Dermatofibrosarcoma protuberans(DFSP), the most common dermal sarcoma, is a low-grade, slow growing fibroblastic malignant neoplasm that most frequently affects middle aged adults and is characterized by a high local ...Dermatofibrosarcoma protuberans(DFSP), the most common dermal sarcoma, is a low-grade, slow growing fibroblastic malignant neoplasm that most frequently affects middle aged adults and is characterized by a high local recurrence rate and a low propensity for metastasis. Wide surgical resection or Mohs micrographic surgery(MMS) are the preferred approaches for localized disease, while radiation therapy is warranted for inoperable disease or for cases with positive margins where re-excision is not possible. DFSP is generally regarded as refractory to conventional chemotherapy. Treatment options for systemic disease were limited until the discovery of a unique translocation, t(17;22)(q22;q13)(COL1A1;PDGFB) found in a majority of cases. In recent years, imatinib, a PDGFβR, ABL and KIT inhibitor, has revolutionized systemic therapy in DFSP. In this review, we summarize the epidemiological, clinical, histological and genetic characteristics of DFSP and update the readers on its current management.展开更多
Immunoradiotherapy holds promise for improving outcomes in patients with advanced solid tumors,including in soft-tissue sarcoma(STS).However,the ideal combination of treatment modalities remains to be determined,and r...Immunoradiotherapy holds promise for improving outcomes in patients with advanced solid tumors,including in soft-tissue sarcoma(STS).However,the ideal combination of treatment modalities remains to be determined,and reliable biomarkers to predict which patients will benefit are lacking.Here,we report the results of the STS cohort of the SABR-PDL1 phase Il trial that evaluated the anti-PDL1 atezolizumab combined with stereotactic body radiation therapy(SBRT)delivered concurrently with the 2nd cycle to at least one tumor site,Eligible patients received atezolizumab until progression or unmanageable toxicity,with SBRT at 45 Gy in 3 fractions).The primary endpoint was one-year progression-free survival(PFS)rate with success defined as 13 patients achieving 1-year PFS.Sixty-one heavily pretreated patients with STS(median 5 prior lines;52%men;median age 54 years;28%leiomyosarcoma)were enrolled across two centers(France,Spain).SBRT was delivered to 55 patients(90%),with the lung being the most commonly irradiated site(50%).After a median follow-up of 45 months,the one-year PFS rate was 8.3%[95%Cl:3.6-18.1].Median PFS and overall survival were 2.5 and 8.6 months,respectively.Best responses included partial responses(5%)and stable disease(60%).Immune profiling revealed increased immunosuppressive tumor-associated macrophages(e.g,IL4l1,HES1)and monocyte-recruiting chemokines in non-responders.Higher monocyte/lymphocyte ratios(MonoLR)in tumor and blood correlated with progression.PD-L1 status,lymphoid infiltration,and tertiary-lymphoid structures were not predictive.Although the primary endpoint was not met,this study highlights MonoLR imbalance as a potential biomarker to identify STS patients likely to benefit from immunoradiotherapy.EudraCT No.2015-005464-42;Clinicaltrial.gov number:NCT02992912.展开更多
Historical overview of the treatment for advanced gastrointestinal stromal tumors(GISTs)GISTs represent a relatively rare entity;however,GISTs are still the most common mesenchymal neoplasm in the gastrointestinal tra...Historical overview of the treatment for advanced gastrointestinal stromal tumors(GISTs)GISTs represent a relatively rare entity;however,GISTs are still the most common mesenchymal neoplasm in the gastrointestinal tract.The majority of GISTs express the transmembrane receptor,KIT,a product of the KIT proto-oncogene that can lead to uncontrolled cell proliferation and resistance to apoptosis1-3.展开更多
Cell-cell fusion is a normal biological process playing essential roles in organ formation and tissue differentiation,repair and regeneration.Through cell fusion somatic cells undergo rapid nuclear reprogramming and e...Cell-cell fusion is a normal biological process playing essential roles in organ formation and tissue differentiation,repair and regeneration.Through cell fusion somatic cells undergo rapid nuclear reprogramming and epigenetic modifications to form hybrid cells with new genetic and phenotypic properties at a rate exceeding that achievable by random mutations.Factors that stimulate cell fusion are inflammation and hypoxia.Fusion of cancer cells with non-neoplastic cells facilitates several malignancy-related cell phenotypes,e.g.,reprogramming of somatic cell into induced pluripotent stem cells and epithelial to mesenchymal transition.There is now considerable in vitro,in vivo and clinical evidence that fusion of cancer cells with motile leucocytes such as macrophages plays a major role in cancer metastasis.Of the many changes in cancer cells after hybridizing with leucocytes,it is notable that hybrids acquire resistance to chemo-and radiation therapy.One phenomenon that has been largely overlooked yet plays a role in these processes is polyploidization.Regardless of the mechanism of polyploid cell formation,it happens in response to genotoxic stresses and enhances a cancer cell’s ability to survive.Here we summarize the recent progress in research of cell fusion and with a focus on an important role for polyploid cells in cancer metastasis.In addition,we discuss the clinical evidence and the importance of cell fusion and polyploidization in solid tumors.展开更多
