SLR - September 2011 - Jessica Kwan
Reference: Latt, L.D., Turcotte, R.E., Isler, M.H., and Wong, C. (2010). Soft-tissue sarcoma of the foot. The Canadian Journal of Surgery, 53(6), p. 424-431.
Scientific Literature Review
Reviewed by: Jessica Kwan, D.P.M.
Residency Program: St. John Hospital and Medical Center, Detroit, Mich.
Podiatric Relevance:
Although rare, soft-tissue sarcoma of the foot has potentially fatal implications, particularly if misdiagnosed or managed inappropriately. Proper imaging and staging of soft-tissue sarcoma is necessary. Often, unplanned excision with adjunctive radiation therapy or chemotherapy is insufficient to prevent local recurrence of soft-tissue sarcoma. The purpose of this study is to determine if limb-salvage surgery can yield both acceptable functional and oncologic outcomes.
Methods:
Sixteen cases of patients treated for soft-tissue sarcoma of the foot over a 15-year period by two of the authors in a musculoskeletal oncology setting were retrospectively reviewed. Follow-up averaged 6 (2-15) years. There were 7 males and 9 females with a mean age of 41 (15-79) years. Eight of the patients were referred to the authors after unplanned excision. Diagnosis of soft-tissue sarcoma distal to the tibio-talar joint was confirmed histologically. Magnetic resonance imaging of the foot and computed tomography of the chest were obtained for local and systemic staging, respectively. Limb salvage was attempted whenever possible, and amputation only if the sarcoma was determined to be unresectable. Resection was performed in 9 patients, resection with arthrodesis in 4 patients, and amputation in 3 patients. Functional outcome was assessed using the Toronto Extremity Salvage Score (TESS) and the Musculoskeletal Tumor Society measure (MSTS 1987).
Results:
There were a total of sixteen patients in the study. Eight patients presented to the musculoskeletal oncologists after unplanned excision. Four of these patients had progression of the disease, and one had evidence of metastasis. Two of the eight patients died, and two of the eight patients required amputation. One of the eight patients experienced local recurrence.
Five patients who underwent limb salvage had postoperative functional scores. MSTS 1987 scores averaged 28 (16-35) out of 35 points and TESS scores average 90% (68-100). At final follow-up, 11/16 patients were alive without disease, two alive with disease, and three had died. Seven of sixteen patients were diagnosed with synovial sarcoma.
Conclusions:
Patients who were seen by musculoskeletal oncologists following unplanned excision had worse outcomes than those who were seen primarily. The authors stress the importance of educating clinicians who may see soft-tissue sarcomas present primarily. Limb salvage is an acceptable form of treatment for soft-tissue sarcoma, however, marginal resections are required and free tissue transfer is often needed for coverage along with radiation therapy for local control. It was found wide surgical resection with the addition of radiation therapy is the most effective way with which to manage soft-tissue sarcoma. Through a combination of limb salvage and radiation therapy, very good functional outcomes were attained.