Analysis of Non Metastatic Soft Tissue Sarcomas of the Extremities in Adults and Role of Re-Excision for Unplanned Excision

Siddappa, K T (2010) Analysis of Non Metastatic Soft Tissue Sarcomas of the Extremities in Adults and Role of Re-Excision for Unplanned Excision. Masters thesis, Cancer Institute (WIA), Chennai.


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INTRODUCTION: Soft tissue sarcomas are rare tumors comprising less than 1% of all malignant tumors whereas extremity soft tissue sarcomas (ESTS) make up about 60% of soft tissue sarcomas. The treatment of ESTS has changed since the 1980s from radical amputations to limb sparing surgery in combination with adjuvant radiotherapy with very similar results, which has been addressed by a prospective, randomized trial at the NCI. Limb sparing excisions can be achieved in approximately 95% of patients. Adjuvant radiotherapy enhances local control, preserve function, and achieve acceptable cosmesis by contributing to tissue preservation. Because upto half of patients with sarcomas after adequate local control of the disease will develop distant metastasis, usually to the lungs. It was hoped that adjuvant chemotherapy would help to decrease the frequency of distant metastasis and increase overall survival. In meta-analysis regarding adjuvant chemotherapy was shown an absolute overall survival of 7% in the group receiving chemotherapy for extremity sarcomas. There are various controversial issues concerning the management of ESTS after unplanned resection such as patient selection for re-excision, imaging before re-excision, factors affecting local and distant recurrence, and the choice of adjuvant therapies. OBJECTIVES: 1. To analyze the patient characteristics, tumor characteristics and prognostic factors in patients with non metastatic soft tissue sarcoma of the extremities in adults. 2. To study the role of re-excision for the previously unplanned excision. MATERIALS AND METHODS: From January 1996 to December 2005, 145 consecutive cases of nonmetastatic adult soft tissue sarcomas of the extremities were included in the study. We excluded all pediatric sarcomas, Rhabdomyosarcoma, Ewing’s sarcomas and Primitive neuroectodermal tumors and stage IV disease at presentation or on evaluation. Others like Dermatofibrosarcoma protuberans and aggressive fibromatosis were also excluded. Out of 145 patients 74 (51%) patients had undergone unplanned resection of a primary sarcoma at a nonspecialized center and were subsequently referred to our institution for further treatment. These were further categorized into re-excision and non re-excision group depending on the review of operative notes, Pathology report, clinical and radiological findings. a) Re-excision group contains 52(36%) patients, out of which 20 patients had clinical or radiological presence of residue disease and the remaining 32 patients had only scar. b) Non re-excision group contains 22 patients of which, 19 were considered for adjuvant radiation and 3 were kept under surveillance without re-excision. All patients were thoroughly evaluated with detail history, physical examination, review of slides, paraffin blocks and surgical notes (if treated initially elsewhere). Metastatic workup includes chest X-ray and CT-scan of thorax. Extent of local disease was assessed by contrast CT-scan or MRI. RESULTS: From January 1996 to December 2005, 145 consecutive adult patients diagnosed with non-metastatic extremity soft tissue were studied and followed up till August 2009. Mean duration of follow-up is 59months (2 - 142months). There were 95 men and 50 women; their mean age was 40.7 years (median age 39years; range 16 to 84). The most common presenting symptom was painless swelling. The duration of symptoms varied from 1 to 240 months with mean duration of 30 months. Most common histology were Synovial sarcoma (23.4%), MFH (19.3%), Liposarcoma (7.6%), Pleomorphic sarcoma(8.3%) and not classified (spindle cell sarcoma- 21.3%). CONCLUSIONS: A patient with any soft tissue swelling, which raises a suspicion of soft tissue sarcoma, should be referred to a specialist centre, where a multidisciplinary team with good experience will be available. Surgery is the main treatment modality. Grade and age were found to be significant prognostic factors for survival. All patients who have undergone unplanned excision for soft tissue sarcomas should be followed by wide re-excision because substantial number patients will have residual disease even with normal imaging and re-excision has shown a significant decrease in risk of local recurrence.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Non Metastatic Soft Tissue Sarcomas, Extremities in Adults, Re-Excision for Unplanned Excision.
Subjects: MEDICAL > Surgical Oncology
Depositing User: Subramani R
Date Deposited: 16 Feb 2020 10:52
Last Modified: 21 Feb 2020 23:55

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