title: Myxofibrosarcoma of the extremity and trunk: a multidisciplinary approach leads to good local rates of LOCAL control.
abstract: OBJECTIVE
  Myxofibrosarcomas (MFSs) are malignant soft-tissue sarcomas characteristically presenting as painless slowly growing masses in the extremities. Locally infiltrative growth means that the risk of local recurrence is high. We reviewed our experience to make recommendations about resection strategies and the role of the multidisciplinary team in the management of these tumours.
  
  
  METHODS
  Patients with a primary or recurrent MFS who were treated surgically in our unit between 1997 and 2012 were included in the study. Clinical records and imaging were reviewed. A total of 50 patients with a median age of 68.4 years (interquartile range 61.6 to 81.8) were included. There were 35 men; 49 underwent surgery in our unit.
  
  
  RESULTS
  The lower limb was the most common site (32/50, 64%). The mean size of the tumours was 8.95 cm (1.5 to 27.0); 26 (52%) were French Fédération Nationale des Centres de Lutte Contre le Cancer grade III. A total of 21 (43%) had positive margins after the initial excision; 11 underwent further excision. Histology showed microscopic spread of up to 29 mm beyond macroscopic tumour. Local recurrence occurred in seven patients (14%) at a mean of 21 months (3 to 33) and 15 (30%) developed metastases at a mean of 17 months (3 to 30) post-operatively.
  
  
  CONCLUSIONS
  High rates of positive margins and the need for further excision makes this tumour particularly suited to management by multidisciplinary surgical teams. Microscopic tumour can be present up to 29 mm from the macroscopic tumour in fascially-based tumours. Cite this article: Bone Joint J 2016;98-B:1682-8.
authors.affiliation: Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne NE7 7DN, UK.
authors.forename: C G
authors.initials: CG
authors.lastname: Ghazala
authors.affiliation: Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne NE7 7DN, UK.
authors.forename: N R
authors.initials: NR
authors.lastname: Agni
authors.affiliation: Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne NE7 7DN, UK.
authors.forename: M
authors.initials: M
authors.lastname: Ragbir
authors.affiliation: Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne NE7 7DN, UK.
authors.forename: P
authors.initials: P
authors.lastname: Dildey
authors.affiliation: Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne NE7 7DN, UK.
authors.forename: D
authors.initials: D
authors.lastname: Lee
authors.affiliation: Newcastle University, Newcastle Upon Tyne NE1 7RU, UK.
authors.forename: K S
authors.initials: KS
authors.lastname: Rankin
authors.affiliation: Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne NE7 7DN, UK.
authors.forename: T B
authors.initials: TB
authors.lastname: Beckingsale
authors.affiliation: Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne NE7 7DN, UK.
authors.forename: C H
authors.initials: CH
authors.lastname: Gerrand
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D005260:Female; D005354:Fibrosarcoma / Q000556:secondary / Q000601:surgery*; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008485:Medical Audit / Q000379:methods; D008875:Middle Aged; D009236:Myxosarcoma / Q000556:secondary / Q000601:surgery*; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D010348:Patient Care Team; D011379:Prognosis; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D016019:Survival Analysis; D034941:Upper Extremity
keywords: Local recurrence; Margins; Multidisciplinary; Myxofibrosarcoma; Surgery