SICO Sarcoma Social

11/12/2025

First day at CTOS2025…uh what a day! 🌴✨
The TARPSWG Meeting opened the congress with high-level discussions on retroperitoneal sarcoma:
multicentric collaborations, upcoming studies, and new strategies to push the field forward.

From updates on ongoing projects to fresh insights shared by the community, today was all about teamwork, vision, and international cooperation.

Stay tuned 🔔 more sessions, more science, and more sarcoma content coming soon.
We’ll keep you updated throughout the congress!

06/24/2025

🔎 Demicco Score in Solitary Fibrous Tumors (SFTs)

Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms, typically indolent, characterized by the NAB2–STAT6 gene fusion. Local control is generally achieved with complete R0 resection, yet metastases occur in 5–25% of cases, often unpredictably.

🧠 How can we assess metastatic risk in primary SFTs?

📌 3-variable Demicco score (2012)
Based on:
– S = Size matters
– F = Fast growth (Mitoses)
– T = Time is ticking (Age)

🔹 10-year metastasis-free survival:
• Low-risk → ~93%
• Intermediate-risk → ~74%
• High-risk → ~0%

📌 4-variable Demicco score (2017)
➕ N = Never ignore the Necrosis!
Adding tumor necrosis improves risk discrimination and enables better prediction of both metastasis-free and disease-free survival, especially in large, older cohorts.

👩‍⚕️ These scores—simple, reproducible, and pathology-based—offer a practical decision-making tool for clinicians.

🧠 Do you routinely apply the Demicco score in your SFT management? Let us know in the comments! 👇

06/24/2025

🔎 Demicco Score in Solitary Fibrous Tumors (SFTs)

Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms, typically indolent, characterized by the NAB2–STAT6 gene fusion. Local control is generally achieved with complete R0 resection, yet metastases occur in 5–25% of cases, often unpredictably.

🧠 How can we assess metastatic risk in primary SFTs?

📌 3-variable Demicco score (2012)
Based on:
– S = Size matters
– F = Fast growth (Mitoses)
– T = Time is ticking (Age)

🔹 10-year metastasis-free survival:
• Low-risk → ~93%
• Intermediate-risk → ~74%
• High-risk → ~0%

📌 4-variable Demicco score (2017)
➕ N = Never ignore the Necrosis!
Adding tumor necrosis improves risk discrimination and enables better prediction of both metastasis-free and disease-free survival, especially in large, older cohorts.

👩‍⚕️ These scores—simple, reproducible, and pathology-based—offer a practical decision-making tool for clinicians.

🧠 Do you routinely apply the Demicco score in your SFT management? Let us know in the comments! 👇

06/10/2025

🔬 Pelvic sarcomas remain one of the most complex entities in soft tissue oncology.
Their location, deep within the pelvis, in proximity to the bladder, ureters, re**um, and iliac vessels, often requires complex resection strategies and multidisciplinary planning.

📌 In this case, a 75-year-old male presented with a 13 cm pelvic mass.
Biopsy: high-risk Solitary Fibrous Tumor (SFT).
After neoadjuvant chemo-radiotherapy, surgical resection was achieved en bloc with the right ureter and bladder cuff.

🤩SFTs are rare mesenchymal tumors with variable clinical behavior. Extended resections are not routinely indicated. Complete resection with negative margins and preserved function is the primary goal.

🧠 How much do you know about SFTs?
Drop your questions or clinical experience in the comments 👇

05/20/2025

📚 Neoadjuvant RT for RPS? Let’s break down the STRASS trial.

👥 Design: STRASS was a multicenter, randomized phase 3 trial.

🧪 Treatment Arms:
Patients were randomized to receive:
• Surgery alone
• Preoperative radiotherapy (50.4 Gy in 28 fractions) + surgery

🕵️‍♀️ Endpoints:
Primary: Abdominal recurrence-free survival (ARFS)
Secondary: Overall survival, metastasis-free survival, safety, and response to RT

💡 Key Surgical Notes:
Multivisceral en bloc resection was the surgical standard. Resection aimed at R0/R1. Surgical strategy and intraoperative findings (e.g., sarcomatosis, rupture) were centrally recorded.
📊 Results
⏱ Jan 2012 – Apr 2017
👥 266 patients enrolled with primary, localized retroperitoneal sarcoma
🌍 31 institutions across Europe and North America

👀 Most resected organs: kidney (~80%), psoas (~75%), colon (~75%).

⏱ Median follow-up: 43.1 months.
🎯 Primary Endpoint (ARFS)
No significant difference overall:
• 3-yr ARFS: 58.7% (surgery) vs. 60.4% (RT+surgery)
• HR 1.01, p=0.95
🧠 But wait—sensitivity & subgroup analyses tell a different story:
Liposarcoma patients had better ARFS with RT:
• 3-yr ARFS up to 75.7% vs. 65.2%
• HR 0.62 (95% CI 0.38–1.02)

📈 Metastasis-Free & Overall Survival
No significant differences between groups.
• 3-year MFS: 68.2% (surgery) vs. 68.3% (RT+surgery) → HR 0.89 (95% CI 0.58–1.36)
• 3-year OS: 84.6% (surgery) vs. 84.0% (RT+surgery)
• 5-year OS: 79.4% (surgery) vs. 76.7% (RT+surgery)
➡️ No survival benefit from preoperative RT.

⚠️ Toxicity
Higher rate of severe (grade 3–4) toxicities in the RT group.
📣 Would you consider neoadjuvant RT in a low-grade liposarcoma? Let us know below 👇
📚 Full article: link in bio

05/06/2025

🧠 Clinical Case #3 is live!

