Posters— Surgical Treatment of Sarcomas

SOFT TISSUE SARCOMAS OF THE HAND AND FOOT

Lin PP, Guzel VB, Pisters PWT, Zagars G.K., and Yasko AW. (University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston TX 77030)

Introduction: Soft tissue sarcomas of the hand and foot pose a special surgical challenge because of the difficulty in obtaining wide surgical margins. This study was designed to evaluate event-free outcome in a cohort of patients with hand and foot sarcomas treated with predominantly limb-sparing approaches.

Methods: A retrospective study was performed on 115 patients with a soft tissue sarcoma of the hand or foot between 1980 and 2000 who were evaluated, treated, and followed at this institution. The medical records were reviewed to evaluate clinicopathologic prognostic factors, treatment, and event-free outcome. Kaplan Meier analysis was used to assess survival, and the log rank test was used to compare different curves.

Results: Most patients (95%) were treated after previous, pre-referral surgery at an outside institution. Most tumors (75%) were T1 lesions (< 5 cm), and most (80%) were intermediate or high grade. Patients who were treated by wide re-excision had a 10 year local relapse-free survival of 88%, and this was significantly better than the corresponding rate of 58% for patients who did not have re-excision (p=0.05). Radiation improved local control for patients who did not undergo re-excision (p=0.02). However, radiation did not improve local control for patients who had wide re-excision. The overall survival rates for patients with localized disease were 76% and 65%, respectively. Survival was significantly worse for patients who had regional metastasis. Radical amputation as initial surgical treatment did not decrease the likelihood of regional metastasis and did not improve survival.

Conclusion: Limb sparing surgery is possible in most patients with soft tissue sarcomas of the hand and foot. Aggressive, wide re-excision is an effective method of achieving a high rate of local control. Radiation seems appropriate when margins are close or positive. There does not appear to be a survival benefit to immediate radical amputation