Sarcomas near extremity joints in adults.
OBJECTIVE
There are technical difficulties in resecting soft tissue sarcomas extending to or crossing a joint. The objective of this study was to determine the rate of amputation and local recurrence rate for these sarcomas and compare them with the respective rates for overall extremity sarcomas.


METHODS
Retrospective review of 78 patients with sarcoma near a joint compared with 215 patients with extremity sarcomas accrued during the same period, 1977-1994. Of these 78 patients, 64 were in the lower and 14 in the upper extremity. Most common histologic subtypes were malignant fibrous histiocytoma (15/78, 19%), synovial sarcoma (11/78, 14%), liposarcoma (11/78, 14%), and leiomyosarcoma (10/78, 13%). The surgical treatment consisted of local excision in 10 (13%), wide excision in 56 (72%), and amputation in 12 (15%). Adjuvant radiation was given to 26 patients.


RESULTS
Local recurrence was noted in 20% (16/78) patients. The incidence of local recurrence in the surgery alone group (n = 52) was 15% (8/52) and in the surgery plus adjuvant radiation group (n = 26) it was 31% (8/26); P = 0.11. Of the 16 patients with local recurrence, 9 (56%) required amputation. The 5-year and 10-year survival rates for the entire group of patients were 68% and 60% respectively. On multivariate analysis survival varied according to grade (P = 0.05) and tumor size (P = 0.02).


CONCLUSIONS
Amputation was finally required in 27% (21/78) for local control of the disease. The local recurrence rate was 20%. These rates appear to be somewhat higher than those reported in our overall extremity sarcoma series and those in most modern series of overall extremity sarcomas, but the 5- and 10-year survival rates are similar to those of the latter.
Karakousis
C P
CP
State University of New York at Buffalo, Millard Fillmore Health System, Roswell Park Cancer Institute, USA.
Kontzoglou
K
K
Driscoll
D
D
D000328:Adult; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D005121:Extremities / Q000601:surgery; D005260:Female; D018219:Histiocytoma, Benign Fibrous / Q000401:mortality / Q000601:surgery; D006801:Humans; D007596:Joints; D008080:Liposarcoma / Q000401:mortality / Q000601:surgery; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000601:surgery*; D013584:Sarcoma, Synovial / Q000401:mortality / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate