Purpose: Lymphoedema is a serious potential complication of the management of extremity soft tissue sarcoma (STS) about which relatively little is known. We aimed to evaluate the incidence of lymphoedema, its severity and associated risk factors following limb salvage for extremity STS.

Method: Lymphoedema severity (EORTC/RTOG) was recorded prospectively in two databases of soft tissue sarcoma patients. Patient’s demographics, tumor characteristics, surgical procedures, radiotherapy dosage, complications and functional outcomes (MSTS, TESS) were also prospectively collected. Charts were also retrospectively abstracted for body mass index (BMI) and medical comorbidities.

Results: 289 patients had sufficient data for analysis (158 male). Mean age was 53 (range 16–88). Mean BMI was 27.4 (range: 15.8–52.1). 209 had lower extremity tumors and 80, upper. Mean tumor size was 8.1 cm (range 1.0–35.6 cm). 77 had no adjuvant radiation, 180 had 50 Gy and 32, 66 Gy. The incidence of lymphoedema was found to be 28.7% (58 mild, 22 moderate, 3 severe). Mean MSTS score was 32 (range: 11–35) and TESS was 89.4 (range: 32.4–100). We grouped cases with lymphoedema grade 0–1 and 2–3. Univariate analysis found significant correlations between the severity of lymphedema and tumor size ≥5 cm (p=0.011), deep location (no patient with a superficial tumor had severe lymphoedema, p=0.001), and radiation dosage 50 vs 66 Gy (p=0.021) but not between upper vs lower extremity (p=0.06).

Conclusion: 9% of STS studied developped significant post-treatment lymphoedema. Large, deep tumors and necessity for 66 Gys were most at risk. This group could be targeted for prophylatic intervention.

Purpose: To review all cases of soft tissue sarcoma of the foot and ankle treated in a specialized musculoskeletal oncology practice over a 15 year period. This was done to gain insight into the presentation, treatments, and outcomes for this rare disease.

Method: 16 patients (mean age at presentation 43, range 15–79, 9 female) were identified from our database of nearly 1000 cases of musculoskeletal tumors (1.6%). 8 were referred following unplanned excision and 3 after local recurrence. The pathologic diagnoses included synovial sarcoma (n=7), clear cell sarcoma (n=2), fibrosarcoma (n=2), and other diagnosis (n=6). AJCC stages were: Ia – 2, IIb – 7, IIc – 1, III – 4, and IV – 2. The tumors were mostly located on the medial (n=7) or dorsal (n=6) aspects of the foot. They were equally distributed among the hindfoot, midfoot, and forefoot.

Results: Treatment consisted of resection in 10, resection and arthrodesis in 3, and amputation in 4 patients. The resections were intralesional in 4 patients, marginal in 7 and wide in 6. Among the 13 limb salvage patients, one needed skin grafting and 9 required free tissue transfers. Radiation therapy was used preoperatively in 5 and post-operatively in 7 cases. Neoadjuvant chemotherapy was given to 2 patients. Followup averaged 6 years (range 2–15). Local recurrence occurred in 2 patients (17%). One was treated with re-excision and one with amputation. Lung metastases occurred in 4 patients. At last followup: 11 of the 17 patients were alive without disease, 2 with disease, and 4 had died of their disease. No local recurrence in primarily treated tumor led to metastasis. Postoperative MSTS 1987 and TESS scores averaged 28 and 90% respectively.

Conclusion: Soft tissue sarcoma of the foot is rare. Surgical treatment is challenging due to the complex anatomy and limited soft tissues. Limb salvage often required accepting intralesional or marginal resections and using free tissue transfer. The addition of radiation therapy yielded an acceptable local control rate and very good functional outcomes. However, the impact this limb salvage approach on mortality is not clear.