Management of extremity malignant fibrous histiocytoma: A 10-year experience

Background: Malignant fibrous histiocytoma (MFH) is a common soft-tissue sarcoma in adults, which commonly affects the extremities, trunk, head, and neck. Of these regions, the extremities are more often affected. However, only a few studies have specifically investigated the clinical behavior and prognosis of this malignancy, especially in East Asian populations. Aims and objectives: We collected data on MFH cases for a period of 10 years and present our experience here in treating patients with extremity MFH. Materials and methods: This study was a retrospective analysis of patients with extremity MFH treated in the Department of Plastic Surgery at National Cheng Kung University Hospital between January 2004 and December 2013. Data on patient profiles, surgical resection, radiotherapy, and chemotherapy were all reviewed. The patients were followed up regarding their local recurrences and survivals. Results: Thirteen patients (6 men and 7 women) were enrolled in this study. The mean age of the patients was 57.9 years (range, 33-82 years). The sizes of the clinical tumors ranged from 1.7 to 15cm in a maximal linear dimension (mean, 7.3cm), and 76.9% of the tumors developed in the lower extremities. The average follow-up time was 63.5 months. One patient received limb amputation, and 12 patients were treated with limb salvage including marginal or wide excisions. Adjuvant radiotherapy was performed in 10 patients whose tumor sizes exceeded 5cm or who exhibited inadequate excision or recurrence. Chemotherapy was performed in six patients who exhibited a distant metastasis or vessel invasion. The local and distant recurrence rates were 53.8% and 30.8%, respectively. A total of 42.9% of patients with local recurrence developed distant metastases. The surgical margin was the only significant factor of local disease control, and distant metastasis was the only factor relevant to the overall survival (OS). Conclusion: An adequate resection margin during treatment for the primary MFH tumor achieves optimal results for local disease control. It influences the OS rate, because local-recurrence-related distant metastasis is significantly associated with high mortality.