Functional and Oncological Outcomes in Patients With Surgically Treated Lower Extremity Soft Tissue Sarcoma

IntroductionTreatment of soft tissue sarcomas can profoundly impact on patients' clinical and functional outcomes, and quality of life (QoL). In this study, we aimed to investigate the factors affecting oncological and functional outcomes in surgically treated lower extremity soft tissue sarcoma patients.MethodsThis retrospective study analyzed 52 patients with lower extremity soft tissue sarcoma treated between 2016 and 2022. All patients underwent surgical excision and radiotherapy, either in the neoadjuvant (n:32, 28 Gy over 10 days) or adjuvant (20 patients, 45 Gy 5 week) setting. QoL was assessed using the QLQ-C30 score, while functional outcomes were evaluated with the Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage Score (TESS) scales. Additionally, factors such as tumor location, histological subtype, surgical margins, tumor volume, and oncologic status were analyzed in relation to functional and QoL outcomes.ResultsPatients who received adjuvant radiotherapy had significantly higher mean MSTS and TESS scores compared to those who received neoadjuvant radiotherapy (P = 0.032, P = 0.010, respectively). Patients who received adjuvant radiotherapy had also significantly higher total QLQ-C30 scores and subscale scores for Physical Functioning, Role Functioning, and Social Functioning compared to those who underwent neoadjuvant treatment (P = 0.033, P = 0.005, P = 0.005, P<0.001, respectively). Five-year overall survival was 72%, and local control was 69%. Mortality rate was higher in patient with pelvic tumors and metastatic disease. In the multivariate analysis, only the presence of metastasis was found to have a significant effect on overall survival (P < 0.05).ConclusionOur study highlights that tumor location, particularly pelvic involvement, and the presence of metastases are associated with poorer oncologic outcomes in patients with lower extremity soft tissue sarcomas. Additionally, adjuvant radiotherapy, delivered using a conventional fractionation scheme, is linked to better functional outcomes and improved QoL compared to neoadjuvant radiotherapy, which is administered in a hypo-fractionated regimen.