LATE COMPLICATIONS AFTER EXCISION OF SOFT TISSUE SARCOMA OF EXTREMITIES WITH OR WITHOUT RADIOTHERAPY: THE EXPERIENCE OF DEPARTMENT OF ORTHOPEDIC ONCOLOGY IN FLORENCE

Aim While the association of surgery and radiation therapy in high grade Soft Tissue Sarcoma (STS) of extremities is considered the “golden standard”, there is not international agreement regarding type, timing, overall dose of radiation, and size, site and histology of tumours to be irradiated. A similar consideration is about low grade STS. The aim of our paper is critically reconsider our experience, trough a retrospective analysis of 15 years experience. This in order to propose a perspective protocol of treatment of high and low grade STS, in order to minimize the late complication rate. Method From January 1994 to June 2009 we have operated in our Centre 976 patients affected by STS of extremities and superficial trunk. They were 741 High grade STS (76%), and 235 Low grade STS (24%). The most represented histotype was Liposarcoma (239) followed by Leiomyosarcoma (150) and synovial sarcoma (94). Regarding tumour site, upper limb was involved in 255 cases, lower limb in 679, superficial trunk in 42; regarding tumor size, 323 where less than 5 cm, 386 where between 5 and 10 cm and 267 where more than 10 cm. Radiation therapy was utilized in 447 cases (46%): 83 patients had a low grade STS, 364 a high grade STS. Result and Conclusion At an average follow up of 6 years, we statistically analyzed both the overall group of 976 patients and the single group of irradiated and not irradiated STS patients, focusing on local recurrence rate by size, site, grade, histology etc. After this, we analyzed the overall rate of complications due to surgery and to radiotherapy (infection, scar slough, bone fracture etc). After this analysis, our actual trend is to try to limit the indications to radiation therapy, in order to reduce the complication rate (overall 74 cases, 17%)