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      Multidisciplinary Management of Soft Tissue Sarcoma

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          Abstract

          Soft tissue sarcoma is a rare malignancy, with approximately 11,000 cases per year encountered in the United States. It is primarily encountered in adults but can affect patients of any age. There are many histologic subtypes and the malignancy can be low or high grade. Appropriate staging work up includes a physical exam, advanced imaging, and a carefully planned biopsy. This information is then used to guide the discussion of definitive treatment of the tumor which typically involves surgical resection with a negative margin in addition to neoadjuvant or adjuvant external beam radiation. Advances in imaging and radiation therapy have made limb salvage surgery the standard of care, with local control rates greater than 90% in most modern series. Currently, the role of chemotherapy is not well defined and this treatment is typically reserved for patients with metastatic or recurrent disease and for certain histologic subtypes. The goal of this paper is to review the current state of the art in multidisciplinary management of soft tissue sarcoma.

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          Cancer Statistics, 2005

          A M Jemal, T H Murray, Lawrence E. Ward … (2005)
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            Soft-tissue sarcomas of adults; study of pathological prognostic variables and definition of a histopathological grading system.

            A Chapelle, C Lagarde, J Goussot … (1984)
            The pathological features of 155 adult patients with soft-tissue sarcomas were studied retrospectively, in an attempt to set up a grading system for these tumors. As the first step, seven histological criteria (tumor differentiation, cellularity, importance of nuclear atypia, presence of malignant giant cells, mitosis count, pattern of tumor necrosis and presence of vascular emboli) were evaluated in a monofactorial analysis. Five of these (tumor differentiation, cellularity, mitosis count, tumor necrosis, and vascular emboli) were correlated with the advent of metastases and with survival. A multivariate analysis, using a Cox model, selected a minimal set of three factors (tumor differentiation, mitosis count, and tumor necrosis) the combination of which was necessary and sufficient to retain all the prognostic information. A grading system was elaborated, which turned out to be correlated with the advent of metastasis and with patients' survival. A second multivariate analysis introducing clinical prognostic features showed that the histological grade was the most important prognostic factor for soft-tissue sarcomas. Thus, this grading system appears to be highly interesting because of its prognostic value and the facility of its elaboration. However, its reproducibility should be tested.
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              Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy: an analysis of 1225 patients.

              Gunar Zagars, Matthew T Ballo, Peter Pisters … (2003)
              Prognostic factors for patients with soft-tissue sarcoma who are treated with conservative surgery and radiation are documented poorly. The clinicopathologic features and disease outcome for 1225 patients with localized sarcoma who were treated with conservative surgery and radiation were reviewed retrospectively. Actuarial univariate and multivariate statistical methods were used to determine significant prognostic factors for local control, metastatic recurrence, and disease specific survival. The median follow-up of surviving patients was 9.5 years. The respective local control rates at 5 years, 10 years, and 15 years were 83%, 80%, and 79%. Factors predictive of local recurrence were positive or uncertain resection margins; tumors located in the head and neck and the deep trunk; presentation with local recurrence; patient age > 64 years; malignant fibrous histiocytoma, neurogenic sarcoma. or epithelioid sarcoma histopathology; tumor measuring > 10 cm in greatest dimension; and high pathologic grade. Freedom from metastasis at 5 years, 10 years, and 15 years was 71%, 68%, and 66%, respectively. Factors that were predictive of metastatic recurrence were high tumor grade; large tumor size (> 5 cm); and leiomyosarcoma, rhabdomyosarcoma, synovial sarcoma, or epithelioid sarcoma. The respective disease specific survival rates at 5 years, 10 years, and 15 years were 73%, 68%, and 65%. Adverse factors for disease specific survival were high tumor grade; large tumor size (> 5 cm); tumors located in the head and neck and deep trunk; rhabdomyosarcoma, epithelioid sarcoma, or clear cell sarcoma; patient age > 64 years; and positive or uncertain resection margins. Soft-tissue sarcoma comprises a heterogeneous group of diseases. Prognostic factors for local recurrence, metastatic recurrence, lymph node recurrence, disease free survival, and disease specific survival are different, and optimal treatment strategies need to take this complexity into account. Copyright 2003 American Cancer Society.DOI 10.1002/cncr.11365
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                Author and article information

                Journal
                Journal ID (nlm-ta): ScientificWorldJournal
                Journal ID (iso-abbrev): ScientificWorldJournal
                Journal ID (publisher-id): TSWJ
                Title: The Scientific World Journal
                Publisher: Hindawi Publishing Corporation
                ISSN (Electronic): 1537-744X
                Publication date Collection: 2013
                Publication date (Electronic): 28 July 2013
                Volume: 2013
                Affiliations
                1Orthopaedic & Sports Medicine Institute, University of Florida, 3450 Hull Road, Gainesville, FL 32605, USA
                2Department of Pathology, Immunology and Laboratory Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL 32608, USA
                3Department of Medicine, Division of Hematology & Oncology, University of Florida, 1600 SW Archer Road, Gainesville, FL 32608, USA
                4Department of Radiation Oncology, University of Florida, 1600 SW Archer Road, Gainesville, FL 32608, USA
                Author notes
                *C. Parker Gibbs Jr.: gibbscp@ 123456ortho.ufl.edu

                Academic Editors: G. J. Hooper, M. M. Petersen, and Y. K. Tu

                Article
                DOI: 10.1155/2013/852462
                PMC ID: 3745982
                PubMed ID: 23983648
                SO-VID: c67958b7-ec71-40de-89fc-24fb0cdb0937
                Copyright statement: Copyright © 2013 Lukas M. Nystrom et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 17 March 2013
                Date accepted : 2 July 2013
                Categories
                Subject: Review Article

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