Background: Very small pigmented lesions may represent an important diagnostic challenge to the clinician. Objectives: The aim of the present study was to establish the diagnostic value, in terms of sensitivity and sp...Background: Very small pigmented lesions may represent an important diagnostic challenge to the clinician. Objectives: The aim of the present study was to establish the diagnostic value, in terms of sensitivity and specificity, of both clinical and dermoscopic examinations in a population of patients with unselected consecutive pigmented lesions with a maximum clinical diameter of 3 mm. Patients and methods: Two hundred and four consecutive patients bearing 206 pigmented skin lesions with a maximum diameter of 3 mm were seen and operated on. Twenty-three of these lesions were melanomas. Each lesion was subjected to both clinical and dermoscopic evaluation before surgery. The results were expressed in terms of sensitivity and specificity of both kinds of evaluation. Results: Clinical evaluation produced a diagnostic sensitivity of 43%and a specificity of 91%. Dermoscopy resulted in a sensitivity of 83%and in a specificity of 69%. The comparison between the sensitivity values of the two diagnostic methods showed a significant difference (P < 0.01). A high value of significance was also obtained comparing the respective specificity values (P < 0.001). Conclusions: Detection of very small melanomas is feasible by accurate visual inspection. Dermoscopy appears to be an important aid to diagnosis, provided that physicians are aware of this type of lesion and maintain the index of suspicion at a high level.展开更多
Soft-tissue sarcomas(STS)represent a group of rare and heterogeneous tumors associated with several challenges,including incorrect or late diagnosis,the lack of clinical expertise,and limited therapeutic options.Digit...Soft-tissue sarcomas(STS)represent a group of rare and heterogeneous tumors associated with several challenges,including incorrect or late diagnosis,the lack of clinical expertise,and limited therapeutic options.Digital pathology and radiomics represent transformative technologies that appear promising for improving the accuracy of cancer diagnosis,characterization and monitoring.Herein,we review the potential role of the application of digital pathology and radiomics in managing patients with STS.We have particularly described the main results and the limits of the studies using radiomics to refine diagnosis or predict the outcome of patients with soft-tissue sarcomas.We also discussed the current limitation of implementing radiomics in routine settings.Standard management approaches for STS have not improved since the early 1970s.Immunotherapy has revolutionized cancer treatment;nonetheless,immuno-oncology agents have not yet been approved for patients with STS.However,several lines of evidence indicate that immunotherapy may represent an efficient therapeutic strategy for this group of diseases.Thus,we emphasized the remarkable potential of immunotherapy in sarcoma treatment by focusing on recent data regarding the immune landscape of these tumors.We have particularly emphasized the fact that the development of immunotherapy for sarcomas is not an aspect of histology(except for alveolar soft-part sarcoma)but rather that of the tumor microenvironment.Future studies investigating immunotherapy strategies in sarcomas should incorporate at least the presence of tertiary lymphoid structures as a stratification factor in their design,besides including a strong translational program that will allow for a better understanding of the determinants involved in sensitivity and treatment resistance to immune-oncology agents.展开更多
Pazopanib is the first and only tyrosine kinase inhibitor currently approved for the treatment of multiple histological subtypes of soft tissue sarcoma(STS).Initially developed as a small molecule inhibitor of vascula...Pazopanib is the first and only tyrosine kinase inhibitor currently approved for the treatment of multiple histological subtypes of soft tissue sarcoma(STS).Initially developed as a small molecule inhibitor of vascular endothelial growth factor receptors,preclinical work indicates that pazopanib exerts an anticancer effect through the inhibition of both angiogenic and oncogenic signaling pathways.Following the establishment of optimal dosing and safety profiles in early phase studies and approval for the treatment of advanced renal cell carcinoma,pazopanib was investigated in STS.A landmark phase III randomized study demonstrated improved progression-free survival with pazopanib compared to that with placebo in pretreated patients with STS of various subtypes.The efficacy of pazopanib in specific STS subtypes has been further described in real-world-based case series in both mixed and subtype-specific STS cohorts.At present,there are no clinically validated predictive biomarkers for use in selecting patients with advanced STS for pazopanib therapy,limiting the clinical effectiveness and cost-effectiveness of the drug.In this review,we summarize the preclinical and clinical data for pazopanib,outline the evidence base for its effect in STS and explore reported studies that have investigated putative biomarkers.展开更多
Desmoplastic small round cell tumor(DSRCT)is an aggressive cancer that predominantly affects adolescents and young adults,typically developing at sites lined by mesothelium[1,2].DSRCT is genetically defined by a chrom...Desmoplastic small round cell tumor(DSRCT)is an aggressive cancer that predominantly affects adolescents and young adults,typically developing at sites lined by mesothelium[1,2].DSRCT is genetically defined by a chromosomal translocation that fuses the N-terminus of EWS RNA binding protein 1(EWSR1)to the C-terminus of Wilms tumor protein(WT1),forming EWSR1::WT1[3].This fusion encodes a potent transcription factor and is the only known driver of oncogenic transformation in DSRCT[4].The lack of a comprehensive understanding of DSRCT biology parallels its dismal survival rate(5%-20%)[1].These challenges are exacerbated by the absence of clinical trials,the limited systematic collection and analysis of DSRCT biomaterial[1],and the notable lack of specific diagnostic markers,necessitating resource-intensive molecular testing for an accurate diagnosis.展开更多
Dear Editor,Sarcomas represent a heterogenous group of tumors accounting for about 1%of cancer in adults and 15%in children[1].However,despite adequate locoregional treatment,up to 40%of patients develop metastatic di...Dear Editor,Sarcomas represent a heterogenous group of tumors accounting for about 1%of cancer in adults and 15%in children[1].However,despite adequate locoregional treatment,up to 40%of patients develop metastatic disease.Drugs used in the advanced setting have very limited efficacy,with a response rate of<10%and progression-free survival of<4 months and are mainly used for palliative purposes[1].It is,therefore,important to monitor individual therapy responses to avoid inefficient therapy and unnecessary toxicity.Such monitoring is currently based on repeated CT imaging which may represent an important burden for patients with advanced disease[2].展开更多
To the editor Soft-tissue sarcomas(STS)represent a very heterogeneous group of rare tumors including more than 100 different subtypes[1].Surgery and neo/adjuvant radiation therapy represent the cornerstone of treatmen...To the editor Soft-tissue sarcomas(STS)represent a very heterogeneous group of rare tumors including more than 100 different subtypes[1].Surgery and neo/adjuvant radiation therapy represent the cornerstone of treatment for STS.However,despite an optimal resection of the tumor,up to 40%of patients will develop metastatic relapse and will die from the disease[1].Doxorubicin represents the first-line standard of care for patients with advanced disease since the 1970s,despite several attempts to identify better regimens.The median overall survival(OS)of patients with metastatic disease is<18 months and has only modestly improved over the past 20 years[2].展开更多
Surgical resection of soft tissue sarcoma of the trunk can result in large defects requiring complex reconstruction for coverage of vital neurovascular structures and tissue defect. Large defects of the back could be ...Surgical resection of soft tissue sarcoma of the trunk can result in large defects requiring complex reconstruction for coverage of vital neurovascular structures and tissue defect. Large defects of the back could be reconstructed with multiple random pattern or local pedicled flaps. We present the case of a 48-year-old patient with a locally advanced dermatofibrosarcoma protuberans of the back. Wide local excision of the lesion was performed. The soft tissue defect measured 22 cm × 20 cm × 4 cm and was reconstructed with bilateral reverse latissimus dorsi myocutaneous (RLDM) flap. Each RLDM flap measured 24 cm × 10 cm. The donor site on the back was closed directly on both sides. The patient recovered well and the two flaps healed uneventfully. Twelve months after surgery the patient is disease-free. The use of a RLDM flap in mid-back reconstructions provided wide well-vascularized soft tissue, minimized risk of infection, and maximized back coverage. This flap is an excellent choice for reconstruction of large defects of the mid-back.展开更多
基金support from the NIHR Royal Marsden/ICR Biomedical Research Center
文摘Dermatofibrosarcoma protuberans(DFSP), the most common dermal sarcoma, is a low-grade, slow growing fibroblastic malignant neoplasm that most frequently affects middle aged adults and is characterized by a high local recurrence rate and a low propensity for metastasis. Wide surgical resection or Mohs micrographic surgery(MMS) are the preferred approaches for localized disease, while radiation therapy is warranted for inoperable disease or for cases with positive margins where re-excision is not possible. DFSP is generally regarded as refractory to conventional chemotherapy. Treatment options for systemic disease were limited until the discovery of a unique translocation, t(17;22)(q22;q13)(COL1A1;PDGFB) found in a majority of cases. In recent years, imatinib, a PDGFβR, ABL and KIT inhibitor, has revolutionized systemic therapy in DFSP. In this review, we summarize the epidemiological, clinical, histological and genetic characteristics of DFSP and update the readers on its current management.
