Abstract
Introduction: Current practice in the UK is to perform clinical follow up on patients with soft tissue sarcoma (STS) and only to request cross sectional imaging if there is clinical suspicion. We aimed to assess the effectiveness of this policy by investigating the patients who developed a local recurrence (LR) after previous treatment for STS and whether the size and extent at diagnosis of LR affected their subsequent management
Method: We reviewed the clinical records and imaging of all patients with diagnosed LR of STS to investigate the site and size of the LR and its management.
Results: 35 patients were diagnosed with LR over a 3 year time period. The average time from previous definitive treatment was almost 19 months. The suspicion was made by the patient in 18 patients, by a doctor in 16 and a district nurse in 1. The patients had MRI to confirm the diagnosis followed by biopsy or excision biopsy. 31 of the tumours were high grade, 2 low and 2 were not excised. The size at time of LR was 5.6 cm (range 0.5–15). 12 of the patients had concomitant metastases. 16 were treated by local excision and 5 by amputation whilst 14 patients had palliation. It was felt that with earlier diagnosis the clinical management would have been different in:
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those 7 whose LR was inoperable due to size,
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those 7 patients with LR_5cm who had concomitant metastases and
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in the 5 patients who already had maximum doses of radiotherapy.
Discussion: Earlier diagnosis could have led to simpler surgery in a third of the affected patients. This study raises the question as to whether a more aggressive policy of follow up with regular imaging (either MRI or ultrasound) could detect LR earlier and lead to improved outcomes.
Correspondence should be addressed to BOOS c/o British Orthopaedic Association, 35-43 Lincoln’s Inn Fields, London WC2A 3PE, England
