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Treatment of locally recurrent and unresectable, locally advanced soft tissue sarcoma of the extremities

Authors
Thomas F DeLaney, MD
Mark C Gebhardt, MD
Christopher W Ryan, MD
Section Editors
Robert Maki, MD, PhD
Russell S Berman, MD
Raphael E Pollock, MD
Deputy Editor
Diane MF Savarese, MD

INTRODUCTION

Soft tissue sarcomas (STS) are rare malignant tumors that arise from extraskeletal connective tissues, including the peripheral nervous system. They can arise at any body site.

Treatment for locally recurrent and locally advanced, potentially unresectable STS of the extremities will be reviewed here. Issues relating to classification, diagnosis, and staging of STS, local treatment options for localized primary STS of the extremities and chest wall, the use of adjuvant and neoadjuvant chemotherapy for extremity STS, and the treatment of STS in locations other than the extremities and chest wall are discussed separately. (See "Overview of multimodality treatment for primary soft tissue sarcoma of the extremities and chest wall" and "Adjuvant and neoadjuvant chemotherapy for soft tissue sarcoma of the extremities" and "Head and neck sarcomas" and "Breast sarcoma: Epidemiology, risk factors, clinical presentation, diagnosis, and staging" and "Clinical features, evaluation, and treatment of retroperitoneal soft tissue sarcoma" and "Clinical presentation, histopathology, diagnostic evaluation, and staging of soft tissue sarcoma", section on 'Introduction'.)

IMPORTANCE OF MULTIDISCIPLINARY EVALUATION AND MANAGEMENT

Because of their rarity and the frequent need for multimodality treatment, evaluation and management of STS should ideally be carried out in a center with expertise in the treatment of sarcomas, including surgical, orthopedic, medical, pediatric, and radiation oncology. The multidisciplinary team approach to the care of STS optimizes treatment planning, minimizes duplication of diagnostic studies, and reduces the time to implementation of the definitive therapeutic protocol, and the expertise gained by dedicated subspecialists improves clinical outcomes.

LOCALLY RECURRENT DISEASE

Approximately 10 to 15 percent of patients with extremity STS who are treated with complete resection and adjunctive radiation therapy (RT) will develop a local tumor failure, the majority within the first two years [1-4]. A local recurrence is associated with a significant worsening of prognosis, although whether the local relapse is causative or simply a marker of worse tumor biology is debated [5-12]. At least in theory, the two mechanisms might coexist and possibly interact, with both contributing to outcomes. On the other hand, if local control can be regained after aggressive management of a local recurrence and there are no metastases, prognosis may not necessarily be adversely impacted.

The approach to the patient with an isolated local recurrence is similar to that for primary disease, with some modification depending on whether the patient has received previous RT.

                         
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Literature review current through: Nov 2017. | This topic last updated: Nov 27, 2017.
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