Epithelioid sarcoma: Results of conservative surgery and radiotherapy

Purpose: To determine the outcome and prognostic factors for patients with localized epithelioid sarcoma treated with conservative surgery and radioth erapy (RT). Methods and Materials: The medical records of 24 patients with nonmetastati c epithelioid sarcoma treated with conservative surgery and RT were reviewe d. Preoperative RT was given to 3 patients (median 46.4 Gy) and postoperati ve RT to 21 patients (median 64.5 Gy). A local (limb-sparing) surgical proc edure was performed in all patients. Results: At a median follow-up of 131 months, 14 patients had relapsed and 13 patients had died. The actuarial overall and disease-free survival rate at 10 years was 50% and 37%, respectively. Local, nodal, and metastatic fai lure occurred in 7, 4, and 10 patients, respectively, yielding a 10-year ac tuarial local, nodal, and metastatic control rate of 63%, 81%, and 56%. res pectively. Univariate analysis revealed that size less than or equal to5 cm and extremity location were favorable prognostic factors for overall, dise ase-free, and metastasis-free survival. The actuarial 5-year overall, disea se-free, and metastasis-free survival rate was 79% vs. 25% (P = 0.002), 51% vs. 13% (P = 0.03), and 79% vs. 13% (p <0.001), respectively, for lesion s ize less than or equal to5 vs. >5 cm. The actuarial 5-year overall, disease -free, and metastasis-free survival rate was 77% vs. 39% (p = 0.002), 56% v s. 0% (p = 0.01), and 78% vs. 17% (p = 0.01), respectively, for extremity v s. nonextremity location. Multivariate analysis of the factors correlating with the overall, disease-free, and metastasis-free survival confirmed the favorable prognostic significance of small lesion size. The prognostic sign ificance of extremity location on univariate analysis was explained by an i mbalance in the mean tumor sizes. Conclusions: Epithelioid sarcoma is an aggressive soft-tissue sarcoma. with high rates of local and distant relapse. Local control with conservative s urgery and RT compares favorably to published surgical series. The poor out come for tumors greater than or equal to5 cm in size emphasizes the need fo r effective systemic therapy. (C) 2001 Elsevier Science Inc.