Annals of Surgical Oncology

, Volume 5, Issue 5, pp 464–472 | Cite as

Combined modality treatment of extremity soft tissue sarcomas

Surgical Oncology Forum


Background: Substantial progress has been made in the multimodality treatment of soft tissue sarcoma over the past decade. This review summarizes current state-of-the-art management for patients with extremity soft tissue sarcoma.

Methods: Literature-based review of combined modality treatment of extremity sarcoma.

Results: The revised staging system of the International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) for this disease is described and a practical approach to diagnosis, evaluation, management, and follow-up of patients is presented. Brief summaries of the roles of surgical therapy, pre- and postoperative radiotherapy, pre- and postoperative chemotherapy, and concurrent chemoradiation in the management of extremity soft tissue sarcoma are provided, with summaries of the available data from randomized prospective trials. The data referenced and discussed herein provide the basis for stage-specific treatment recommendations for the management of patients with localized soft tissue sarcoma of the extremities.

Conclusions: Soft tissue sarcoma remains a challenging disease to treat. The majority of patients require an integrated combined modality approach. Future research should be directed at developing more effective systemic therapies and minimizing the toxicities of local therapies.

Key Words

Soft tissue sarcoma 


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  1. 1.
    Tumours of bone and soft tissues. In: Sobin LH, Wittekind C, ed.TNM Classification of Malignant Tumours. 5th ed. New York: Wiley, 1997:101–9.Google Scholar
  2. 2.
    Fong Y, Coit DG, Woodruff JM, Brennan MF. Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients.Ann Surg 1993;217:72–7.PubMedGoogle Scholar
  3. 3.
    Weiss SW, Sobin LH.Histologic Typing of Soft Tissue Tumors. 2nd ed. Berlin: Springer-Verlag, 1994.Google Scholar
  4. 4.
    Costa J, Wesley RA, Glatstein E, Rosenberg SA. The grading of soft tissue sarcomas. Results of a clinicohistopathologic correlation in a series of 163 cases.Cancer 1984;53:530–41.PubMedGoogle Scholar
  5. 5.
    Trojani M, Contesso G, Coindre JM, Rouesse J, Bui NB, de Mascarel A, Goussot JF, et al. Soft-tissue sarcomas of adults: study of pathological prognostic variables and definition of a histopathological grading system.Int J Cancer 1984;33:37–42.PubMedGoogle Scholar
  6. 6.
    Guillou L, Coindre J, Bonichon F, Bui N, Terrier P, Collin F, Vilain M, et al. Comparative study of the National Cancer Institute and French Federation of Cancer Centers Sarcoma Group grading systems in a population of 410 adult patients with soft tissue sarcoma.J Clin Oncol 1997;15:350–62.PubMedGoogle Scholar
  7. 7.
    Heslin MJ, Lewis JJ, Woodruff JM, Brennan MF. Core needle biopsy for diagnosis of extremity soft tissue sarcoma.Ann Surg Oncol 1997;4:425–31.CrossRefPubMedGoogle Scholar
  8. 8.
    Panicek DM, Gatsonis C, Rosenthal DI, Seeger LL, Huvos AG, Moore SG, Caudry DJ, et al. CT and MR imaging in the local staging of primary malignant musculoskeletal neoplasms: report of the Radiology Diagnostic Oncology Group.Radiology 1997;202:237–46.PubMedGoogle Scholar
  9. 9.
    Cheng EY, Springfield DS, Mankin HJ. Frequent incidence of extrapulmonary sites of initial metastasis in patients with liposarcoma.Cancer 1995;75:1120–7.PubMedGoogle Scholar
