Department of Orthopaedic Surgery, University of Arizona, Tucson AZ 85724-5064, USA.
Can J Surg. 2010 Dec;53(6):424-31.
We reviewed cases of soft-tissue sarcoma of the foot to gain insight into the presentation, treatments and outcomes for this rare disease and to determine whether limb-salvage surgery yields reasonable functional and oncological outcomes.
We reviewed the cases of 16 patients treated by 2 of us (R.T. and M.I.) for soft-tissue sarcoma of the foot over a 15-year period. We extracted the following information from each patient's medical record: disease status at presentation, prior treatment, histological diagnosis, American Joint Committee on Cancer (AJCC) stage, details of treatment, oncological outcome and functional outcome. Functional outcome was assessed with the Toronto Extremity Salvage Score (TESS) and the Musculoskeletal Tumor Society (MSTS 1987).
Follow-up averaged 6 (range 2–15) years. Eight patients presented after unplanned excision. Histological diagnosis was synovial sarcoma for 7 of 16 patients.The tumours were evenly distributed among the hindfoot, midfoot and forefoot. Most patients (n = 13) presented with AJCC stage II or III disease. Amputation was necessary for 3 patients, whereas limb salvage was possible for the other 13. Free tissue transfer (n = 9) and radiation therapy (n = 12) were used in most cases. Surgical margins were microscopically positive in 4 of the 13 patients treated with limb salvage.Local disease recurred in 2 patients. Lung metastases occurred in 4 patients. At last follow-up, 11 of 16 patients were alive without disease, 2 with disease and 3 had died of their disease. Functional assessment with MSTS 1987 and the TESS averaged 28%and 90%, respectively, after limb salvage.
In this series, we found that, first, patients frequently presented after unplanned excision, and this may have led to worse oncological outcomes compared with patients who presented primarily. Second, limb salvage was usually possible, but it required accepting marginal resections, relying on free tissue transfer to obtain coverage and using radiation therapy to obtain local control. Third, this combination yielded an acceptable local control rate and very good functional outcomes.
我们回顾了足部软组织肉瘤病例，旨在深入了解这种罕见疾病的表现、治疗方法和结果，并确定保肢手术是否能获得合理的功能和肿瘤学结果。
我们回顾了两位医生（R.T.和 M.I.）在过去 15 年中治疗的 16 例足部软组织肉瘤患者的病例。我们从每位患者的病历中提取了以下信息：就诊时的疾病状态、既往治疗、组织学诊断、美国癌症联合委员会（AJCC）分期、治疗细节、肿瘤学结果和功能结果。功能结果采用多伦多肢体保留评分（TESS）和肌肉骨骼肿瘤学会（MSTS 1987）进行评估。
平均随访 6 年（范围 2-15 年）。8 例患者为意外切除后就诊。16 例患者中，7 例为滑膜肉瘤。肿瘤均匀分布于足跟、中足和前足。大多数患者（n=13）表现为 AJCC II 期或 III 期疾病。3 例患者需要截肢，而另外 13 例患者可以保肢。大多数患者（n=9）采用游离组织移植和（n=12）放射治疗。13 例保肢治疗患者中有 4 例手术切缘显微镜下阳性。2 例患者局部疾病复发。4 例患者发生肺转移。末次随访时，16 例患者中 11 例无瘤生存，2 例带瘤生存，3 例死于疾病。保肢治疗后 MSTS 1987 和 TESS 评分平均为 28%和 90%。
在本系列中，我们发现，首先，患者经常在意外切除后就诊，这可能导致与初诊患者相比，肿瘤学结果更差。其次，保肢通常是可行的，但需要接受边缘性切除，依靠游离组织移植获得覆盖，使用放射治疗获得局部控制。第三，这种联合治疗方案获得了可接受的局部控制率和非常好的功能结果。
