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Spermatic cord sarcoma: outcome, patterns of failure and management
M T Ballo1, G K Zagars, P W Pisters
1Department of Radiation Oncology, the University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Purpose:
We evaluate the outcome, clarify the patterns of failure and suggest treatment strategies for sarcoma in the spermatic cord.
Materials And Methods:
Between 1956 and 1998, 32 patients with spermatic cord sarcoma were treated at M. D. Anderson Cancer Center. A retrospective review of disease outcome, patterns of relapse and patient survival was performed.
Results:
Histological subtypes of sarcoma were malignant fibrous histiocytoma in 12 patients, leiomyosarcoma in 6, liposarcoma in 8 and other subtypes in 6. All except 2 patients underwent radical orchiectomy with or without additional resection to achieve negative margins. Margins were microscopically negative in 29 cases and positive in 3. There were 3 patients who received adjuvant radiation to the surgical site. With a median followup of 9 years the 10 and 15-year actuarial local control, distant metastasis-free and overall survival rates were 72% and 61%, 85% and 85%, and 63% and 52%, respectively. The major pattern of failure was local recurrence that occurred in 8 of the 12 patients in whom disease relapsed and was the sole site of relapse in 7. Pelvic nodes had relapsed in 2 patients and para-aortic nodes in 1. Hematogenous metastases had developed in 4 patients. Of the 7 cases of disease that recurred locally only 3 were salvaged. No relapse occurred in the 3 patients treated with combined surgery and radiation.
Conclusions:
Spermatic cord sarcoma has a high propensity for local recurrence after surgery. Nodal relapse is less frequent than commonly believed. Because of the relatively high local failure rate seen in surgery alone and durable local control noted in 3 patients treated with surgery plus radiotherapy, combined modality treatment should be considered in those with spermatic cord sarcoma who are believed to be at high risk for local failure.
Insights
Spermatic cord sarcoma frequently recurs locally after surgery. Combined surgery and radiation may improve local control for high-risk patients.
Area of Science:
- Oncology
- Surgical Oncology
- Urologic Oncology
Background:
- Sarcomas of the spermatic cord are rare malignancies.
- Understanding their behavior and outcomes is crucial for effective treatment.
Purpose of the Study:
- To evaluate outcomes of spermatic cord sarcoma.
- To clarify patterns of failure.
- To suggest optimal treatment strategies.
Main Methods:
- Retrospective review of 32 spermatic cord sarcoma patients treated between 1956 and 1998.
- Analysis of disease outcomes, relapse patterns, and survival rates.
- Histological subtypes included malignant fibrous histiocytoma, leiomyosarcoma, and liposarcoma.
Main Results:
- Local recurrence was the predominant failure pattern (8/12 relapsed patients).
- 10- and 15-year actuarial local control rates were 72% and 61%.
- No relapse occurred in 3 patients treated with combined surgery and radiation.
Conclusions:
- Spermatic cord sarcoma exhibits a high propensity for local recurrence post-surgery.
- Nodal relapse is less common than anticipated.
- Combined modality treatment (surgery plus radiotherapy) should be considered for high-risk cases to improve local control.