This month, we focus on a well-differentiated retroperitoneal liposarcoma treated with neoadjuvant radiotherapy, in accordance with STRASS trial recommendations.
From incidental diagnosis to multidisciplinary discussion, all the way to multivisceral resection: each step of this case reflects real-world decision-making.

❓ Why was RT indicated before surgery in this case?
❓ Would you have opted for the same treatment strategy?

👉 Swipe through for clinical images, surgical details, and key decision points.
🎯 Then tell us your thoughts in the comments or via DM — we want to hear from you!

🤝 Acknowledgment for imaging sharing: Sarcoma Surgery Unit - Istituto Oncologico Europeo (IEO), Milan.

04/08/2025

🔪 How do you remove a left ?
It’s not just about .
It’s about , , and knowing when and why to take surrounding organs with the tumor.

This week, we break down the surgical technique for left-sided RPS, step by step — as described and validated in high-volume centers.
From vascular control, to pancreas and colon mobilization, down to the resection of the psoas and removal of the specimen.

💡 Why is this important?
RPS is complex, but when done properly, it changes the patient’s . That’s why understanding every step, and the reasoning behind it, is essential.

📚 Based on a key publication by Dingley, Fiore, and Gronchi, a must-read!
🔗 Link in bio

Whether you’re a learning in real context, a surgical building confidence, or a specialist refining technique..
👉 this post is for you.

🗣️ Let’s talk surgical decisions:
➡️ Which step do you find most technically demanding?
➡️ What would you preserve? What would you resect?

👇 Drop your thoughts in the comments or in DMs.
Let’s open the discussion, this is exactly what is about.

04/07/2025

🇮🇹 The Italian Sarcoma Group (ISG) Annual Meeting took place in Florence from April 3rd to 5th and, as always, couldn’t miss this important event!

💡 This year’s program covered critical and cutting-edge topics in both bone and soft tissue sarcomas.

1. Prof. DA Campanacci opened the congress with institutional greetings and moderated the orthopedic oncology session on central , where surgical margins, functional preservation, and the risk of recurrence continue to raise important questions.

2&3. Dr. Sara Coppola presented the role of Isolated Limb Perfusion (ILP) for locally advanced extremity STS. ILP allows for limb salvage, converting unresectable tumors into resectable ones and enabling tumor downsizing. Due to its complexity and need for high specialization, ILP is still limited to a few expert centers worldwide (only 31 globally, and just 4 in Italy!).

4. Dr. Marco Fiore discussed the surgical approach to pelvic sarcomas, now increasingly recognized as a distinct entity from retroperitoneal sarcomas. In some cases, the tumor herniates into the thigh, requiring alternative surgical approaches.
Dr. Alessandro Gronchi addressed the ongoing controversy around the use of preoperative RT and pembrolizumab in high-grade UPS and DDLPS. Could this be a new standard of care?

5. Dr. Sergio Valeri chaired the session dedicated to GIST, where the discussion focused on current management strategies, rare subtypes, and novel approaches.

Among the most innovative topics:
▶️ : a treatment strategy that combines imaging and targeted therapy, potentially useful in advanced or therapy-refractory STS.
▶️ A new randomized to evaluate RT in extremity and superficial trunk STS.

🗣️ Did you attend the meeting?
💛 Which session or topic caught your attention most?
Let us know in the comments or via DM and stay tuned for more from .

04/01/2025

🔵 New month, new topic!
In this Clinical Case we go through the management of a Left Retroperitoneal Sarcoma, from preoperative assessment to multivisceral resection, step by step!

💬 Why is this important?
Retroperitoneal sarcomas often require challenging surgeries where the first treatment is crucial for the patient's prognosis.
This is why proper management in sarcoma referral centers is essential, and why knowledge sharing is absolutely fundamental to improve patient outcomes.

➡️ Have you ever managed or assisted in a case like this?
➡️ What are your thoughts about multivisceral resections?

👇 Share your questions, doubts or personal experiences in the comments or via DM! We will continue the discussion next week with the next Journal Club post.

🤝 Acknowledgment for image sharing: Surgery Unit - Università Campus Bio-Medico (Rome, Italy).

04/01/2025

👀 The most important photo? Well… you’ll find it at the very end!

The 2025 Annual Meeting took place on March 27-29, 2025, in Tampa, Florida and once again, SICO Sarcoma SOCIAL was there!
The Society of Surgical Oncology, with over 3,500 members from more than 69 countries, is the international counterpart of SICO and one of the leading global societies dedicated to surgical oncology.

🔵 The congress offered highly interactive and educational sessions, featuring disease-specific and translational focused on sarcomas.

🔵 The agenda of the TARPSWG Semiannual Meeting was packed with updates on major trials such as , , and new , including the combination of chemo-immunotherapy in the setting for high-risk sarcomas.

🔵 tumors and their systemic management were also widely discussed. Nirogacestat, a gamma-secretase inhibitor, showed promising results for local control and reduction, especially when other systemic treatments fail. The role of for abdominal wall desmoids was debated..first, last, or never? Considering that 40% may remain stable or regress spontaneously.

🔵 Hypofractionated was another hot topic, with discussions around its potential to reduce treatment sessions by delivering higher doses. More data is needed, but interest is growing.

And finally...Did our SICO Sarcoma Social surgeons manage to complete the "Operation" game without setting off the buzzer? 🤭

03/28/2025