Radiation Oncology/Sarcoma/Hand-Foot

Sarcomas of the Hand and Foot

• Review - MDACC (2002) - PMID 12209730 — "Surgical management of soft tissue sarcomas of the hand and foot." Lin PP et al. Cancer. 2002 Aug 15;95(4):852-61.
  • Summary: limb-sparing treatment is possible. High rate of local control after re-excision for positive margins (after initial unplanned tumor excision).

• UofFlorida (2006) - PMID 16462505 — "Adjuvant Radiotherapy in the Management of Soft Tissue Sarcoma Involving the Distal Extremities." Schoenfeld G et al. AJCO. 2006 Feb 29;(1) 62-5.
  • Retrospective review of 23 patients with hand/wrist or foot/ankle sarcoma; median follow-up of 11 years
  • Summary: Combined modality therapy with limb-conserving surgery and radiotherapy results in excellent local control (91%), survival (91%) and functional outcome in selected patients).

• UCLA; 1990 (1974-1988) PMID 2380094 -- "Limb salvage therapy for soft tissue sarcomas of the foot." (Selch MT, Int J Radiat Oncol Biol Phys. 1990 Jul;19(1):41-8.)
  • Retrospective. 20 patients; 16 primary presentation and 4 local recurrences. 16 patients neoadjuvant chemotherapy and radiation, followed by surgery; 4 patients surgery followed by postop radiation. Neoadjuvant radiation given as 3.5 Gy x 10 fractions, 3.5 Gy x 8 fractions or 3.5 Gy x 5 fractions. Postop RT 41.4 - 64.8 Gy
  • Outcome: Local control 90%. In-field recurrences at 24 and 30 months. 3-year OS 83%; 3-year RFS 63%
  • Toxicity: Good/excellent function 86%; no patient required amputation for complications
  • Conclusion: Limb salvage is reasonable

• National Cancer Institute
  • 1983 (1972-1979) PMID 6307940 -- "Extremity preservation by combined modality therapy in sarcomas of the hand and foot: an analysis of local control, disease free survival and functional result." (Kinsella TJ, Int J Radiat Oncol Biol Phys. 1983 Aug;9(8):1115-9.)
    • Retrospective. 10 patients, combined modality. Seven with Ewing's Sarcoma received radiation to 50 Gy after incisional biopsy. Three with STS received 60 Gy radiation after gross excision.
    • Outcome: local control 90%
    • Toxicity: 5 patients no functional limitations; 2 patients Grade 1; 1 patient Grade 2 requiring orthopedic appliance; 2 patients loco/regional recurrence requiring more surgery
    • Conclusion: Extremity preservation results in excellent local control, while maintaining good function, and is a viable alternative to amputation
  • 1994 (1977 - 1992) PMID 8040019 -- "Sarcomas of the hand and foot: analysis of local control and functional result with combined modality therapy in extremity preservation." (Johnstone PA, Int J Radiat Oncol Biol Phys. 1994 Jul 1;29(4):735-45.)
    • Retrospective. 28 patients . Ewing Sarcoma (n=15), rhabdomyosarcoma (n=7), other soft tissue sarcoma (n=6). Median age 18. Median F/U 9.5 years. Radiation 50/25 for ES, 54/30 for rhabdomyosarcoma, 63/35 for other STS
    • Local control: ES 84%; rhabdomyosarcoma 100%;
    • Toxicity: all but one patient functional distal extremities
    • Conclusion: Equivalent local control to amputation, but better functional quality of life