Management of patients with sarcoma of soft tissue in an extremity

Results of management of 57 patients with sarcoma of soft tissue on an extremity by radical dose radiation therapy are presented. These patients had been treated 2 to 10 years previously at the University of Texas M.D. Anderson Hospital. Forty-six patients were seen after simple excision (no palpable tumor at time of our examination), while 11 patients were treated for the primary or a recurrent tumor. The recommended surgical treatment was amputation in all patients of this study sample. Radiation therapy technique was complex; dose level was 6300–7000 rads or the equivalent in 61/2-7 weeks. Local control has been achieved in 50 of 57 patients. For the 46 patients with lesions in the elbow-hand or knee-foot regions, local control has been 100%. In contrast, 7 of 11 tumors located in the proximal extremities (upper arm or thigh) have recurred locally. A useful limb has been retained for 2 to 10 years in 34 of the cases. The more refined techniques of therapy now being employed yield a good functional result in nearly all cases. Metastasis-free survival at 2 to 10 years is 58%. This figure depends not only upon histologic type but apparently also on histologic grade: 26 of 36 (72%) for Grades 1 and 2 but only 7 of 17 (41%) for Grade 3.