title: Primary extremity sarcoma: what is the appropriate follow-up?
abstract: BACKGROUND
  Our objective was to evaluate the effectiveness of follow-up tests for detecting first local and distant recurrences in patients with primary extremity soft tissue sarcoma.
  
  
  METHODS
  We retrospectively analyzed all adult cases of primary extremity soft tissue sarcoma (n = 174) treated between 1982 and 1992. Patients were observed every 3 months for 2 years, every 4 months the third year, every 6 months the next 2 years, and annually, thereafter. Each visit consisted of taking the patient's history, a physical examination, a complete blood count, a blood chemistry panel, and a chest x-ray. For high-grade tumors, the primary site was imaged annually when clinically appropriate.
  
  
  RESULTS
  Of 141 patients who were assessable, 29 patients developed local recurrence and 57 developed distant recurrence. All but one of the local recurrences was detected on the basis of an abnormal physical examination. Of the 29 patients who developed local recurrence, 25 were resected. Distant metastases were detected because of symptoms in 21 cases. Of the 36 asymptomatic lung recurrences, 30 were detected by follow-up chest x-ray. Of the 36 asymptomatic lung recurrences, 24 patients underwent metastasectomy. The positive and negative predictive values of surveillance chest x-ray were 92% and 97%, respectively. Laboratory testing never led to the detection of recurrence.
  
  
  CONCLUSIONS
  Close surveillance by clinical assessment and chest x-ray is appropriate for follow-up observation of patients with primary extremity soft tissue sarcoma.
authors.affiliation: Roswell Park Cancer Institute, State University of New York at Buffalo, 14263, USA.
authors.forename: B P
authors.initials: BP
authors.lastname: Whooley
authors.forename: J F
authors.initials: JF
authors.lastname: Gibbs
authors.forename: M M
authors.initials: MM
authors.lastname: Mooney
authors.forename: B E
authors.initials: BE
authors.lastname: McGrath
authors.forename: W G
authors.initials: WG
authors.lastname: Kraybill
mesh_terms: D005121:Extremities / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D011859:Radiography; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000628:therapy; D016019:Survival Analysis