Local Recurrence After Initial Multidisciplinary Management of Soft Tissue Sarcoma: Is there a Way Out?
- 150 Downloads
Multimodality treatment of primary soft tissue sarcoma by expert teams reportedly affords a low incidence of local recurrence. Despite advances, treatment of local recurrence remains difficult and is not standardized.
We (1) determined the incidence of local recurrence from soft tissue sarcoma; (2) compared characteristics of the recurrent tumors with those of the primary ones; (3) evaluated local recurrences, metastases and death according to treatments; and (4) explored the relationship between the diagnosis of local recurrence and the occurrence of metastases.
From our prospective database, we identified 618 soft tissue sarcomas. Thirty-seven of the 618 patients (6%) had local recurrence. Leiomyosarcoma was the most frequent diagnosis (eight of 37). The mean delay from original surgery was 22 months (range, 2–75 months). Mean size was 4.8 cm (range, 0.4–28.0 cm). Median followup after local recurrence was 16 months (range, 0–98 months).
Recurrent tumors had a tendency toward becoming deeper seated and higher graded. Nineteen of the 37 patients with recurrence underwent limb salvage (nine free flaps) and six had an amputation. Twenty-two (59%) had metastases, including 10 occurring after the local recurrence event at an average delay of 21 months (range, 1–34 months). Six patients developed additional local recurrences, with no apparent difference in risk between amputation (two of six) and limb salvage (four of 19).
Patients with a local recurrence of a soft tissue sarcoma have a poor prognosis. Limb salvage and additional radiotherapy remain possible but with substantial complications. Amputation did not prevent additional local recurrence or death.
Level of Evidence
Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
KeywordsLocal Recurrence Soft Tissue Sarcoma Limb Salvage Local Relapse Soft Tissue Sarcoma Patient
We thank Ms Cindy Wong, RN, for her invaluable help with the management of the sarcoma database and the data collection.
- 2.Broders AC, Hargrave R, Meyerding HW. Pathological features of soft tissue fibrosarcoma: with special reference to the grading of its malignancy. Surg Gynecol Obstet. 1939;69:267.Google Scholar
- 8.Ghert MA, Abudu A, Driver N, Davis AM, Griffin AM, Pearce D, White L, O’Sullivan B, Catton CN, Bell RS, Wunder JS. The indications for and the prognostic significance of amputation as the primary surgical procedure for localized soft tissue sarcoma of the extremity. Ann Surg Oncol. 2005;12:1–2.CrossRefGoogle Scholar
- 24.Sobin LH, Gospodarowicz MK, Wittekind CH, eds, for the International Union Against. Cancer (UICC). Soft tissues. In: TNM Classification of Malignant Tumors. 7th ed. Oxford, UK: Wiley-Blackwell; 2009:157–156.Google Scholar
- 30.Zagars GK, Ballo MT, Pisters PW, Pollock RE, Patel SR, Benjamin RS. Prognostic factors for disease-specific survival after first relapse of soft-tissue sarcoma: analysis of 402 patients with disease relapse after initial conservative surgery and radiotherapy. Int J Radiat Oncol Biol Phys. 2003;57:739–747.CrossRefPubMedGoogle Scholar