Surgery with or without radiation therapy

Patients who develop a local recurrence can often be treated with local therapy, such as surgical excision plus radiation therapy (after previous minimal therapy) or amputation (after previous aggressive treatment).[1-7] Resection of limited pulmonary metastases may be associated with favorable disease-free survival.[8-10][Level of evidence C3] However, the contribution of selection factors, such as low tumor burden, slow tumor growth, and long disease-free interval, to these favorable outcomes is not known.