Consequences of local recurrence of soft tissue sarcoma: 205 patients from the Scandinavian Sarcoma Group Register

Abstract

From the Scandinavian Sarcoma Group Register, information on 1,224 surgically-treated patients with soft tissue sarcoma (STS) of the extremity or trunk wall, diagnosed between 1987 and 1995, was collected. 205 patients, one third of whom were referred to a center with a local recurrence, had a total of 284 local recurrences. This analysis describes the treatment for these local recurrences, complications and risk of further recurrences. 169 patients were surgically treated for their first local recurrence. An intralesional or marginal margin was achieved in 110 of these patients, 59 of whom were also given radiotherapy. 54 of the 169 patients had a second local recurrence. The second local recurrence rate was 0.50 if the first local recurrence had been treated with only surgery with a marginal margin, compared to 0.28 if treated with surgery with a marginal margin and radiotherapy or with a wide margin (p = 0.0008). In extremity STS, the crude amputation rate for local recurrences was 0.22 (31 of 142)-i.e., higher than for primary tumors 0.09 (96 of 1065) (p < 0.0001).A high local recurrence rate after treatment outside of sarcoma centers has earlier been shown. We conclude that the consequences of local recurrence in terms of morbidity and costs justifies referral of STS patients for multidisciplinary evaluation and multimodality treatment.

Local recurrence of deep-seated, high-grade, soft tissue sarcoma: 459 patients from the Scandinavian Sarcoma Group Register

“…The studies cannot be readily compared with ours since patients with recurrent sarcoma were included in some of these one-center studies, and more patients were treated with chemotherapy. It does appear, however, that the general use of radiotherapy for all deep-seated, high-grade soft tissue sarcomas yields better local control, but better control does not improve survival (Rööser et al 1990, Gustafson 1994, Lewis et al 1997, Trovik et al 2000a. Hence, the morbidity associated with radiotherapy may not be justified to attain a 10% reduction in the recurrence rate (Sugerbaker et al 1982, Bell et al 1989, Stinson et al 1992, Wiklund et al 1993.…”

Do Surgical Margin and Local Recurrence Influence Survival in Soft Tissue Sarcomas?

“…However, the influence of local recurrence on the overall survival in soft tissue sarcomas of the extremities is not clear [10,16,25,31]. Two previous prospective studies have concluded local recurrences had no influence on survival.…”

Surgical margins and reresection in the management of patients with soft tissue sarcoma using conservative surgery and radiation therapy

“…3,9,10 Currently, it is recognized that, although such terms are useful in the planning of a surgical procedure, the crucial determinant of adequacy of resection is the actual microscopic resection margin. [11][12][13][14][15][16][17][18][19] In virtually all reports, positive resection margins are correlated with a significantly heightened risk for local recurrence [11][12][13][14][15][16][17] ; and, in some reports, positive resection margins also are correlated with an increased risk of developing metastatic disease and a poorer disease specific survival. 11,15,16 Thus, the achievement of negative resection margins is an important therapeutic principle for patients with STS.…”