Periosteal margin in soft-tissue sarcoma.
BACKGROUND
Soft-tissue sarcomas frequently rest in contact with bone. The purpose of the study was to evaluate the risk of local recurrence for sarcomas adjacent to bone and to determine whether the periosteum provides an adequate margin of resection.


METHODS
Fifty patients with soft-tissue sarcomas abutting bone were treated at a single institution between 1990 and 2004. All patients had high-grade, T2 (>5 cm), nonmetastatic disease in the lower extremity. Bone contact was verified by preoperative magnetic resonance imaging (MRI) and/or computed tomography (CT) scans. Forty-three of 50 patients received preoperative radiation with a mean dose of 50 Gy. In 11 cases a composite resection of bone and soft tissue was performed. In 39 cases the excision involved only soft tissue.


RESULTS
True bone invasion was verified by histopathologic examination in 3 of 50 cases (6%). Local recurrence in the soft tissues developed in 8 of 50 (16%) patients. In no case did the recurrence involve destruction of cortical bone or erosion into bone. The recurrent tumor resided against the region of previous bone contact in 1 of 8 cases. There was no statistically significant difference in local recurrence between patients who had composite bone resection and patients who had soft-tissue resection only (P = .87).


CONCLUSIONS
Relatively few sarcomas are able to penetrate cortical bone. Composite bone and soft-tissue resections are indicated primarily for frank bone invasion. In the absence of this, the periosteum is an adequate surgical margin for sarcomas treated with wide excision and radiation.
Lin
Patrick P
PP
Section of Orthopaedic Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77230, USA. plin@mdanderson.org
Pino
Eduardo Diaz
ED
Normand
Anne N
AN
Deavers
Michael T
MT
Cannon
Christopher P
CP
Ballo
Matthew T
MT
Pisters
Peter W T
PW
Pollock
Raphael E
RE
Lewis
Valerae O
VO
Zagars
Gunar K
GK
Yasko
Alan W
AW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D010521:Periosteum / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D012509:Sarcoma / Q000473:pathology* / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate