Soft Tissue Sarcomas

  • Daniel J. Indelicato
Part of the Medical Radiology book series (MEDRAD)


The incidence of local recurrence after wide local excision and radiation of soft tissue sarcoma (STS) ranges from 5 to 20%. Approximately 80% of these relapses will occur in the absence of metastatic disease. The optimal management of locally recurrent STS must be individualized and depends on prior therapy, the location of the recurrence, and the feasibility of conservative surgery. Following retreatment, the likelihood of ultimate local control ranges from 37 to 100% and is a reflection of well-known risk factors for de novo sarcomas such as the number of prior recurrences, high grade, positive margins, deep location, and non-extremity tumor site. Approaches for retreatment include wide local reexcision followed by a variety of radiation techniques, each with the potential for severe side effects. For select patients, repeat irradiation may be unnecessary.


Soft Tissue Sarcoma Wide Local Excision Intraarterial Chemotherapy Brachytherapy Boost Recurrent Sarcoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Azinovic I, Martinez MR, Javier AJ et al (2003) Intraoperative radiotherapy electron boost followed by moderate doses of external beam radiotherapy in resected soft-tissue sarcoma of the extremities. Radiother Oncol 67:331–337PubMedCrossRefGoogle Scholar
  2. Casson AG, Putnam JB, Natarajan G et al (1992) Five-year survival after pulmonary metastasectomy for adult soft tissue sarcoma. Cancer 69:662–668PubMedCrossRefGoogle Scholar
  3. Catton C, Davis A, Bell R et al (1996) Soft tissue sarcoma of the extremity. Limb salvage after failure of combined conservative therapy. Radiother Oncol 41:209–214PubMedCrossRefGoogle Scholar
  4. Dalton RR, Lanciano RM, Hoffman JP, Eisenberg BL (1996) Wound complications after resection and immediate postoperative brachytherapy in the management of soft-tissue sarcomas. Ann Surg Oncol 3:51–56PubMedCrossRefGoogle Scholar
  5. Essner R, Selch M, Eilber FR (1991) Reirradiation for extremity soft tissue sarcomas. Local control and complications. Cancer 67:2813–2817PubMedCrossRefGoogle Scholar
  6. Garcia Franco CE, Algarra SM, Ezcurra AT et al (2009) Long-term results after resection for soft tissue sarcoma pulmonary metastases. Interact Cardiovasc Thorac Surg 9:223–226PubMedCrossRefGoogle Scholar
  7. Graham JD, Robinson MH, Harmer CL (1992) Re-irradiation of soft-tissue sarcoma. Br J Radiol 65:157–161PubMedCrossRefGoogle Scholar
  8. Horner MJ, Ries LAG, Krapcho M et al (2009) SEER Cancer Statistics Review 1975–2006. National Cancer Institute, Bethesda, MDGoogle Scholar
  9. Indelicato DJ, Meadows K, Gibbs CP Jr, Morris CG, Scarborough MT, Zlotecki RA (2009) Effectiveness and morbidity associated with reirradiation in conservative salvage management of recurrent soft-tissue sarcoma. Int J Radiat Oncol Biol Phys 73(1):267–272PubMedCrossRefGoogle Scholar
  10. Karakousis CP, Emrich LJ, Rao U, Krishnamsetty RM (1986) Feasibility of limb salvage and survival in soft tissue sarcomas. Cancer 57:484–491PubMedCrossRefGoogle Scholar
  11. Kinsella TJ, Loeffler JS, Fraass BA, Tepper J (1983) Extremity preservation by combined modality therapy in sarcomas of the hand and foot: an analysis of local control, disease free survival and functional result. Int J Radiat Oncol Biol Phys 9:1115–1119PubMedCrossRefGoogle Scholar
  12. Lindberg RD, Martin RG, Romsdahl MM, Barkley HT Jr (1981) Conservative surgery and postoperative radiotherapy in 300 adults with soft-tissue sarcomas. Cancer 47:2391–2397PubMedCrossRefGoogle Scholar
  13. Moureau-Zabotto L, Thomas L, Bui BN et al (2004) Management of soft tissue sarcomas (STS) in first isolated local recurrence: a retrospective study of 83 cases. Radiother Oncol 73:313–319PubMedCrossRefGoogle Scholar
  14. Mundt AJ, Awan A, Sibley GS et al (1995) Conservative surgery and adjuvant radiation therapy in the management of adult soft tissue sarcoma of the extremities: clinical and radiobiological results. Int J Radiat Oncol Biol Phys 32:977–985PubMedCrossRefGoogle Scholar
  15. National Cancer Institute (2009) A snapshot of sarcoma. National Cancer Institute (8-18-2010)Google Scholar
  16. National Comprehensive Cancer Network (2007) NCCN clinical practice guidelines in oncology. Soft tissue sarcomasGoogle Scholar
