T Nakamura1, A Abudu, H Murata, R J Grimer, S R Carter, R M Tillman, L Jeys. 1. Oncology Service, The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham B31 2AP, UK; Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu-city, Mie 514-8507, Japan.
Abstract
AIMS: The treatment of pelvic soft tissue sarcomas (STS) presents one of the most challenging problems in musculoskeletal oncology because of the complex anatomy of the pelvis, late diagnosis and large tumor size. Our study was designed to determine the outcome and prognostic factors for survival and local recurrence in patients with pelvic STS located deep to the fascia and deemed suitable for curative surgical treatment. PATIENTS AND METHODS: Ninety consecutive pelvic STS patients with at least 5-year possible follow-up from diagnosis were studied. Mean age at diagnosis was 54 years. Mean follow-up and tumor size were 69 months and 13 cm, respectively. Histological grades were grade 3 in 51, grade 2 in 22 and grade 1 in 17 patients. Tumor locations were extra-pelvic or outside pelvic brim (n=67), intra-pelvic or within pelvic brim (n=10), and combined or involving both outside and within pelvic brim (n=13). RESULT: Surgical treatment was excision in 84 patients and hindquarter amputation in 6 patients. In 84 patients who underwent excision, surgical margin was wide in 21 patients, marginal in 33, and intralesional in 30. Radiotherapy was used for all high grade tumors. Disease-specific survival was 53.3% at 5 years. Local recurrence occurred in 23%. Development of local recurrence was related to surgical margin (p=0.03). Local recurrence, tumor histological grade and metastasis at diagnosis independently influenced disease-specific survival (p=0.0008, p<0.0001, p=0.02, respectively). CONCLUSION: The patients with high grade tumors and positive surgical margins represent a particular group with high risk of local recurrence even with radiotherapy.
AIMS: The treatment of pelvic soft tissue sarcomas (STS) presents one of the most challenging problems in musculoskeletal oncology because of the complex anatomy of the pelvis, late diagnosis and large tumor size. Our study was designed to determine the outcome and prognostic factors for survival and local recurrence in patients with pelvic STS located deep to the fascia and deemed suitable for curative surgical treatment. PATIENTS AND METHODS: Ninety consecutive pelvic STS patients with at least 5-year possible follow-up from diagnosis were studied. Mean age at diagnosis was 54 years. Mean follow-up and tumor size were 69 months and 13 cm, respectively. Histological grades were grade 3 in 51, grade 2 in 22 and grade 1 in 17 patients. Tumor locations were extra-pelvic or outside pelvic brim (n=67), intra-pelvic or within pelvic brim (n=10), and combined or involving both outside and within pelvic brim (n=13). RESULT: Surgical treatment was excision in 84 patients and hindquarter amputation in 6 patients. In 84 patients who underwent excision, surgical margin was wide in 21 patients, marginal in 33, and intralesional in 30. Radiotherapy was used for all high grade tumors. Disease-specific survival was 53.3% at 5 years. Local recurrence occurred in 23%. Development of local recurrence was related to surgical margin (p=0.03). Local recurrence, tumor histological grade and metastasis at diagnosis independently influenced disease-specific survival (p=0.0008, p<0.0001, p=0.02, respectively). CONCLUSION: The patients with high grade tumors and positive surgical margins represent a particular group with high risk of local recurrence even with radiotherapy.