title: The Width of the Surgical Margin Does Not Influence Outcomes in Extremity and Truncal Soft Tissue Sarcoma Treated With Radiotherapy.
abstract: It is unclear whether the quantitative width of the surgical margin influences outcomes in patients with extremity and truncal soft tissue sarcoma (STS) treated with radiotherapy (RT).
  
  
  
  We performed a retrospective review of 382 patients with localized extremity or truncal STS who underwent limb-sparing surgery and RT from 1983 to 2010, and we analyzed the significance of resection margin status and quantitative margin width on outcomes.
  
  
  
  Surgical margins were positive in 68 (18%) patients and negative in 314 (82%) patients. For those patients with a reported quantitative margin width (n = 235), the width of the negative margin was ≤1 mm (n = 128), >1 mm and ≤5 mm (n = 79), and >5 mm (n = 28). At a median follow-up of 82 months, the local recurrence rates were 5.4% and 11.8% for margin-negative and margin-positive patients, respectively. There were no differences in the rates of local or distant recurrence nor of any survival outcome based on the quantitative width of the surgical margin, provided that it was negative.
  
  
  
  In patients undergoing RT and limb-sparing surgery for STS, achieving a negative margin is essential for optimizing both local control and survival. However, the absolute quantitative width of the negative margin does not significantly influence outcome, and so attempts at wide margins of resection appear to be unnecessary. Importantly, the conclusions drawn from this study must not be applied to those patients undergoing surgery alone as the local treatment of their STS, in which case wider margins of resection may be necessary.
  
  
  
  In patients undergoing radiation therapy and limb-sparing surgery for soft tissue sarcoma, the quantitative width of the negative margin does not influence outcome, and so attempts at wide margins of resection appear to be unnecessary, especially when such attempts compromise the functional outcome. Importantly, the conclusions drawn from this study must not be applied to those patients undergoing surgery alone as the local treatment of their soft tissue sarcoma, in which case wider margins of resection may be necessary.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Rima
authors.initials: R
authors.lastname: Ahmad
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Jacobson
authors.affiliation: Department of Orthopedics, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Francis
authors.initials: F
authors.lastname: Hornicek
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Alex B
authors.initials: AB
authors.lastname: Haynes
authors.affiliation: Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Edwin
authors.initials: E
authors.lastname: Choy
authors.affiliation: Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Cote
authors.affiliation: Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: G Petur
authors.initials: GP
authors.lastname: Nielsen
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Yen-Lin
authors.initials: YL
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: DeLaney
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA jmullen@partners.org.
authors.forename: John T
authors.initials: JT
authors.lastname: Mullen
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D023821:Limb Salvage; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012509:Sarcoma / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Extremity; Margin width; Outcome ; Radiation therapy; Soft tissue sarcoma