1. Low-grade soft-tissue sarcomas: What is an adequate margin for local disease control?
- Author
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Fujiwara T, Kaneuchi Y, Tsuda Y, Stevenson J, Parry M, and Jeys L
- Subjects
- Adult, Aged, Aged, 80 and over, Female, France epidemiology, Humans, Male, Middle Aged, Neoplasm Recurrence, Local pathology, Prognosis, Radiotherapy, Adjuvant, Sarcoma radiotherapy, Sarcoma surgery, Soft Tissue Neoplasms radiotherapy, Soft Tissue Neoplasms surgery, Margins of Excision, Neoplasm Recurrence, Local mortality, Sarcoma mortality, Sarcoma pathology, Soft Tissue Neoplasms mortality, Soft Tissue Neoplasms pathology
- Abstract
Background: Whilst the resection margin is an established factor predictive of local control of soft-tissue sarcomas (STSs), the adequacy of margin width for low-grade STSs has been rarely described. We aimed to investigate the margin adequacy and its prognostic relevance in low-grade STSs., Methods: 109 patients who underwent surgical treatment for a low-grade STS were studied. The prognostic value of margin status was evaluated according to the R-, R+1-classification, and width in millimetres., Results: The 10-year local recurrence (LR) rates were 6%, 27%, 54% in R0, R1, and R2, respectively (p < 0.001), according to the R-classification. The R+1-classification resulted in a decreased LR rate in R1, but no major differences in LR rates in R0 and R2; 7%, 14%, 54% in R0, R1, and R2, respectively (p < 0.001). When classified by metric distance, 10-year LR rates were 0%, 8%, and 38% by ≥ 2.0 mm, 0.1-1.9 mm, and 0 mm margins, respectively (p < 0.001). Patients with close margins (0.1-1.9 mm) who received adjuvant radiotherapy had a trend toward lower LR risk than those without radiotherapy (10-year, 4% vs. 12%; p = 0.406). The 5 and 10-year disease-specific mortality was 9% and 13%, respectively; margin width was not associated with disease-specific mortality but LR was a poor prognostic factor for survival (p = 0.003)., Conclusion: Whilst negative margin provided local control over 90%, excellent local control was achieved with microscopic margins ≥2 mm. The role of margins is more important than radiotherapy in local control. Margins do not determine survival, but LR is associated with a poor prognosis., (Copyright © 2020 Elsevier Ltd. All rights reserved.)
- Published
- 2020
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