dc.description.abstract | Soft tissue sarcomas are a heterogenous group of neoplasms
accounting for 1% of all malignancies and 5% of childhood
malignancies according to Western Series, while locally they
account for about 3.8% of all malignancies. Eighteen (18)
different histological types were recorded compared with over 30
types recognised world wide so far. This study presents a reVlew
of 187 patients whose histological diagnosis of soft tissue
sarcomas was made at Kenyatta National Hospital and subsequently
treated between 1991 and 1996.
The peak incidence of soft tissue sarcomas is in the first decade
of life with more than half of these tumours occurring during the
first three decades. Mean age of occurrence is 29.5 years and
male female ratio is 1.2:1 in this study.
About 31 new patients ,are seen annually with soft tissue
sarcomas. There is no evidence of decrease nor increase in the
incidence of these cases. The commonest presenting complaint is
painless swelling (85%) and our patients present late with 71%
presenting with tumours greater than 5 cm.
Of the 178 patients whose site of tumours was recorded at the
Cancer Registry, 52 (29.3%) were in the lower limbs, 39 (19.1%)
were in the trunk, 39 (19.1%) head and neck, 20 (11.3%) upper
limb visceral, 16 (8.9%) retroperitoneal, 14 (7.8%)
genitourinary, 6 (3.4%) and intrathoracic 2 (1.1%). Extremities
therefore took 40.6% which is inkeeping with Memorial Sloan
Kettering Cancer Centre Series (40-50%) (1). Retroperitoneal
tumours are slightly less than in other series 7.8% cf 15-17%,
head and neck were more in our series 19.1% cf 5-8% in Western
Series (2)
The five commonest histological types in this series were:
Rhabdomyosarcoma 15 (20.8%), fibrosarcoma 13 (18.1%), liposarcoma
12 (16.7%), dermatofibrosarcoma 6 (8.4%) and malignant fibrous
histiocytoma 5 (6.9%)
Rhabdomyosarcoma was the predominant tumour below 20 years of age
54%, followed by fibrosarcoma (14%) and then atypical tumours
(9%). After the age of 40 years, malignant fibrous histiocytoma
23%, fibrosarcoma 15% and liposarcoma were the commonest in that
order. Eighty five (8~) patients had their tumours graded with
24 (53%) having high grade tumours, 9 (20%) intermediate grade
and 27% low grade sarcomas.
Diagnostic methods used were fine needle aspiration cytology 20%,
excisional biopsy 35%, incisional biopsy 45%, CT scan 5%
abdominal ultrasound 7% The high incidence of incisional biopsy
is explained by the late presentation of the patients and lack of
core needle biopsy facilities, No conclusive diagnosis was
provided by FNAC and other biopsies had to be taken.
Surgery was the mainstay of treatment offered 12 out of 85
patient (14%) underwent enucleation/shelling out which is wrong
treatment, 19 (22.3%) wide excision, 6 (7%) amputation, 10
(11.8%) radiotherapy alone, 15 (18%) surgery and radiotherapy, 2
(2.3%) surgery and chemotherapy and 3 (3.5%) a combination of the
three modalities. Enucleation, chemotherapy alone, radiotherapy
alone or radiotherapy and chemotherapy alone had poor results
with 2 years recurrence rate of 50%, 98%, 70% and 50%
respectively with 3,4,3,4 patients dead within 2 years from the
disease respectively. Wide excision and amputation and when
combined with adjuvant therapyhadabest results. Of 19 patient
treated with wide excision alone, 7 had greater than 2 years
recurrence free period (37%), 10 had less than 2 years recurrence
free period (53%), while only 2 were dead from disease within 2
years (10%), while all the six who underwent amputation were all
alive and free of disease by the end of 2 year~.
Size of the tumour, grade and site were noted to be prognosis
determinants. Visceral tumours had the worst prognosis with 5 of
the 6 patients dead within 2 years (8%), while 1 had no change in
disease progress (17%), while extremity sarcoma had the best
prognosis with 6 out of 10 (60%) getting greater than 2 years
recurrence free period, 2 (20%) got recurrence within 2 years and
2 (20%) died within 2 years.Seven out of 22 (32%) of those with high grade tumours had
recurrence within 2 years, 6 (27%) had recurrence free period> 2
years, while 9 out of 12 (41%) were dead within 2 years from
sarcoma as compared to those with low grade tumours where 3 out
of 13 (23%) with recurrence within 2 years, 8(81%) recurrence
period greater than 2 years and only 1 dead (7.6%) within the
same time span of the patients with low grade tumours less than 5
cm, all (100%) had no recurrence by the end of 2 years while for
the 9 with tumours greater than 5 cm, 3 out of 9 (33%) had
recurrence within 2 years, 4 out of 9 (44.4%) had recurrence
period greater than 2 years and 2 out of 9 (22%) were dead within
2 years. These differences were treated statistically and found
to be significant for the grade butOinsignificant for size.
The main recommendation from this series is to sensitize our
people in the need to report early when they notice lumps in the
body:
To discourage any temptations to do enucleation of
these tumours
To emphasize to the pathologists to give grades of
tumours at histology and to be more aggressive
surgically even when dealing with retroperitoneal
tumour
Planned adjuvant therapy should always be instituted and need to
have more studies especially prospective ones carried out in
order to come up with set down protocols for the management of
these neoplasms. | en |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |