Treatment and local control of primary extremity soft tissue sarcomas

✍ Scribed by Karakousis, Constantine P.; Driscoll, Deborah L.

• Publisher: John Wiley and Sons
• Year: 1999
• Tongue: English
• Weight: 81 KB
• Volume: 71
• Category: Article
• ISSN: 0022-4790
• DOI: 10.1002/(sici)1096-9098(199907)71:3<155::aid-jso4>3.0.co;2-7

✦ Synopsis

Background and Objectives: Modern series of adult extremity soft tissue sarcomas utilize combinations of modalities in all patients. Remaining questions: 1) is it necessary to strive for wide margins in the multimodality era; 2) to use adjuvant therapy in every high-grade sarcoma? 3) Does previous partial or marginal resection seriously interfere with the definitive resection? Methods: In a retrospective review of 194 extremity soft tissue sarcomas (1977)(1978)(1979)(1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994), limb preservation was possible in 181/194 (93%) of cases. Patients with narrow margins received adjuvant radiation. Some patients were referred after partial (n ‫ס‬ 39) or "complete" (n ‫ס‬ 63) excision. Results: Local recurrence was observed in 181/141 (13%) of patients treated with wide or compartmental resection, and in 10 of 42 (24%) of those treated with conservative resection plus radiation (P ‫ס‬ 0.14). The 5-year survival rate for grade III, Ն5-cm sarcomas was not significantly different (P ‫ס‬ 0.82) with adjuvant (46%) or without (48%) adjuvant systemic chemotherapy. Five-year survival varied (P ‫ס‬ 0.0001) according to grade. Patients referred with partial, or "complete" (63%, 38/63, had residual tumor at reoperation) excision had a local recurrence rate of 8% and 6%, and 5-year survival rates of 75% and 84%, respectively. Conclusions: 1) It is important to strive for wide margins even when adjuvant radiation is intended. 2) When a wide margin is possible, adjuvant radiation may not be necessary. 3) Adjuvant systemic chemotherapy may be considered for high-grade tumors, preferably within a prospective protocol. 4) A partial or "complete" excision of the tumor before referral to a tertiary center does not appear to compromise the limb preservation, local control, or survival rates of these patients.