The management of soft tissue sarcomas in adults: surgery and postoperative radiotherapy

Traditionally soft tissue sarcomas have been managed by surgery, because they were considered radioresistant. Experience has shown that the local recurrence rate after a simple excision is 90 per cent and 30 per cent after radical surgical procedures. The treatment of soft tissue sarcomas by radical ratiation therapy alone is also unrewarding-the local recurrence rate being 66 per cent. In order to preserve a functional limb, a selected group of patients was treated using a conservative surgical excision of the gross tumor (usually a simple "shelling out"), and immediate postoperative radiation therapy. The rationale for removing all gross tumor by conservative surgical excision is that the remaining subclinical disease can be destroyed with moderate doses of postoperative irradiation. In 70 patients with soft tissue sarcomas of the extremities, all local failures occurred in tumors of the fleshy parts with a recurrence rate of 17.2 per cent, independent of the histological type. In spite of generous radiation fields, 4 of the 12 local recurrences were outside of the irradiated volume, some more than 5 cm from the margin of the field. This documents the tendency of soft tissue sarcomas to spread along the fascial planes for a great distance. To avoid complications only part of the entire circumference of an extremity must be irradiated since a severe constricting fibrosis may result with varying degrees of edema distal to the irradiated volume when all of most of the circumference is irradiated. This retrospective review of patients treated for extremity lesions by conservative excision and postoperative radiotherapy shows that a functionnal limb can be preserved in 80 per cent of the patients.