Konsensus Diagnose und Therapie von Weichteilsarkomen

Abstract

Soft tissue sarcomas are heterogeneous tumours and relatively uncommon. There have been advances over the past years concerning pathology, clinical behaviour, diagnosis strategies and the treatment. To summarize these advances as well as making it public is one of the goals of the following consensus guidelines. But why do we need special guidelines for Austria? There are international guidelines published by the European Society of Medical Oncology (ESMO) and the National Comprehensive Cancer Network (NCCN). The cause is that we need an explanation of the matrix the ESMO and the NCCN gave according to our clinical practice, the local requirements and facilities in Austria. The following recommendations were drawn up following a consensus meeting of sarcoma specialists from the three high volume centres located at the medical universities in Austria. All fields of involved physicians from diagnosis to therapy worked together to know that soft tissue sarcomas are an interdisciplinary challenge and multimodal treatment is essential. For this reason, these guidelines not only explain but also give the state of the art and clear recommendations. One of the most important guidelines is that any patient with a suspected soft tissue sarcoma should be referred to one of the three university centres and managed by a specialist sarcoma multidisciplinary team. We hope that the consensus is helpful for the clinical practice and improves the quality of care for patients with soft tissue sarcomas in Austria.

A giant malignant phyllodes tumor of breast post mastectomy with metastasis to stomach manifesting as anemia: a case report and review of literature

“…Adjuvant radiotherapy is recommended in borderline and malignant PTs with tumor-free margin < 1 cm [ 23 ]. For high-risk malignant tumors (higher grade, size > 5 cm), adjuvant radiotherapy is considered after R0 resection and recommended after R1 resection [ 24 ]. According to Chao et al, a meta-analysis with 696 patients enrolled in 17 studies, they found radiotherapy is effective in achieving local disease control and preventing metastasis [ 25 ].…”

Clinical perspectives and outcomes of the giant breast phyllodes tumor and sarcoma: a real-world retrospective study

“…Adjuvant radiation therapy is recommended for borderline and malignant PTs with a tumor-free margin of 1 cm or greater [ 57 ]. Adjuvant radiation is recommended after R1 resection and indicated after R0 resection for high-risk malignant tumors (higher grade, size > 5 cm) [ 58 ]. Radiation-induced secondary sarcoma limits the clinical application of radiotherapy.…”

The role of pathology in sarcoma

“…Standard gross description parameters include the following: (1) measuring the specimen in three dimensions, (2) giving the closest distance of each margin from the edge of the tumour in millimeter (mm) or centimeter (cm), (3) the tumour relationship with anatomical structures, (4) the depth (subcutis, fascial, intramuscular) of the tumour, (5) the size of the tumour, and (6) presence of necrosis, as percentage of the total tumour. Individual blocks need to be taken from the margins and generally one block per cm of the maximum diameter of the neoplasm needs to be taken for histologic evaluation [5][6][7]. A photo documentation of a representative cross section is always helpful (Figs.…”

“…For other STT the line of differentiation, despite extensive IHC (immunohistochemistry), cannot be assessed leaving these tumours in the "undifferentiated" sarcoma cat-egory. Finally one must be aware that another subset of sarcomas can be classified based on their genetic fingerprint in combination with H&E morphology and IHC ( [7]; Fig. 1).…”