American Surgical Association
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Long-Term Results of Prospective Trial of Selective Use of Surgery Alone For Patients With T1 Extremity and Trunk Soft Tissue Sarcomas (STS)
Peter WT Pisters
UT MD Anderson Cancer Center, Houston, TX

OBJECTIVE(S): There is increased perception that not all patients with surgically treated STS require adjuvant radiotherapy. There are no prospective trials reported to date of unimodality treatment. We initiated a prospective trial of surgery with selective use of postoperative external-beam radiotherapy (EBRT) for patients with T1 extremity and trunk STS.
METHODS: Following multidisciplinary case review and informed consent, patients with T1 primary STS were treated with limb-sparing surgery and microscopic assessment of surgical margins. Postoperative EBRT was employed selectively for patients with microscopically positive final surgical margins (R1 Surgery + RT arm). Patients who underwent resection with microscopically negative final margins did not receive radiotherapy (R0 surgery alone arm).
RESULTS: 84 patients were entered on this protocol between February 1996 and April 2002. Site distribution: extremity (n=48), trunk (n=16). Fifty-three (63%) had high-grade STS; 43 patients (51%) had superficial (T1A) disease. 14 patients underwent resection with positive microscopic margins and were treated with postoperative radiation treatment; 70 underwent resection with negative margins (R0) and were treated by surgery alone. The median follow-up is 59 mos. Local recurrences have been observed in 11 patients (13%; R1 arm 5, R0 arm 6). The 5-year overall actuarial overall survival was 93% (95% CI, 86-100%). In the R0 surgery alone arm, 5-year local recurrence (LR)-free survival was 90% (95% CI, 81-99%).
CONCLUSIONS: Selected patients with primary T1 STS of the extremity and trunk can be treated by surgery alone with satisfactory local control and without the short- and long-term risks associated with radiation treatment.

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