Foot sarcomas: Factors affecting oncological and functional outcomes

Kozawa,Eiji; Nishida,Yoshihiro; Nakashima,Hiroatsu; Tsukushi,Satoshi; Toriyama,Kazuhiro; Kamei,Yuzuru; Ishiguro,Naoki

doi:10.3892/ol.2011.427

Foot sarcomas: Factors affecting oncological and functional outcomes

Authors:
- Eiji Kozawa
- Yoshihiro Nishida
- Hiroatsu Nakashima
- Satoshi Tsukushi
- Kazuhiro Toriyama
- Yuzuru Kamei
- Naoki Ishiguro
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Affiliations: Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Aichi 466-8550, Japan, Department of Orthopaedic Surgery, Aichi Cancer Center Aichi Hospital, Okazaki, Aichi 444-0011, Japan, Department of Plastic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan
Published online on: September 22, 2011 https://doi.org/10.3892/ol.2011.427
Pages: 82-88

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Abstract

Oncological and functional prognostic factors for patients with foot sarcomas have yet to be clarified. This study was undertaken to identify the prognostic factors for oncological and functional outcomes and the significance of adjuvant radiotherapy in achieving local control in patients with foot sarcomas. We reviewed 31 consecutive patients with soft tissue (24), and bone (7) sarcomas arising in the foot and analyzed the impact of patient characteristics on the functional and oncological outcomes. There were seven cases with clear cell or epithelioid sarcomas. Two of the 31 cases experienced local recurrence despite the fact that only two cases received adjuvant radiotherapy. Sixteen out of 18 cases of soft tissue sarcomas with limb salvage surgery underwent reconstructive procedures for soft tissue defects. Amputation required as a surgical treatment (p=0.002) was a poor prognostic factor. Larger size (p=0.029) and bone reconstruction (p=0.018) were poor prognostic factors for local recurrence-free survival, and amputation (p=0.001) and bone reconstruction (p=0.008) for metastasis-free survival in patients with soft tissue sarcomas. No significant factors were derived in patients with bone sarcomas. Larger size (p=0.021), amputation (p=0.016) and bone reconstruction (p=0.03) were poor prognostic factors affecting function in patients with soft tissue sarcomas, and hindfoot site (p=0.028) and amputation (p=0.028) were poor prognostic factors affecting function in patients with bone sarcomas. Surgery with a negative operative margin and reconstructive procedures achieved good local control and function. Patients that had tumors with larger size, necessitating amputation or bone reconstruction, required novel multimodal treatment in order to improve their outcomes.

