High-grade soft tissue sarcomas of the extremities

Abstract

From July 1975 to December 1982, 358 patients were referred to the Surgery Branch of the National Cancer Institute (NCI) with the diagnosis of soft tissue sarcoma of the extremities. Two hundred eleven of these patients presented with resectable, localized high-grade soft-tissue sarcomas and have been included in the present analysis of the management and outcome of patients with high-grade soft tissue sarcomas of the extremity treated at the NCI. One hundred forty-seven of these 211 patients have been included in randomized prospective trials. The remaining 64 patients in this analysis have been followed at the NCI, but were not included in randomized trials because of patient refusal or ineligibility. Tumor size was identified as a highly significant prognostic variable for disease-free and overall survival (P2 = 0.00001 and 0.0081, respectively). Tumor site, histologic type, and microscopic margins of resection were not significant prognostic variables. There was no difference between patients undergoing amputation compared to those undergoing limb-sparing procedures plus postoperative radiotherapy in disease-free or overall survival for all 211 patients in this study (P2 = 0.068 and 0.131, respectively). A significantly greater frequency of local failure among patients treated by local excision was noted compared to patients undergoing amputation (12/128 versus 0/83, P2 = 0.004), but this did not result in decreased overall survival in patients undergoing combined modality limb-sparing procedures. Adjuvant chemotherapy significantly prolonged disease-free survival (P2 = 0.005) for the 124/211 patients treated with adjuvant chemotherapy, although analysis of overall survival did not reveal a significant increase (P2 = 0.10). In a subset of 65 patients included in a prospective randomized trial evaluating the efficacy of adjuvant chemotherapy, a significant improvement in both disease-free (P2 = 0.033) and overall (P2 = 0.055) survival was seen in patients receiving chemotherapy. Sixty-five patients developed recurrent disease (65/211, 31%) and 42 of these patients were rendered disease-free surgically. Survival from the time of first recurrence was significantly prolonged among the 42 patients who were rendered disease-free (median survival, 31 months) compared to those who were not (median survival, 9 months, P2 less than 0.001).

Outcome and prognostic factor analysis of 217 consecutive isolated limb perfusions with tumor necrosis factor‐α and melphalan for limb‐threatening soft tissue sarcoma

“…ILP with consecutive limb-sparing surgery is considered the alternative for amputation in this study population. This is based on the insight that limbpreserving surgery is equal to amputation in terms of survival, [2][3][4] although the local recurrence rate of 10% to 20% 26 -28 after limb-sparing resection is obviously higher than when an amputation is performed. There is still debate as to whether local recurrence of STS is a determinant of overall survival, with studies that do not find a statistically significant effect, 2,29 and studies that do.…”

High-grade soft tissue sarcomas of the extremities: surgical margins influence only local recurrence not overall survival

“…Following from this, the question of the prognostic role of local recurrence arises. In this study, the occurrence of local recurrence was associated with an increased risk of death, as shown in several studies [2,13,10,19], while others show no association between local recurrence and overall survival [9,21,22]. As to the cause of the increased risk we can merely hypothesize between a direct effect of local recurrence on survival and an indirect effect with local recurrence as a marker of high biological tumour aggressiveness.…”

Prognostic factors for soft tissue sarcoma patients with lung metastases only who are receiving first‐line chemotherapy: An exploratory, retrospective analysis of the European Organization for Research and Treatment of Cancer‐Soft Tissue and Bone Sarcoma Group (EORTC‐STBSG)

“…Systemic spread seems to be an early event in STS. Amputation of extremity tumors compared to limb sparing procedures did not result in improved survival rates 10. Surgical resection of metachronous lung metastases is always considered in the case of limited disease and longer interval since primary surgery as it has been associated with long‐term survival 11, 12…”