Soft tissue sarcomas

Authors

  • Sumitra Chanpeng Surgery Division, Chaiyaphum Hospital Medical Education Center

Keywords:

Soft tissue sarcoma, Sarcoma, Soft tissue tumor

Abstract

Abstract

          Soft tissue sarcomas (STS) are a group of rare tumors that arise from mesenchymal tissues. Although the etiology is unknown, there are risk factors that increase the risk of STS, such as chemical substances, pesticides, herbicides, and radiation therapies. STS is classified by the WHO into more than 50 histological subtypes and they typically appear as an asymptomatic mass. They can occur anywhere in the body, particularly the arm, leg, trunk, retroperitoneum, head and neck. Diagnosis is made by biopsy for pathological examination. The recommended method is to perform a core needle biopsy along with radiologic imaging, e.g., CT, MRI, or PET scan to assess the size of the tumor, the stage of the disease, and the ability to determine the exact location of the biopsy. The American Joint Committee on Cancer (AJCC) staging system for soft tissue sarcomas is based on histologic grade, tumor size and depth, and the presence of nodal or distant metastases. The treatment goals are to achieve long-term survival, local disease control, and to preserve the function of and the quality of life. Wide local resections are still the primary treatment. Adjuvant radiation therapy is for prevention of local recurrence, whereas radiation therapy prior to resection is to reduce the tumor size. The purpose of chemotherapy is systemic control; therapeutic, adjuvant, and palliative. However, there is still controversy over survival, therefore, chemotherapy is considered on a case-by-case basis. Currently, studies of the molecular characteristics of these tumors have led to the invention of targeted therapy. Most studies are still in phases one and two, but they are likely to be incorporated into standard treatment strategies in the future.

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References

Jemal A, Siegel R, Ward E, et al. Cancer Statistics, 2007 CA Cancer J Clin 2007;57(1):43-66.

Cormier JN, Pollock RE. Soft Tissue Sarcomas. CA Cancer J Clin 2004;54(2):94-109.

Gustafson P. Soft tissue sarcoma. Epidemiology and prognosis in 508 patients. Acta Orthop Scand Suppl 1994;259:1-31.

Fletcher CDM, Rydholm A, Singer S, et al. Soft tissue tumors: Epidemiology, clinical features, histopathological typing and grading. In: Fletcher CDM, editor. pathology and genetics of tumors of soft tissue and bone. France: IARCPress; 2002:p.8-12.

Eriksson M, Hardell L, Adami HO. Exposure to dioxins as a risk factor for soft tissue sarcoma: a population-based case-control study. J Natl Cancer Inst 1990;82(6):486-90.

Karlsson P, Holmberg E, Johansson KA, Kindblom LG, Carstensen J, Wallgren A. Soft tissue sarcoma after treatment for breast cancer. Radiother Oncol 1996;38(1):25-31.

Latres E, Drobnjak M, Pollack D, Oliva MR, Ramos M, Karpeh M, et al. Chromosome 17 abnormalities and TP53 mutations in adult soft tissue sarcomas. Am J Pathol 1994;145(2):345-55.

Clark MA, Fisher C, Judson I, Thomas JM. Soft-tissue sarcomas in adults. N Engl J Med 2005;353(7):701-11.

Johnson CJ, Pynsent PB, Grimer RJ. Clinical features of soft tissue sarcomas. Ann R Coll Surg Engl 2001;83(3):203-5.

Fadul D, Fayad LM. Advanced modalities for the imaging of sarcoma. Surg Clin North Am 2008;88(3):521-37.

Knapp EL, Kransdorf MJ, Letson GD. Diagnostic imaging update: soft tissue sarcomas. Cancer Control 2005;12(1):22-6.

Somerhausen Aubain S D N, Fletcher CD. Soft-tissue sarcomas: an update. Eur J Surg Oncol 1999;25(2):215-20.

Dupuy DE, Rosenberg AE, Punyaratabandhu T, et al. Accuracy of CT-Guided Needle Biopsy of Musculoskeletal Neoplasms. AJR Am J Roentgenol 1998;171(3):759-62.

Sbaraglia M, Bellan E,Dei Tos AP. The 2020 WHO Classification of Soft Tissue Tumours: new and perspectives. Pathologica 2021;113:70-84.

Coindre JM, Trojani M, Contesso G, et al. Reproducibility of a histopathologic grading system for adult soft tissue sarcoma. Cancer 1986;58(2):306-9.

Tanaka K, Ozaki T. New TNM classification (AJCC eight edition) of bone and soft tissue sarcomas: JCOG Bone and Soft Tissue Tumor Study Group. Jpn J Clin Oncol 2019;49(2):103-7.

Ramanathan RC, A'Hern R, Fisher C, Thomas JM. Modified staging system for extremity soft tissue sarcomas. Ann Surg Oncol 1999 Jan-Feb;6(1):57-69.

Wittekind C, Compton C, Quirke P, et al. A uniform residual tumor (R) classification: integration of the R classification and the circumferential margin status. Cancer 2009;115(15):3483-8.

Shmookler B, Bickels J, Jelinek J, et al. Bone and Soft-tissue Sarcomas: Epidemiology, Radiology, Pathology and Fundamentals of Surgical Treatment. Musculoskeletal Cancer Surgery: Treatment of Sarcomas and Allied Diseases. Dordrecht: Springer Netherlands; 2001. p. 3-35.

