Treatment and local control of primary extremity soft tissue sarcomas

Background and Objectives: Modem series of adult extremity soft tissue sarc omas utilize combinations of modalities in all patients. Remaining question s: 1) is it necessary to strive for wide margins in the multimodality era; 2) to use adjuvant therapy in every high-grade sarcoma? 3) Does previous pa rtial or marginal resection seriously interfere with the definitive resecti on? Methods: In a retrospective review of 194 extremity soft tissue sarcomas (1 977-1994), limb preservation was possible in 181/194 (93%) of cases. Patien ts with narrow margins received adjuvant radiation. Some patients were refe rred after partial (n = 39) or "complete" (n = 63) excision. Results: Local recurrence was observed in 181/141 (13%) of patients treated with wide or compartmental resection, and in 10 of 42 (24%) of those treat ed with conservative resection plus radiation (P = 0.14). The 5-year surviv al rate for grade III, greater than or equal to 5-cm sarcomas was not signi ficantly different (P = 0.82) with adjuvant (46%) or without (48%) adjuvant systemic chemotherapy. Five-year survival varied(P = 0.0001) according to grade. Patients referred with partial, or "complete" (63%, 38/63, had resid ual tumor at reoperation) excision had a local recurrence rate of 8% and 6% , and 5-year survival rates of 75% and 84%, respectively. Conclusions: 1) It is important to strive for wide margins even when adjuva nt radiation is intended. 2) When a wide margin is possible, adjuvant radia tion may not be necessary. 3) Adjuvant systemic chemotherapy may be conside red for high-grade tumors, preferably within a prospective protocol. 4) A p artial or "complete" excision of the tumor before referral to a tertiary ce nter does not appear to compromise the limb preservation, local control, or survival rates of these patients. (C) 1999 Wiley-Liss, Inc.