Abstract
Purpose. Limb-sparing surgery combined with radiation treatment has become the accepted treatment for patients with high-grade soft-tissue sarcoma. Adjuvant radiation was not routinely used at this institution for patients with clear margins after surgery.This retrospective review analyses the outcome of this group of patients. Patients and methods. Patients studied were referred from 1984 to 1995, were over 16 years of age, were diagnosed with primary high-grade soft-tissue sarcoma of the extremity or superficial trunk, had clear margins after excision and did not receive radiation as a part of their initial treatment. A total of 46 patients were identified. Results. At 5 years, the local control rate was 87%, disease-specific survival was 75% and overall survival was 68%. Of the 6 local recurrences, 3 were located in the buttock (from a total of 7 patients with primary tumours of the buttock), 3 had a primary size of ≥ 10 cm (from a total of 8 primary tumours of that size) and all were deep tumours. Discussion. Our data, and those from other reports, suggest that in carefully selected patients appropriate surgery alone results in acceptable local control and survival, and that the morbidity of radiation can be avoided.
Highlights
Soft tissue sarcomas (STSs) are rare neoplasms, accounting for approximately 1% of cancer cases diagnosed annually in the USA.[1]
The treatment of the primary site continues to be re® ned with the development of newer surgical and radiation techniques.With surgical treatment alone, local recurrence (LR) rates are clearly related to the extent of surgery
After amputation orradical’ local excision, LR rates of 2± 13% are reported, compared with substantially higher LR rates with less radical surgery.2,3There are many reports demonstrating acceptable LR rates after limb-sparing wide local excision (WLE) combined with pre- or post-operative radiation treatment.3± 8 Currently, most cancer treatment centres have adopted limb-sparing surgery and adjuvant radiation as the treatment of choice for STS, and amputation for primary treatment is recommended for very few patients.[9,10]
Summary
Soft tissue sarcomas (STSs) are rare neoplasms, accounting for approximately 1% of cancer cases diagnosed annually in the USA.[1] The treatment of the primary site continues to be re® ned with the development of newer surgical and radiation techniques.With surgical treatment alone, local recurrence (LR) rates are clearly related to the extent of surgery. The use of adjuvant radiation, is associated with added morbidity that is not insigni® cant. Complications including fracture, oedema, contracture and poor wound healing have been reported.[11] Because of the morbidity associated with adjuvant radiation, it has not been used routinely at our institution in the management of primary STS. Our practice has been to employ limb-sparing WLE without radiation therapy for patients with negative margins following surgery. The purpose of this study is to review the outcome of 46 patients with highgrade STS of the extremity or super® cial trunk treated in this fashion
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