RESULTS AND PROGNOSTIC FACTORS AFTER RESECTION OF SOFT TISSUE SARCOMAS OF THE EXTREMITIES

Abstract

Goal: Evaluation of prognostic factors on the long term survival of soft tissue sarcomas after resection.

Methods: Between 1991–2003

1. a) 29 synovial sarcomas males:femals 15:14 (mean age 36),

2. b) 15 leiomyosarcomas m:f 8:7 (mean age 62) and between 1997–2004

3. c) 26 malignant fibrous histiocytoma MFH m:f 11:15 (mean age 69) cases were treated individually with multimodal therapy regimen (irradiation/chemotherapy).

R0 resection was archived by 71% of the synovialsarcomas, 60% of leiomyosarcomas and 73% of MFHs’. The histological garding of synovialsarcomas was: G1: 0%, G2:21%, G3:73% and Gx: 6%. The histological garding of leiomyosarcomas was: G1:7%, G2:20%, G3:73% with 11 primary recurrences and the grading of the MFHs’ was G1: 7,7%, G2: 15,4%, G3: 69,2% und Gx: 7,7%.

Results:

1. Synovial sarcomas:

   After a follow-up of 8 (2–14) years the overall survival was 57%, after R0-resection 65% and after R1 resection 0%. The survival of G2 und G3 was 67% and 53% respectively. The survival of T1 and T2-tumors was 100% and 39% respectively. The 2- and 4 year survival of patients with primary metastases and local recurrence was 50% und 28%. 55% of the patients developed local recurrence.

2. Leiomyosarcomas

   After a follow-up of 8 (2–14) years the overall survival was 33%, after R0-resection 44% and after R1 resection 17%. The survival of G2 und G3 was 33% and 27% respectively. The survival of T1 and T2-tumors was 50% and 33% respectively. The 2- and 4 year survival of patients with primary metastases and local recurrence was 73% und 32%. 80% of the patients developed local recurrence.

3. MFHs’

   After a follow-up of 4,5 (1–8) years the overall survival was 73%, after R0-resection 90% and after R1 resection 50%. The survival of G1, G2 und G3 was 50%, 75% and 83% respectively. The survival of T1 and T2-tumors was 100% and 75% respectively. The 2- and 4 year survival of patients with primary metastases and local recurrence was 20% und 0%. 19% of the patients developed local recurrence.

Scores for function and quality of life after treatment were 79% (37%–100%) for synovial- and 76% (53%–93%) for leiomyosarcomas and 76% (44%–100%) for MFHs

Conclusions: The investigated soft tissue sarcomas are highly malignant tumors. Bad prognostic factors for reduced long term survival are T2-tumors and G3-tumors (except MFHs’), local recurrence, metastases at the time of diagnosis and tumors after R1-resection, requiring aggressive multimodal treatment with chemotherapy, radiation and wide or even radical surgery.