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Open Access Research article

High incidence of metastatic disease in primary high grade and large extremity soft tissue sarcomas treated without chemotherapy

Benedikt Leidinger1*, Thomas Heyse1, Andreas Schuck2, Horst Buerger3, Philipp Mommsen4, Thomas Bruening4, Susanne Fuchs1 and Georg Gosheger4

Author Affiliations

1 Philipps-University Marburg, Department of Orthopaedics and Rheumatology, 35043 Marburg, Germany

2 University Hospital Muenster, Department of Radiation Therapy, 48149 Muenster, Germany

3 Institute of Pathology, University of Muenster, 48149 Muenster, Germany

4 University Hospital Muenster, Department of Orthopaedic Surgery, 48149 Muenster, Germany

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BMC Cancer 2006, 6:160  doi:10.1186/1471-2407-6-160

Published: 18 June 2006

Abstract

Background

The risk of metastasis and the survival in patients with primary extremity soft tissue sarcomas is worse when tumour size is large and the grade of malignancy is high. Such tumours may receive chemotherapy and/or radiation therapy (RTX) for optimising local control. Irradiation can either be applied preoperatively or after tumour resection. The question arises if the kind of RTX in the absence of chemotherapy influences the outcome concerning local control, metastatic disease, survival and complications.

Methods

We retrospectively reviewed the clinical outcome of 233 patients with a primary extremity soft tissue sarcoma treated between 1990 – 2000 with a mean follow-up of 35.8 (4–120) months in our institute. 41 patients had high grade, deep and large tumours (>8 cm), an AJCC stage III (no evidence of metastasis prior to treatment) and were treated with limb salvage surgery and irradiation but stayed without additional chemotherapy. Two groups of patients were compared: the first group received postoperative RTX after tumour resection (n = 33); the second group was treated with preoperative RTX (n = 8). Both groups did not differ concerning clinical parameters. We analysed primary and secondary outcomes.

Results

56% (23/41) of the population developed metastatic disease, 24% (10/41) local recurrence. The risk of metastasis was higher in the group with preoperative irradiation (p = 0.046). The overall (p = 0.0248) and relapse free survival (p = 0.104) were worse in this group. The delay to tumour resection amounted 8 weeks on average in the preoperative group. Local control was not different (p = 0.38) in both study groups. Wound infections and other combined therapy related complications were equally distributed (p = 0.22).

Conclusion

Without chemotherapy there remains a high risk of metastasis in AJCC grade 3 patients. In high risk patients treated without chemotherapy the elapsed time to tumour resection after preoperative radiation might contribute to the development of metastasis. This outcome may support the thesis that a combination of RTX and offensive multimodal treatment protocols is advantageous in such a subset of patients