title: Factors predicting local recurrence, metastasis, and survival in pediatric soft tissue sarcoma in extremities.
abstract: BACKGROUND
  Pediatric soft tissue sarcomas are rare and differ from those in adults regarding the spectrum of diagnoses and treatment. Sarcomas in extremities may have different prognoses from those located elsewhere.
  
  
  OBJECTIVE
  We sought risk factors predicting local recurrence, metastasis, and overall survival and asked whether radiation and chemotherapy influenced local recurrence, metastasis, and overall survival.
  
  
  METHODS
  We retrospectively reviewed all 98 patients aged 18 years or younger diagnosed with soft tissue sarcomas in extremities from 1990 to 2008. Age, tumor size, depth, location, bone or neurovascular involvement, histologic subtypes, unplanned excision, surgical margins, metastasis at diagnosis, and adjuvant treatments were reviewed for each patient. We determined the effect of each prognostic variable on local recurrence, metastasis, and overall survival.
  
  
  RESULTS
  Ninety-four patients underwent surgical excision and seven patients had local recurrence at a median time of 18.6 months. Radiation therapy reduced the rate of local recurrence. Fourteen patients had metastasis at diagnosis and seven patients later developed metastasis. The median time to metastasis was 20.9 months. Six patients died and the median time to death was 28.0 months. Metastasis at diagnosis was a predictive factor for death.
  
  
  CONCLUSIONS
  When limited to extremities, radiation therapy reduced the rate of local recurrence in pediatric soft tissue sarcomas. Metastases at diagnosis predict death.
authors.affiliation: Harvard School of Public Health, Boston, MA, USA.
authors.forename: Chigusa
authors.initials: C
authors.lastname: Sawamura
authors.forename: Dempsey S
authors.initials: DS
authors.lastname: Springfield
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Marcus
authors.forename: Antonio R
authors.initials: AR
authors.lastname: Perez-Atayde
authors.forename: Mark C
authors.initials: MC
authors.lastname: Gebhardt
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000671:Amputation, Surgical; D001900:Boston; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005121:Extremities; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D023821:Limb Salvage; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D019637:Orthopedic Procedures; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012509:Sarcoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult