Limb‐preserving treatment for soft tissue sarcomas of the extremities. The significance of surgical margins

Abstract

Background and Methods. Between 1970 and 1990, 74 patients with extremity soft tissue sarcomas began a regimen of limb‐sparing surgery and irradiation. Ninety‐two percent received postoperative irradiation, 7% received preoperative irradiation, and one patient was treated with radiation after an incisional biopsy only. Radiation was administered with a shrinking‐field technique (median total dose, 63 Gy; range, 39.6–71 Gy), with 14 patients receiving interstitial brachytherapy as a component of treatment. Ten patients received adjuvant chemotherapy. Results. Local control of disease was 82% at 5 years, and 95% after salvage therapy. The actuarial risk of distant disease recurrence was 27%, with an overall survival rate of 70% at 5 years. Histologic subtype, tumor grade, size of tumor, location of tumor, status of the surgical margins, use of chemotherapy, radiation dose, interval until initiation of radiation therapy, and use of a brachytherapy boost were analyzed to determine their effect on survival, local control, and freedom from distant metastasis. Microscopic involvement of the surgical margins predicted for local disease recurrence (P = 0.0002), distant disease recurrence (P = 0.008), and poorer overall survival (P = 0.02). Low histologic grade was favorably correlated with freedom from distant disease recurrence (P = 0.004) and survival (P = 0.002). Patients with liposarcomas had superior local control (P = 0.004) compared with patients with tumors of other histologic subtypes. Five patients experienced a complication of therapy, for an actuarial risk of 10% at 5 years. Only two patients required hospital admittance for treatment‐related morbidity. Conclusions. These findings support the continued use of limb‐preserving management for extremity sarcomas and emphasize the importance of the status of the surgical margins. Copyright © 1993 American Cancer Society