title: Combined Limb-Sparing Surgery and Radiation Therapy to Treat Sarcomas of the Hands and Feet: Long-Term Cancer Outcomes and Morbidity.
abstract: OBJECTIVE
  The purpose of this study was to investigate local control, survival outcomes, and complication rates of patients treated with limb-sparing surgery and radiation therapy (RT) for soft tissue sarcomas (STS) of the hands and feet.
  
  
  METHODS
  We reviewed the medical records of 85 consecutive patients treated for STS of the hands (n=38, 45%) and feet (n=47, 55%) between 1966 and 2012. The median age was 41 years (range, 10-82 years of age). Sixty-seven patients (79%) received postoperative RT after resection of their tumor (median dose, 60 Gy; range, 45-70 Gy). The remaining 18 patients (21%) were treated with preoperative RT followed by tumor resection (median dose, 50 Gy; range, 50-64 Gy).
  
  
  RESULTS
  Median follow-up was 140 months (range, 24-442 months). Five-year local control, overall survival, and disease-specific survival rates were 86%, 89%, and 89%, respectively. Positive or uncertain surgical margin status was the only factor adversely associated with local recurrence (19% vs 6% for negative margins, P=.046) but this lost significance on multivariate analysis when adjusting for RT dose ≥64 Gy. Of the 12 patients who had local relapses, 6 (50%) were salvaged, and only 2 of those required salvage amputation. Five patients had grade ≥3 late RT sequelae, with 2 patients (2%) having moderate limitations of limb function and 3 patients (4%) having severe limitations requiring procedures for skin ulceration.
  
  
  CONCLUSIONS
  Limb-sparing surgery combined with RT provides excellent local control outcomes for sarcomas arising in the hands or feet. In patients who have local recurrence, salvage without amputation is possible. The excellent cancer control outcomes observed, considering the minimal impact on limb function, support use of combined modality, limb-sparing local therapy for STS arising in the hands or feet.
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Bishop
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Gunar K
authors.initials: GK
authors.lastname: Zagars
authors.affiliation: Department of Orthopedic Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Bryan S
authors.initials: BS
authors.lastname: Moon
authors.affiliation: Department of Orthopedic Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Patrick P
authors.initials: PP
authors.lastname: Lin
authors.affiliation: Department of Orthopedic Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Valerae O
authors.initials: VO
authors.lastname: Lewis
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas; Department of Health Services Research, MD Anderson Cancer Center, Houston, Texas. Electronic address: aguadagn@mdanderson.org.
authors.forename: B Ashleigh
authors.initials: BA
authors.lastname: Guadagnolo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001859:Bone Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D002648:Child; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005260:Female; D005533:Foot Dermatoses / Q000209:etiology; D005534:Foot Diseases / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D050276:Hand Bones / Q000528:radiation effects / Q000601:surgery*; D006229:Hand Dermatoses / Q000209:etiology; D006801:Humans; D023821:Limb Salvage / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery; D018365:Neoplasm, Residual; D059351:Organ Sparing Treatments / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011855:Radiodermatitis / Q000473:pathology; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D016896:Treatment Outcome