Stojadinovic A, Leung DH, Hoos A, et al. Analysis of the prognostic significance of microscopic margins in 2,084 localized primary adult soft tissue sarcomas. Ann Surg 2002;235(3):424-34.

Rosenberg SA, Tepper J, Glatstein E, Costa J, Baker A, Brennan M, et al. 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 1982;196(3):305-15.

Stojadinovic A, Jaques DP, Leung DH, Healey JH, Brennan MF. Amputation for recurrent soft tissue sarcoma of the extremity: indications and outcome. Ann Surg Oncol 2001;8(6):509-18.

Kandel R, Coakley N, Werier J, Engel J, Ghert M, Verma S, et al. Surgical margins and handling of soft-tissue sarcoma in extremities: a clinical practice guideline. Curr Oncol 2013;20(3):e247-e54.

Zagars GK, Ballo MT, Pisters PW, Pollock RE, Patel SR, Benjamin RS. Surgical margins and reresection in the management of patients with soft tissue sarcoma using conservative surgery and radiation therapy. Cancer 2003;97(10):2544-53.

Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 1998 Jan;16(1):197-203.

Cahlon O, Spierer M, Brennan MF, et al. Long-term outcomes in extremity soft tissue sarcoma after a pathologically negative re-resection and without radiotherapy. Cancer 2008;112(12):2774-9.

Suit HD, Mankin HJ, Wood WC, Proppe KH. Preoperative, intraoperative, and postoperative radiation in the treatment of primary soft tissue sarcoma. Cancer 1985;55(11):2659-67.

O'Sullivan B, Davis AM, Turcotte R, Bell R, Catton C, Chabot P, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet 2002;359(9325):2235-41.

Cheng EY, Dusenbery KE, Winters MR, Thompson RC. Soft tissue sarcomas: Preoperative versus postoperative radiotherapy. J Surg Oncol 1996;61(2):90-9.

Davis AM, O'Sullivan B, Turcotte R, et al. Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma. Radiother Oncol 2005;75(1):48-53.

Zagars GK, Ballo MT, Pisters PW, Pollock RE, Patel SR, Benjamin RS. Preoperative vs. postoperative radiation therapy for soft tissue sarcoma: a retrospective comparative evaluation of disease outcome. Int J Radiat Oncol Biol Phys. 2003;56(2):482-8.

Pisters PW, Harrison LB, Leung DH, Woodruff JM, Casper ES, Brennan MF. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 1996;14(3):859-68.

Calvo FA, Meirino RM, Orecchia R. Intraoperative radiation therapy. Crit Rev Oncol Hematol 59(2):116-27

Oertel S, Treiber M, Zahlten-Hinguranage A, Eichin S, Roeder F, Funk A, et al. Intraoperative electron boost radiation followed by moderate doses of external beam radiotherapy in limb-sparing treatment of patients with extremity soft-tissue sarcoma. Int J Radiat Oncol Biol Phys 2006;64(5):1416-23.

Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults: meta-analysis of individual data. Sarcoma Meta-analysis Collaboration. Lancet 1997;350(9092):1647-54.

Pervaiz N, Colterjohn N, Farrokhyar F, Tozer R, Figueredo A, Ghert M. A systematic meta-analysis of randomized controlled trials of adjuvant chemotherapy for localized resectable soft-tissue sarcoma. Cancer 2008;113(3):573-81.

Woll PJ, Reichardt P, Le Cesne A, Bonvalot S, Azzarelli A, Hoekstra HJ, et al. Adjuvant chemotherapy with doxorubicin, ifosfamide, and lenograstim for resected soft-tissue sarcoma (EORTC 62931): a multicentre randomised controlled trial. Lancet Oncol 2012;13(10):1045-54.

Mehren VM, Kane JM, Agulnik M, et al. Soft Tissue Sarcoma, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022;20(7):815-33.

Riedel RF. Systemic Therapy for Advanced Soft Tissue Sarcomas. Cancer 2012;118(6):1474-85.

Bramwell VH, Anderson D, Charette ML. Doxorubicin-based chemotherapy for the palliative treatment of adult patients with locally advanced or metastatic soft-tissue sarcoma: a meta-analysis and clinical practice guideline. Sarcoma 2000;4(3):103-12.

Thompson JF, Kam PC, Waugh RC, et al. Isolated limb infusion with cytotoxic agents: a simple alternative to isolated limb perfusion. Semin Surg Oncol 1998;14(3):238-47.

Creech O, Krementz ET, Ryan RF, Winblad JN. Chemotherapy of Cancer: Regional Perfusion Utilizing an Extracorporeal Circuit. Ann Surg 1958;148(4):616-32.

Lejeune FJ, Pujol N, Lienard D, et al. Limb salvage by neoadjuvant isolated perfusion with TNFalpha and melphalan for non-resectable soft tissue sarcoma of the extremities. Eur J Surg Oncol 2000;26(7):669-78.

Ganjoo KN. New developments in targeted therapy for soft tissue sarcoma. Curr Oncol Rep 2010;12(4):261-5

D'Adamo DR, Anderson SE, Albritton K, Yamada J, Riedel E, Scheu K, et al. Phase II study of doxorubicin and bevacizumab for patients with metastatic soft-tissue sarcomas. J Clin Oncol 2005;23(28):7135-42.

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Published

2022-12-29

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Review Article (บทความวิชาการ)