Annals of Surgical Oncology

, Volume 7, Issue 1, pp 9–14 | Cite as

Primary Extremity Sarcoma: What Is the Appropriate Follow-Up?

  • Brian P. Whooley
  • John F. Gibbs
  • Margaret M. Mooney
  • Brian E. McGrath
  • William G. Kraybill
Original Article

Abstract

Background: Our objective was to evaluate the effectiveness of follow-up tests for detecting first local and distant recurrences in patients with primary extremity soft tissue sarcoma.

Methods: We retrospectively analyzed all adult cases of primary extremity soft tissue sarcoma (n 5 174) treated between 1982 and 1992. Patients were observed every 3 months for 2 years, every 4 months the third year, every 6 months the next 2 years, and annually, thereafter. Each visit consisted of taking the patient’s history, a physical examination, a complete blood count, a blood chemistry panel, and a chest x-ray. For high-grade tumors, the primary site was imaged annually when clinically appropriate.

Results: Of 141 patients who were assessable, 29 patients developed local recurrence and 57 developed distant recurrence. All but one of the local recurrences was detected on the basis of an abnormal physical examination. Of the 29 patients who developed local recurrence, 25 were resected. Distant metastases were detected because of symptoms in 21 cases. Of the 36 asymptomatic lung recurrences, 30 were detected by follow-up chest x-ray. Of the 36 asymptomatic lung recurrences, 24 patients underwent metastasectomy. The positive and negative predictive values of surveillance chest x-ray were 92% and 97%, respectively. Laboratory testing never led to the detection of recurrence.

Conclusions: Close surveillance by clinical assessment and chest x-ray is appropriate for follow-up observation of patients with primary extremity soft tissue sarcoma.

