Paratesticular sarcoma: Failure patterns after definitive local therapy

Purpose: We examine disease control and patterns of failure for patients wi th adult paratesticular sarcoma treated with wide repeat excision and posto perative radiation for close margins. Materials and Methods: A retrospective analysis was performed on 14 patient s with paratesticular sarcomas referred to 1 institution from 1988 to 1995. Results: Median followup was 50 months (range 26 to 90). Pathology review r evealed malignant fibrous histiocytoma in 5 cases and liposarcoma in 3. Tum or grade was high in 8 cases. Microscopic residual disease was identified a fter repeat excision in 3 of 11 completely excised cases (27%). Cause speci fic survival 5 years after diagnosis was 70%. Both patients with local fail ure after wide excision had undergone initial intralesional excision and 1 had also received postoperative irradiation In 5 patients metastases develo ped in the liver, lung, nodes or multiple sites 0 to 60 months after diagno sis. Conclusions: Simple excision is inadequate treatment for paratesticular sar coma, since wide repeat excision revealed microscopic residual disease in 2 7% of completely excised cases. The 2 local failures occurred in patients w ith a history of inadvertent intralesional surgery, which may be a risk fac tor for local relapse after wide repeat excision; Adjuvant radiation should be considered for those patients as well as those with narrow repeat resec tion margins. Systemic failure was frequent in patients with high grade tum ors, who will require effective systemic adjuvant therapy.