Local Recurrence After Initial Multidisciplinary Management of Soft Tissue Sarcoma: Is there a Way Out?

Abstract

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.

Soft Tissue Masses for the General Orthopedic Surgeon

“…At 5 years, primary soft tissue sarcomas of the extremities have a local recurrence rate of 6% to 17%, metastatic disease rate of 22% to 36%, and mortality rate of 24% to 33%. [30][31][32][33] Operative margin has been demonstrated to be the most important treatment factor and achieving negative margins is associated with decreased rates of local recurrence. 31,34 Histologic high-grade tumors are associated with increased local recurrence, metastasis, and mortality.…”

“…5 Multiple studies have shown no difference in survival rates between limb salvage techniques verses amputation. 33,39 Epineural dissection has been demonstrated to be a safe technique that facilitates limb salvage, in particular in cases in which the soft tissue sarcoma abuts the sciatic nerve. 40 Some centers advocate for plastic surgery involvement for closure, particularly in the setting of irradiated tissue, with one study noting a trend toward decreased reoperation rates.…”

Multidisciplinary Management of Soft Tissue Sarcoma

“…Local recurrence rates after radiation and resection of soft tissue sarcoma have been reported as high as 20% [61, 62]; however, most modern series report the number at 10% or less [34, 35, 63, 64]. Local recurrence can be an extremely difficult problem to manage effectively.…”

What Are Risk Factors for Local Recurrence of Deep High-grade Soft-tissue Sarcomas?

“…Patients who develop a local recurrence from a soft-tissue sarcoma have a poor prognosis [1,7,8]. One study suggests the development of a local recurrence is the most important factor associated with decreased survival, and once patients develop a local recurrence, they are about three times more likely to die from disease compared to patients who do not develop a local recurrence [6].…”

“…Novais et al [8] confirmed local recurrence independently predicts survival after adjusting for all major risk factors. Contemporary multimodal treatment of primary soft-tissue sarcoma reportedly reduces the incidence of local recurrence [1,6]. However, when it occurs, local recurrence remains a devastating event for patients and usually entails substantial morbidity.…”