Clinical Orthopaedics and Related Research®

, Volume 468, Issue 11, pp 3019–3027

Factors Predicting Local Recurrence, Metastasis, and Survival in Pediatric Soft Tissue Sarcoma in Extremities

  • Chigusa Sawamura
  • Dempsey S. Springfield
  • Karen J. Marcus
  • Antonio R. Perez-Atayde
  • Mark C. Gebhardt
Symposium: Highlights of the ISOLS/MSTS 2009 Meeting



Pediatric soft tissue sarcomas are rare and differ from those in adults regarding the spectrum of diagnoses and treatment. Sarcomas in extremities may have different prognoses from those located elsewhere.


We sought risk factors predicting local recurrence, metastasis, and overall survival and asked whether radiation and chemotherapy influenced local recurrence, metastasis, and overall survival.


We retrospectively reviewed all 98 patients aged 18 years or younger diagnosed with soft tissue sarcomas in extremities from 1990 to 2008. Age, tumor size, depth, location, bone or neurovascular involvement, histologic subtypes, unplanned excision, surgical margins, metastasis at diagnosis, and adjuvant treatments were reviewed for each patient. We determined the effect of each prognostic variable on local recurrence, metastasis, and overall survival.


Ninety-four patients underwent surgical excision and seven patients had local recurrence at a median time of 18.6 months. Radiation therapy reduced the rate of local recurrence. Fourteen patients had metastasis at diagnosis and seven patients later developed metastasis. The median time to metastasis was 20.9 months. Six patients died and the median time to death was 28.0 months. Metastasis at diagnosis was a predictive factor for death.


When limited to extremities, radiation therapy reduced the rate of local recurrence in pediatric soft tissue sarcomas. Metastases at diagnosis predict death.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Chigusa Sawamura
    • 1
  • Dempsey S. Springfield
    • 2
  • Karen J. Marcus
    • 3
  • Antonio R. Perez-Atayde
    • 4
  • Mark C. Gebhardt
    • 5
    • 6
  1. 1.Harvard School of Public HealthBostonUSA
  2. 2.Department of Orthopaedic SurgeryMassachusetts General HospitalBostonUSA
  3. 3.Department of Radiation OncologyChildren’s HospitalBostonUSA
  4. 4.Department of PathologyChildren’s HospitalBostonUSA
  5. 5.Department of Orthopaedic SurgeryChildren’s HospitalBostonUSA
  6. 6.Department of Orthopaedic SurgeryBeth Israel Deaconess Medical CenterBostonUSA

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