Pre-operative assessment of soft tissue sarcomas by computed tomography

The current trend towards limb-sparing surgery in patients with soft tissue sarcomas has increased the need for accurate pre-operative assessment of the primary tumour. Tumour site, extent and relationship to bone and neurovascular structures determine whether adequate radical surgery is feasible or whether more limited excision as a part of multimodality treatment is appropriate. Pre-operative computed tomography (CT) was compared with operative findings in 38 patients with soft tissue sarcomas. CT prediction of muscle group involvement by tumour was correct in 95 per cent and prediction of major artery or vein invasion was correct in 92 per cent and 97 per cent respectively. Assessment of tumour relationship to major peripheral nerve was accurate for thigh sarcomas but was not possible in upper limb tumours. While CT confirmed frank bony involvement in two patients, it failed to distinguish between tumours closely adjacent to periosteum and those with periosteal invasion. Detection of residual or recurrent tumour nodules is less reliable; CT is most accurate before any surgical intervention.     

Pediatric soft tissue sarcomas

Soft tissue sarcomas in children are rare. Approximately 850 to 900 children and adolescents are diagnosed each year with rhabdomyosarcoma (RMS) or a non-RMS soft tissue sarcoma (NRSTS). RMS is more common in children 14 years old and younger and NRSTS in adolescents and young adults. Infants get NRSTS, but their tumors constitute a distinctive set of histologies. Surgery is a major therapeutic modality and radiation plays a role. RMS is treated with adjuvant chemotherapy, whereas chemotherapy is reserved for the NRSTS that are high grade or unresectable. This review discusses the etiology, biology, and treatment of pediatric soft tissue sarcomas.     

Radiosensitivity of soft tissue sarcomas

The correlation between the effectiveness of radiation therapy and the histology of soft tissue sarcomas was investigated. Of 31 cases with a soft tissue sarcoma of an extremity treated by conservative surgery and postoperative radiation of 3,000-6,000 cGy, local recurrence occurred in 12; 5 out of 7 synovial sarcomas, 4 of 9 MFH, one of 8 liposarcomas, none of 4 rhabdomyosarcomas and 2 of 3 others. As for the histological subtyping, the 31 soft tissue sarcomas were divided into spindle cell, pleomorphic cell, myxoid and round cell type, and recurrence rates were 75%, 33.3%, 16.7% and 0%, respectively. From the remarkable difference in recurrence rate, it was suggested that round cell and myxoid type of soft tissue sarcomas showed a high radiosensitivity compared to the spindle cell type with low sensitivity. Clarifying the degree of radiosensitivity is helpful in deciding on the management of limb salvage in soft tissue sarcomas of an extremity.     

Prognostic factors of soft tissue sarcomas

Background The management and outcome of soft tissue sarcomas is strongly influenced by the rarity of these tumors. Different determinations of tumor-, patient and treatment related facts with predominant influence on outcome and prognosis make comparison of results difficult. Methods To select the prognostic variables, a critical review of all points in the management of soft tissue sarcomas is necessary. Results A variety of clinical, pathological, surgical and adjuvant treatment variables results in relative and absolute prognostic value. The duration of symptoms, the physician delay, the kind of diagnosis, staging and multidisciplinary management are important variables. The anatomical site, sex, age and histologic category seems to play a secondary role. The prognostic value of the size of tumors is related to their localization and resectability, time of diagnosis, quality of resection and adjuvant treatment. Tumor localization and tumor size strongly influences resectability. Tumor grade and quality of surgical resection and therefore local tumor control are the most important prognostic variables. The risk of dissemination and metastatic disease is also highly correlated with tumorgrade, surgical treatment and adjuvant therapy. Conclusions The clinical evaluation and treatment of patients with soft tissue sarcomas are challenging problems. Revised definitions and concepts in prospective multicenter treatment modalities are necessary to improve the prognosis and select factors of prognosis.     

Management of extremity soft tissue sarcomas

This article provides an understanding of the evaluation, staging, and management of patients with extremity soft tissue sarcoma. Although there are straightforward guidelines to the management of patients with extremity soft tissue sarcoma, each patient presents with a unique tumor, and considerations for tumor control, functional outcome, and the toxicity of therapy must be considered. As is true for patients diagnosed with sarcoma at other anatomic sites, a multidisciplinary team approach streamlines care with attention to the complexities and intricacies of choosing and delivering optimal therapy.     

Management of extremity soft tissue sarcomas

Soft-tissue sarcomas are a rare and heterogeneous group of tumors. The last few decades have seen rapid strides in surgery with function preserving alternatives for local control in these lesions becoming the norm without compromising on overall disease survival. Good functional and oncological results can be achieved with a combination of excision of the tumor, and where required, suitable adjuvant therapies. These lesions are best managed at specialty centres where the requisite multidisciplinary care can be offered to the patient to optimise results. This overview is intended as a review of current understanding and the multimodality management of these challenging tumors.     

The management of soft tissue sarcomas

BackgroundSoft tissue sarcomas are a rare and heterogeneous group of malignancies that are derived from the mesenchymal cell lines. In the last few decades, the management of these lesions has been improved by the introduction of dedicated Multi Disciplinary Teams (MDTs) where most bone and soft tissue tumours are now treated.¹Following the recent changes to management outlined by the NICE/IOGs, we believe it is pertinent to review the current thinking on soft tissue tumour management.² We also discuss the principles of diagnosis and treatment and the role of adjuvant therapy.MethodsThis is a retrospective review. In the preparation of this paper, we have referred to recent NICE guidelines in this field and have performed a Medline search of the existing literature.ResultsThe key to success is early and appropriate patient referral. Whilst the responsibility for performing surgery has shifted away from the generalist and towards the super-specialist, improvements in survivability can be achieved by promoting basic knowledge within the medical profession as a whole.ConclusionsBoth excision and biopsy of a soft tissue sarcoma by a non-specialist surgeon have been shown to increase the risk of tumour recurrence and all invasive procedures should now be performed within the MDT setting.     

The management of soft tissue sarcomas

The management of soft tissue sarcomas presents one of the more exciting areas of the application of multimodal therapy for malignancy. Rapid developments have taken place in the understanding of the histogenesis, histopathology, prognostic indicators and treatment approaches. With the combination of local irradiation and adjuvant chemotherapy, limb sparing operations can now be widely advocated with amputation being reserved for proximal difficult lesions. Retroperitoneal sarcomas, however, remain a major challenge with little progress in results of therapy, other than improved operative morbidity in the last 10-15 years. Current prospective, randomized studies of the management policies designed to maximize survival while minimizing morbidity should provide further insights in the near future. Our current and past experience with more than 150 new cases each year allows a brief summary of the understanding and management of these difficult problems.     

Clinical management of soft tissue sarcomas

The prognosis of soft tissue sarcomas has dramatically improved over the past few decades thanks to the use of increasingly suitable multidisciplinary therapeutic approaches. An assessment of the results of our series of 21 patients, carried out in the light of the most recent literature data, has led us to revise our approach to a number of problems regarding the natural history, the nosographical classification and the therapy of these cancers. This type of tumour arises in a muscle compartment and then spreads proximally and distally within the compartment without involving adjacent structures, except in a relatively advanced phase, while as regards remote metastases the preferential diffusion route is via the bloodstream. Thorough assessment of the clinical and morphological characteristics is essential for adequate treatment: echotomography, CT, and MRI are particularly useful in preoperative staging; a microscopic examination should always include precise classification and accurate assessment of the tumour grade. Surgical management consists in extensive en bloc resection, followed by radiotherapy in the event of unclear margins and/or high grade tumour even when dealing with small sarcomas. The main indications for chemotherapy are locally advanced cases or cases with distant metastases. Thanks to these therapeutic approaches today, good results can be achieved, with 5-year survival rates of 80 and 67%, respectively, in stages I and II, and of 12 to 50% in the more advanced stages.     

Experiences from tissue microarray in soft tissue sarcomas

The tissue microarray (TMA) technology was introduced in 1998 as a tissue preserving, high-throughput technique that allows studies of multiple markers in large sample sets. TMA slides can be analyzed using techniques such as immunohistochemistry and in situ hybridization and represents a powerful tool for the investigation of potential diagnostic and prognostic markers identified in DNA microarray studies. We review the TMA method, its reproducibility, advantages, limitations and future perspectives with specific focus on soft tissue sarcomas.     

