LIMB-SPARING THERAPY OF EXTREMITY SOFT-TISSUE SARCOMAS - TREATMENT OUTCOME AND LONG-TERM FUNCTIONAL RESULTS

The purpose of this study is to assess the long-term success rate and functional results of limb-sparing therapy in a group of 156 patients with soft tissue sarcomas of the extremities in the Netherlands Cancer Institute, treated according to a standard protocol of surgery and ra diotherapy, if indicated. The patients (79 females and 77 males) were treated between 1977 and 1983 by an intended wide local excision with a margin of at least 2 cm. Postoperative radiotherapy was applied in 1 17 patients; 26 patients had surgery only, including 13 patients who h ad to be treated by amputation. The total dose was 60 Gy, with 40 Gy t o a large volume and a boost of 20 Gy to the tumour bed at 2 Gy per fr action, five fractions per week. Most sarcomas were located in the pro ximal part of the lower extremity (51%). The group comprised 50 liposa rcomas, 47 malignant fibrous hystiocystoma (MFH) and 59 other histolog ies; 69 (44%) had high-grade tumours, Three treatment groups with limb -sparing treatment were defined: group I (n = 26) patients who had a c omplete excision receiving no further treatment, group II (n = 64) wit h narrow surgical margins and radiotherapy and group III (n = 53) with incomplete resection and radiotherapy. The 10-year actuarial overall survival and local control rate for all patients was 63 and 81%, respe ctively. Multivariate analysis showed that histological grade (P < 0.0 001), age (P = 0.0005) and location deep to the fascia (P = 0.0008) we re independent prognostic factors for survival, while local control wa s predicted by grade (P = 0.0014) and treatment group (p = 0.028). Pat ients with surgery only (group I) had 81% 5-year local control as comp ared to 92% with radiotherapy after narrow surgery (group II) and 74% with incomplete surgery and radiotherapy (group III). Limb preservatio n when attempted was achieved in 90% of the patients. After limb-spari ng treatment, 7% had severe impairment of mobility, 3% had lymph oedem a and 16% marked fibrosis. Fractures in the irradiated bone occurred i n 6% of the patients. The combination of limited surgery followed by r adiotherapy resulted in a high local control rate with good functional results. Ultimately limb sparing treatment was successful in 83% of a ll patients with extremity sarcomas.