitions changing over time and by cooperative group. The International Soft Tissue Sarcoma Consortium (INSTRuCT) is a collaboration of the Children's Oncology Group (COG) Soft Tissue Sarcoma Committee, European pediatric Soft Tissue sarcoma Study Group (EpSSG), and the European Cooperative Weichteilsarkom Studiengruppe (CWS) devoted to improving patient outcomes by pooling and mining cooperative group clinical trial data.

Methods: The INSTRuCT non-rhabdomyosarcoma soft tissue sarcoma (NRSTS) working group aimed to develop international harmonized recommendations regarding surgical margin assessment and definitions in children and adolescents with soft tissue tumors.

Results and conclusion: This review addresses accepted principles and areas of controversy, including the perspectives of surgeons, pathologists, radiation oncologists, and pediatric oncologists, to develop a framework for building common guidelines for future research.

Keywords: margins; pediatric/adolescent oncology; radiotherapy; soft tissue sarcoma; surgery.

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Conflict of interest statement

The authors declare that there are no conflicts of interest concerning this article.

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The significance of margins in pediatric Non-Rhabdomyosarcoma soft tissue sarcomas: Consensus on surgical margin definition harmonization from the INternational Soft Tissue SaRcoma ConsorTium (INSTRuCT)

Affiliations

The significance of margins in pediatric Non-Rhabdomyosarcoma soft tissue sarcomas: Consensus on surgical margin definition harmonization from the INternational Soft Tissue SaRcoma ConsorTium (INSTRuCT)

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