Effect of Reresection in Extremity Soft Tissue Sarcoma

BACKGROUND.The aim was to study the clinicopathological characteristics, treatment, and outcome of liposarcoma in an unselected, population‐based patient sample, and to establish whether treatment was according to the Scandinavian Sarcoma Group (SSG) treatment guidelines.METHODS.The SSG Pathology Board reviewed 319 liposarcoma cases reported between 1986 and 1998. After the review, 237 patients without metastasis were analyzed for local recurrence rate in relation to surgical margins, radiotherapy, occurrence of metastasis, and survival.RESULTS.Seventy‐eight percent of the patients were primarily operated on at a sarcoma center, 45% with wide margins. All patients operated on outside the center had nonwide margins. Low‐grade lesions constituted 67% of cases. Despite nonwide surgery, only 58% of high‐grade lesions were treated with postoperative radiotherapy. The risk of local recurrence after nonwide surgery, without irradiation, was 47% for high‐grade lesions. The estimated 10‐year, local recurrence‐free and metastasis‐free survival in the low‐grade group was 87% and 95%, respectively. In the high‐grade group, it was 75% and 61%, respectively. Independent adverse prognostic factors for local recurrence were surgery outside a sarcoma center and histological type dedifferentiated liposarcoma. For metastases, they were old age, large tumor size, high grade, and histological type myxoid liposarcoma with a round cell component. Radiotherapy showed significant effect on local recurrence rate for the same grade and margin.CONCLUSIONS.Patients with liposarcoma should be treated at specialized centers. Postoperative radiotherapy decreases the local recurrence rate. To maintain quality and provide support for further trials, reporting to quality registers is crucial. Cancer 2008. © 2008 American Cancer Society.

Section: Discussionsupporting

confidence: 92%

Liposarcoma

Engström

Bergh

Gustafson

et al. 2008

“…However, as it turned out, there were no significant differences in outcome by any of the overall treatment parameters. The potential influence of factors such as reexcision of tumor beds, 29 the utility of preoperative XRT versus postoperative XRT, 30 and the significance of XRT dose [31][32][33] will be reported separately. It should be reiterated that this series included relatively few patients with STS arising in the deep trunk, particularly in the retroperitoneum, because it was not general policy to offer adjuvant XRT to patients with such disease.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for patients with localized soft‐tissue sarcoma treated with conservation surgery and radiation therapy

Zagars

Ballo

Pisters

et al. 2003

605

474

BACKGROUNDPrognostic factors for patients with soft‐tissue sarcoma who are treated with conservative surgery and radiation are documented poorly.METHODSThe clinicopathologic features and disease outcome for 1225 patients with localized sarcoma who were treated with conservative surgery and radiation were reviewed retrospectively. Actuarial univariate and multivariate statistical methods were used to determine significant prognostic factors for local control, metastatic recurrence, and disease specific survival.RESULTSThe median follow‐up of surviving patients was 9.5 years. The respective local control rates at 5 years, 10 years, and 15 years were 83%, 80%, and 79%. Factors predictive of local recurrence were positive or uncertain resection margins; tumors located in the head and neck and the deep trunk; presentation with local recurrence; patient age > 64 years; malignant fibrous histiocytoma, neurogenic sarcoma. or epithelioid sarcoma histopathology; tumor measuring > 10 cm in greatest dimension; and high pathologic grade. Freedom from metastasis at 5 years, 10 years, and 15 years was 71%, 68%, and 66%, respectively. Factors that were predictive of metastatic recurrence were high tumor grade; large tumor size (> 5 cm); and leiomyosarcoma, rhabdomyosarcoma, synovial sarcoma, or epithelioid sarcoma. The respective disease specific survival rates at 5 years, 10 years, and 15 years were 73%, 68%, and 65%. Adverse factors for disease specific survival were high tumor grade; large tumor size (> 5 cm); tumors located in the head and neck and deep trunk; rhabdomyosarcoma, epithelioid sarcoma, or clear cell sarcoma; patient age > 64 years; and positive or uncertain resection margins.CONCLUSIONSSoft‐tissue sarcoma comprises a heterogeneous group of diseases. Prognostic factors for local recurrence, metastatic recurrence, lymph node recurrence, disease free survival, and disease specific survival are different, and optimal treatment strategies need to take this complexity into account. Cancer 2003;10:2530–43. © 2003 American Cancer Society.DOI 10.1002/cncr.11365

