Diagnosis and treatment of soft-tissue sarcomas of the extremities and trunk

Abstract

The relatively low incidence and often atypical clinical presentation of soft-tissue sarcomas (STS) impedes early and adequate diagnosis. Patients may report on recently enlarged soft-tissue swellings, infrequently complain of painful lesions, or even have no symptoms at all.A thorough diagnostic work-up is essential in order to distinguish between benign soft-tissue tumours and STSs. Patient history, clinical features and radiological findings all help in assessing the underlying pathology. ‘Worrying’ features such as recent increase in size, deep location relative to the fascia, a tumour exceeding 4 cm in size, and invasive growth patterns seen on imaging should prompt verification by biopsy.Even though acquisition of biopsy material may be incomplete, one should bear in mind some essential rules. Regardless of the biopsy technique applied, the most direct route to the lump in question should be identified, contamination of adjacent structures should be avoided and a sufficient amount of tissue acquired.Treatment of STS is best planned by a multidisciplinary team, involving experts from various medical specialities. The benchmark therapy consists of en bloc resection of the tumour, covered by a safety margin of healthy tissue. Depending on tumour histology, grade, local extent and anatomical stage, radiotherapy, chemotherapy and isolated hyperthermic limb perfusion may be employed.Due to the complexity of treatment, any soft-tissue swelling suspected of malignancy is best referred directly to a sarcoma centre, where therapeutic management is carefully planned by an experienced multidisciplinary team.Cite this article: EFORT Open Rev 2017;2:421-431. DOI: 10.1302/2058-5241.2.170005

Are We Heading to the Future of Musculoskeletal Tumor Imaging with Ultra-High Field 7T MRI?

“…Sarcomas are generally handled by a complete surgical resection and for some histological subtypes, it represents the only therapeutic solution [1,2]. Curative surgery is commonly targeting a complete removal of the tumor through en-bloc resection which necessarily ends up with the removal of healthy tissues.…”

“…The main issue for this type of surgery is related to the potential sparing of limb and can be compromised if vessels or nerves are involved by the tumor. On that basis, a proper resection protocol is intended to perform a safe oncological surgery and to spare these structures [2]. Although imaging details provided by MRI and/or CT-Scan might be helpful, per operative conditions may compromise safe removal and/or create unscheduled technical difficulties [2].…”

“…On that basis, a proper resection protocol is intended to perform a safe oncological surgery and to spare these structures [2]. Although imaging details provided by MRI and/or CT-Scan might be helpful, per operative conditions may compromise safe removal and/or create unscheduled technical difficulties [2]. In addition, tumor margins delineation might be a complex task, especially when radiologists and surgeons have to face a tumoral surrounding edema and decide to grade it as inflammatory or tumoral [3].…”

Emerging therapeutic approaches for canine sarcomas: Pushing the boundaries beyond the conventional

“…Treatment of canine soft tissue sarcomas is largely similar to treatment in humans, with surgery, radiation therapy (RT) and chemotherapy providing the underlying platform for both species . Surgical resection with complete histologic margins is the treatment of choice for soft tissue tumours and yields long‐term control in many paediatric and canine patients; incomplete margin status is associated with a high likelihood of tumour recurrence . In dogs, wide excision is recommended and local tumour recurrence is more likely following conservative excision, with high‐grade or undifferentiated tumours more likely to recur .…”

“…10,12 Surgical resection with complete histologic margins is the treatment of choice for soft tissue tumours and yields long-term control in many paediatric and canine patients; incomplete margin status is associated with a high likelihood of tumour recurrence. [40][41][42][43][44][45][46][47][48][49] In dogs, wide excision is recommended and local tumour recurrence is more likely following conservative excision, with high-grade or undifferentiated tumours more likely to recur. 44,[46][47][48]50 RT plays an integral role in the management of human and canine soft tissue sarcomas and improves local control when combined with surgical resection.…”