Soft tissue sarcoma of the extremities: pending questions on surgery and radiotherapy
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REVIEW
Open Access
Soft tissue sarcoma of the extremities: pending questions on surgery and radiotherapy Fien Hoefkens1, Charlotte Dehandschutter1, Johan Somville1,2, Paul Meijnders1,3 and Dirk Van Gestel3,4*
Abstract Soft tissue sarcomas are uncommon tumours of mesenchymal origin, most commonly arising in the extremities. Treatment includes surgical resection in combination with radiotherapy. Resection margins are of paramount importance in surgical treatment of soft tissue sarcomas but unambiguous guidelines for ideal margins of resection are still missing as is an uniform guideline on the use of radiotherapy. The present paper reviews the literature on soft tissue sarcomas of the extremities regarding the required resection margins, the impact of new radiotherapy techniques and the timing of radiotherapy, more particularly if it should be administered before or after surgical resection. This review was started by searching guidelines in different databases (National Guideline Clearinghouse, EBMPracticeNet, TRIP database, NCCN guidelines,…). After refinement of the query, more specific articles were found using MEDLINE, PubMed, Web of Science and Google Scholar. Used keywords include “soft tissue sarcoma”; “extremities OR limbs”; “radiotherapy”, “surgery”, “margins”, “local recurrence” and “overall survival”. Finally, the articles were selected based on the accessibility of the full text, use of the English language and relevance based on title and abstract. Literature demonstrates positive resection margins to be an important adverse prognostic factor for local recurrence of soft tissue sarcomas of the extremities. Still, no consensus is reached on the definition of what a good margin might be. The evolution of new radiation techniques, especially Intensity Modulated Radiotherapy, resulted in a s healthy surrounding tissues. However, the timing of radiotherapy treatment remains controversial as both preoperative and postoperative radiotherapy are characterised by several advantages and disadvantages. Keywords: Soft tissue sarcoma, Extremities, Surgery, Radiotherapy
Background Soft tissue sarcomas (STS) are relatively uncommon tumours, representing 1 % of adult and 7–15 % of paediatric malignancies [1]. In Europe, the incidence is estimated at 4-5/100.000/year [2]. It is a heterogeneous group of tumours of mesenchymal origin that can occur anywhere in the body, with the extremities being the most common primary site, accounting for 60 % of the STS [3, 4]. More than 50 different histological subtypes of STS have been identified. Sarcomas are usually classified into two broad * Correspondence: [email protected] 3 Department of Radiotherapy, University Radiotherapy Antwerp UZA/ZNA, Antwerp, Belgium 4 Department of Radiotherapy, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium Full list of author information is available at the end of the article
categories: sarcomas of the soft tissues and sarcomas of the bone. Furthermore, STS are subdivided in several subgroups according to local
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