Management of soft tissue sarcomas in Portsmouth 1965-1985

This paper describes the results of combined surgical and radiotherapy management of 118 patients with soft tissue sarcoma referred to the Department of Radiotherapy and Oncology at Portsmouth between 1965 and 1985. After exclusion of paediatric rhabdomysarcomas, tumours of the gastrointestinal tract and patients who were referred for follow-up only, 109 patients were left for retrospective analysis: 23 patients had surgery only, 11 received a course of preoperative radiotherapy, 52 were irradiated postoperatively and 14 had only radiotherapy. A range of doses and fractionations was used. The total 5-year actuarial survival was 39.7%, the disease-free survival was 35.6%. After excluding Kaposi sarcomas, retroperitoneal tumours, patients with distant metastases or those too ill for radical therapy, the respective figures were 55.5% and 49.7%. If we also excluded patients, treated by radiotherapy only, or irradiated with gross postoperative disease, the figures were 62.7% and 57.3% respectively. Five-year actuarial local control in 68 patients irradiated either without surgery, or postoperatively, was 57.2%. In tumours smaller than 5 cm in diameter, 5-year survival was 86.7%, and local control was 93.3%. For large tumours over 10 cm in diameter, the respective values were 22.2% and 50%. The dose of 60 Gy was satisfactory, if the surgical procedure removed all macroscopical disease, but higher doses are recommended when there is clinically apparent residual disease.