Service de chirurgie, Service de radiothérapie, Service d’anatomopathologie, Service de médecine, Institut Bergonié, Centre régional de lutte contre le cancer, 229, cours de l’Argonne, 33076 Bordeaux Cedex
Purpose. To evaluate the place of conservative surgery in locally recurrent soft tissue sarcoma of the extremities and the trunk wall. Methods. Retrospective data base analysis. Comparison between 32 patients with recurrent sarcoma of the extremities and the trunk wall to 105 comparable patients with primary sarcoma treated from 1996 to 1999. Tumor characteristics, quality of surgery and outcome are analyzed. Mean follow-up are respectively 63 and 61 months. Results. Rates of resections R0 are 56% vs 68%, amputations 13% vs 1%, local recurrences 29% vs 9% (p < 0.01) in recurrent and primary sarcoma, respectively. Two prognostic sub-groups are identified within patients with recurrent sarcoma: good (n = 25) and bad prognosis (n = 7) with resections R0 in 64% vs 29% of patients, five year survival of 76% vs 29%, respectively. The differences are due to tumor biology, anterior treatment, especially radiotherapy, and recurrence-free interval. A decision tree is developed, taking into account precedent radiotherapy and prognosis. Conclusion. In recurrent sarcoma, conservative treatment remains possible in a selected group of patients, combined to new means of treatment.