  10. 10.
    Williard WC, Collin C, Casper ES, Hajdu SI, Brennan MF. The changing role of amputation for soft tissue sarcoma of the extremity in adults.Surg Gynecol Obstet 1992;175:389–96.PubMedGoogle Scholar
  11. 11.
    Rosenberg SA, Tepper J, Glatstein E, Costa J, Baker A, Brennan M, DeMoss EV, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluation of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy.Ann Surg 1982;196:305–15.PubMedGoogle Scholar
  12. 12.
    Pisters PWT, Harrison LB, Leung DHY, Woodruff JM, Casper ES. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma.J Clin Oncol 1996;14:859–68.PubMedGoogle Scholar
  13. 13.
    Yang JC, Chang AE, Baker AR, Sindelar WF, Danforth DN, Topalian SL, DeLaney T, et al. A randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity.J Clin Oncol 1998;16:197–203.PubMedGoogle Scholar
  14. 14.
    Karakousis CP. Surgery for soft tissue sarcomas. In: Bland KI, Karakousis CP, Copeland EM, eds.Atlas of Surgical Oncology. Philadelphia: WB Saunders, 1995:283–400.Google Scholar
  15. 15.
    Geer RJ, Woodruff J, Casper ES, Brennan MF. Management of small soft-tissue sarcoma of the extremity in adults.Arch Surg 1992;127:1285–89.PubMedGoogle Scholar
  16. 16.
    Rydholm A, Gustafson P, Rooser B, Willen H, Akerman M, Herrlin K, Alvegard T, et al. Limb-sparing surgery without radiotherapy based on anatomic location of soft tissue sarcoma.J Clin Oncol 1991;9:1757–65.PubMedGoogle Scholar
  17. 17.
    Healey B, Corson J, Demetri G, Singer S. Surgery alone may be adequate treatment for select stage IA-IIIA soft tissue sarcomas.Proc Am Soc Clin Oncol 1995;14:517 (Abstract).Google Scholar
  18. 18.
    Peat BG, Bell RS, Davis A, O'Sullivan B, Mahoney J, Manktelow RT, Bowen V, et al. Wound-healing complications after soft-tissue sarcoma surgery.Plast Reconstr Surg 1994;93:980–7.PubMedGoogle Scholar
  19. 19.
    Bujko K, Suit HD, Springfield DS, Convery K. Wound healing after preoperative radiation for sarcoma of soft tissues.Surg Gynecol Obstet 1993;176:124–34.PubMedGoogle Scholar
  20. 20.
    Janjan NA, Yasko AW, Reece GP, Miller MJ, Murray JA, Ross MI, Romsdahl MM, et al. Comparison of charges related to radiotherapy for soft tissue sarcomas treated by preoperative external beam irradiation versus interstitial implantation.Ann Surg Oncol 1994;1:415–22.CrossRefPubMedGoogle Scholar
  21. 21.
    Pisters PWT, Harrison LB, Woodruff JM, Gaynor JJ, Brennan MF. A prospective randomized trial of adjuvant brachytherapy in the management of low grade soft tissue sarcomas of the extremity and superficial trunk.J Clin Oncol 1994;12:1150–5.PubMedGoogle Scholar
  22. 22.
    Tierney JF. Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults: meta-analysis of individual data.Lancet 1997;350:1647–54.Google Scholar
  23. 23.
    LeLorier J, Gregoire G, Benhaddad A, Lapierre J, Derderian F. Discrepancies between meta-analyses and subsequent large randomized controlled trials.N Engl J Med 1997;337:536–42.CrossRefPubMedGoogle Scholar
  24. 24.
    Frustaci S, Gherlinzoni F, De Paoli A, Pignatti G, Zmerley H, Azzarelli A, Comadone A, et al. Preliminary results of an adjuvant randomized trial on high risk extremity soft tissue sarcomas (STS). The interim analysis.Proc Am Soc Clin Oncol 1997;16:1785 (Abstract).Google Scholar
  25. 25.
    Pisters PWT, Leung DHY, Woodruff J, Shi W, Brennan MF. Analysis of prognostic factors in 1041 patients with localized soft tissue sarcomas of the exremities.J Clin Oncol 1996;14:1679–89.PubMedGoogle Scholar
