Surgical margin in soft tissue sarcoma. The Scandinavian Sarcoma Group experience

Area of Science:

• Oncology
• Surgical Oncology
• Clinical Trials

Background:

• High-grade soft tissue sarcomas require effective treatment strategies to improve local tumor control and patient survival.
• Surgical margins are a critical factor influencing the risk of local recurrence in sarcoma treatment.

Purpose of the Study:

• To evaluate the impact of different surgical margins on local tumor control in adult patients with high-grade soft tissue sarcoma.
• To assess the efficacy of postoperative doxorubicin and radiotherapy in conjunction with surgical management.

Main Methods:

• A randomized clinical trial involving 240 adult patients with high-grade soft tissue sarcoma across 18 hospitals.
• Patients were randomized to postoperative doxorubicin or control, with radiotherapy for marginal surgical margins.
• Analysis focused on local tumor control rates based on surgical margin status in 185 extremity tumors (Grades III or IV).

Main Results:

• Overall cumulative local tumor control was 91% after a median follow-up of 47 months.
• Compartmental or wide amputation (100%) and compartmental local excision (96%) demonstrated the highest local control rates.
• Marginal excision alone resulted in a significantly lower local control rate (63%) compared to other surgical approaches.
• The risk of local recurrence was 13 times higher after marginal surgery than compartmental surgery (P=0.02) and 3 times higher for tumors >10 cm (P=0.05).
• Postoperative doxorubicin did not significantly influence the risk of local recurrence.

Conclusions:

• Wide surgical margins, including compartmental or wide amputation and compartmental local excision, are associated with superior local tumor control in high-grade soft tissue sarcomas.
• Marginal excision alone is insufficient for local tumor control and significantly increases recurrence risk.
• Adjuvant doxorubicin therapy did not improve local recurrence rates in this study.