Surgery alone is adequate treatment for early stage soft tissue sarcoma of the extremity.
Al-Refaie WB; Habermann EB; Jensen EH; Tuttle YM; Pisters PWT; Virnig BA
Brit J Surg 2010 May; 97(5):707-713
Background: Evolving evidence suggests that, in selected patients with tumour category 1 (T1) extremity soft tissue sarcoma (ESTS), surgery alone offers satisfactory results without decreasing survival. This study assessed the effect of sarcoma treatments on survival outcomes of T1 ESTS in a population-based data set. Methods: Using the Surveillance, Epidemiology, and End Results database, 1618 patients with primary ESTS underwent limb-sparing surgery. Multivariable analysis was used to assess the impact of radiotherapy on overall survival (OS) and sarcoma-specific survival (SSS), adjusting for co-variables. Results: Some 803 patients (49·6 per cent) underwent surgery alone for T1 ESTS. Radiotherapy in patients with low- and high-grade tumours did not result in any significant difference in OS or SSS. When stratified by grade, multivariable analysis showed that adjuvant radiotherapy was not an independent predictor of SSS (hazard ratio (HR) 1·05; P = 0·906) or OS (HR 0·89; P = 0·695) in low-grade tumours. Neither was radiotherapy a significant predictor of SSS (HR 0·87; P = 0·608) or OS (HR 0·67; P = 0·071) in high-grade tumours. Conclusion: This population-based appraisal validated previous evidence supporting a role for surgery alone in the treatment of T1 ESTS. Future policies should be tailored to offer patients minimal yet effective therapy, rather than maximum tolerated therapy.
Analytical-processes; Epidemiology; Mathematical-models; Risk-analysis; Sarcomagenicity; Statistical-analysis; Surgery; Tissue-distribution
Dr W. B. Al-Refaie, Division of Surgical Oncology, Department of Surgery, Mayo Mail Code 195, University of Minnesota and Minneapolis VA Medical Center, 420 Delaware Street SE, Minneapolis, MN 55455
British Journal of Surgery
University of Minnesota Twin Cities