Malignant Fibrous Histiocytoma-An Institutional Experience and Literature Review

Background: Malignant fibrous histiocytoma (MFH) is an aggressive clinical biological behavior soft tissue sarcoma. Despite of advance in adjuvant chemotherapy and radiotherapy, wide excision is the paramount treatment. However, the rate of local recurrence and distant metastasis still remained high. Detailed understanding of tumor behavior would improve therapeutic control. Aim and Objectives: The purpose of this study is to provide our experience in treating MFH. Materials and Methods: An institutional review was performed retrospectively on patients diagnosed with MFH between June 1982 and October 2013. A subgroup analysis was carried out on the tumor located in head, neck, trunk and extremities after wide excision. Results: Fifty-seven patients were diagnosed with MFH in our institution. In them, thirty-three patients were enrolled by MFH over head, neck, trunk and extremities and receiving wide excision. Local recurrences occurred in 15 patients (45%), and 11 of 15 patients (73%) occurred within 2 years with median interval of 12 months. Lung metastasis occurred in 11 patients (33%), and 10 of 11 patients (91%) presented within 38 months with median interval of 16 months. Higher local recurrence and lung metastasis was observed in patients of age ≧70 years, male, tumor size ≧ 5 cm, proximal site of extremity, and inflammatory pathologic subtype. Adjuvant radiotherapy or chemotherapy were suggested for tumor with larger size, inflammatory subtype and close tumor-free margin, but higher local recurrence and lung metastasis still occurred. Local recurrence was an independent factor to lung metastasis and influenced prognosis significantly. Overall survival was about 85% at 3 years and 72% at 5 years. The median survival time after pulmonary metastasis was 6 months. Conclusion: Aggressive wide excision should be performed at initial operation to decrease local recurrence of MFH. A strict postoperative follow-up at least 3 years is necessary, especially in patients over 70 years of age, male, tumor size ≧ 5 cm, proximal tumor location, inflammatory subtype, and close tumor-free margin. If local recurrence occurred, lung metastasis would follow and should be detected as early as possible for possible metastasectomy.