Abstract
Any soft tissue swelling beneath the deep fascia should be considered a sarcoma until proven otherwise. As the most important factor in the primary treatment of these cancers is the adequacy of the primary surgical resection, it is vital to diagnose these malignant tumours pre-operatively. The modern treatment of soft tissue sarcomas may involve all modalities, but the most important aspect of treatment of a primary localised sarcoma is wide excisional surgery preserving limb function. Radiotherapy is a vital adjunct in high-grade tumours, or in tumours whose resectability is limited either by size or anatomical proximity to vital structures. Apart from a few chemosensitive sarcomas, the role of chemotherapy is limited to treatment of metastatic disease where documented response rates are no greater than 30%. As 50% of patients with high-grade sarcomas will die from metastatic disease, improvements in survival rates will only come from improvements in response to systemic therapy. No controlled trials have shown any survival benefit for adjuvant chemotherapy, although a recent meta-analysis of published data has shown a trend to increased survival at two years. Multicentre randomised trials are ongoing. The prognosis of these lesions is highly variable, but is intimately related to the anatomical site (i.e., resectability), and also the grade and size of the tumour.
Full text
PDF




Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Ball A. B., Fisher C., Pittam M., Watkins R. M., Westbury G. Diagnosis of soft tissue tumours by Tru-Cut biopsy. Br J Surg. 1990 Jul;77(7):756–758. doi: 10.1002/bjs.1800770713. [DOI] [PubMed] [Google Scholar]
- Ball A. B., Serpell J. W., Fisher C., Thomas J. M. Primary soft tissue tumours of the pelvis causing referred pain in the leg. J Surg Oncol. 1991 May;47(1):17–20. doi: 10.1002/jso.2930470105. [DOI] [PubMed] [Google Scholar]
- Coindre J. M., Trojani M., Contesso G., David M., Rouesse J., Bui N. B., Bodaert A., De Mascarel I., De Mascarel A., Goussot J. F. Reproducibility of a histopathologic grading system for adult soft tissue sarcoma. Cancer. 1986 Jul 15;58(2):306–309. doi: 10.1002/1097-0142(19860715)58:2<306::aid-cncr2820580216>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
- Collin C., Godbold J., Hajdu S., Brennan M. Localized extremity soft tissue sarcoma: an analysis of factors affecting survival. J Clin Oncol. 1987 Apr;5(4):601–612. doi: 10.1200/JCO.1987.5.4.601. [DOI] [PubMed] [Google Scholar]
- Creagan E. T., Hahn R. G., Ahmann D. L., Bisel H. F. A clinical trial adriamycin (NSC 123127) in advanced sarcomas. Oncology. 1977;34(2):90–91. doi: 10.1159/000225192. [DOI] [PubMed] [Google Scholar]
- Enneking W. F., Spanier S. S., Malawer M. M. The effect of the Anatomic setting on the results of surgical procedures for soft parts sarcoma of the thigh. Cancer. 1981 Mar 1;47(5):1005–1022. doi: 10.1002/1097-0142(19810301)47:5<1005::aid-cncr2820470532>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]
- Gadd M. A., Casper E. S., Woodruff J. M., McCormack P. M., Brennan M. F. Development and treatment of pulmonary metastases in adult patients with extremity soft tissue sarcoma. Ann Surg. 1993 Dec;218(6):705–712. doi: 10.1097/00000658-199312000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jenkins M. P., Alvaranga J. C., Thomas J. M. The management of retroperitoneal soft tissue sarcomas. Eur J Cancer. 1996 Apr;32A(4):622–626. doi: 10.1016/0959-8049(95)00638-9. [DOI] [PubMed] [Google Scholar]
- Karakousis C. P. Modified anterior compartment resection. J Surg Oncol. 1991 Jan;46(1):25–30. doi: 10.1002/jso.2930460107. [DOI] [PubMed] [Google Scholar]
- Kissin M. W., Fisher C., Webb A. J., Westbury G. Value of fine needle aspiration cytology in the diagnosis of soft tissue tumours: a preliminary study on the excised specimen. Br J Surg. 1987 Jun;74(6):479–480. doi: 10.1002/bjs.1800740616. [DOI] [PubMed] [Google Scholar]
- Lindberg R. D., Martin R. G., Romsdahl M. M., Barkley H. T., Jr Conservative surgery and postoperative radiotherapy in 300 adults with soft-tissue sarcomas. Cancer. 1981 May 15;47(10):2391–2397. doi: 10.1002/1097-0142(19810515)47:10<2391::aid-cncr2820471012>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
- Mankin H. J., Lange T. A., Spanier S. S. The hazards of biopsy in patients with malignant primary bone and soft-tissue tumors. J Bone Joint Surg Am. 1982 Oct;64(8):1121–1127. [PubMed] [Google Scholar]
- Pitcher M. E., Davidson T. I., Fisher C., Thomas J. M. Post irradiation sarcoma of soft tissue and bone. Eur J Surg Oncol. 1994 Feb;20(1):53–56. [PubMed] [Google Scholar]
- Pitcher M. E., Fish S., Thomas J. M. Management of soft tissue sarcoma. Br J Surg. 1994 Aug;81(8):1136–1139. doi: 10.1002/bjs.1800810817. [DOI] [PubMed] [Google Scholar]
- Pitcher M. E., Thomas J. M. Functional compartmental resection for soft tissue sarcomas. Eur J Surg Oncol. 1994 Aug;20(4):441–445. [PubMed] [Google Scholar]
- Potter D. A., Kinsella T., Glatstein E., Wesley R., White D. E., Seipp C. A., Chang A. E., Lack E. E., Costa J., Rosenberg S. A. High-grade soft tissue sarcomas of the extremities. Cancer. 1986 Jul 1;58(1):190–205. doi: 10.1002/1097-0142(19860701)58:1<190::aid-cncr2820580133>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
- Putnam J. B., Jr, Roth J. A., Wesley M. N., Johnston M. R., Rosenberg S. A. Analysis of prognostic factors in patients undergoing resection of pulmonary metastases from soft tissue sarcomas. J Thorac Cardiovasc Surg. 1984 Feb;87(2):260–268. [PubMed] [Google Scholar]
- Robinson M., Barr L., Fisher C., Fryatt I., Stotter A., Harmer C., Wiltshaw E., Westbury G. Treatment of extremity soft tissue sarcomas with surgery and radiotherapy. Radiother Oncol. 1990 Jul;18(3):221–233. doi: 10.1016/0167-8140(90)90058-5. [DOI] [PubMed] [Google Scholar]
- Ruka W., Emrich L. J., Driscoll D. L., Karakousis C. P. Clinical factors and treatment parameters affecting prognosis in adult high-grade soft tissue sarcomas: a retrospective review of 267 cases. Eur J Surg Oncol. 1989 Oct;15(5):411–423. [PubMed] [Google Scholar]
- Simon M. A., Enneking W. F. The management of soft-tissue sarcomas of the extremities. J Bone Joint Surg Am. 1976 Apr;58(3):317–327. [PubMed] [Google Scholar]
- Steward W. P., Verweij J., Somers R., Spooner D., Kerbrat P., Clavel M., Crowther D., Rouesse J., Tursz T., Tueni E. Granulocyte-macrophage colony-stimulating factor allows safe escalation of dose-intensity of chemotherapy in metastatic adult soft tissue sarcomas: a study of the European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group. J Clin Oncol. 1993 Jan;11(1):15–21. doi: 10.1200/JCO.1993.11.1.15. [DOI] [PubMed] [Google Scholar]
- Stotter A. T., A'Hern R. P., Fisher C., Mott A. F., Fallowfield M. E., Westbury G. The influence of local recurrence of extremity soft tissue sarcoma on metastasis and survival. Cancer. 1990 Mar 1;65(5):1119–1129. doi: 10.1002/1097-0142(19900301)65:5<1119::aid-cncr2820650515>3.0.co;2-p. [DOI] [PubMed] [Google Scholar]
- Suruda A. J., Ward E. M., Fingerhut M. A. Identification of soft tissue sarcoma deaths in cohorts exposed to dioxin and to chlorinated naphthalenes. Epidemiology. 1993 Jan;4(1):14–19. doi: 10.1097/00001648-199301000-00004. [DOI] [PubMed] [Google Scholar]
- Sørensen S. A., Mulvihill J. J., Nielsen A. Long-term follow-up of von Recklinghausen neurofibromatosis. Survival and malignant neoplasms. N Engl J Med. 1986 Apr 17;314(16):1010–1015. doi: 10.1056/NEJM198604173141603. [DOI] [PubMed] [Google Scholar]
- Tehranzadeh J., Mnaymneh W., Ghavam C., Morillo G., Murphy B. J. Comparison of CT and MR imaging in musculoskeletal neoplasms. J Comput Assist Tomogr. 1989 May-Jun;13(3):466–472. doi: 10.1097/00004728-198905000-00019. [DOI] [PubMed] [Google Scholar]
- Tierney J. F., Mosseri V., Stewart L. A., Souhami R. L., Parmar M. K. Adjuvant chemotherapy for soft-tissue sarcoma: review and meta-analysis of the published results of randomised clinical trials. Br J Cancer. 1995 Aug;72(2):469–475. doi: 10.1038/bjc.1995.357. [DOI] [PMC free article] [PubMed] [Google Scholar]