847 Conservative local treatment by multimodality therapy in 361 adults’ soft tissue sarcoma (STS)

Abstract

Methods From 1975 to 1992,361 patients (pts) had their initial treatment at Institut Bergonie for non metastatic STS. There were 210 males and 151 females at a mean age of 50 years (16–87 years). 59% of the tumours were localized in the extremities. All pathological slides have been centrally reviewed. Grading according to the FNCLCC system was: G1 (18%), G2 (44%), G3 (38%). The local treatment combined surgery and radiotherapy in 83% of the cases. Surgery was conservative when possible. Marginal surgery was performed in 45% of the cases, wide excision in 48%. Compartmental radiotherapy was performed at a dose of 50 Gy, associated with a local boost (external beam, intraoperative or brachytherapy) when surgery was marginal. Chemotherapy was given in 126 pts (35%), in 60 of whom preoperatively. Results Amputation was necessary in only 7 pts (2%). Complete remission was obtained in 97.5%. Severe local complications occurred in 26 patients (7.2%). With a median follow-up of 6 years (1–20 years) local recurrence occurred in 21. 4% of the cases, and metastasis in 28.7%. Actuarial 5-year overall and disease free survival are 66% and 59%. The function of the treated members was good in 92% of the pts. In univariate analysis, no difference was seen in local recurrence after marginal vs large excision when radiotherapy was done. Conclusion These treatment results compare favourably to those found in the literature. Satisfying functional outcome without amputation can be obtained by a multidisciplinary treatment approach.