The Impact of Surgical Margins and Adjuvant Radiotherapy in Patients with Undifferentiated Pleomorphic Sarcomas of the Extremities: A Single-Institutional Analysis of 192 Patients

Abstract

Background: Undifferentiated pleomorphic sarcomas are a frequent subtype within the heterogeneous group of soft tissue sarcomas. As the attainment of negative margins can be complicated at the extremities, we determined the prognostic significance of surgical margins in our patient population. Methods: We retrospectively determined the relationship between local recurrence-free survival (LRFS), overall survival (OS), and potential prognostic factors in 192 patients with UPS of the extremities who were suitable for surgical treatment in curative intent. The median follow-up time was 5.1 years. Results: The rates of LRFS and OS after 2 years were 75.7% and 87.2% in patients with R0-resected primary tumors and 49.1% and 81.8% in patients with R1/R2-status (LRFS: p = 0.013; OS: p = 0.001). Adjuvant radiotherapy significantly improved LRFS (5-year: 67.6% vs. 48.4%; p < 0.001) and OS (5-year: 82.8 vs. 61.8; p = 0.016). Both, negative margins and adjuvant radiotherapy were found to be independent prognostic factors in multivariate analysis. Conclusions: The data from this study could underscore the beneficial prognostic impact of negative margins on LRFS and OS. However, the width of negative margins seemed to be not relevant. Notably, adjuvant radiotherapy was not only able to decrease the risk of local failure but also improved OS in a significant manner.

Undifferentiated Pleomorphic Sarcoma of the Spine in a patient with Li-Fraumeni syndrome: a case report

“…UPS, previously termed malignant brous histiocytomas (MFH), is a common subtype of soft tissue sarcoma [5]. UPS is an aggressive tumor type and is associated with a high risk of local recurrence and distant metastasis [5][6][7][8][9][10]. UPS of the bones predominantly affects males and has a peak incidence between the ages of 50 and 70 years old [11,12].…”

“…The prognosis of UPS is poor, with ve-year survival rates ranging between 30-50% [1,2]. UPS can appear throughout the body, but 60% of cases occur in the extremities [5,13]. Primary UPS arising from the bone is relatively rare.…”

“…Ozkurt et al reported that patients with wide surgical margins had a ve-year survival probability of 81.9%, while for patients with marginal surgical margins this was 33.3% [14]. Goertz et al retrospectively studied 192 UPS patients and found that those with negative margins had better overall survival [5]. In the treatment of UPS, surgery alone is not su cient and the rate of local recurrence (LR) and distant metastasis is high.…”

“…In one large study, patients with high-grade MFH of the extremities who underwent excisional surgery, followed by postoperative radiotherapy, experienced a 10-year relapsefree survival of 62% and an overall survival rate of 80% [15,17]. Ole Goertz et al found that adjuvant radiotherapy could decrease the risk of local failure and signi cantly improve overall survival (OS) [5]. The use of chemotherapy in spinal UPS treatment is controversial.…”

“…The use of chemotherapy in spinal UPS treatment is controversial. UPS is also less sensitive to the rst-line chemotherapeutics Doxorubicin and Ifosfamide [5]. Lehnhardt et al analyzed 140 patients with UPS in their extremities and found adjuvant chemotherapy to have no effect on prognosis [3,8].…”