If it comes back

1How often it comes back

Often. In a 101-tumor soft-tissue series, 42% of malignant tumors recurred locally and 32% metastasized¹. A review puts recurrence and metastasis at up to 40 to 50%², and in one sarcoma unit 13 of 24 patients relapsed³. In salivary tumors, 27% of the patients with follow-up in one series developed distant metastases⁴, and in another, ten of 25 patients had recurrences, mostly more than one⁵. In children, nine of 17 whose tumors were completely removed with clear margins still had a local recurrence⁶.

So a recurrence is the expected course for many patients, and does not by itself mean that treatment failed or that nothing more can be done.

2When

It can be early or very late. Follow-up in the soft-tissue series ran from 4 to 252 months¹. In children the deaths came at a median of nine months⁶, while in the pooled literature median progression-free survival was 48 months⁷. This is the reason for a long surveillance schedule.

3Where it spreads

The lung is the most common distant site: 83% of distant metastases in one salivary series⁴. Of patients with major salivary gland tumors and a recorded stage, 14.5% had lymph-node involvement and 6.6% had distant spread at diagnosis⁸.

Sites of spread named in 83 single-patient reports that describe metastasis, from the case registry. A report can name several.

4What was done

• More surgery. Complete removal with clear margins is the factor most tied to survival in the pooled data⁷, and re-excision is the usual first answer to a local recurrence that can be removed.
• Radiotherapy. After surgery it reduced local and regional recurrence in the pooled analysis⁷.
• Implanted radiation. In 27 patients with tumors of the mouth and face treated with radioactive iodine seeds, 14 of them after a recurrence that could not be operated on, recurrence-free survival was 51.9% at three years and overall survival 68.6%. Patients treated at first diagnosis did better than those treated at relapse⁹.
• Mohs surgery has been reported for a recurrent myoepithelioma of the skin¹⁰.
• Drugs. The catalog holds 32 reports of drug treatment for recurrent or metastatic disease. They are set out on the treatments page.
• Trials. The authors of the adult soft-tissue series encourage enrollment³. See trials to ask about.

5In the published cases

Of 362 single-patient reports read for the registry, 52 describe a local recurrence and 83 describe metastasis. Reports are not a sample of patients, so these are not rates. Browse the reports.

6What to ask

• Is this a recurrence where the first tumor was, a new tumor, or spread? How do we know?
• Can it be removed with a clear margin?
• Should the new tissue be tested for fusions, if the first was not?
• Is radiotherapy an option here, including implanted radiation?
• Is there a trial open to me now?
• What will the surveillance schedule be after this?

7References