Case series. Soft-tissue sarcoma of the foot.

BACKGROUND

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.

METHODS

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).

RESULTS

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.

CONCLUSION

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.