Soft tissue sarcomas of the extremities. Survival and patterns of failure with conservative surgery and postoperative irradiation compared to surgery alone

Abstract

Between 1960 and 1978, 81 patients received their primary treatment for localized soft tissue sarcomas of the extremities, buttock and shoulder at the University of California, San Francisco. Initial treatment consisted of surgery alone in 47 patients, planned conservative surgery followed by radiation therapy in 29 patients, and irradiation alone in five patients. The two- and five-year determinate survival for all cases was 86% and 73%, respectively. The local control rate achieved with surgery alone was related to the extent of surgery. Eighty-seven percent (14/16) of the patients undergoing amputation were locally controlled. Seventy-two percent (8/11) were treated with wide en bloc resection and had local tumor control while only 30% (6/20) having simple excision were controlled. The local control rate with surgery and postoperative irradiation was 90% (26/29). No patients treated with radiation therapy alone were controlled. The development of distant metastases was significantly influenced by the grade of the primary tumor, and was independent of initial primary treatments, histologic type, and tumor site. Fifty-three percent of patients with Grade III tumors developed distant metastases, while only 7% of patients with Grade I or Grade II disease developed distant spread. Distant metastases with or without control of the primary was the most common initial pattern of relapse in patients with combined treatment. The primary site was the most common site of failure in the group receiving surgery alone. The ultimate pattern of failure in both the surgery alone and combined groups was distant metastases with or without local control. This review suggests that local tumor control achieved with limb preserving conservative surgery and postoperative irradiation is superior to limited surgery alone. The survival and patterns of failure of patients undergoing radical surgery is comparable to combined treatment with the risk-benefit ratio favoring the latter.