OUTCOME OF TREATMENT FOR PEDIATRIC SARCOMA OF THE FOOT - A RETROSPECTIVE REVIEW OVER A 20-YEAR PERIOD

Soft tissue sarcomas (STS) arising in the foot are rare in children. F rom 1975 to 1994, 18 children (median age, 13.5 years) were treated at St Jude Children's Research Hospital for STS of the foot. Five childr en had rhabdomyosarcoma (RMS), with alveolar histology in four cases. All of these patients presented with metastatic disease, which proved fatal within 9 to 24 months despite combined modality treatment with c hemotherapy, radiation, and surgery. Thirteen patients had nonrhabdomy osarcoma soft tissue sarcoma (NRSTS), The most common histological var iant was synovial sarcoma (7 patients). Of the 10 who presented with l ocalized disease, seven survived 1 to 22 years (median, 7 years). Surg ical treatment for these consisted of local excision (n = 2), wide loc al excision (9 = 3), below knee amputation (n = 1), ray amputation (n = 1). Three received supplemental radiation, and one was also treated with chemotherapy. Local or distant recurrence proved fatal in the thr ee other children who had localized disease. Three children who presen ted with metastatic NRSTS died 8 to 14 months after diagnosis. All sur viving patients are without significant functional disability. In our experience, pediatric RMS of the foot has a poor outcome, attributable to both alveolar histology and presence of metastatic disease at diag nosis. In contrast, NRSTS of the foot is more often localized, and lim ited surgery with adjuvant radiation in the absence of clear margins s hould be the treatment of choice. Copyright (C) 1997 by W.B. Saunders Company.