Abstract
Background: Among deep extremity soft tissue sarcomas, skin ulceration is infrequent. Fungating sarcomas may lead to infection or clinically significant bleeding. Data regarding management of ulcerating sarcomas is lacking. We sought to evaluate the outcomes of different treatments for these tumors.Patients and methods: A retrospective review of patients treated at two sarcoma referral centers with histologically confirmed extremity soft tissue sarcoma was performed from 2000-2018. Patient demographics, clinicopathologic, and treatment factors were analyzed in terms of method of resection, receipt of radiation, and wound complications.Results: Overall, 22 patients had fungating lesions. Most patients were male with tumors of the distal extremity.Median tumor size was 8 cm. Half had undifferentiated pleomorphic sarcoma histology, followed by myxofibrosarcoma (n=5), leiomyosarcoma (n=3), or other (n=3). Fifteen patients (68%) underwent limb-preserving resection, of which 7 underwent adjuvant radiation. Six patients (27%) developed wound complications, which occurred equally between amputation versus local excision (p = 0.93). Among local excision patients, one who received adjuvant radiation developed a wound complication (14%), which was not significantly different from those who did not undergo radiation (n=3 of 8, 38%; p = 0.31).Conclusions: Similar rates of wound complications were seen between amputation and limb-preserving groups.Among patients who underwent local excision, the administration of adjuvant radiation therapy did not significantly increase wound complication rates.
Highlights
Soft tissue sarcoma represents 1% of all malignancies in adults, half of which originate in the extremity [1]
Examples of fungating extremity sarcomas are shown in figure 1
This study demonstrates that among patients with fungating soft tissue sarcoma of the extremity, the development of wound complications was not significantly affected by method of resection or administration of adjuvant radiation
Summary
Soft tissue sarcoma represents 1% of all malignancies in adults, half of which originate in the extremity [1]. Wound complications are more common with neoadjuvant radiation therapy, which is a significant consideration in the setting of increasing tumor sizes. Clinicopathologic, and treatment factors were analyzed in terms of method of resection, receipt of radiation, and wound complications. Six patients (27%) developed wound complications, which occurred between amputation versus local excision (p = 0.93). One who received adjuvant radiation developed a wound complication (14%), which was not significantly different from those who did not undergo radiation (n=3 of 8, 38%; p = 0.31). Among patients who underwent local excision, the administration of adjuvant radiation therapy did not significantly increase wound complication rates
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