The management of adult soft tissue sarcomas.
Soft tissue sarcomas are a relatively rare, heterogeneous group of tumors arising from mesenchymal tissues and occurring almost anywhere in the body. The rate of progression and likelihood of hematogenous dissemination, usually to the lung, is determined primarily by tumor grade. The likelihood of regional spread is low. Pretreatment evaluation includes computed tomography of the primary site and chest and magnetic resonance imaging of the primary tumor. The mainstay of treatment is surgery; wide excision for low-grade lesions and wide or radical (compartmental) resection for high-grade tumors. Often, these procedures cannot be achieved either because of the location and extent of the sarcoma or anticipated functional deficit. Adjuvant preoperative and/or postoperative radiotherapy improves the likelihood of local control and preserves function when adequate margins cannot be achieved with surgery alone. The role of adjuvant chemotherapy is unclear; however, some data suggest the doxorubicin containing regimens may improve the likelihood of cure for high-grade lesions, particularly large tumors arising in the extremities. Prognosis is influenced by a variety of factors, including age, tumor size, histologic grade, depth (superficial or deep), histologic subtype, and site. Approximately 90% and 98% of recurrences are observed within 5 years and 10 years, respectively. Five-year overall survival rates range from approximately 60% to 80%.
Mendenhall
William M
WM
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA. mendwm@shands.ufl.edu
Indelicato
Daniel J
DJ
Scarborough
Mark T
MT
Zlotecki
Robert A
RA
Gibbs
C Parker
CP
Mendenhall
Nancy P
NP
Mendenhall
Charles M
CM
Enneking
William F
WF
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009367:Neoplasm Staging; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011832:Radiation Injuries / Q000517:prevention & control; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012509:Sarcoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D012983:Soft Tissue Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D013514:Surgical Procedures, Operative / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome