2001 CTOS Annual Meeting Posters— Surgery

SPERMATIC CORD SARCOMA: OUTCOME, PATTERNS OF FAILURE AND MANAGEMENT
Matthew T. Ballo,  Gunar K. Zagars,  Peter W. T. Pisters,  Barry W. Feig,  Shreyaskumar R. Patel,  Andrew C. von Eschenbach
UT M.D. Anderson Cancer Center

METHODS: Between 1956 and 1998, 32 patients were identified through a search of our patient registry with the diagnosis of non-metastatic spermatic cord sarcoma. A retrospective review of disease outcome, patterns of relapse and patient survival was performed.

RESULTS: Histologic subtypes of sarcoma were: malignant fibrous histiocytoma (12 patients), leiomyosarcoma (6 patients), liposarcoma (8 patients), and other subtypes (6 patients). All patients had radical orchiectomy with or without additional resection to achieve negative margins. Margins were microscopically negative in 29 and positive in three. Three patients received adjuvant radiation to the surgical site. With a median follow-up of 9 years, 14 patients have died resulting in a 10- and 15-year actuarial overall survival of 63% and 52%, respectively. The actuarial 10- and 15-year local control, distant metastasis-free and disease-free survival rates were 72% and 61%, 85% and 85%, and 60% and 51%, respectively. Pattern of failure analysis revealed 8 local failures, 2 regional failures within the pelvis and 6 distant failures. Of the 6 distant failures 2 included synchronous para-aortic lymph node metastases resulting in an actuarial 15-year para-aortic failure rate of 7%. Only three of the seven patients in whom disease recurred locally were salvaged. None of the three patients treated with combined surgery and radiation relapsed.

CONCLUSION: Spermatic cord sarcoma has a high propensity for local recurrence following surgery, while para-aortic nodal failures remain uncommon. This result suggests a role for localized radiotherapy to the pelvis. Elective surgery or irradiation of the para-aortic lymph nodes appears unnecessary.