Clinical features of soft tissue sarcomas.

The presenting features of 526 patients referred to an open access 'lumps and bumps' clinic were reviewed to try and identify whether the four cardinal features of soft tissue malignancy were in fact predictive of this. The features investigated were: size bigger than 5 cm, pain, increase in size, depth beneath the deep fascia. All of these factors were found to be associated more frequently with malignancy than a benign state. Using the summed weights of evidence method we have constructed a graph which will allow prediction of whether a lump is likely to be malignant or not.     

Radiobiological considerations in radio-induced soft tissue sarcomas

Soft tissue sarcomas are relative rare tumors with an incidence of almost 1% of all malignancies. Although their etiology is not well understood, studies regarding the effect of ionizing radiation, showed their capacity to induce sarcomas in soft tissues, after several years from the treatment of other primary tumor. Their early diagnosis could be achieved by genetic analysis of radio-induced chromosomal translocations specific to each histological type. Dose-response curves reveals the dynamics of the process, taking into consideration the beam energy and linear energy transfer.     

Adult head and neck soft tissue sarcomas

BACKGROUND: The purpose was to determine the optimal treatment for adult patients with head and neck soft tissue sarcomas. METHODS: We conducted a review of the pertinent literature. RESULTS: Local control after surgery alone or combined with radiotherapy was obtained in approximately 60% to 70% of the patients. The probability of local control is influenced by histologic grade, tumor size, and surgical margins. Patients with high-grade tumors and/or positive margins have improved local control if adjuvant radiotherapy is used. Distant metastases occurred in 10% to 30% of patients. The 5-year overall and cause-specific survival rates varied from approximately 60% to 70% and are affected by age, histologic grade, previous treatment of tumor, invasion of deep structures, and adequacy of surgery. CONCLUSIONS: The optimal treatment for adult head and neck soft tissue sarcomas is surgery. Adjuvant radiotherapy improves outcomes for those with high-grade tumors and/or positive margins. Radiotherapy alone will cure a small subset of patients with unresectable tumors.     

Extremity soft tissue sarcomas presented as hematomas

Introduction

Soft tissue sarcoma (STS) with extensive intra-tumoral hemorrhage is an infrequently described entity, usually misdiagnosed as intra-muscular hematoma. The outcomes in this group of patients have not been previously described.

Materials and methods

We retrospectively identified 15 patients, with initial clinical or imaging diagnosis of hematoma, or hematoma versus hemorrhagic sarcoma, although final diagnosis of high-grade STS was established in all cases.

Results

The most common location was the thigh. Three patients had a bleeding predisposition. Ten patients were referred for further evaluation with the initial diagnosis of muscle strain/hematoma, hematoma versus abscess in one, whereas four were referred for soft tissue mass evaluation. Final diagnosis was made by one biopsy in only 53% of patients. Mean time to diagnosis for patients with two biopsies was 7 months from initial presentation. Histologic diagnosis was malignant fibrous histiocytoma in ten patients. Surgical treatment included tumor resection in eleven and amputation in three patients. One patient had lung metastatic disease at presentation and eight developed lung metastases within a median time of 7 months.

Conclusion

We suggest that an STS masquerading as hematoma should be suspected when the mechanism and the energy of the trauma do not justify the clinically detected severity of the injury, or the lesion does not follow the expected clinical course of resolution after initial conservative management. Bleeding predisposition does not exclude malignancy. The evacuation of hematomas should include pathologic examination of tissue. Prognosis is dismal due to early metastatic disease.     

Treatment of soft tissue sarcomas of the leg

An analysis of data of 548 patients with different diseases of soft tissues of lower extremities after using a complex of diagnostic measures (clinical, radionuclide data, thermography, puncture, biopsy) has shown that the number of erroneous conclusions may be minimized to 2%. Modern advances of plastic surgery can widen indications for preserving operations in malignant tumors of soft tissues of lower extremities without prejudice to the main principle of oncology concerning its fascial character. Combined treatment can also improve the results.