Purpose: Local resection with or without irradiation is the primary treatment modality of soft tissue sarcomas. Adequate surgical margin is required for local tumour control and avoiding local recurrence. Adjacent bone should be included into the resection plan if the tumour is in the close proximity of the bone or cortical and medullary tumour invasion was present. Reconstruction method depends on the location.

Methods: 25 patient (10 female, 15 male) with soft tissue sarcomas received local wide excision including adjacent bone between 1995–2007. Histological types were 3 MPNSTM, 3MFH, 10 Synovial sarcoma, 2 liposarcoma, 4 angiosarcoma, 2 fibrosarcoma, 1 Leiomyosarcoma. Localisations were 5 glutea, 9 thigh, 5 cruris, 1 forearm, 5 foot. In 8 patients with proximal bone resection including the joint surface prosthetic reconstruction were aplied. 6 Patients with intercalary resections required allograft reconstruction with I.M nail, 2 patients required autoclaved graft, 1 patient needed tricortical iliac autograft. 8 patients in the gluteal region required iliac and sacral resections without any bony reconstruction. 25 patient received irradiation. 16 of them had neoadjuant chemotherapy also.

Results: At mean 64 mo.s follow up (min11–max159). Mean age was 44, 5 (min 18–max 71). Oncologically 17 patients were NED, 1 AWD, 7 DOD (2 with local recurrence). Regarding complications 7 patients developed local recurrence, 2 patient developed infection, 2 patient had developed wound healing. 5 of 7 local recurrences were amputated. 2 of them died of the disease. 2 local recurrences could be re-resected. Delayed wound healing and infection occured in the patients received preoperative chemotherapy and irradiation.

Conclusion: If a large soft tissue sarcoma is in the close proximity of an adjacent bone or had cortical or medullary invasion, adjacent bone must be included in the resection plan so that a wide margin could be achieved. Reconstruction of the created bone defect in the weight bearing bone close to a major joint should be prosthetic reconstruction. Allograft reconstruction is recommended in the foot and upper extrimity. A thorough preoperative plan with appropriate imaging should be done and local resection should be performed precisely to achieve satisfactory wide margin which influences the both local and systemic outcome.

Our purpose was to assess the role of preoperative radio-therapy +/− neoadjuvant chemotherapy in nonmetastatic soft tissue sarcoma of extremities for limb-sparing surgery and identify the role of neoadjuvant therapies on local control and survival rate.

Forty-seven patients with soft tissue sarcoma of extremities who were treated at Cerrahpasa Medical Faculty within a limb salvage protocol, including preoperative radiotherapy +/− chemotherapy were retrospectively analized. Median age was 45 years (17–72 years). The tumor size was between 5–33 cm. Seventeen patients were in stage I, 11 in stage II, 19 in stage III. The most common histology was synovial sarcoma. Nine patients were treated for locally recurrent tumour. The tumour and surrounding tissues with probable microscopic tumour involvement observed clinically and radiologically, were irradiated. Thirty-two patients, with a high grade tumour and/or tumours larger than 8 cm, also received neoadjuvant chemotherapy. Neoadjuvant chemotherapy regimen was consisted of doxorubicine and ifosphamide with mesna. Preoperative radiotherapy was applied, usually between the second and third cycles of chemotherapy. Definitive surgery was administered 2–6 weeks after radiotherapy or after the third cycle of chemotherapy. Chemotherapy was completed to 6 courses after the surgery. Postoperative external beam radio-therapy boost of 16 Gy was given who had close or positive surgical margins. Median follow-up time was 67 months (12–217 months). All of the patients had limb-sparing surgery. Patients had; 30 marginal excision, 13 wide local excision, 4 radical resection. Nine patients locally recurred. Limb-sparing surgery was performed for 8 patients. 25 patients had distant metastases. Metastasectomy were applied for 10 patients with lung metastasis. The 5-year local control, disease free survival and overall survival rates were 82.3%, 50.1% and 67.2%, respectively.

Preoperative radiotherapy +/− chemotherapy seems to increase the chance of extremity-sparing surgery with good local control and the survival rates which were comparable with the literature.