Surgical lessons from the Intergroup Rhabdomyosarcoma Study (IRS) pertaining to extremity tumors

The large number of patients entered into the Intergroup Rhabdomyosarcoma Study (IRS) has allowed a study of prognostic factors and clinical management decisions for a specific primary site‐the extremities. A retrospective review of IRS I (1972–1978) and IRS II (1978–1984) included 217 patients with sarcomas of the extremities of 1,415 patients without distant metastases. Disease‐free survival and survival data from this subgroup of patients demonstrated that: (a) the UICC clinical staging system has clear‐cut validity, (b) total gross resection of sarcomas of the extremities is an optimal therapeutic approach in spite of proven benefits from nonoperative therapies, (c) results of treatment are improved by reexcision of the initial resection site if the histologic margin is involvedor the initial resection was an unplanned procedure for diagnosis, (d) regional lymph node biopsy or dissection is an important procedure for planning and conduct of the treatment program, and (e) vigorous and thorough surgical procedures are required for optimal end results of treatment of extremity sarcomas despite the proven value of nonoperative therapies.