Treatment of Primary Pleomorphic Soft Tissue Sarcoma of the Extremities

Background: Pleomorphic Sarcoma is the most common histologic subtype of high grade soft tissue sarcoma involving the extremities. Methods: This retrospective study analyzed 135 patients presenting with primary Pleomorphic Sarcomas which were treated at a single referral institute between 1980 and 2006. Data was collected from an institutional database and univariate and multivariate analysis was conducted regarding significant risk factors which influence outcome. 125 (93%) patients underwent wide limb sparing resection, primary amputation was necessary in 10 (7%) patients. 52 patients (39%) received post-operative radiation therapy alone, 23 (17%) received adjuvant chemotherapy alone and 37 patients (27%) received both chemotherapy and radiation therapy. 23 patients (17%) received no adjuvant therapy. Results: The 5-year disease specific survival rate was 74%±4%, metastatic rate 29% and local recurrence rate was 22%±4%. Significant prognostic factors negatively influencing survival were a local recurrence, large size, deep tumors, close margins and proximal location. Risk factors for a local recurrence were a superficial lesion, upper extremity and extra-compartmental location. Induction chemotherapy did not show a survival or a local recurrence benefit. Chemotherapy induced tumor necrosis rates did not correlate with a survival benefit. Conclusions: Anatomic location of Pleomorphic soft tissue sarcoma influences local recurrence and survival rates. Induction chemotherapy did not show a survival benefit. Chemotherapy induced tumor necrosis rate does not correlate with survival and therefore should not guide adjuvant treatment decisions.