Functional Limb-Salvage Surgery with Postoperative Radiotherapy as A Treatment Strategy for Adult Soft Tissue Sarcoma of The Lower Extremity

Nader Taweela, Hussein Abdel Fatah, Mohamed Saied, Abdel Shaker, Mohamed Mitkis, Emad Abd Al Hafez, Ahmed Al-Barah, Hamdy Saker
2007 Research in Oncology  
objectives: This prospective multicenter study was conducted to evaluate the outcome of patients with lower extremity soft tissue sarcoma (STS) treated with functional limb-salvage surgery (FLSS) with adjuvant radiotherapy (RT), defined as the 5-year local recurrence free rate (LRFR), distant metastasis free rate (DMFR), local recurrence/distant metastasis free rate (LR/DMFR) and survival rate (SR). Patients and methods: Treatment strategy was functional compartmental resection that emphases
more » ... on that emphases wide surgical excision with a preservation of at least one innervated muscle in a compartment to improve functional outcome combined with adjuvant postoperative RT. excised specimens were examined histopathologically for evaluation of the surgically defined margin as free histological margin; positive microscopic resection margin was defined as tumor cells present at or within 1 mm of the inked margins of resection. Complications were assessed in terms of significant wound complication, bone fracture, and peripheral nerve damage. The study included 26 patients; 14 females and 12 males with mean age of 46.9±16 years. results: All managed lesions were non-central (not arising from the groin); 4 lesions (15.4%) were superficial without deep fascial invasion and 22 lesions (84.6%) were deep with a mean excised lesion diameter was 9.3±6.35. Excision margin was free in 22 specimens (84.6%) but was positive for sarcoma cells in 4 specimens (15.4%). Significant wound complications developed in 5 patients (19.2%), 2 required re-operation, bone fracture occurred only in one patient (3.8%) and three patients had nerve damage. Five patients (19.2%) developed LR after a mean duration of 27.6±4.8 months, 3 of them had positive margins; one patient required amputation, 3 patients required wide local excision plus further radiation and wide local excision alone in one patient. Distant metastasis developed in 8 patients (30.8%) after a mean duration of 27±6.5 months and 11 patients (42.3%) patients died after a mean duration of 31.6±7.5 months; all the 8 patients with distant metastasis and 2 whom had local recurrence died and one died of myocardial infarction. All determined rates showed progressive decrease throughout the follow-up period with the least LRFR (80.8%) and DMFR (73.1%) were at 36 months after surgery, while the least LR/DMFR was 50% at 42 months after surgery. The final SR was 57.7% at 48 months. There was a negative significant correlation between the postoperative 5-year local control rate and presence of free surgical margin (r=-0.562, p=0.003) and the diameter of the resected tumor, (r=-0.494, p=0.01) and a negative significant correlation between 5-year disease free rate and the diameter of the resected tumor, (r=-0.406, p=0.039). conclusion: The reported local recurrence rate after treatment of STS of lower extremity with functional limb salvage surgery with RT is comparable to published rates and suggested that in patients with lower extremity STS carefully performed FLSS followed by RT may serve as definitive therapy with acceptable outcome. original article abStract
doi:10.21608/resoncol.2007.374 fatcat:3b4ea7ctkrdyjcaqvwswiwxkce