INFLUENCE OF SURGICAL MARGINS ON OUTCOME IN PATIENTS WITH PREOPERATIVELY IRRADIATED EXTREMITY SOFT-TISSUE SARCOMAS

Background, Limb-sparing surgery for soft tissue sarcomas of the extre mities may result in microscopically positive surgical margins. The co nsequences of these microscopically positive margins are unknown. We h ave analyzed the influence of surgical margins on local disease contro l and overall survival in patients with extremity soft tissue sarcomas who received preoperative radiation therapy followed by limb-sparing surgery. Methods. Ninety-five consecutive patients with intermediate a nd high grade extremity sarcomas who received preoperative radiation t herapy and limb-sparing surgery were identified from a soft tissue sar coma database. The clinical outcome of 24 patients who had microscopic ally positive surgical margins was compared with that of 71 patients w ho had clear surgical margins. Results. Multivariate statistical analy sis revealed that patients with microscopically positive surgical marg ins or intraoperative tumor violation had an increased risk for local failure. High grade, large size, and intraoperative violation of the t umors were associated with decreased overall survival. However, neithe r the presence of a positive surgical margin nor the occurrence of a l ocal failure adversely affected overall survival. Conclusions. Achievi ng negative surgical margins in patients with intermediate and high gr ade extremity sarcomas enhances local disease control but does not mea surably improve overall survival. These data should be factored into p atient management decisions in cases where the goal of achieving clear surgical margins requires amputation or the significant functional co mpromise of the extremity.