Posters— Surgical Treatment of Sarcomas

PREOPERATIVE RADIATION THERAPY IN THE TREATMENT OF SOFT TISSUE SARCOMAS

Virkus, Mollabashy A, Reith JD, Berrey HB, Zlotecki RA, Scarborough MT (University of Florida, Gainesville, FL 32610

This report presents the results of a cohort of patients with a soft tissue sarcoma treated with a standard protocol including preoperative radiation therapy (PRT) and surgical resection, assessing wound complications, local recurrence, and oncologic outcome.

A standard protocol of PRT followed by en bloc resection was performed in 218 patients with a primary soft tissue sarcoma from 1984 to 1999. Wound complications were defined as minor (local wound care), moderate (operative I&D), major (STSG or flap), and amputation. Wound complications are reported for the entire patient population. Oncologic results are reported on a subset of patients that excluded patients who were stage III at the time of resection, or received chemotherapy. There were 114 males, 104 females, with an average age of fifty-six (range 8-86). Thirty-six patients received chemotherapy. At the time of resection, 13 patients were stage IA, 16 IB, 63 IIA, 111 IIB, and 15 III. Ten patients had an intralesional surgical margin, 91 marginal, 115 wide, and 2 radical. Primary wound closure was obtained in 187 patients, 9 needed a split-thickness skin graft, 20 a rotational flap, and 2 a free flap for closure. Only six patients underwent primary amputation. Mean oncologic follow-up was 53 months.

The overall wound complication rate was 32.6% (minor 10%, moderate 13%, major 7%, and amputation 1%). If minor wound problems treatable with short-term local wound care are excluded, the wound complication rate was 22.9%. When stage III and chemotherapy patients were removed, 172 patients remained for oncologic outcome analysis. Seventy-three (42%) developed late metastases, predominantly to the lungs (82%). Eighteen patients developed a local recurrence, which was 15.1/o of those patients with a minimum of 2 years of follow-up. The recurrence rate in patients with prior surgery at an outside institution was 24%, versus 12% if initial surgery was at our institution. At latest follow-up, 80 patients (46%) were continuously disease free, 6 (3%) ANED, 8 (4%) alive with disease, and 65 (38%) dead of disease. The two and five-year survival rates were 77% and 66%, respectively.

The ideal timing of adjuvant radiation therapy remains to be determined. PRT allows for a smaller radiation dose and field to be delivered, theoretically decreasing the morbidity of radiation. Our local control rate is similar to that seen in other studies where a high percentage of adequate surgical margins is obtained. Twenty-two percent of our patients required a return to the operating room for wound complications. This is similar to the wound complication rates in studies where postoperative XRT or no XRT is used. Distant control continues to be a difficult problem in the treatment in soft tissue sarcomas.