Abstract
Sarcomas are clustered in two oncological entities named bone and soft tissue sarcomas. Both are rare cancers originating from the mesenchyme, characterized by their propensity to induce the development of lung metastases. Sarcoma cells escaping from the primary tumor site spread to the pulmonary tissue through the bloodstream where they found a favorable microenvironment to establish metastatic foci. The low number of patients, the high histological, genetic, and molecular heterogeneity of sarcomas combined with the absence of specific markers expressed by cancer cells make the detection and follow-up of the minimal residual disease challenging. Over the last decade, tremendous technological progress has been made towards the detection of recurrent diseases. The literature is now enriched of information describing the use of liquid biopsies in clinical care of sarcoma patients. This chapter aims to give a brief overview of the most recent data available on the detection of circulating tumor cells and circulating tumor DNA in sarcomas.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
WHO Classification of Tumours Editorial Board. Soft tissue and bone tumours, WHO classification of tumours series, vol. 3. 5th ed. Lyon: International Agency for Research on Cancer; 2020.
Grünewald TG, Alonso M, Avnet S, Banito A, Burdach S, Cidre-Aranaz F, Di Pompo G, Distel M, Dorado-Garcia H, Garcia-Castro J, González-González L, Grigoriadis AE, Kasan M, Koelsche C, Krumbholz M, Lecanda F, Lemma S, Longo DL, Madrigal-Esquivel C, Morales-Molina Á, Musa J, Ohmura S, Ory B, Pereira-Silva M, Perut F, Rodriguez R, Seeling C, Al Shaaili N, Shaabani S, Shiavone K, Sinha S, Tomazou EM, Trautmann M, Vela M, Versleijen-Jonkers YM, Visgauss J, Zalacain M, Schober SJ, Lissat A, English WR, Baldini N, Heymann D. Sarcoma treatment in the era of molecular medicine. EMBO Mol Med. 2020;12:e11131.
Brown HK, Schiavone K, Gouin F, Heymann MF, Heymann D. Biology of bone sarcomas and new therapeutic developments. Calcif Tissue Int. 2018;102(2):174–95.
Pennacchioli E, Tosti G, Barberis M, De Pas TM, Verrecchia F, Menicanti C, Testori A, Mazzarol G. Sarcoma spreads primarily through the vascular system: are there biomarkers associated with vascular spread? Clin Exp Metastasis. 2012;29(7):757–73.
Nicolini A, Rossi G, Ferrari P, Carpi A. Minimal residual disease in advanced or metastatic solid cancers: The G0-G1 state and immunotherapy are key to unwinding cancer complexity. Semin Cancer Biol. 2020;21:1054.
Vallette FM, Olivier C, Lézot F, Oliver L, Cochonneau D, Lalier L, Cartron PF, Heymann D. Dormant, quiescent, tolerant and persister cells: four synonyms for the same target in cancer. Biochem Pharmacol. 2019;162:169–76.
Alix-Panabières C, Schwarzenbach H, Pantel K. Circulating tumor cells and circulating tumor DNA. Annu Rev Med. 2012;63:199–215.
Cortés-Hernández LE, Eslami-S Z, Alix-Panabières C. Circulating tumor cells as the functional aspect of liquid biopsy to understand the metastatic cascade in solide cancer. Mol Asp Med. 2020;72:100816.
Coombs CC, Dickherber T, Crompton BD. Chasing ctDNA in patients with sarcoma. Am Soc Clin Oncol Educ Book. 2020;40:e351–60.
Tellez-Gabriel M, Brown HK, Young R, Heymann MF, Heymann D. The challenges of detecting circulating tumor cells in sarcoma. Front Oncol. 2016;6:202.
Gabriel MT, Calleja LR, Chalopin A, Ory B, Heymann D. Circulating tumor cells: a review of non-EpCam-based approaches for cell enrichment and isolation. Clin Chem. 2016;62(4):571–81.
Hayashi M, Zhu P, McCarty G, Meyer CF, Pratilas CA, Levin A, Morris CD, Albert CM, Jackson KW, Tang CM, Loeb DM. Size-based detection of sarcoma circulating tumor cells and cell clusters. Oncotarget. 2017;8(45):78,965–77.
Li H, Meng QH, Noh H, Batth IS, Somaiah N, Torres KE, Xia X, Wang R, Li S. Detection of circulating tumor cells from cryopreserved human sarcoma peripheral blood mononuclear cells. Cancer Lett. 2017;403:216–23.
Benini S, Gamberi G, Cocchi S, Garbetta J, Alberti L, Righi A, Gambarotti M, Picci P, Ferrari S. Detection of circulating tumor cells in liquid biopsy from Ewing sarcoma patients. Cancer Manag Res. 2018;10:49–60.
Chinen LTD, Mello CAL, Abdallah EA, Ocea LM, Buuim ME, Breve NM, Junior JLG, Fanelli MF, Paterlini-Brechot P. Isolation, detection, and immunomorphological characterization of circulating tumor cells (CTCs) from patients with different types of sarcoma using isolation by size of tumor cells: a window on sarcoma-cell invasion. Onco Targets Ther. 2014;7:1609–17.
Braun AC, de Mello CAL, Corassa M, Abdallah EA, Urvanegia AC, Alves VS, Flores BCTCP, Díaz M, Nicolau UR, Silva VSE, Calsavara V, Paterlini-Brechót P, Chinen LTD. EGFR expression in circulating tumor cells from high-grade metastatic soft tissue sarcomas. Cancer Biol Ther. 2018;19(6):454–60.
Mihály D, Nagy N, Papp G, Pápai Z, Sápi Z. Release of circulating tumor cells and cell-free nucleic acids is an infrequent event in synovial sarcoma: liquid biopsy analysis of 15 patients diagnosed with synovial sarcoma. Diagn Pathol. 2018;13(1):81.
Przybyl, van de Rijn M, Rutkowski P. Detection of SS18-SSX1/2 fusion transcripts in circulating tumor cells of patients with synovial sarcoma. Diagn Pathol. 2019;14(1):24.
West DC, Grier HE, Swallow MM, Demetri GD, Granowetter L, Sklar J. Detection of circulating tumor cells in patients with Ewing's sarcoma and peripheral primitive neuroectodermal tumor. J Clin Oncol. 1997;15(2):583–8.
Schleiermacher G, Peter M, Oberlin O, Philip T, Rubie H, Mechinaud F, Sommelet-Olive D, Ladman-Parker J, Bours D, Michon J, Delattre O. Société Française de Pédiatrie. Increased risk of systemic relapses associated with bone marrow micrometastasis and circulating tumor cells in localized Ewing tumor. J Clin Oncol. 2003;21(1):85–91.
Avigad S, Cohen IJ, Ziberstein J, Liberzon E, Goshen Y, Ash S, Meller I, Kollender Y, Issakov J, Zaizov YI. The predictive potential of molecular detection in the nonmetastatic Ewing family of tumors. Cancer. 2004;100(5):1053–8.
Fagnou C, Michon J, Peter M, Bernoux A, Oberlin O, Zucker JM, Magdelenat H, Delattre O. Presence of tumor cells in bone marrow but not in blood is associated with adverse prognosis in patients with Ewing’s tumor. Société Française d'Oncologie Pédiatrique. J Clin Oncol. 1998;16(5):1707–11.
Peter M, Madgelenat H, Michon J, Melot T, Oberlin O, Zucker JM, Thomas G, Delattre O. Sensitive detection of occult Ewing’s cells by the reverse transcriptase-polymerase chain reaction. Br J Cancer. 1995;72(1):96–100.
Zoubek A, Ladenstein R, Windhager R, Amann G, Fischmeister G, Kager L, Jugovic D, Ambros PF, Gadner H, Kovar H. Predictive potential of testing for bone marrow involvement in Ewing tumor patients by RT-PCR: a preliminary evaluation. Int J Cancer. 1998;79(1):56–60.
Satelli A, Mitra A, Cutrera JJ, Devarie M, Xia X, Ingram DR, Dibra D, Somaiah N, Torres KE, Ravi V, Ludwig JA, Kleinerman ES, Li S. Universal marker and detection tool for human sarcoma circulating tumor cells. Cancer Res. 2014;74(6):1645–50.
Wong IH, Chan AT, Johnson PJ. Quantitative analysis of circulating tumor cells in peripheral blood of osteosarcoma patients using osteoblast-specific messenger RNA markers: a pilot study. Clin Cancer Res. 2000;6(6):2183–8.
Hatano H, Kawashima H, Ogose A, Hotta T, endo N. A PCR-ELISA assay for the detection of disseminated osteosarcoma cells in a mouse metastatic model. J Orthop Sci. 2001;6(3):269–75.
Chalopin A, Tellez-Gabriel M, Brown HK, Vallette F, Heymann MF, Gouin F, Heymann D. Lsolation of circulating tumor cells in a preclinical model of osteosarcoma: effect of chemotherapy. J Bone Oncol. 2018;12:83–90.
Hasegawa N, Nakamura IT, Ueno T, Kojima S, Kawazu M, Akaike K, Okubo T, Takagi T, Suehara Y, Hayashi T, Saito T, Kaneko K, Kohsaka S. Detection of circulating sarcoma tumor cells using a microfluidic chip-type cell sorter. Sci Rep. 2019;9(1):20047.
Hoshino M, Ogose A, Kawasima H, Izumi T, Hotta T, Hatano H, Morita T, Otsuka H, Yanoma S, Tsukuda M, Endo N. Molecular analyses of cell origin and detection of circulating tumor cells in the peripheral blood in alveolar soft part sarcoma. Cancer Genet Cytogenet. 2009;190(2):75–80.
Balasubramanian P, Kinders RJ, Kummar S, Gupta V, Hasegawa D, Menachery A, Lawrence SM, Wang L, Ferry-Galow K, Davis D, Parchment RE, Tomaszewski JE, Doroshow JH. Antibody-independent capture of circulating tumor cells of non-epithelial origin with the ApoStream® system. PLoS One. 2017;12(4):e0175414.
Kelly KM, Womer RB, Barr FG. Minimal disease detection in patients with alveolar rhabdomyosarcoma using a reverse transcriptase-polymerase chain reaction method. Cancer. 1996;78(6):1320–7.
Li H, Meng QH, Noh H, Somaiah N, Torres KE, Xia X, Batth IS, Joseph CP, Liu M, Wang R, Li S. Cell-surface vimentin-positive macrophage-like circulating tumor cells as a novel biomarker of metastatic gastrointestinal stromal tumors. Onco Targets Ther. 2018;7(5):e1420450.
Zheng Y, Zhang J, Huang M, Wang T, Qu X, Wu L, Song J, Wang W, Song Y, Yang C. selection of aptamers against vimentin for isolation and release of circulating tumor cells undergoing epithelial mesenchymal transition. Anal Chem. 2020;92(7):5178–84.
Martín-Broto J, Pousa AL, Brohl AS, Van Tine BA, Powers B, Stacchiotti S, Blay JY, Hu JS, Oakley GJ 3rd, Wang H, Szpurka AM, Levy DE, Mo G, Ceccarelli M, Jones RL. Circulating tumor cells and biomarker modulation with Olaratumab monotherapy followed by Olaratumab plus doxorubucin : phase Ib study in patients with soft-tissue sarcoma. Mol Cancer Ther. 2021;20:132–41.
Satelli A, Brownlee Z, Mitra A, Meng QH, Li S. Circulating tumor cell enumeration with a combination of epithelial cell adhesion molecule- and cell-surface vimentin-based methods for monitoring breast cancer therapeutic response. Clin Chem. 2015;61(1):259–66.
Chen M, Zhao H. Next-generation sequencing in liquid biopsy: cancer screening and early detection. Hum Genomics. 2019;13:34.
Volckmar AL, Sültmann H, Riediger A, Fioretos T, Schirmacher P, Endris V, Stenzinger A, Dietz S. A field guide for cancer diagnostics using cell-free DNA: from principles to practice and clinical applications. Genes Chromosomes Cancer. 2018;57:123–39.
Coombs CC, Dicherber T, Crompton BD. Chasing ctDNA in patients with sarcoma. Am Soc Clin Oncol Educ Book. 2020;40:e351–60.
Namlos HM, Boye K, Meza-Zepeda LA. Cell-free DNA in blood as a noninvasive insight into the sarcoma genome. Mol Aspect Med. 2020;72:100827.
Barris DM, Weiner SB, Dubin RA, Fremed M, Zhang X, Piperdi S, Zhang W, Maqbool S, Gill J, Roth M, Hoang B, Geller D, Gorlick R, Weiser DA. Detection of circulating tumor DNA in patients with osteosarcoma. Oncotarget. 2018;9:12695–704.
Gutteridge A, Rathbone VM, Gibbons R, Bi M, Archard N, Davies KEJ, Brown J, Plagnol V, Pillay N, Amary F, O’Donnell GM, Tirabisco R, Flanagan AM, Forshew T. Digital PCR analysis of circulating tumor DNA: a biomarker for chondrosarcoma diagnosis, prognostication, and residual disease detection. Cancer Med. 2017;6:2194–202.
Shukla NN, Patel JA, Magnan H, Zehir A, You D, Tang J, Meng F, Samoila A, Slotkin EK, Ambati SR, Chou AJ, Wexler LH, Meyers PA, Peerschke EI, Viale A, Berger MF, Ladanyi M. Plasma DNA-based molecular diagnosis, prognostication, and monitoring of patients with EWSR1 fusion-positive sarcomas. JCO Precis Oncologia. 2017;2017:PO.16.00028.
Boonstra PA, Ter Elst A, Tibbesma M, Bosman LJ, Mathijssen R, Atrafi F, van Coevorden F, Steeghs N, Farag S, Gelderblom H, van der Graaf WTA, Desar OME, Maier J, Overbosch J, Suurmeijer AJH, Gitema J, Schuuring E, Reuners AKL. A single digital droplet PCR assay to detect multiple KIT exon 11 mutations in tumor and plasma from patients with gastrointestinal stromal tumors. Oncotarget. 2018;9:13870–83.
Eastley NC, Ottolini B, Neumann R, Luo JL, Hastings RK, Khan I, Moore DA, Esler CP, Shaw JA, Royle NJ, Ashford RU. Circulating tumour-derived DNA in metastatic soft tissue sarcoma. Oncotarget. 2018;9:10549–60.
Namløs HM, Boye K, Mishkin SJ, Barøy T, Lorenz S, Bjerkehagen B, Stratford EW, Munthe E, Kudlow BA, Myklebost O, Meza-Zepeda LA. Noninvasive detection of ctDNA reveals intratumor heterogeneity and is associated with tumor burden in gastrointestinal stromal tumor. Mol Cancer Ther. 2018;17:2473–80.
Ogino S, Konishi H, Ichikawa D, Hamada J, Shoda K, Arita T, Komatsu S, Shiozaki A, Okamoto K, Yamazaki S, Yaskuwa S, Konishi E, Otsuji E. Detection of fusion gene in cell-free DNA of a gastric synovial sarcoma. World J Gastroenterol. 2018;24:949–56.
Shulman DS, Klega K, Imamovic-Tuco A, Clapp A, Nag A, Thorner AR, Van Allen E, Ha G, Lessnick SL, Gorlick R, et al. Detection of circulating tumour DNA is associated with inferior outcomes in Ewing sarcoma and osteosarcoma: a report from the Children’s Oncology Group. Br J Cancer. 2018;2018(119):615–21.
Maier J, Lange T, Kerle I, Specht K, Bruegel M, Wickenhauser C, Jost P, Niederwieser D, Peschel C, Duyster J, von Bubnoff N. Detection of mutant free circulating tumor DNA in the plasma of patients with gastrointestinal stromal tumor harboring activating mutations of CKIT or PDGFRA. Clin Cancer Res. 2013;19:4854–67.
Yoo C, Ryu MH, Na YS, Ryoo BY, Park SR, Kang YK. Analysis of serum protein biomarkers, circulating tumor DNA, and dovitinib activity in patients with tyrosine kinase inhibitor-refractory gastrointestinal stromal tumors. Ann Oncol. 2014;25:2272–7.
Krumbholz M, Hellberg J, Steif B, Bäuerle T, Gillmann C, Fritscher T, Agaimy A, Frey B, Juengert J, Wardelmann E, Hartmann W, Juergens H, Dirksen U, Metzler M. Genomic EWSR1 fusion sequence as highly sensitive and dynamic plasma tumor marker in Ewing sarcoma. Clin Cancer Res. 2016;22:4356–65.
Snyder MW, Kircher M, Hill AJ, Daza RM, Shendure J. Cell-free DNA comprises an in vivo nucleosome footprint that informs its tissues-of-origin. Cell. 2016;164:57–68.
