Sarcomas of the hand and foot: analysis of local control and functional result with combined modality therapy in extremity preservation.
OBJECTIVE
The records of 28 patients with sarcomas of the hand and foot treated at the National Cancer Institute (NCI) between 1977 and 1992 were reviewed to assess local control and functional results.


METHODS
Histologic types included 15 cases of the Ewing's sarcoma family of tumors, 7 cases of alveolar rhabdomyosarcoma, and 6 cases of nonrhabdomyosarcoma soft tissue sarcomas. Median age of all patients was 18 years (range 4-61), with a median potential follow-up of 114 months following diagnosis. Surgery varied from incisional biopsies for Ewing's Sarcoma and rhabdomyosarcoma lesions to complete excision when possible for nonrhabdomyosarcoma soft tissue sarcoma lesions. Amputation was not primarily performed, except in two patients who underwent ray resections of hand lesions (patients 13 and 24). Radiotherapy generally consisted of 50 Gy/25 fractions (fx)/5 weeks for Ewing's Sarcoma, 54 Gy/30 fx/6 weeks for rhabdomyosarcoma, and 63 Gy/35 fx/7 weeks for nonrhabdomyosarcoma soft tissue sarcomas. Chemotherapy was administered on various NCI protocols.


RESULTS
Actuarial local control for Ewing's Sarcoma was 84% at 5 and 10 years. All but one survivor are capable of hand/foot function for routine activities without orthotic requirements. Five of six patients (83%) who died of metastatic disease had functional distal extremities. Actuarial local control for rhabdomyosarcomas was 100%, with equivalent function. No patient developed a second malignancy in the treatment field.


CONCLUSIONS
Although equivalent local control may be achieved in these lesions with either amputation or radiotherapy, a prudent management course would be to defer amputation for management of local recurrences. Many patients with these lesions fail in distant sites only and die without local failure. For these patients and for those who remain long-term survivors, we believe a functional hand and foot provides a better quality of life than a prosthesis.
Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892.
P A
PA
Johnstone
L H
LH
Wexler
D J
DJ
Venzon
J
J
Jacobson
J C
JC
Yang
M E
ME
Horowitz
T F
TF
DeLaney
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005528:Foot; D006225:Hand; D006801:Humans; D008297:Male; D008875:Middle Aged; D018242:Neuroectodermal Tumors, Primitive / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D018241:Neuroectodermal Tumors, Primitive, Peripheral / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D012189:Retrospective Studies; D018232:Rhabdomyosarcoma, Alveolar / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D012509:Sarcoma / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D012512:Sarcoma, Ewing / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D016019:Survival Analysis