“…The data regarding the prognostic implication of undergoing a re-resection are somewhat conflicting, in particular with regard to local control. 2,5,12,14 Lewis et al 12 found that patients who undergo a re-resection have improved disease-specific and metastasesfree survival compared with those patients who are treated with a single definitive surgery. Re-resection, however, did not significantly decrease the rate of LR in that study.…”

Section: Discussionmentioning

confidence: 99%

“…Other series have reported no residual sarcoma in 37% to 65% of patients at the time of reresection. 2,15,12,18 Interestingly, little has been published on the prognostic significance of a negative reresection, yet there seems to be an inclination to forego adjuvant RT in this group of patients under the assumption that the risk of local recurrence should be low, irrespective of other prognostic factors. Perhaps this is because many believe that the presence of a pathologically negative re-excision represents the 'ultimate' wide negative margin.…”

Section: Discussionmentioning

confidence: 99%

“…It is estimated that at the time of re-resection 40% to 75% of patients will not have evidence of residual sarcoma on pathologic assessment. 5,12,13 It is generally assumed that such patients have a low rate of local recurrence (LR) and may constitute a subset of patients who do not require adjuvant radiation; however, the data supporting this are scant. 14,15 The purpose of this study was to determine the feasibility of omitting adjuvant radiation in a group of patients with primary extremity STS treated with limb-sparing surgery who were found to have a pathologically negative re-resection specimen.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Long‐term outcomes in extremity soft tissue sarcoma after a pathologically negative re‐resection and without radiotherapy

Cahlon

Spierer

Brennan

et al. 2008

Self Cite

BACKGROUND.The purpose was to define the rate of local recurrence (LR) and identify prognostic factors for LR in patients with extremity soft‐tissue sarcoma (STS) treated with limb‐sparing surgery and a pathologically negative re‐resection specimen without radiotherapy (RT).METHODS.A review of the prospective sarcoma database identified 200 patients with primary, nonmetastatic, extremity STS treated with limb‐sparing surgery between June 1982 and December 2002 who had a pathologically confirmed negative re‐resection. None of the patients had adjuvant RT. Univariate and multivariate analyses were performed to determine clinicopathologic factors associated with LR.RESULTS.With a median follow‐up of 82 months the 5‐year actuarial LR rate was 9%. Factors associated with higher LR rates on univariate and multivariate analysis were older age, stage III presentation, and histology. The 5‐year LR rate was 5% for those <50 compared with 15% for those ≥50 (P = .001). For patients with stage III the LR rate was 26% versus 7% for those with stage I/II (P < .001). On multivariate analysis only age ≥50 (relative risk [RR] 3.3; P = .02) and stage III disease (RR 3.4; P = .01) remained significant predictors for LR. When the cohort of patients was divided into 3 groups based on the number of risk factors present, the 5‐year LRs were as follows: no risk factors (stage I/II and <50 years old) 4%, 1 risk factor (stage III or ≥50) 12%, and 2 risk factors (stage III and ≥50) 31% (P < .01).CONCLUSIONS.Patients with a pathologically negative re‐excision represent a heterogeneous group. Whereas the overall rate of local recurrence at 5 years was 9% for the entire cohort, patients with older age and/or stage III disease had a higher rate of LR. Therefore, treatment decisions especially with regard to adjuvant RT should be individualized and not be based solely on the finding of a negative re‐resection. Cancer 2008. © 2008 American Cancer Society.