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Limb‐preserving treatment for soft tissue sarcomas of the extremities. The significance of surgical margins
Author(s) -
Herbert Scott H.,
Corn Benjamin W.,
Solin Lawrence J.,
Lanciano Rachelle M.,
Schultz Delray J.,
McKenna W. Gillies,
Coia Lawrence R.
Publication year - 1993
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19930815)72:4<1230::aid-cncr2820720416>3.0.co;2-j
Subject(s) - medicine , radiation therapy , surgery , brachytherapy , soft tissue , complication , biopsy , regimen , sarcoma , chemotherapy , surgical margin , soft tissue sarcoma , radiology , pathology , resection
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.