OUTCOME AND PROGNOSTIC FACTORS IN SOFT-TISSUE SARCOMA IN THE ADULT

Purpose: To evaluate the outcome, patterns of failure and prognostic f actors in this rare disease in adult patients treated at a single inst itution in the modern era. Methods and Materials: The records of all p atients (389 cases) with soft tissue sarcoma in the extremities, torso (excluding retroperitoneum), and head and neck managed between 1980 a nd 1988 were reviewed. A curative (radical) approach was used in 321 p atients of whom 10% were recurrent lesions. The local management consi sted of surgery alone in 54 cases, surgery and radiotherapy in 250 and radiotherapy alone in 17. Adjuvant chemotherapy was used as a policy for high grade lesions in the initial five years of the study (98 case s), but was omitted subsequently. Results: Extremity lesions fared mor e favourably compared to head and neck and torso lesions (p = 0.02) wi th respect to survival. Extremity and torso lesions had significantly better local control (p < 0.0001) than in the head and neck where loca l failure was a common cause of death. A multiple Cox regression analy sis revealed that resection margins, local extension of tumor, age at diagnosis, and grade correlated with local relapse and distant relapse was also associated with local extension, high grade and in addition, large lesions. Size appeared especially predictive for distant failur e, the most common cause of death. Distant failure was not influenced by the use of adjuvant chemotherapy. Patients treated for recurrence i n this series had significantly worse survival due to increased distan t failure despite similar local control to primary cases. Conclusion: This series highlights the overall problem of distant failure in this disease. It also reaffirms the importance of obtaining local control b oth in the head and neck, where uncontrolled local disease is the majo r cause of death, and in general since local relapse appears to increa se the risk of distant failure. It appears that the current staging sy stems should be reviewed in the light of the apparent effect of differ ent prognostic factors.