Extremity Soft Tissue Sarcoma in Adults
In general, patients with superfi cial low-grade tumors that are less than 5 cm in diameter can be treated with surgical excision alone when negative margins of ≥1 cm are achieved and can expect excellent local control and survival rates approximating 90%.
In patients with intermediate grade lesions, surgical excision with negative margins in combination with radiotherapy has achieved excellent local control, with overall survival rates approximating 80%. For larger, deep-seated tumors, preoperative RT appears to be more effective than postoperative radiation to prevent local tumor recurrence. Acute wound healing complications are higher with preoperative RT for lower extremity lesions, but generally irreversible late complications, including grade 3–4 fi broses, are more common in those patients receiving postoperative RT.
In patients with high-grade STS greater than 5 cm, excellent local control can be achieved with surgery and radiotherapy, but at least 50% of these patients will develop metastatic disease. In this setting, the use of neoadjuvant chemotherapy may benefi t some and should be considered in the context of a clinical trial, to be followed by defi nitive surgery combined with either pre- or postoperative radiotherapy or BRT.
BRT can provide excellent local control and functional results in appropriately selected patients.
KeywordsClin Oncol Soft Tissue Sarcoma Radiat Oncol Biol Phys Synovial Sarcoma Soft Tissue Sarcoma
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