Combined Limb-Sparing Surgery and Radiation Therapy to Treat Sarcomas of the Hands and Feet: Long-Term Cancer Outcomes and Morbidity

Abstract

The purpose of this study was to investigate local control, survival outcomes, and complication rates of patients treated with limb-sparing surgery and radiation therapy (RT) for soft tissue sarcomas (STS) of the hands and feet. We reviewed the medical records of 85 consecutive patientstreated for STS of the hands (n=38, 45%) and feet (n=47, 55%) between 1966 and 2012. The median age was 41years (range, 10-82years of age). Sixty-seven patients (79%) received postoperative RT after resection of their tumor (median dose, 60Gy; range, 45-70Gy). The remaining 18 patients (21%) were treated withpreoperative RT followed by tumor resection (median dose, 50Gy; range, 50-64Gy). Median follow-up was 140months (range, 24-442months). Five-year localcontrol, overall survival, and disease-specific survival rates were 86%, 89%,and 89%, respectively. Positive or uncertain surgical margin status was the onlyfactor adversely associated with local recurrence (19% vs 6% for negative margins,P=.046) but this lost significance on multivariate analysis when adjusting forRT dose ≥64Gy. Of the 12 patients who had local relapses, 6 (50%) were salvaged, and only 2 of those required salvage amputation. Five patients had grade≥3 late RT sequelae, with 2 patients (2%) having moderate limitations of limb function and 3 patients (4%) having severe limitations requiring procedures for skin ulceration. Limb-sparing surgery combined with RT provides excellent local control outcomes for sarcomas arising in the hands or feet. In patients who have local recurrence, salvage without amputation is possible. The excellent cancer control outcomes observed, considering the minimal impact on limb function, support use of combined modality, limb-sparing local therapy for STS arising in the hands or feet.