ONCOLOGICAL OUTCOMES OF OPERATIVE TREATMENT OF SUBCUTANEOUS SOFT-TISSUE SARCOMAS OF THE EXTREMITIES

We reviewed the cases of sixty-two patients who had had a subcutaneous sarcoma to determine the effect of tumor and treatment-related variab les on the rates of survival and local recurrence, Fifty-nine (95 per cent) of the patients had had an operation at another hospital before being referred to us, Twenty-nine (47 per cent) of the sixty-two tumor s were high-grade, forty-two (68 per cent) were small (five centimeter s or less), and thirty (48 per cent) were malignant fibrous histiocyto mas. We followed a treatment strategy that consisted of repeat excisio n with the goal of obtaining wide margins, Excluding thirteen patients who had had a palpable local recurrence at the time of presentation, twenty (49 per cent) of forty-one patients who had had a marginal exci sion at another hospital had microscopic residual tumor on repeat exci sion, At a median of fifty-six months after the repeat excision, fifty (81 per cent) of the sixty-two patients had been continuously disease -free, one had no evidence of disease, eight had died of the disease, and three had died of other causes, The five-year rate of disease-free survival was 85 per cent (fifty-three of sixty-two patients), There w ere three local recurrences, all in patients who had had a marginal re section, No recurrences were noted in patients who had had a wide loca l excision of the tumor or of the previous operative field, Multivaria te analysis revealed that a large tumor (greater than five centimeters ), a marginal excision, and adjuvant radiation therapy were associated with a worse prognosis, Excellent rates of survival for patients who have a subcutaneous sarcoma, including those who have a large or high- grade tumor and those who have residual tumor following a previous ope ration, can be obtained with carefully planned operative treatment alo ne, We recommend operative excision or repeat excision with wide margi ns because of the high prevalence of residual tumor, Size is the most important tumor-related factor, and the operative margin is the most i mportant treatment-related factor, The additional value of adjuvant ra diation therapy remains unproved.