Long-term outcomes after function-sparing surgery without radiotherapy forsoft tissue sarcoma of the extremities and trunk

Purpose: To define the rate of local recurrence (LR) and identify prognosti c factors for LR for patients with soft tissue sarcoma (STS) treated with f unction-sparing surgery (FSS) without radiotherapy (RT). Patients and Methods: Between 1970 and 1994, 242 patients with STS of the t runk and extremity presented with primary localized disease, 74 of whom wer e treated with FSS without RT (31%). The median tumor size was 4 cm (range, 0.5 to 31 cm), There were 40 patients with grade 1 tumors and 34 with grad e 2 and 3 tumors. Median follow-up was 126 months. Results: The 10-year actuarial local control rate was 93% +/- 4%, Resection margin status was ct significant predictor for LR. patients with closest h istologic resection margins of less than 1 cm herd a 10-year local control rate of 87% +/- 6% compared with 100% for patients with closest histologic resection margins of greater than or equal to 1 cm (P = .04). There was no significant association between LR and tumor grade, size, site (truncal v e xtremity), or depth (superficial v deep). For all patients, the 10-year act uarial survival rate was 73% +/- 6%. Conclusion: The 7% LR rate after treatment of STS with FSS without RT repor ted herein is comparable to published rates following treatment where adjuv ant RT is used. These results suggest there may be a select subset of patie nts with STS in whom carefully per formed FSS may serve as definitive thera py and in whom adjuvant RT may not he necessary. However, further study is needed to carefully define this subset of patients and to identify the opti mal surgical approach and technique for patients treated without RT. (C) 19 99 by American Society of Clinical Oncology.