FACTS AND UNCERTAINITIES IN THE TREATMENT OF SOFT TISSUE SARCOMAS

Abstract

Introduction: Soft tissue sarcomas represent a rare malignancy showing 2–3 new cases/100.000/year. Based on that and other factors the therapeutic approach is not standardized. In the last years the most radical procedures as compartment resections hade been no longer adviced but there is still no common recommondation which surgical approach seems to be the best in respect to oncological and functional outcome. Radiation theray is part of the multimodal concept is unquestionable but there is still a discussion regarding timing and inclusion of patients. There are many ongoing studies to evaluate the effect of systemic chemotherapies with or without local procedures as hyperthermia or perfusion of the extremities. Aim of this review is therefore to give an overview about facts and speculations in this subject.

Methods: All relevant studies regarding the prognostic impact of resection margin, timing of radiation therapy, chemotherapy and local combined treatment modalities of the last 20 years had been reviewed. The foccus had only been the non-metastazised patient.

Results: Regrading the influence of resection margins an advantage of radical compartment resections could not been shown. There are conflicting datas showing prognostic disadvantages with resectionmargins of millimrters but also demonstrating no benefit with margins of serveral centimeters. The benficial effect of radiation in respect to local reccurencies is well accepted. By applying radiation before surgery the treated volumes are smaller, posttherapeutic complications hence reduced. But the risk of local complications regarding surgery seems to be enhanced. The systemic advantage is unclear. The position of intraoperative radiation therapy is also conflicting. Regarding systemic chemotherapy the results are also conflicting. One has to be aware that only 20% to 30% of the patients will have a regression of the tumour whereas a prolongation of survival still is debated. Local combined therapies show a sometimes dramatic effect to the tumour but seem not to alter prognosis.

Conclusions: Radical compartment resections seem no longer to be justified in comparision to wide resections. The local benefical effect of radiation therapy is well accepted, timing depended on local factors. Systemic chemotherapy shows conflicting results. Local combined therapies may influence the tumour but seem not to influence the prognosis of the patient.