Spermatic cord sarcoma: Outcome, patterns of failure and management

Purpose: We evaluate the outcome, clarify the patterns of failure and sugge st treatment strategies for sarcoma in the spermatic cord. Materials and Methods: Between 1956 and 1998, 32 patients with spermatic co rd sarcoma were treated at M. D. Anderson Cancer Center. A retrospective re view of disease outcome, patterns of relapse and patient survival was perfo rmed. Results: Histological subtypes of sarcoma were malignant fibrous histiocyto ma in 12 patients, leiomyosarcoma in 6, liposarcoma in 8 and other subtypes in 6. All except 2 patients underwent radical orchiectomy with or without additional resection to achieve negative margins. Margins were microscopica lly negative in 29 cases and positive in 3. There were 3 patients who recei ved adjuvant radiation to the surgical site. With a median followup of 9 ye ars the 10 and 15-year actuarial local control, distant metastasis-free and overall survival rates were 72% and 61%, 85% and 85%, and 63% and 52%, res pectively. The major pattern of failure was local recurrence that occurred in 8 of the 12 patients in whom disease relapsed and was the sole site of r elapse in 7. Pelvic nodes had relapsed in 2 patients and para-aortic nodes in 1. Hematogenous metastases had developed in 4 patients. Of the 7 cases o f disease that recurred locally only 3 were salvaged. No relapse occurred i n the 3 patients treated with combined surgery and radiation. Conclusions: Spermatic cord sarcoma has a high propensity for local recurre nce after surgery. Nodal relapse is less frequent than commonly believed. B ecause of the relatively high local failure rate seen in surgery alone and durable local control noted in 3 patients treated with surgery plus radioth erapy, combined modality treatment should be considered in those with sperm atic cord sarcoma who are believed to be at high risk for local failure.