Long-Term Outcomes After Function-Sparing Surgery Without Radiotherapy for Soft Tissue Sarcoma of the Extremities and Trunk

Abstract

The 7% LR rate after treatment of STS with FSS without RT reported herein is comparable to published rates following treatment where adjuvant RT is used. These results suggest there may be a select subset of patients with STS in whom carefully performed FSS may serve as definitive therapy and in whom adjuvant RT may not be necessary. However, further study is needed to carefully define this subset of patients and to identify the optimal surgical approach and technique for patients treated without RT.

Extremity Soft Tissue Sarcoma Resections: How Wide Do You Need to Be?

“…Local recurrence rates have ranged considerably in previous reports, some of which can be attributed to varying inclusion and exclusion criteria and differences in the categorization of quantitative margin (Table 4). Our overall local recurrence rate of 3.4% for negative-margin patients with extremity soft tissue sarcoma echoes recent findings of other investigators [2,3,8,14,18,23,26]. Despite a number of reports suggesting a higher local recurrence rate associated with close margins of 1-2 mm or less [3,8,14,18], the rate of 4.4% in our study would suggest, as long as oncologic resection principles are followed and radiation is used judiciously, close margins can be tolerated to minimize morbidity and maximize function of the patient with limb salvage.…”

“…Twenty-four percent of our patients had low-grade tumors, a higher percentage than those in studies by Novais et al [18], Tanabe et al [25], McKee et al [17], Zagars et al [26], and Kim et al [14]. Studies by Gronchi et al [8], Baldini et al [2], Pisters et al [19], Stojadinovic et al [24], Kim et al [15], and Al Yami et al [1] included a higher percentage of low-grade tumors than our study, and Kawaguchi et al [10], Sadoski et al [21], and Dickinson et al [3] did not report specific grade of the lesions.…”

“…Investigators have attempted to assign quantitative values to various qualitative tissue planes in an effort to determine the appropriate clinical resection guidelines [10][11][12]. Few authors have looked specifically at the relationship between close but negative margins and local recurrence [2,8,14,16,18,19,21]. Evaluation of the literature is complicated by varying inclusion and exclusion criteria and numerous confounders.…”

“…Positive resection margins reportedly increase the risk of local recurrence [4,19,[22][23][24][25][26]. Controversy exists as to the amount of the surrounding normal tissue that constitutes an adequate negative margin [2,3,10,11,[13][14][15][16][17] to prevent local recurrence. The issue of what constitutes an adequate margin is complicated by the question of the relative importance of qualitative versus quantitative margin.…”

Long‐term outcomes in extremity soft tissue sarcoma after a pathologically negative re‐resection and without radiotherapy

“…However, in patients with an optimal resection (>1 cm margin) RT did not have a significant effect on LR rates. Baldini et al 8 also found that the extent of the surgical margin impacted the rate of local control. In that study the local control rate for patients with a negative surgical margin of <1 cm was 87%, compared with 100% for patients with a histologic margin of 1 cm in a group of patients treated with surgery alone.…”