title: Adjuvant radiotherapy in the management of soft tissue sarcoma involving the distal extremities.
abstract: OBJECTIVE
  Treating soft tissue sarcoma (STS) of the distal extremity is challenging in terms of achieving local control and avoiding complications. It is now accepted that a limb conserving approach provides equivalent survival when compared with radical amputation.
  
  
  METHODS
  Twenty-three patients with STS involving the hand-wrist or foot-ankle complex received adjuvant radiotherapy (RT) for limb conservation and were evaluated to determine if local control, survival, and functional ability were achieved. The median patient age was 64 and median time of follow-up was 11 years. The location of the sarcoma included the hand (n = 12) or foot (n = 11). Seven patients received preoperative RT (median dose, 50.40 Gy) and 16 patients received postoperative RT (median dose, 64.80 Gy). Patients treated preoperatively and 9 treated postoperatively received hyperfractionated RT at 1.2 Gy twice-daily. Seven patients treated postoperatively received conventional daily-fractionated treatment.
  
  
  RESULTS
  Twenty of 23 patients received RT at first presentation; 3 were treated for locally recurrent disease. The 5- and 10-year rates of local control were 91%. The 10-year rates of cause-specific and absolute survival were 96% and 91%, respectively. The 5- and 10-year rates of distant metastases-free survival were 87%. The ultimate limb-conservation rate was 91%. No patient required an amputation because of local recurrence or treatment complications. Function of the hand or foot was maintained for all of the 21 patients for whom limb-conserving treatment was achieved.
  
  
  CONCLUSIONS
  Combined modality therapy with limb-conserving surgery and adjuvant RT achieves excellent local control (91%) and potential overall survival (91%) rates with excellent functional outcome.
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32610-0385, USA.
authors.forename: Gordon S
authors.initials: GS
authors.lastname: Schoenfeld
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morris
authors.forename: Mark T
authors.initials: MT
authors.lastname: Scarborough
authors.forename: Robert A
authors.initials: RA
authors.lastname: Zlotecki
mesh_terms: D000368:Aged; D005260:Female; D005528:Foot / Q000473:pathology; D006225:Hand / Q000473:pathology; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D018714:Radiotherapy, Adjuvant; D012983:Soft Tissue Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome