Surgical treatment and other localized therapy for metastatic soft tissue sarcoma
- Chandrajit P Raut, MD, MSc, FACS
Chandrajit P Raut, MD, MSc, FACS
- Associate Professor of Surgery, Harvard Medical School
- Division of Surgical Oncology, Brigham and Women's Hospital
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute
- Suzanne George, MD
Suzanne George, MD
- Associate Professor of Medicine
- Harvard Medical School
- George D Demetri, MD
George D Demetri, MD
- Professor of Medicine
- Harvard Medical School
- Section Editors
- Robert Maki, MD, PhD
Robert Maki, MD, PhD
- Section Editor — Bone and Soft Tissue Tumors
- Professor of Medicine
- Monter Cancer Center
- Hofstra-Northwell School of Medicine
- Russell S Berman, MD
Russell S Berman, MD
- Section Editor — Skin and Soft Tissue Surgery
- Chief of Surgical Oncology
- New York University Langone Medical Center
Soft tissue sarcomas are a heterogeneous group of uncommon tumors arising from mesenchymal cells at all body sites. The malignant precursor cell(s) differentiate along one or several lineages, such as muscle, adipose, fibrous, cartilage, nerve, or vascular tissue. These tumors arise most often in the limbs (particularly the lower extremity), followed in order of frequency by the abdominal cavity/retroperitoneum, trunk/thoracic region and the head and neck. (See "Clinical presentation, histopathology, diagnostic evaluation, and staging of soft tissue sarcoma", section on 'Clinical presentation' and "Clinical presentation, histopathology, diagnostic evaluation, and staging of soft tissue sarcoma", section on 'Introduction'.)
While local complications from primary or recurrent sarcomas can cause significant morbidity and occasional mortality, the most life-threatening aspect of sarcomas is their propensity for hematogenous dissemination. The pattern of tumor spread varies according to tumor type:
●For most sarcomas of the extremity, chest wall, and head or neck, the primary metastatic site is the lung [1,2]. However, there are exceptions. Extrapulmonary metastases to the retroperitoneum, spine, and paraspinous soft tissues predominate with myxoid/round cell liposarcomas, although lung metastases develop eventually in almost all . (See "Clinical presentation, histopathology, diagnostic evaluation, and staging of soft tissue sarcoma", section on 'Pattern of spread'.)
●The primary site of failure is locoregional for retroperitoneal and visceral sarcomas; less commonly, these tumors spread hematogenously to the liver, and also to the lungs .
●Spread to locoregional lymph nodes is rare (≤5 percent) with the exception of clear cell and epithelioid sarcomas, angiosarcomas, and rhabdomyosarcomas .
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- PULMONARY METASTASES
- Criteria for resection
- Preoperative staging
- Intraoperative staging and resection technique
- Adjuvant chemotherapy
- Neoadjuvant chemotherapy
- Second metastasectomy
- HEPATIC METASTASES
- OTHER THERAPEUTIC OPTIONS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Pulmonary metastasectomy
- Hepatic metastasectomy
- Other local treatment options