title: High-grade extremity soft tissue sarcomas: factors predictive of local recurrence and its effect on morbidity and mortality.
abstract: OBJECTIVE
  To identify patient characteristics associated with the development of local recurrence and the effect of local recurrence on subsequent morbidity and mortality in patients with intermediate- to high-grade extremity soft tissue sarcomas.
  
  
  BACKGROUND
  Numerous studies on extremity soft tissue sarcomas have consistently shown that presentation with locally recurrent disease is associated with the development of subsequent local recurrences and that large tumor size and high histologic grade are significant factors associated with decreased survival. However, the effect of local recurrence on patient survival remains unclear.
  
  
  METHODS
  From 1975 to 1997, 753 patients with intermediate- to high-grade extremity soft tissue sarcomas were treated at UCLA. Treatment outcomes and patient characteristics were analyzed to identify factors associated with both local recurrence and survival.
  
  
  RESULTS
  Patients with locally recurrent disease were at a significantly increased risk of developing a subsequent local recurrence. Local recurrence was a morbid event requiring amputation in 38% of the cases. The development of a local recurrence was the most significant factor associated with decreased survival. Once a patient developed a local recurrence, he or she was about three times more likely to die of disease compared to similar patients who had not developed a local recurrence.
  
  
  CONCLUSIONS
  Local recurrence in patients with intermediate- to high-grade extremity soft tissue sarcomas is associated with the development of subsequent local recurrences, a morbid event decreasing functional outcomes and the most significant factor associated with decreased survival. Although 85% to 90% of patients with high-grade extremity soft tissue sarcomas are treatable with a limb salvage approach, patients who develop a local recurrence need aggressive treatment and should be considered for trials of adjuvant systemic therapy.
authors.affiliation: Division of Surgical Oncology, 54-140 CHS, UCLA Medical Center, 10833 Le Conte Avenue, Los Angeles, CA 90095-1782, USA. eilberf@mskcc.org
authors.forename: Fritz C
authors.initials: FC
authors.lastname: Eilber
authors.forename: Gerald
authors.initials: G
authors.lastname: Rosen
authors.forename: Scott D
authors.initials: SD
authors.lastname: Nelson
authors.forename: Michael
authors.initials: M
authors.lastname: Selch
authors.forename: Frederick
authors.initials: F
authors.lastname: Dorey
authors.forename: Jeffery
authors.initials: J
authors.lastname: Eckardt
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Eilber
mesh_terms: D000671:Amputation, Surgical; D000970:Antineoplastic Agents / Q000627:therapeutic use; D024221:Antineoplastic Protocols; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage / Q000627:therapeutic use; D005121:Extremities; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000628:therapy*; D010984:Platinum / Q000008:administration & dosage; D011379:Prognosis; D011878:Radiotherapy / Q000379:methods; D012307:Risk Factors; D012509:Sarcoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D010984:Platinum; D004317:Doxorubicin; D007069:Ifosfamide