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Extremity tumors
Source: Soft Tissue Sarcoma Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: February 21, 2025 · Captured 2026-09-09.
Selected source text with whitespace normalised. This Triangle page is not an NCI PDQ summary.
Context: Treatment Option Overview for Soft Tissue Sarcoma / Surgery
When feasible, wide-margin function-sparing surgical excision is the cornerstone of effective treatment for extremity tumors. This may be facilitated by soft tissue reconstructive surgery, which generally permits wider margins than those obtained when the surgical plan involves direct closure of the excision site.[8] Cutting into the tumor mass or shelling out the gross tumor is associated with an elevated risk of local recurrence. Even for high-grade disease, soft tissue sarcomas of the extremities can usually be effectively treated while preserving the limb with combined-modality treatment consisting of preRT or PORT to reduce local recurrence.[9] For more information, see the Radiation Therapy section.
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Evidence (amputation vs. limb-sparing surgery):
A retrospective study analyzed a prospective sarcoma database of 649 patients with extremity soft tissue sarcoma. Ninety-two patients underwent amputation, and 557 patients had a limb-sparing procedure. Patients who underwent amputation had large (≥5 cm) high-grade tumors that invaded major vascular or nervous structures.[10]
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A retrospective study analyzed a prospective sarcoma database of 649 patients with extremity soft tissue sarcoma. Ninety-two patients underwent amputation, and 557 patients had a limb-sparing procedure. Patients who underwent amputation had large (≥5 cm) high-grade tumors that invaded major vascular or nervous structures.[10]
The patients who underwent amputation achieved significantly better local control than the patients who had a limb-sparing procedure (P = .007).
A retrospective study analyzed a prospective sarcoma database of 649 patients with extremity soft tissue sarcoma. Ninety-two patients underwent amputation, and 557 patients had a limb-sparing procedure. Patients who underwent amputation had large (≥5 cm) high-grade tumors that invaded major vascular or nervous structures.[10]
However, no survival benefit was demonstrated in the patients selected for amputation (i.e., patients with large high-grade tumors) when compared with patients undergoing a limb-sparing procedure with similar tumors.
A retrospective study analyzed a prospective sarcoma database of 649 patients with extremity soft tissue sarcoma. Ninety-two patients underwent amputation, and 557 patients had a limb-sparing procedure. Patients who underwent amputation had large (≥5 cm) high-grade tumors that invaded major vascular or nervous structures.[10]
Prevention of local recurrence by amputation did not improve survival in this group compared with similar patients undergoing limb-sparing surgery who did develop a local recurrence.
A retrospective study included 769 patients with a high-grade sarcoma of the extremities who underwent a limb-sparing surgery. Eighty-nine patients were treated with neoadjuvant radiation therapy, 315 patients were treated with adjuvant irradiation, and 365 patients were treated with surgery alone.[11]
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A retrospective study included 769 patients with a high-grade sarcoma of the extremities who underwent a limb-sparing surgery. Eighty-nine patients were treated with neoadjuvant radiation therapy, 315 patients were treated with adjuvant irradiation, and 365 patients were treated with surgery alone.[11]
After a mean follow-up of 45 months, 95 local recurrences occurred, resulting in a local recurrence-free survival rate of 83.2% after 5 years and 75.9% after 10 years.
A retrospective study included 769 patients with a high-grade sarcoma of the extremities who underwent a limb-sparing surgery. Eighty-nine patients were treated with neoadjuvant radiation therapy, 315 patients were treated with adjuvant irradiation, and 365 patients were treated with surgery alone.[11]
Neoadjuvant radiation therapy provided the best local recurrence-free rate for 5 years (90.0%), but after 10 years (78.3%) adjuvant irradiation resulted in better local control.
A retrospective study included 769 patients with a high-grade sarcoma of the extremities who underwent a limb-sparing surgery. Eighty-nine patients were treated with neoadjuvant radiation therapy, 315 patients were treated with adjuvant irradiation, and 365 patients were treated with surgery alone.[11]
Patients treated with neoadjuvant radiation therapy had the highest rate of revision surgery (9.0%), followed by patients who were treated with surgery alone (5.5%) and patients who received adjuvant irradiation (4.4%) (P = .085).
Publication references
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Preserved source evidence · Not medical advice