Extremity soft-tissue sarcomas selectively treated with surgery alone.

Abstract

This study determined local control (LC), freedom from distant recurrence (FFDR), overall survival (OS), and potential prognostic factors in 34 adult patients with primary extremity or limb girdle soft-tissue sarcoma selectively managed with limb-conservation surgery alone. The medical records of 34 patients who underwent surgery alone for localized soft-tissue sarcoma of the extremity were reviewed. Median duration of follow-up in survivors was 55 months (range, 24-143). There were 13 (38%) females. Eighteen (53%) of the tumors were low-grade, 15 (44%) were superficial, 15 (44%) were small (5 cm or less), and 16 (47%) involved the distal extremity. Actuarial 5-year LC was 80%, FFDR was 86%, and OS was 82%. All recurrences (local and distant) were in patients with high-grade tumors; their 5-year LC was 60%, FFDR was 71%, and OS was 69%. In 2 patients, metastatic disease developed either concurrent with or after their local recurrence. Univariate analysis revealed better OS, FFDR, and LC for patients with low-grade tumors (p < 0.05). Female patients had significantly better FFDR and OS (p < 0.05). It is appropriate to consider withholding irradiation for selected patients with low-grade tumors resected with negative margins if, in the event of a local failure, a function-preserving surgical salvage is anticipated. For patients with high-grade sarcomas, the control of local and distant disease was not acceptable with limb-conservation surgery alone.