  26. 26.
    Pisters PWT, Patel SR, Varma DGK, Cheng S, Chen NP, Nguyen HTB, Feig BW, et al. Preoperative chemotherapy for stage IIIB extremity soft tissue sarcoma: long-term results from a single institution.J Clin Oncol 1997;15:3481–7.PubMedGoogle Scholar
  27. 27.
    Casper ES, Gaynor JJ, Harrison LB, Panicek DM, Hajdu SI, Brennan MF. Preoperative and postoperative adjuvant combination chemotherapy for adults with high grade soft tissue sarcoma.Cancer 1994;73:1644–51.PubMedGoogle Scholar
  28. 28.
    Patel SR, Vadhan-Raj S, Papadopolous N, Plager C, Burgess MA, Hays C, Benjamin RS. High-dose ifosfamide in bone and soft tissue sarcomas: results of phase II and pilot studies—dose-response and schedule dependence.J Clin Oncol 1997;15:2378–84.PubMedGoogle Scholar
  29. 29.
    Gortzak E, Rouesse J, Verwey J, van Geel AN, Buesa J, Santoro A, Tursz T, et al. Randomised phase II study of neoadjuvant chemotherapy in soft tissue sarcomas in adults. Protocol 62874.Eur J Cancer 1993;29A(Suppl6):S183 (Abstract).Google Scholar
  30. 30.
    Spiro IJ, Suit H, Gebhardt M, et al. Neoadjuvant chemotherapy and radiotherapy for large soft tissue sarcomas.Proc Am Soc Clin Oncol 1996;15:524 (Abstract).Google Scholar
  31. 31.
    Eilber FR, Giuliano AE, Huth JF, Morton DL. Postoperative adjuvant chemotherapy (Adriamycin) in high grade extremity soft tissue sarcoma: a randomized prospective trial. In: Salmon SE, ed.Adjuvant Therapy of Cancer. 5th ed. Orlando: Grune & Stratton, 1987:719–23.Google Scholar
  32. 32.
    Eilber F, Giuliano A, Huth JH, Mirra J, Rosen G, Morton D. Neoadjuvant chemotherapy, radiation, and limited surgery for high grade soft tissue sarcoma of the extremity. In: Ryan JR, Baker LO, ed.Recent Concepts in Sarcoma Treatment. Dordrecht, The Netherlands: Kluwer Academic, 1988:115–22.Google Scholar
  33. 33.
    Eggermont AMM, Shraffordt Koops H, Lienard D, Kroon BBR, van Geel AN, Hoekstra HJ, Lejeune FJ, et al. Isolated limb perfusion with high-dose tumor necrosis factor-α in combination with interferon-γ and melphalan for nonresectable extremity soft tissue sarcomas: a multicenter trial.J Clin Oncol 1996;14:2653–65.PubMedGoogle Scholar
  34. 34.
    Lieberman MD, Kilburn H, Lindsey M, Brennan MF. Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy.Ann Surg 1995;222:638–45.PubMedGoogle Scholar
  35. 35.
    Gustafson P, Dreinhofer KE, Rydholm A. Soft tissue sarcoma should be treated at a tumor center. A comparison of quality of surgery in 375 patients.Acta Orthop Scand 1994;65:47–50.PubMedGoogle Scholar
  36. 36.
    Singer S, Antman K, Corson JM, Eberlein TJ. Long-term salvage-ability for patients with locally recurrent soft-tissue sarcomas.Arch Surg 1992;127:548–53.PubMedGoogle Scholar
  37. 37.
    Nori D, Schupak K, Shiu MH, Brennan MF, Shupak K. Role of brachytherapy in recurrent extremity sarcoma in patients treated with prior surgery and irradiation.Int J Radiat Oncol Biol Phys 1991;20:1229–33.PubMedGoogle Scholar
  38. 38.
    Lewis J, Leung D, Piskum G, Woodruff E, Casper E, Brennan MF. Multifactorial analysis of long-term (>5 year) survival in extremity soft tissue sarcoma.Proc Soc Surg Onc 1995;48 (Abstract).Google Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 1998

Authors and Affiliations

  1. 1.Dept. of Surgical Oncology, Box 106The University of Texas M. D. Anderson Cancer CenterHouston

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