基金supported by the French National Research Agency under the FRANCE2030 investment plan(grant application No.ANR-21-RHUS-0005)by the imCORE research network(No.SG40863)+1 种基金The authors would like to thank the collaborators from the histopathology department of Gustave Roussythe Experimental and Translational Pathology(PETRA,AMMICA,INSERM US23/CNRS)。
文摘Immunoradiotherapy holds promise for improving outcomes in patients with advanced solid tumors,including in soft-tissue sarcoma(STS).However,the ideal combination of treatment modalities remains to be determined,and reliable biomarkers to predict which patients will benefit are lacking.Here,we report the results of the STS cohort of the SABR-PDL1 phase Il trial that evaluated the anti-PDL1 atezolizumab combined with stereotactic body radiation therapy(SBRT)delivered concurrently with the 2nd cycle to at least one tumor site,Eligible patients received atezolizumab until progression or unmanageable toxicity,with SBRT at 45 Gy in 3 fractions).The primary endpoint was one-year progression-free survival(PFS)rate with success defined as 13 patients achieving 1-year PFS.Sixty-one heavily pretreated patients with STS(median 5 prior lines;52%men;median age 54 years;28%leiomyosarcoma)were enrolled across two centers(France,Spain).SBRT was delivered to 55 patients(90%),with the lung being the most commonly irradiated site(50%).After a median follow-up of 45 months,the one-year PFS rate was 8.3%[95%Cl:3.6-18.1].Median PFS and overall survival were 2.5 and 8.6 months,respectively.Best responses included partial responses(5%)and stable disease(60%).Immune profiling revealed increased immunosuppressive tumor-associated macrophages(e.g,IL4l1,HES1)and monocyte-recruiting chemokines in non-responders.Higher monocyte/lymphocyte ratios(MonoLR)in tumor and blood correlated with progression.PD-L1 status,lymphoid infiltration,and tertiary-lymphoid structures were not predictive.Although the primary endpoint was not met,this study highlights MonoLR imbalance as a potential biomarker to identify STS patients likely to benefit from immunoradiotherapy.EudraCT No.2015-005464-42;Clinicaltrial.gov number:NCT02992912.
文摘Historical overview of the treatment for advanced gastrointestinal stromal tumors(GISTs)GISTs represent a relatively rare entity;however,GISTs are still the most common mesenchymal neoplasm in the gastrointestinal tract.The majority of GISTs express the transmembrane receptor,KIT,a product of the KIT proto-oncogene that can lead to uncontrolled cell proliferation and resistance to apoptosis1-3.
文摘Cell-cell fusion is a normal biological process playing essential roles in organ formation and tissue differentiation,repair and regeneration.Through cell fusion somatic cells undergo rapid nuclear reprogramming and epigenetic modifications to form hybrid cells with new genetic and phenotypic properties at a rate exceeding that achievable by random mutations.Factors that stimulate cell fusion are inflammation and hypoxia.Fusion of cancer cells with non-neoplastic cells facilitates several malignancy-related cell phenotypes,e.g.,reprogramming of somatic cell into induced pluripotent stem cells and epithelial to mesenchymal transition.There is now considerable in vitro,in vivo and clinical evidence that fusion of cancer cells with motile leucocytes such as macrophages plays a major role in cancer metastasis.Of the many changes in cancer cells after hybridizing with leucocytes,it is notable that hybrids acquire resistance to chemo-and radiation therapy.One phenomenon that has been largely overlooked yet plays a role in these processes is polyploidization.Regardless of the mechanism of polyploid cell formation,it happens in response to genotoxic stresses and enhances a cancer cell’s ability to survive.Here we summarize the recent progress in research of cell fusion and with a focus on an important role for polyploid cells in cancer metastasis.In addition,we discuss the clinical evidence and the importance of cell fusion and polyploidization in solid tumors.
文摘Background: Very small pigmented lesions may represent an important diagnostic challenge to the clinician. Objectives: The aim of the present study was to establish the diagnostic value, in terms of sensitivity and specificity, of both clinical and dermoscopic examinations in a population of patients with unselected consecutive pigmented lesions with a maximum clinical diameter of 3 mm. Patients and methods: Two hundred and four consecutive patients bearing 206 pigmented skin lesions with a maximum diameter of 3 mm were seen and operated on. Twenty-three of these lesions were melanomas. Each lesion was subjected to both clinical and dermoscopic evaluation before surgery. The results were expressed in terms of sensitivity and specificity of both kinds of evaluation. Results: Clinical evaluation produced a diagnostic sensitivity of 43%and a specificity of 91%. Dermoscopy resulted in a sensitivity of 83%and in a specificity of 69%. The comparison between the sensitivity values of the two diagnostic methods showed a significant difference (P < 0.01). A high value of significance was also obtained comparing the respective specificity values (P < 0.001). Conclusions: Detection of very small melanomas is feasible by accurate visual inspection. Dermoscopy appears to be an important aid to diagnosis, provided that physicians are aware of this type of lesion and maintain the index of suspicion at a high level.
基金Agence Nationale de la Recherche-Recherche Hospitalo-Universitaire en sante(RHU)CONDOR programme。
文摘Soft-tissue sarcomas(STS)represent a group of rare and heterogeneous tumors associated with several challenges,including incorrect or late diagnosis,the lack of clinical expertise,and limited therapeutic options.Digital pathology and radiomics represent transformative technologies that appear promising for improving the accuracy of cancer diagnosis,characterization and monitoring.Herein,we review the potential role of the application of digital pathology and radiomics in managing patients with STS.We have particularly described the main results and the limits of the studies using radiomics to refine diagnosis or predict the outcome of patients with soft-tissue sarcomas.We also discussed the current limitation of implementing radiomics in routine settings.Standard management approaches for STS have not improved since the early 1970s.Immunotherapy has revolutionized cancer treatment;nonetheless,immuno-oncology agents have not yet been approved for patients with STS.However,several lines of evidence indicate that immunotherapy may represent an efficient therapeutic strategy for this group of diseases.Thus,we emphasized the remarkable potential of immunotherapy in sarcoma treatment by focusing on recent data regarding the immune landscape of these tumors.We have particularly emphasized the fact that the development of immunotherapy for sarcomas is not an aspect of histology(except for alveolar soft-part sarcoma)but rather that of the tumor microenvironment.Future studies investigating immunotherapy strategies in sarcomas should incorporate at least the presence of tertiary lymphoid structures as a stratification factor in their design,besides including a strong translational program that will allow for a better understanding of the determinants involved in sensitivity and treatment resistance to immune-oncology agents.
文摘Pazopanib is the first and only tyrosine kinase inhibitor currently approved for the treatment of multiple histological subtypes of soft tissue sarcoma(STS).Initially developed as a small molecule inhibitor of vascular endothelial growth factor receptors,preclinical work indicates that pazopanib exerts an anticancer effect through the inhibition of both angiogenic and oncogenic signaling pathways.Following the establishment of optimal dosing and safety profiles in early phase studies and approval for the treatment of advanced renal cell carcinoma,pazopanib was investigated in STS.A landmark phase III randomized study demonstrated improved progression-free survival with pazopanib compared to that with placebo in pretreated patients with STS of various subtypes.The efficacy of pazopanib in specific STS subtypes has been further described in real-world-based case series in both mixed and subtype-specific STS cohorts.At present,there are no clinically validated predictive biomarkers for use in selecting patients with advanced STS for pazopanib therapy,limiting the clinical effectiveness and cost-effectiveness of the drug.In this review,we summarize the preclinical and clinical data for pazopanib,outline the evidence base for its effect in STS and explore reported studies that have investigated putative biomarkers.
基金supported by grants from the Matthias-Lackas Foundation,the Dr.Leopold und Carmen Ellinger Foundation,the European Research Council(ERC CoG 2023#101122595)the Deutsche Forschungsgemeinschaft(DFG 458891500)+8 种基金the German Cancer Aid(DKH-70112257,DKH-7011411,DKH-70114278,DKH-70115315)the Dr.Rolf M.Schwiete foundation,the SMARCB1 association,the Ministry of Education and Research(BMBFSMART-CARE and HEROES-AYA)the Barbara and Wilfried Mohr foundation.The research team of Florencia Cidre-Aranaz was supported by the German Cancer Aid(DHK-70114111)the Dr.Rolf M.Schwiete Stiftung(2020-028 and 2022-31)supported by the Cancer Grand Challenges partnership funded by Cancer Research UK,the National Cancer Institute,the Scientific Foundation of the Spanish Association Against Cancer And KiKa(Children Cancer Free Foundation)Florian Henning Geyer,Tobias Faehling,Endrit Vinca,and Alina Ritter were supported by the German Academic Scholarship Foundation.In addition,Endrit Vinca was supported by scholarships from the Heinrich F.C.Behr foundation and the Rudolf and Brigitte Zenner foundation,Tobias Faehling by the Heinrich F.C.Behr foundationFlorian Henning Geyer and Alina Ritter are supported by the German Cancer Aid through the‘Mildred-Scheel-Doctoral Program’(DKH-70114866)This project is co-funded by the European Union(ERC,CANCER-HARAKIRI,101122595)。
文摘Desmoplastic small round cell tumor(DSRCT)is an aggressive cancer that predominantly affects adolescents and young adults,typically developing at sites lined by mesothelium[1,2].DSRCT is genetically defined by a chromosomal translocation that fuses the N-terminus of EWS RNA binding protein 1(EWSR1)to the C-terminus of Wilms tumor protein(WT1),forming EWSR1::WT1[3].This fusion encodes a potent transcription factor and is the only known driver of oncogenic transformation in DSRCT[4].The lack of a comprehensive understanding of DSRCT biology parallels its dismal survival rate(5%-20%)[1].These challenges are exacerbated by the absence of clinical trials,the limited systematic collection and analysis of DSRCT biomaterial[1],and the notable lack of specific diagnostic markers,necessitating resource-intensive molecular testing for an accurate diagnosis.
文摘Dear Editor,Sarcomas represent a heterogenous group of tumors accounting for about 1%of cancer in adults and 15%in children[1].However,despite adequate locoregional treatment,up to 40%of patients develop metastatic disease.Drugs used in the advanced setting have very limited efficacy,with a response rate of<10%and progression-free survival of<4 months and are mainly used for palliative purposes[1].It is,therefore,important to monitor individual therapy responses to avoid inefficient therapy and unnecessary toxicity.Such monitoring is currently based on repeated CT imaging which may represent an important burden for patients with advanced disease[2].
基金MSD(Merck Sharp and Dohme)AVENIR.Grant Number:HEART。
文摘To the editor Soft-tissue sarcomas(STS)represent a very heterogeneous group of rare tumors including more than 100 different subtypes[1].Surgery and neo/adjuvant radiation therapy represent the cornerstone of treatment for STS.However,despite an optimal resection of the tumor,up to 40%of patients will develop metastatic relapse and will die from the disease[1].Doxorubicin represents the first-line standard of care for patients with advanced disease since the 1970s,despite several attempts to identify better regimens.The median overall survival(OS)of patients with metastatic disease is<18 months and has only modestly improved over the past 20 years[2].
文摘Surgical resection of soft tissue sarcoma of the trunk can result in large defects requiring complex reconstruction for coverage of vital neurovascular structures and tissue defect. Large defects of the back could be reconstructed with multiple random pattern or local pedicled flaps. We present the case of a 48-year-old patient with a locally advanced dermatofibrosarcoma protuberans of the back. Wide local excision of the lesion was performed. The soft tissue defect measured 22 cm × 20 cm × 4 cm and was reconstructed with bilateral reverse latissimus dorsi myocutaneous (RLDM) flap. Each RLDM flap measured 24 cm × 10 cm. The donor site on the back was closed directly on both sides. The patient recovered well and the two flaps healed uneventfully. Twelve months after surgery the patient is disease-free. The use of a RLDM flap in mid-back reconstructions provided wide well-vascularized soft tissue, minimized risk of infection, and maximized back coverage. This flap is an excellent choice for reconstruction of large defects of the mid-back.