  17. Nori D, Schupak K, Shiu MH, Brennan MF (1991) Role of brachytherapy in recurrent extremity sarcoma in patients treated with prior surgery and irradiation. Int J Radiat Oncol Biol Phys 20:1229–1233PubMedCrossRefGoogle Scholar
  18. Okunieff P, Sundararaman S, Chen Y (1999) Biology of large dose per fraction radiation therapy. In: Gunderson LL, Willett CG, Harrison LB, Calvo FA (eds) Intraoperative irradiation. Humana Press, Inc., Totowa, NJ, pp 25–46Google Scholar
  19. Pearlstone DB, Janjan NA, Feig BW et al (1999) Re-resection with brachytherapy for locally recurrent soft tissue sarcoma arising in a previously radiated field. Cancer J Sci Am 5:26–33PubMedGoogle Scholar
  20. Pisters PW, Harrison LB, Leung DH et al (1996) Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 14:859–868PubMedGoogle Scholar
  21. Ramanathan RC, A’Hern R, Fisher C, Thomas JM (2001) Prognostic index for extremity soft tissue sarcomas with isolated local recurrence. Ann Surg Oncol 8:278–289PubMedCrossRefGoogle Scholar
  22. Rehders A, Hosch SB, Scheunemann P et al (2007) Benefit of surgical treatment of lung metastasis in soft tissue sarcoma. Arch Surg 142:70–75PubMedCrossRefGoogle Scholar
  23. Rosenberg SA, Tepper J, Glatstein E et al (1982) The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg 196:305–315PubMedCrossRefGoogle Scholar
  24. Shiu MH, Castro EB, Hajdu SI, Fortner JG (1975) Surgical treatment of 297 soft tissue sarcomas of the lower extremity. Ann Surg 182:597–602PubMedCrossRefGoogle Scholar
  25. Singer S, Antman K, Corson JM, Eberlein TJ (1992) Long-term salvageability for patients with locally recurrent soft-tissue sarcomas. Arch Surg 127:548–553PubMedCrossRefGoogle Scholar
  26. Spencer SA, Harris J, Wheeler RH et al (2007) Final report of RTOG 9610, a multi-institutional trial of reirradiation and chemotherapy for unresectable recurrent squamous cell carcinoma of the head and neck. Head Neck 30:281–288CrossRefGoogle Scholar
  27. Suit HD, Mankin HJ, Wood WC, Proppe KH (1985) Preopertive, intraoperative, and postoperative radiation in the treatment of primary soft tissue sarcoma. Cancer 55:2659–2667PubMedCrossRefGoogle Scholar
  28. Torres MA, Ballo MT, Butler CE et al (2007) Management of locally recurrent soft-tissue sarcoma after prior surgery and radiation therapy. Int J Radiat Oncol Biol Phys 67:1124–1129PubMedCrossRefGoogle Scholar
  29. van Geel AN, Pastorino U, Jauch KW et al (1996) Surgical treatment of lung metastases: the European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group study of 255 patients. Cancer 77:675–682PubMedCrossRefGoogle Scholar
  30. Verazin GT, Warneke JA, Driscoll DL et al (1992) Resection of lung metastases from soft-tissue sarcomas. A multivariate analysis. Arch Surg 127:1407–1411PubMedCrossRefGoogle Scholar
  31. Weber DC, Rutz HP, Bolsi A et al (2007) Spot scanning proton therapy in the curative treatment of adult patients with sarcoma: the Paul Scherrer institute experience. Int J Radiat Oncol Biol Phys 69:865–871PubMedCrossRefGoogle Scholar
  32. Willett CG, Czito BG, Tyler DS (2007) Intraoperative radiation therapy. J Clin Oncol 25:971–977PubMedCrossRefGoogle Scholar
  33. Wood WC, Suit HD, Mankin HJ et al (1984) Radiation and conservative surgery in the treatment of soft tissue sarcoma. Am J Surg 147:537–541PubMedCrossRefGoogle Scholar
  34. Yang JC, Chang AE, Baker AR et al (1998) Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 16:197–203PubMedGoogle Scholar
  35. Zagars GK, Ballo MT, Pisters PW et al (2003) Prognostic factors for disease-specific survival after first relapse of soft-tissue sarcoma: analysis of 402 patients with disease relapse after initial conservative surgery and radiotherapy. Int J Radiat Oncol Biol Phys 57:739–747PubMedCrossRefGoogle Scholar
  36. Zelefsky MJ, Nori D, Shiu MH, Brennan MF (1990) Limb salvage in soft tissue sarcomas involving neurovascular structures using combined surgical resection and brachytherapy. Int J Radiat Oncol Biol Phys 19:913–918PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Department of Radiation OncologyUniversity of Florida College of MedicineGainesvilleUSA
  2. 2.University of Florida Proton Therapy InstituteJacksonvilleUSA

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