Evidence brief
Soft Tissue Sarcoma: Wide Excision and Radiation
Wide local excision + radiation = amputation survival
Limb-sparing approach became standard
Radiation reduces local recurrence
Margin status critical
Adjuvant chemotherapy role still debated
This landmark NCI trial established limb-sparing surgery with radiation as equivalent to amputation for soft tissue sarcoma, transforming management.
Standard treatment: wide excision (1-2cm or fascial margin) + radiation (neo or adjuvant). Indications for amputation: cannot achieve margins, NV involvement. Know common types (UPS, liposarcoma, synovial). Discuss staging (AJCC), margin principles, radiation timing.
Rosenberg SA et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of limb-sparing surgery plus radiation therapy compared with amputation and the role of adjuvant chemotherapy. Ann Surg. 1982;196(3):305-315.
Level I
Systematic review of RCTs or high-quality RCT