Treatment of Primary Pleomorphic Soft Tissue Sarcoma of the Extremities

ABSTRACT

Pleomorphic Sarcoma is the most common histologic subtype of high grade soft tissue sarcoma involving the extremities.

This retrospective study analyzed 135 patients presenting with primary Pleomorphic Sarcomas which were treated at a single referral institute between 1980 and 2006. Data was collected from an institutional database and univariate and multivariate analysis was conducted regarding significant risk factors which influence outcome. 125 (93%) patients underwent wide limb sparing resection, primary amputation was necessary in 10 (7%) patients. 52 patients (39%) received post-operative radiation therapy alone, 23 (17%) received adjuvant chemotherapy alone and 37 patients (27%) received both chemotherapy and radiation therapy. 23 patients (17%) received no adjuvant therapy.

The 5-year disease specific survival rate was 74%±4%, metastatic rate 29% and local recurrence rate was 22%±4%. Significant prognostic factors negatively influencing survival were a local recurrence, large size, deep tumors, close margins and proximal location. Risk factors for a local recurrence were a superficial lesion, upper extremity and extra-compartmental location. Induction chemotherapy did not show a survival or a local recurrence benefit. Chemotherapy induced tumor necrosis rates did not correlate with a survival benefit.

Anatomic location of Pleomorphic soft tissue sarcoma influences local recurrence and survival rates. Induction chemotherapy did not show a survival benefit. Chemotherapy induced tumor necrosis rate does not correlate with survival and therefore should not guide adjuvant treatment decisions.