Ulz P, Auer M, Heitzer E. Detection of circulating tumor DNA in the blood of cancer patients: an important tool in cancer chemoprevention. Methods Mol Biol. 2016;1379:45–68.
Riggi N, Knoechel B, Gillespie SM, Rheinbay E, Boulay G, Suvà ML, Rossetti NE, Boonseng WE, Oksuz O, Cook EB, Formey A, Patel A, Gymrek M, Thapar V, Deshpande V, Ting DT, Hornicek FJ, Nielsen GP, Stamenkovic I, Aryee MJ, Bernstein BE, Rivera MN. EWS-FLI1 utilizes divergent chromatin remodeling mechanisms to directly activate or repress enhancer elements in Ewing sarcoma. Cancer Cell. 2014;26(5):668–81.
Sheffield NC, Pierron G, Klughammer J, Datlinger P, Schönegger A, Schuster M, Hadler J, Surdez D, Guillemot D, Lapouble E, Freneaux P, Champigneulle J, Bouvier R, Walder D, Ambros IM, Hutter C, Sorz E, Amaral AT, de Alava E, Schallmoser K, Strunk D, Rinner B, Liegl-Atzwanger B, Huppertz B, Leithner A, de Pinieux G, Terrier P, Laurence V, Michon J, Ladenstein R, Holter W, Windhager R, Dirksen U, Ambros PF, Delattre O, Kover H, Bock C, Tomazou EM. DNA methylation heterogeneity defines a disease spectrum in Ewing sarcoma. Nat Med. 2017;23:386–95.
Tomazou EM, Sheffield NC, Schmidl C, Schuster M, Schönegger A, Datlinger P, Kubicek S, Bock C, Kovar H. Epigenome mapping reveals distinct modes of gene regulation and widespread enhancer reprogramming by the oncogenic fusion protein EWS-FLI1. Cell Rep. 2015;10:1082–95.
Keller L, Pantel K. Unravelling tumour heterogeneity by single-cell profiling of circulating tumour cells. Nat Rev Cancer. 2019;19(10):553–67.
Brown HK, Tellez-Gabriel M, Cartron PF, Vallette FM, Heymann MF, Heymann D. Characterization of circulating tumor cells as a reflection of the tumor heterogeneity: myth or reality? Drug Discov Today. 2019;24(3):763–72.
Paoletti C, Cani AK, Larios JM, Hovelson DH, Aung K, Darga EP, Cannell EM, Baratta PJ, Liu CJ, Chu D, Yazdani M, Blevins AR, Sero V, Tokudome N, Thomas DG, Gersch C, Schott AF, Wu YM, Lonigro R, Robinson DR, Chinnaiyan AM, Bischoff FZ, Johnson MD, Park BH, Hayes DF, Rae JM, Tomlins SA. Comprehensive mutation and copy number profiling in archived circulating breast cancer tumor cells. Cancer Res. 2018;78(4):1110–22.
Wu ZJ, Tan JC, Qin X, Liu B, Yuan ZC. Significance of circulating tumor cells in osteosarcoma patients treated by neoadjuvant chemotherapy and surgery. Cancer Manag Res. 2018;10(10):3333–9.
Tellez-Gabriel M, Heymann MF, Heymann D. Circulating tumor cells as a tool for assessing tumor heterogenetity. Theranostics. 2019;9(16):4580–94.
Tellez-Gabriel M, Cochonneau D, Cadé M, Jubellin C, Heymann MF, Heymann D. Circulating tumor cell-derived pre-clinical models for personalized medicine. Cancers (Basel). 2018;11(1):19.
Acknowledgments
The authors are also grateful to M. Clément Heymann for reviewing the English style.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Jubelin, C., Cochonneau, D., Moranton, E., Muñoz-Garcia, J., Heymann, D. (2022). Circulating Tumor Cells and ctDNA in Sarcomas. In: Leong, S.P., Nathanson, S.D., Zager, J.S. (eds) Cancer Metastasis Through the Lymphovascular System. Springer, Cham. https://doi.org/10.1007/978-3-030-93084-4_12
Download citation
DOI: https://doi.org/10.1007/978-3-030-93084-4_12
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-93083-7
Online ISBN: 978-3-030-93084-4
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)