title: Management of soft tissue sarcomas (STS) in first isolated local recurrence: a retrospective study of 83 cases.
abstract: OBJECTIVE
  To analyze the management and clinical outcome of patients treated for a first isolated local recurrence of soft tissue sarcomas (trunk or extremities) and to identify prognosis factors.
  
  
  METHODS
  Between 1980 and 1999, 83 adult patients were included in the study. Mean age was 61 years. Mean tumor size was 6 cm. Most sarcomas were located in extremities (n=74), were deep (n=60), and proximal (n=53); 30 involved nerves or vessels. Histologic subtypes were mainly grade 2 (42%) or 3 (36%) histiocytofibrosarcomas (49%) and liposarcomas (20%). Surgical treatment of recurrences consisted in wide excision (29 cases), marginal resection (43 cases), 5 patients requiring amputation. Final results were R0 (n=33), R1 (n=47) or R2 (n=3) resection. Besides surgery, 6 patients received neo-adjuvant and 7 others adjuvant chemotherapy. Twenty three patients received post-operative external beam radiotherapy (EBRT) (mean dose 55 Gy) and 26 interstitial 192Ir low dose rate brachytherapy (BCT) (mean dose 45 Gy for BCT alone, 22 Gy when associated with EBRT), 19 patients being re-irradiated.
  
  
  RESULTS
  Mean follow up was 13 years. Thirty-seven (45%) patients relapsed, 62% of whom presenting an isolated local recurrence. Nineteen patients developed distant metastases. Multivariate analysis showed only tumor depth (P=0.05) and re-resection for primary R1 resection (P=0.018) being independent prognosis factors for tumor control, radiotherapy (EBRT and/or BCT) being significant in univariate analysis (P=0.05). Overall survival rate was 73%, 54%, and 47% at, respectively, 3.5 and 10 years, and was 65%, 35% and 32% after a further local recurrence. Multivariate analysis showed trunk (P=0.0001) or inferior extremity locations (P=0.023), symptomatic (P=0.001), high grade (P=0.01), deep (P=0.01) tumors, and the occurrence of a further local failure (P=0.004) as unfavorable characteristics for overall survival.
  
  
  CONCLUSIONS
  A first isolated local recurrence of STS increases mainly the risk of a subsequent local relapse. Quality of local treatment is decisive. When a conservative treatment is feasible, it should combine surgical resection and radiotherapy, BCT being the best suited in previously irradiated patients. Efforts have to be pursued to increase quality of the treatment of primary tumors, at best performed in centers that have expertise in this field.
authors.affiliation: Department of Radiation Oncology, C. Regaud Institute, Toulouse, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Moureau-Zabotto
authors.forename: Laurence
authors.initials: L
authors.lastname: Thomas
authors.forename: Binh N'Guyen
authors.initials: BN
authors.lastname: Bui
authors.forename: Christine
authors.initials: C
authors.lastname: Chevreau
authors.forename: Eberhard
authors.initials: E
authors.lastname: Stockle
authors.forename: Pierre
authors.initials: P
authors.lastname: Martel
authors.forename: Paul
authors.initials: P
authors.lastname: Bonneviale
authors.forename: Bernard
authors.initials: B
authors.lastname: Marques
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Coindre
authors.forename: Guy
authors.initials: G
authors.lastname: Kantor
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Matsuda
authors.forename: Martine
authors.initials: M
authors.lastname: Delannes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005354:Fibrosarcoma / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008080:Liposarcoma / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D012509:Sarcoma / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery