Surgical Management of Extremity and Truncal Sarcoma

2017 ◽  
Author(s):  
Christina L Roland ◽  
Janice N Cormier
Keyword(s):  
Radiation Therapy ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Treatment Approach ◽  
Multidisciplinary Treatment ◽  
Survival Rates ◽  
Soft Tissue Sarcomas ◽  
The Body ◽  
Wide Resection ◽  
Staging Surgery

Soft tissue sarcomas are a heterogeneous group of neoplasms that arise throughout the body, but most commonly in the extremity and trunk. A multidisciplinary treatment approach has resulted in local control rates exceeding 90% and 5-year survival rates exceeding 70%. For patients with localized soft tissue sarcoma, limb-sparing surgical resection is the mainstay of therapy, with radiation therapy and chemotherapy used as adjuncts to reduce local and distant recurrences. Amputation is reserved for patients with primary or recurrent tumors that cannot be grossly resected with a limb-sparing procedure and preservation of function, which should occur in less than 5% of patients. Most patients who die of soft tissue sarcoma die of metastatic disease, which becomes evident within 2 to 3 years of initial diagnosis in 80% of cases, highlighting the need for improved systemic therapy options and optimal treatment at the time of diagnosis. This review contains 13 figures, 4 tables and 53 references Key words: amputation, multimodality, radiation therapy, soft tissue sarcoma, staging, surgery, treatment, wide resection  

Surgical Management of Extremity and Truncal Sarcoma

2017 ◽  
Author(s):  
Christina L Roland ◽  
Janice N Cormier
Keyword(s):  
Radiation Therapy ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Treatment Approach ◽  
Multidisciplinary Treatment ◽  
Survival Rates ◽  
Soft Tissue Sarcomas ◽  
The Body ◽  
Wide Resection ◽  
Staging Surgery

Soft tissue sarcomas are a heterogeneous group of neoplasms that arise throughout the body, but most commonly in the extremity and trunk. A multidisciplinary treatment approach has resulted in local control rates exceeding 90% and 5-year survival rates exceeding 70%. For patients with localized soft tissue sarcoma, limb-sparing surgical resection is the mainstay of therapy, with radiation therapy and chemotherapy used as adjuncts to reduce local and distant recurrences. Amputation is reserved for patients with primary or recurrent tumors that cannot be grossly resected with a limb-sparing procedure and preservation of function, which should occur in less than 5% of patients. Most patients who die of soft tissue sarcoma die of metastatic disease, which becomes evident within 2 to 3 years of initial diagnosis in 80% of cases, highlighting the need for improved systemic therapy options and optimal treatment at the time of diagnosis. This review contains 13 figures, 4 tables and 53 references Key words: amputation, multimodality, radiation therapy, soft tissue sarcoma, staging, surgery, treatment, wide resection  

Adjuvant Therapy for Soft Tissue Sarcoma

2005 ◽  
Vol 3 (2) ◽  
pp. 207-213 ◽  
Author(s):  
Scott M. Schuetze ◽  
Michael E. Ray
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
High Risk ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Survival Rates ◽  
Wide Resection ◽  
High Grade ◽  
Postoperative Radiation Therapy ◽  
Increased Risk

Wide surgical excision is the backbone of therapy for localized soft tissue sarcoma and often produces excellent results. Patients with a marginal resection of disease and high-grade or large tumors are at an increased risk of recurrence. Radiation therapy (external beam or brachytherapy) has been shown to reduce the risk of local recurrence of disease and should be offered to patients with large (>5 cm) or high-grade sarcomas, especially if a wide resection cannot be performed. Use of preoperative versus postoperative radiation therapy should be planned, in consultation with a radiation oncologist and a surgical oncologist, before resection of the sarcoma if possible. Chemotherapy using an anthracycline- and ifosfamide-based regimen may improve disease-free and overall survival rates. Chemotherapy appears to be most beneficial for patients with very large (≥10 cm), high-grade sarcomas of the extremity who are at a high risk of experiencing distant recurrence of disease. The effect of adjuvant chemotherapy on overall survival remains controversial. Research is greatly needed to identify the patients who are most likely to benefit from conventional chemotherapy, improve the treatment of retroperitoneal sarcomas, and identify novel agents that may impact the natural history of high-risk soft tissue sarcoma.

scholarly journals Clinicopathological study of soft tissue sarcoma-retrospective study of tertiary cancer institute in eastern India

2020 ◽  
Vol 8 (11) ◽  
pp. 4075
Author(s):  
Kunhi Mohammed K. P. ◽  
Snehasis Pradhan ◽  
Supratim Bhattacharyya ◽  
Prafulla Kumar Das ◽  
Muhammed Navas N. K.
Keyword(s):  
Retrospective Study ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Malignant Tumors ◽  
Soft Tissue Sarcomas ◽  
The Body ◽  
Female Ratio ◽  
Pleomorphic Sarcoma ◽  
Frequent Variety ◽  
Male To Female

Background: Soft tissue sarcomas are a rare and heterogeneous group of malignant tumors of mesenchymal origin that comprise less than 1 percent of all adult malignancies. Although they occur anywhere in the body, they involve most commonly in extremities, trunk, retroperitoneum and head and neck. The aim of the study was to analyze clinical and histopathological features of various soft tissue sarcomas.Methods: This was a retrospective study, conducted in tertiary cancer centre in Odisha during the period 2015 to 2018. We collected clinical parameters like age, sex, site of swelling, any associated pain and biopsy reports and these variables were correlated with final histopathology reports.Results: A total of 107 patients were included in the study, with male to female ratio of 2:1(71 and 36) and average age of 43.45 years. All of them presented with a swelling. The lower extremities were the most common sites i.e. 44.62%. Pleomorphic sarcoma was the most frequent histologic variety comprising 43% and less frequent variety were angiosarcoma, and myxoid sarcoma.Conclusions: Soft tissue sarcoma are predominant in males and middle aged population are frequently affected. Most common affected site is lower extremity and pleomorphic sarcoma is the prominent histologic type.

scholarly journals Limb Salvage from a Multidisciplinary Treatment Approach for Skeletal and Soft Tissue Sarcomas of the Extremity

1976 ◽  
Vol 184 (3) ◽  
pp. 268-278 ◽  
Author(s):  
DONALD L. MORTON ◽  
FREDERICK R. EILBER ◽  
COURTNEY M. TOWNSEND ◽  
TODD T. GRANT ◽  
JOSEPH MIRRA ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Limb Salvage ◽  
Treatment Approach ◽  
Multidisciplinary Treatment ◽  
Soft Tissue Sarcomas

scholarly journals Study of soft tissue sarcomas over a period of 3 years

2017 ◽  
Vol 5 (6) ◽  
pp. 2678 ◽  
Author(s):  
Jenna Prabhakar ◽  
J. Sushma ◽  
B. V. S. Kartheek ◽  
A. Bhagya Lakshmi ◽  
Chapara Vaibhav
Keyword(s):  
Soft Tissue ◽  
Health Education ◽  
Soft Tissue Sarcoma ◽  
Treatment Options ◽  
Survival Rates ◽  
Soft Tissue Sarcomas ◽  
Mesenchymal Cell ◽  
Histological Type ◽  
Treatment Modalities ◽  
Site Distribution

Background: Soft tissue malignancies constituted a heterogeneous group of rare solid tumors of mesenchymal cell origin with distinct clinical and pathological features. The aim of the study was to know the prevalence of soft tissue sarcoma, sex, age and site distribution, histopathology and various treatment options adopted with follow up.Methods: A total of 26 cases of soft tissue sarcoma were analyzed for a three-year period. Clinical presentation, age and sex distribution, histological type and treatment modalities adopted were recorded and analyzed.Results: Out of 26 cases 44% of cases were between 30-50 years and 44% of tumors were situated in lower extremity. The commonest histological type was liposarcomas and fibrosarcoma. Lymph node metastasis was seen in 4% of cases. Distant metastasis was present in 3 cases, 2 with lung metastasis and l with lung and liver metastasis. Surgery was the main modality of the treatment. 12% of the cases presented with recurrent tumor, the duration between surgery and recurrence was 6 months. Only 38% turned for follow up, 2 patients succumbed to death because of multiple pulmonary secondaries and chest infections.Conclusion: In the present study, all the cases of soft tissue sarcoma presented in late stage of the disease due to illiteracy and lack of health education. Recurrence was seen in 12% of cases. The overall survival rates and quality of life of the patients can be improved by frequent health camps at primary health centers for early detection of the disease, providing adequate health education, diagnostic and management facilities.

scholarly journals The Future of Radiation Oncology in Soft Tissue Sarcoma

2018 ◽  
Vol 25 (1) ◽  
pp. 107327481881550
Author(s):  
Arash O. Naghavi ◽  
George Q. Yang ◽  
Kujtim Latifi ◽  
Robert Gillies ◽  
Howard McLeod ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Radiation Therapy ◽  
Soft Tissue ◽  
Personalized Medicine ◽  
Soft Tissue Sarcoma ◽  
Radiation Oncology ◽  
Soft Tissue Sarcomas ◽  
Clinicopathologic Features ◽  
The Future ◽  
Treatment Paradigm

Radiotherapy (RT) is an important component of the treatment of soft tissue sarcomas (STS) and has been traditionally incorporated with a homogenous approach despite the reality that STS displays a known heterogeneity in clinicopathologic features and treatment outcomes. In this article, we explore the principle components of personalized medicine, including genomics, radiomics, and treatment response, along with their impact on the future of radiation therapy for STS. We propose a shift in the treatment paradigm for STS from a one-size-fits-all technique to one that implements the tenets of personalized medicine and includes the framework for a potential clinical trial technique in this heterogeneous disease.

Soft Tissue Sarcoma

2017 ◽  
Author(s):  
Marianne Berwick ◽  
Charles Wiggins
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Soft Tissue Sarcomas ◽  
Relative Survival ◽  
Major Complication ◽  
The United States ◽  
The Body ◽  
Molecular Characteristics ◽  
Relative Survival Rate ◽  
Head Neck

Soft tissue sarcoma (STS) is a rare tumor, occurring in approximately one to four of every 100,000 individuals worldwide. Soft tissue sarcomas can form anywhere in the body, including muscle, tendons, fat, blood vessels, lymph vessels, nerves, and tissues around joints. They are most common in the head, neck, arms, legs, trunk, and abdomen. Prognosis is generally poor, with a relative survival rate of approximately 65% at five years, with little difference by race. Approximately 11,930 cases and 4,870 deaths from STS occurred in the United States in 2015. The etiology of STS is still poorly understood, which makes prevention of this relatively rare cancer difficult. A major complication in studying STS is the histologic diversity —more than 100 subtypes. Newer investigations are evaluating molecular characteristics and prognostic factors but continue to be hampered by a lack of standardized histology.

scholarly journals Tissue Expander Use for Reconstruction of Scalp Soft Tissue Sarcoma Wide Resection Defects

2020 ◽  
Vol 6 ◽  
pp. 2513826X2090350
Author(s):  
Matthew A. Strode ◽  
Robert F. Lohman ◽  
Kilian E. Salerno ◽  
John M. Kane
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Primary Closure ◽  
Soft Tissues ◽  
Tissue Expander ◽  
Soft Tissue Sarcomas ◽  
Tissue Expansion ◽  
Curative Treatment ◽  
Wide Resection ◽  
Preoperative Radiation

The potentially curative treatment for soft tissue sarcomas is wide resection. When located on the scalp, this can require removal of significant volumes of adjacent soft tissues as well as the skull periosteum. Consequently, reconstruction of the surgical defect is challenging. For patients receiving preoperative radiation or chemotherapy, gradual tissue expansion through the placement of a preoperative tissue expander can allow for primary closure of the wide resection defect, typically with hair-bearing scalp.

scholarly journals Bone and Soft‐Tissue Sarcoma Risk in Long‐Term Survivors of Hereditary Retinoblastoma Treated With Radiation

2019 ◽  
Vol 37 (35) ◽  
pp. 3436-3445 ◽  
Author(s):  
Ruth A. Kleinerman ◽  
Sara J. Schonfeld ◽  
Byron S. Sigel ◽  
Jeannette R. Wong-Siegel ◽  
Ethel S. Gilbert ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Head And Neck ◽  
Cumulative Incidence ◽  
Soft Tissue Sarcomas ◽  
Bone Sarcoma ◽  
The Body ◽  
Radiotherapy Field ◽  
Screening Protocol ◽  
Clinical Surveillance

PURPOSE Survivors of hereditary retinoblastoma have excellent survival but substantially increased risks of subsequent bone and soft-tissue sarcomas, particularly after radiotherapy. Comprehensive investigation of sarcoma risk patterns would inform clinical surveillance for survivors. PATIENTS AND METHODS In a cohort of 952 irradiated survivors of hereditary retinoblastoma who were originally diagnosed during 1914 to 2006, we quantified sarcoma risk with standardized incidence ratios (SIRs) and cumulative incidence analyses. We conducted analyses separately for bone and soft-tissue sarcomas occurring in the head and neck (in/near the radiotherapy field) versus body and extremities (out of field). RESULTS Of 105 bone and 124 soft-tissue sarcomas, more than one half occurred in the head and neck (bone, 53.3%; soft tissue, 51.6%), one quarter in the body and extremities (bone, 29.5%; soft tissue, 25.0%), and approximately one fifth in unknown/unspecified locations (bone, 17.1%; soft tissue, 23.4%). We noted substantially higher risks compared with the general population for head and neck versus body and extremity tumors for both bone (SIR, 2,213; 95% CI, 1,671 to 2,873 v SIR, 169; 95% CI, 115 to 239) and soft-tissue sarcomas (SIR, 542; 95% CI, 418 to 692 v SIR, 45.7; 95% CI, 31.1 to 64.9). Head and neck bone and soft-tissue sarcomas were diagnosed beginning in early childhood and continued well into adulthood, reaching a 60-year cumulative incidence of 6.8% (95% CI, 5.0% to 8.7%) and 9.3% (95% CI, 7.0% to 11.7%), respectively. In contrast, body and extremity bone sarcoma incidence flattened after adolescence (3.5%; 95% CI, 2.3% to 4.8%), whereas body and extremity soft-tissue sarcoma incidence was rare until age 30, when incidence rose steeply (60-year cumulative incidence, 6.6%; 95% CI, 4.1% to 9.2%), particularly for females (9.4%; 95% CI, 5.1% to 13.8%). CONCLUSION Strikingly elevated bone and soft-tissue sarcoma risks differ by age, location, and sex, highlighting important contributions of both radiotherapy and genetic susceptibility. These data provide guidance for the development of a risk-based screening protocol that focuses on the highest sarcoma risks by age, location, and sex.

scholarly journals Clinical Significance of Additional Wide Resection for Unplanned Resection of High Grade Soft Tissue Sarcoma

2008 ◽  
Vol 2 (1) ◽  
pp. 126-129 ◽  
Author(s):  
T Morii ◽  
H Yabe ◽  
H Morioka ◽  
U Anazawa ◽  
Y Suzuki ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Soft Tissue Sarcomas ◽  
Wide Resection ◽  
High Grade ◽  
Event Free Survival ◽  
Free Survival ◽  
Musculoskeletal Sarcoma ◽  
Oncological Outcomes ◽  
Local Recurrence Free Survival

Purpose: Unplanned resection of musculoskeletal sarcoma involves tumor excision without any suspicion of malignancy or regard for the necessity of defining adequate margins. For orthopaedic oncologists, many opportunities arise for management of unplanned resections initially performed by non-specialist surgeons. The puropose of this study is to assess the clinical outcomes and the problems of the patients with unplanned resection of high-grade soft tissue sarcoma. Methods: 77 consecutive patients were retrospectively reviewed. Oncological outcomes together with validity and problems of additional treatments were analyzed. Results: Five-year local recurrence-free survival, metastasis-free survival, event-free survival and total survival were 71.55%, 73.2%, 57.5% and 85.9%, respectively. Among adjuvant therapy including additional wide resection, radiotherapy and systemic chemotherapy, only additional wide resection significantly improved oncological outcomes. Conclusion: Additional wide resection appears to be effective in the treatment of high-grade soft tissue sarcomas following primary resection with compromised margins of resection.

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