Neoadjuvant Chemotherapy, Radiation, and Limited Surgery for High Grade Soft Tissue Sarcoma of the Extremity

Abstract

Malignant soft tissue sarcomas of the extremity continue to present clinical challenges in terms of local tumor control and preservation of a functional extremity. Historically, surgical excision of the primary tumor was the primary mode of therapy and, in order to achieve local tumor control, radical surgical procedures were necessary.(1) This involved amputation in approximately 35% of the cases, or large compartment resections in the remainder.(2) Although these treatment methods were effective in terms of local tumor control, they all resulted in significant functional impairment. Limited surgical excision, which is possible in approximately 75% of cases, followed by high-dose radiation therapy has recently been shown to be equally effective in terms of providing local tumor control and has, in general, provided excellent function.(3–7) The goals of primary therapy in extremity soft tissue sarcomas are to obtain local tumor control, achieve the best functional results with the fewest complications, lower cost both in terms of time, money and function, and finally to design a therapy that is applicable and acceptable to the most patients.