Combined limb-sparing surgery and radiation therapy to treat sarcomas of the hands and feet: long-term cancer outcomes and morbidity
Menée à partir de données portant sur 85 patients atteints d'un sarcome des tissus mous des mains et des pieds et traités entre 1966 et 2012 (âge médian au diagnostic : 41 ans ; durée médiane de suivi : 140 mois), cette étude évalue, du point de vue des taux de contrôle local, de survie sans maladie et de survie globale à 5 ans, l'efficacité d'une chirurgie épargnant les membres en combinaison avec une radiothérapie
Purpose : To investigate local control, survival outcomes, and complication rates of patients treated with limb-sparing surgery and radiation therapy (RT) for soft-tissue sarcomas (STS) of the hands and feet. Methods : We reviewed the medical records of 85 consecutive patients treated for STS of the hands (n=38, 45%) and feet (n=47, 55%) between 1966 and 2012. The median age was 41 years (range, 10-82 years). Sixty-seven patients (79%) received postoperative RT after resection of their tumor (median dose, 60 Gy; range, 45-70 Gy). The remaining 18 patients (21%) were treated with preoperative RT followed by tumor resection (median dose 50 Gy; range, 50-64 Gy). Results : Median follow-up was 140 months (range, 24-442 months). The 5-year LC, OS, and DSS rates were 86%, 89% and 89%, respectively. Positive/uncertain surgical margin status was the only factor adversely associated with local recurrence (19% vs. 6% for negative margins, P=0.046), but lost significance on multivariate analysis when adjusting for RT dose ≥ 64 Gy. Of the 12 patients that relapsed locally, 6 (50%) were salvaged and only 2 of those required salvage amputation. Five patients had ≥ grade 3 late RT sequelae with 2 patients (2%) having moderate limitations of limb function and 3 patients (4%) having severe limitations requiring procedures for skin ulceration. Conclusions : Limb-sparing surgery combined with RT provides excellent local control outcomes for sarcomas arising in the hands or feet. In patients that recur locally, salvage without amputation is possible. The excellent cancer-control outcomes observed, considering the minimal impact on limb function, support use of combined modality, limb-sparing local therapy for STS arising in the hands or feet.
http://www.redjournal.org/article/S0360-3016(15)00422-8/abstract 2015