Keywords

Soft tissue sarcoma Recurrence Follow-up 

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REFERENCES

  1. 1.
    Landis SH, Murray T, Bolder S, Wingo PA. Cancer statistics 1998. CA Cancer J Clin 1998;48:10–11.CrossRefGoogle Scholar
  2. 2.
    Lawrence W Jr, Donegan WL, Natarajan W, et al. Adult soft tissue sarcomas: a pattern of care survey of the American College of Surgeons. Ann Surg 1987;25:349–359.CrossRefGoogle Scholar
  3. 3.
    Keohan ML, Taub RN. Chemotherapy for advanced sarcomas: therapeutic decisions and modalities. Semin Oncol 1997;24:572–579.PubMedGoogle Scholar
  4. 4.
    Pisters PW, Leung DH, Woodruff J, Shi W, Brennan MF. Analysis of prognostic factors in 1041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol 1996;14:1679–1689.PubMedGoogle Scholar
  5. 5.
    Gadd MA, Casper ES, Woodruff JM, McCormack PM, Brennan MF. Development and treatment of pulmonary metastases in adult patients with extremity soft tissue sarcoma. Ann Surg 1993;218:705–712.PubMedGoogle Scholar
  6. 6.
    Casson AG, Putnam JB, Natarajan G, et al. Five year survival after pulmonary metastasectomy for adult soft tissue sarcoma. Cancer 1992;69:662–669.PubMedGoogle Scholar
  7. 7.
    Van Geet AN, Pastorini U, Jauch KW, et al. The surgical treatment of lung metastases: the European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group Study of 255 patients. Cancer 1996;77:675–682.CrossRefPubMedGoogle Scholar
  8. 8.
    NCCN sarcoma practice guidelines. Oncology 1998;3:183–218.Google Scholar
  9. 9.
    Weiss M, Loprinzi CL, Creagan ET, Dalton RJ, Novotny P, O’Fallon JR. Utility of follow-up tests for detecting recurrent disease in patients with melanoma. JAMA 1995;272:1703–1705.Google Scholar
  10. 10.
    Mooney MM, Mettlin C, Michalek AM, Petrelli NJ, Kraybill WG. Life-long screening of patients with intermediate thickness cutaneous melanoma for asymptomatic pulmonary recurrences. Cancer 1997;80:1052–1064.PubMedGoogle Scholar
  11. 11.
    The GIVO Investigators. Impact of follow-up testing on survival and health-related quality of life in breast cancer patients. JAMA 1994;271:1587–1592.Google Scholar
  12. 12.
    Del Turco MR, Palli D, Cariddi A, Ciatto S, Pacini P, Distante V. Intensive diagnostic follow-up after treatment of primary breast cancer. JAMA 1994;271:1593–1597.Google Scholar
  13. 13.
    Brennan MF. The enigma of local recurrence. Ann Surg Oncol 1997;4:1–12.PubMedGoogle Scholar
  14. 14.
    Kaplan E, Meier P. Nonparametric estimation from incomplete observation. J Am Stat Assoc 1958;53:457–481.Google Scholar
  15. 15.
    Singer S, Antman K, Corson JM, Eberlein TJ. Long-term salvageability for patients with locally recurrent soft tissue sarcomas. Arch Surg 1992;127:548–553.PubMedGoogle Scholar
  16. 16.
    Putnam JB Jr, Suell DM, Natarajan G, Roth JA. Extended resection of pulmonary metastases: is the risk justified? Ann Thorac Surg 1993;55:1440–1446.PubMedCrossRefGoogle Scholar
  17. 17.
    Sarcoma Meta-Analysis Collaboration. Adjuvant chemotherapy for localized resectable soft tissue sarcoma of adults: meta-analysis of individual data. Lancet 197;350:1647–1654.Google Scholar
  18. 18.
    Antman K, Crowley J, Balcerzak SP, et al. An intergroup phase III randomized study of doxorubicin and dacarbazine with or without ifosfamide and mesna in advanced soft tissue and bone sarcomas. J Clin Oncol 1993;11:1276–1285.PubMedGoogle Scholar
  19. 19.
    Weekes RG, Berquist TH, McLeod RA, Zimmer WD. Magnetic resonance imaging of soft tissue tumors: comparison with computed tomography. Magn Reson Imaging 1985;3:345–352.CrossRefPubMedGoogle Scholar
  20. 20.
    Reuther G, Mutschler W. Detection of local recurrent disease in musculoskeletal tumors: magnetic resonance imaging versus computed tomography. Skeletal Radiol 1990;19:85–90.PubMedGoogle Scholar
  21. 21.
    Hudson TM, Schakel M, Springfield DS. Limitations of computed tomography following excisional biopsy of soft tissue sarcomas. Skeletal Radiol 1985;13:49–54.PubMedGoogle Scholar
  22. 22.
    Kole AC, Nieweg OE, van Ginkel RJ, et al. Detection of local recurrence of soft tissue sarcoma with positron emission tomography using (18F) fluorodeoxyglucose. Ann Surg Oncol 1997;4:57–63.PubMedGoogle Scholar
  23. 23.
    Kollins SA. Computed tomography of the pulmonary parenchyma and chest wall. Radiol Clin North Am 1997;15:297–308.Google Scholar
  24. 24.
    Muhm JR, Brown LR, Crowe JK. Use of computed tomography in the detection of pulmonary nodules. Mayo Clin Proc 1977;52:345–348.PubMedGoogle Scholar
  25. 25.
    Muhm JR, Brown LR, Crowe JK. Detection of pulmonary nodules by computed tomography. AJR Am J Roentgenol 1977;128:267–270.PubMedGoogle Scholar
  26. 26.
    Chang AE, Schaner EG, Conkle DM, Flye MW, Doppman JL, Rosenberg SA. Evaluation of computed tomography in the detection of pulmonary metastases: a prospective study. Cancer 1979;43:913–916.PubMedGoogle Scholar
  27. 27.
    Schaner EG, Chang AE, Doppman JL, Conkle DM, Flye MW, Rosenberg SA. Comparison of computed and conventional whole lung tomography in detecting pulmonary nodules: a prospectivepathologic study. AJR Am J Roentgenol 1978;131:51–54.PubMedGoogle Scholar
  28. 28.
    Povoski SP, Fong Y, Sgouros SC, Kemeny NE, Downey RJ, Blumgart LH. Role of chest CT in patients with negative chest x-rays referred for hepatic colorectal metastases. Ann Surg Oncol 1998;5:9–15.PubMedGoogle Scholar
  29. 29.
    Mooney MM, Whooley BP, Gibbs JF, McGrath B, Kraybill WG. The cost-effectiveness of CXR surveillance for high-grade soft tissue extremity sarcoma [Abstract]. Proc Am Soc Clin Oncol 1999;18:427a.Google Scholar
  30. 30.
    Danese ND, Powe NR, Swain CT, Ladenson PW. Screening for mild thyroid failure at the periodic health examination. JAMA 1996;276:285–292.PubMedGoogle Scholar
  31. 31.
    Frame PS, Frybach DG, Paterson C. Screening for abdominal aortic aneurysm in men ages 60–80. Ann Intern Med 1993;119:411–416.PubMedGoogle Scholar
  32. 32.
    Littenberg B, Garber AM, Sox HC. Screening for hypertension. Ann Intern Med 1990;112:192–202.PubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2000

Authors and Affiliations

  • Brian P. Whooley
    • 1
  • John F. Gibbs
    • 1
  • Margaret M. Mooney
    • 1
  • Brian E. McGrath
    • 1
  • William G. Kraybill
    • 1
    • 2
  1. 1.Roswell Park Cancer InstituteState University of New York at BuffaloBuffalo
  2. 2.Soft-Tissue Melanoma and Bone DepartmentRoswell Park Cancer InstituteBuffalo

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