Soft Tissue Sarcoma Knowledge Centre
Management
Overview
Some of the information within this section is taken from the ESMO clinical guidelines and its use is subject to permission from ESMO
Soft tissue sarcomas are ubiquitous in their site of origin, and are often treated with multimodality treatment. Multidisciplinary treatment planning is therefore mandatory in all cases (involving pathologists, radiologists, surgeons, radiation therapists, medical oncologists, paediatric oncologists if needed). This should be carried out in referral centers for sarcomas and/or within collaborative networks sharing multidisciplinary expertise. These centers are involved in ongoing clinical trials, in which sarcoma patients’ enrolment is highly encouraged. This centralized referral should be pursued as from the time of the clinical diagnosis of a suspect sarcoma. In practice, referral of all patients with a lesion likely to be a sarcoma would be recommended. Practically, this would mean referring all patients with a deep mass of soft tissues, or with a superficial lesion of soft tissues having a diameter of >5 cm.
Management of STS depends on the stage of disease and histological subtype1. Surgery is the mainstay of treatment for patients with localised disease and is often curative. However, as recurrence is likely to occur when tumour cells remain after surgery, adjuvant radiotherapy is often also considered, especially for patients with intermediate or high-grade tumours. Radiotherapy is also often administered for patients in whom surgery is inappropriate or who decline surgery1. Adjuvant chemotherapy is not standard practice even though it might improve distant and local recurrent rate2. Its impact on overall survival is still debated2.
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References:
1. Clark MA, Fisher C et al. (2005) “Soft-tissue sarcomas in adults.” N Engl JMed 353(7): 701–11
2. Leyvraz S. (2007) “Soft tissue sarcomas: ESMO Clinical Recommendations for diagnosis, treatment and follow-up.” Ann Oncol 18(Suppl 2): ii74–76.