Surgery and radiation therapy in the treatment of soft tissue sarcomas of extremities

Abstract

Between January 1979 and December 1987, 99 patients (pts.) with a diagnosis of localized soft tissue sarcoma of the extremities received preoperative radiation therapy (Preop. RT, 50 pts.) or postoperative irradiation (Postop. RT, 49 pts.). In the preop. RT group, doses ranged from 42 Gy/17 fractions to 51 Gy/17 fractions; pts. treated with RT after surgery, received a dose comprised between 46 Gy/23 fractions to 66 Gy/33 fractions. The surgical procedure consisted of making a wide resection of the mass with preservation of the affected limb, in each patient. The main cause of failure was dissemination of the disease (33.3%). The incidence of local failures was low (7.1%). Recurrences were related to the size of the disease (5 cm: 0/12; 5-10 cm: 2/45 2.3%; 10 cm: 5/42, 11.9%), as were also distant metastases. The incidence of distant failures was higher in the group treated with preop. RT (44.0% vs. 22.4%), probably because a higher percentage of patients in this group had large volume diseases. Late sequelae were evaluable in 59 pts. with a follow up longer than 24 months. The incidence of complications was low (10.1%, 6/59); it was higher in the preoperative than in the postoperative group (15.4% vs. 6.1%); this observation is probably related to the different modalities of fractionation.

Superficial Soft Tissue Sarcomas of the Extremities and Trunk

“…Preoperative radiation therapy has been shown to be of similar value, but it has been associated with increased morbidity because of difficult wound healing [27, 28]. No patients in our cohort received neoadjuvant RT, and we advocate this regimen only in exceptional cases to optimize the operative approach to large tumors.…”

Does the method of treatment affect the outcome in soft-tissue sarcomas of the adductor compartment?

“…Several previous studies have looked at the outcomes of treatment of soft-tissue sarcomas in the limbs. [11][12][13][14][15][16][17] Generalising results for a limb may not be justifiable, as the nature of the anatomical compartments may influence the outcome owing to differences in vascular anatomy or lymphatic drainage. This review assesses the outcomes following resection of soft-tissue sarcoma from a single anatomical compartment.…”

Soft-tissue sarcomas of the hand

“…1,2 Most soft-tissue sarcomas of the limbs are currently treated by wide excision and adjunctive radiotherapy. [3][4][5][6] However, this approach is difficult to apply to the hand because of its anatomy and the lack of readily expendable soft tissue (Fig. 1).…”