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1	Chou LB, Ho YY and Malawer MM: Tumors of the foot and ankle: experience with 153 cases. Foot Ankle Int. 30:836–841. 2009. View Article : Google Scholar : PubMed/NCBI
2	Papagelopoulos PJ, Mavrogenis AF, Badekas A and Sim FH: Foot malignancies: a multidisciplinary approach. Foot Ankle Clin. 8:751–763. 2003. View Article : Google Scholar : PubMed/NCBI
3	Unni KK: General aspects and data on 10,135 cases. Dahlin’s Bone Tumors. 6th edition. Lippincott Williams & Wilkins; Philadelphia, PA: pp. 1–224. 2010
4	Brennan MF: Diagnosis and management of soft tissue sarcoma. Martin Dunitz; London: 2002
5	Cribb GL, Loo SCS and Dickinson I: Limb salvage for soft-tissue sarcomas of the foot and ankle. J Bone Joint Surg. 92:424–429. 2010. View Article : Google Scholar : PubMed/NCBI
6	Enneking WF, Dunham W, Gebhardt MC, Malawar M and Pritchard DJ: A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 286:241–246. 1993.PubMed/NCBI
7	Fletcher C, Unni K and Mertens F; World Health Organization. Classification of Tumours Pathology and Genetics of Tumours of Soft Tissue and Bone. IARC Press; Lyon: 2002
8	Guillou L, Coindre JM, Bonichon F, et al: Comparative study of the National Cancer Institute and the French Federation of Cancer Centers Sarcoma Group grading systems in a population of 410 adult patients with soft tissue sarcoma. J Clin Oncol. 15:350–362. 1997.
9	Greene FL, Page DL and Flemming FD: American Joint Committee on Cancer: Cancer Staging Manual (6th edition). Springer. New York, NY: 157–164. 2002.
10	Arai E, Nishida Y, Tsukushi S, Wasa J and Ishiguro N: Clinical and treatment outcomes of planned and unplanned excisions of soft tissue sarcomas. Clin Orthop Relat Res. 11:3028–3034. 2010. View Article : Google Scholar : PubMed/NCBI
11	Giuliano AE and Eilber FR: The rationale for planned reoperation after unplanned total excision of soft-tissue sarcomas. J Clin Oncol. 10:1344–1348. 1985.PubMed/NCBI
12	Schwab JH, Agarwal P, Boland PJ, Kennedy JG and Healey JH: Patellar complications following distal femoral replacement after bone tumor resection. J Bone Joint Surg Am. 88:2225–2230. 2006. View Article : Google Scholar : PubMed/NCBI
13	Kaplan EL and Meier P: Nonparametric-estimation from incomplete observations. J Am Stat Assoc. 53:457–481. 1958. View Article : Google Scholar
14	Temple HT, Worman DS and Mnaymneh WA: Unplanned surgical excision of tumors of the foot and ankle. Cancer Control. 8:262–268. 2001.PubMed/NCBI
15	Zeytoonjian T, Mankin HJ, Gebhardt MC and Hornicek FJ: Distal lower extremity sarcomas: frequency of occurrence and patient survival rate. Foot Ankle Int. 5:325–30. 2004.PubMed/NCBI
16	Colterjohn NR, Davis AM, O’Sullivan B, Catton CN, Wunder JS and Bell RS: Functional outcome in limb-salvage surgery for soft tissue tumours of the foot and ankle. Sarcoma. 1:67–74. 1997. View Article : Google Scholar : PubMed/NCBI
17	Selch MT, Kopald KH, Ferreiro GA, Mirra JM, Parker RG and Eilber FR: LIMB salvage therapy for soft-tissue sarcomas of the foot. Int J Radiat Oncol Biol Phys. 19:41–48. 1990. View Article : Google Scholar : PubMed/NCBI
18	Thacker MM, Potter BK, Pitcher JD and Temple HT: Soft tissue sarcomas of the foot and ankle: impact of unplanned excision, limb salvage, and multimodality therapy. Foot Ankle Int. 29:690–698. 2008. View Article : Google Scholar : PubMed/NCBI
19	Talbert ML, Zagars GK, Sherman NE and Romsdahl MM: Conservative surgery and radiation-therapy for soft-tissue sarcoma of the wrist, hand, ankle, and foot. Cancer. 66:2482–2491. 1990. View Article : Google Scholar : PubMed/NCBI
20	Murari TM, Callaghan JJ, Berrey BH and Sweet DE: Primary benign and malignant osseous neoplasms of the foot. Foot Ankle. 10:68–80. 1989. View Article : Google Scholar : PubMed/NCBI
21	O’Sullivan B, Davis AM, Turcotte R, et al: Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 359:2235–2241. 2002.PubMed/NCBI
22	Refaat Y, Gunnoe J, Hornicek FJ and Mankin HJ: Comparison of quality of life after amputation or limb salvage. Clin Orthop Relat Res. 397:298–305. 2002. View Article : Google Scholar : PubMed/NCBI
23	Zahlten-Hinguranage A, Bernd L, Ewerbeck V and Sabo D: Equal quality of life after limb-sparing or ablative surgery for lower extremity sarcomas. Br J Cancer. 6:1012–1014. 2004.PubMed/NCBI
24	Weiss SW and Goldblum JR: Enzinger and Weiss’s soft tissue tumors. 4th edition. Mosby; St. Louis, MO: pp. 1191–1203. 2001