Paratesticular sarcoma: failure patterns after definitive local therapy.
We examine disease control and patterns of failure for patients with adult paratesticular sarcoma treated with wide repeat excision and postoperative radiation for close margins. A retrospective analysis was performed on 14 patients with paratesticular sarcomas referred to 1 institution from 1988 to 1995. Median followup was 50 months (range 26 to 90). Pathology review revealed malignant fibrous histiocytoma in 5 cases and liposarcoma in 3. Tumor grade was high in 8 cases. Microscopic residual disease was identified after repeat excision in 3 of 11 completely excised cases (27%). Cause specific survival 5 years after diagnosis was 70%. Both patients with local failure after wide excision had undergone initial intralesional excision and 1 had also received postoperative irradiation. In 5 patients metastases developed in the liver, lung, nodes or multiple sites 0 to 60 months after diagnosis. Simple excision is inadequate treatment for paratesticular sarcoma, since wide repeat excision revealed microscopic residual disease in 27% of completely excised cases. The 2 local failures occurred in patients with a history of inadvertent intralesional surgery, which may be a risk factor for local relapse after wide repeat excision. Adjuvant radiation should be considered for these patients as well as those with narrow repeat resection margins. Systemic failure was frequent in patients with high grade tumors, who will require effective systemic adjuvant therapy.