title: Spermatic cord sarcoma: outcome, patterns of failure and management.
abstract: OBJECTIVE
  We evaluate the outcome, clarify the patterns of failure and suggest treatment strategies for sarcoma in the spermatic cord.
  
  
  METHODS
  Between 1956 and 1998, 32 patients with spermatic cord sarcoma were treated at M. D. Anderson Cancer Center. A retrospective review of disease outcome, patterns of relapse and patient survival was performed.
  
  
  RESULTS
  Histological subtypes of sarcoma were malignant fibrous histiocytoma in 12 patients, leiomyosarcoma in 6, liposarcoma in 8 and other subtypes in 6. All except 2 patients underwent radical orchiectomy with or without additional resection to achieve negative margins. Margins were microscopically negative in 29 cases and positive in 3. There were 3 patients who received adjuvant radiation to the surgical site. With a median followup of 9 years the 10 and 15-year actuarial local control, distant metastasis-free and overall survival rates were 72% and 61%, 85% and 85%, and 63% and 52%, respectively. The major pattern of failure was local recurrence that occurred in 8 of the 12 patients in whom disease relapsed and was the sole site of relapse in 7. Pelvic nodes had relapsed in 2 patients and para-aortic nodes in 1. Hematogenous metastases had developed in 4 patients. Of the 7 cases of disease that recurred locally only 3 were salvaged. No relapse occurred in the 3 patients treated with combined surgery and radiation.
  
  
  CONCLUSIONS
  Spermatic cord sarcoma has a high propensity for local recurrence after surgery. Nodal relapse is less frequent than commonly believed. Because of the relatively high local failure rate seen in surgery alone and durable local control noted in 3 patients treated with surgery plus radiotherapy, combined modality treatment should be considered in those with spermatic cord sarcoma who are believed to be at high risk for local failure.
authors.affiliation: Department of Radiation Oncology, the University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: M T
authors.initials: MT
authors.lastname: Ballo
authors.forename: G K
authors.initials: GK
authors.lastname: Zagars
authors.forename: P W
authors.initials: PW
authors.lastname: Pisters
authors.forename: B W
authors.initials: BW
authors.lastname: Feig
authors.forename: S R
authors.initials: SR
authors.lastname: Patel
authors.forename: A C
authors.initials: AC
authors.lastname: von Eschenbach
mesh_terms: D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005834:Genital Neoplasms, Male / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012509:Sarcoma / Q000628:therapy*; D013085:Spermatic Cord; D015996:Survival Rate; D017211:Treatment Failure