Skip to main content
SpringerLink
Log in

Extremity Soft Tissue Sarcomas

  • Chapter
Surgical Oncology

  • 270 Accesses

Conclusions

Soft tissue sarcoma is a rare malignancy that accounts for approximately 6000 cases per year in the United States. Surgical resection is the primary mode of therapy, and in many cases no further therapy is required. Local recurrence is best controlled with surgical resection and adjuvant radiation therapy in the form of EBRT or brachytherapy. Numerous trials of various chemotherapy regimens, mainly doxorubicin-based, have been performed. It is unclear at this time what role chemotherapy has in the treatment of this disease, and all potential patients should be enrolled in investigational studies.

Approximately one-third of patients have locally recurrent disease with a median disease-free interval of 18 months. Treatment for local recurrence involves reexcision and usually adjuvant radiation therapy, with results approaching those for treatment of the primary lesion if complete resection can be attained. Metastatic disease occurs primarily in the lungs alone. Resection of isolated pulmonary lesions can be undertaken with 3-year survival rates of 20–30%. Nonresectable pulmonary metastasis or extrapulmonary metastatic disease has a poor prognosis, and these patients should be treated with investigational chemotherapeutic regimens.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 329.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Brennan MF. Management of extremity soft-tissue sarcoma. Am J Surg 1989;158:71–78.

    CAS  Google Scholar 

  2. Lawrence WJ, Donegan WL, Natarajan N, et al. Adult soft tissue sarcomas: a pattern of care survey of the American College of Surgeons. Ann Surg 1987;25:349–359.

    Google Scholar 

  3. Brand KG. Foreign body induced sarcomas. In: Becker FF (ed) Cancer. New York: Plenum, 1975;485–489.

    Google Scholar 

  4. Li FP, Fraumeni JF. Soft-tissue sarcomas, breast cancer, and other neoplasms: a familial syndrome? Ann Intern Med 1969;71:747–752.

    CAS  PubMed  Google Scholar 

  5. Li FP, Fraumeni JF, Mulvihill JJ, et al. A cancer family syndrome in twenty-four kindreds. Cancer Res 1988;48:5358–5362.

    CAS  PubMed  Google Scholar 

  6. Sorensen SA, Mulvihill JJ, Nielsen A. Long-term follow-up of Von Recklinghausen neurofibromatosis: survival and malignant neoplasms. N Engl J Med 1986;314:1010–1015.

    Article  CAS  PubMed  Google Scholar 

  7. Barken D, Wright E, Nguyen K. Gene for Von Recklinghausen neurofibromatosis is in the pericentromeric region of chromosome 17. Science 1987;236:1100–1102.

    Google Scholar 

  8. Robinson E, Neugut AI, Wylie P. Clinical aspects of postirradiation sarcomas. J Natl Cancer Inst 1988;80:233–240.

    CAS  PubMed  Google Scholar 

  9. Davidson T, Westbury G, Harmer CL. Radiation-induced soft-tissue sarcoma. Br J Surg 1986;73:308–309.

    CAS  PubMed  Google Scholar 

  10. Stewart FW, Treves N. Lymphangiosarcoma in post mastectomy lymphedema: a report of six cases of elephantiasis chirugica. Cancer 1948;1:64–68.

    PubMed  CAS  Google Scholar 

  11. Heslin MJ, Lewis JJ, Woodruff JM, Brennan MF. Core needle biopsy for the diagnosis of extremity soft tissue sarcoma. Ann Surg Oncol 1997;4:421–431.

    Article  Google Scholar 

  12. Kissen MW, Fisher C, Webb AJ, et al. Value of fine needle aspiration cytology in the diagnosis of soft tissue tumors: a preliminary study on the excised specimens. Br J Surg 1987;74:479–480.

    Google Scholar 

  13. Akerman M, Idvall I, Rydholm A. Cytodiagnosis of soft tissue tumors and tumor-like conditions by means of fine needle aspiration biopsy. Arch Orthop Trauma Surg 1980;96:61–67.

    Article  CAS  PubMed  Google Scholar 

  14. Brennan MF, Lewis JJ. Soft tissue sarcomas. Curr Probl Surg 1996;33:819–872.

    Google Scholar 

  15. Bowden L, Booher RJ. The principles and techniques of resection of soft parts for sarcomas. Surgery 1958;44:963–977.

    CAS  PubMed  Google Scholar 

  16. Brooks JJ. Immunohistochemistry in sarcomas. In: Ryan JR, Baker LO (eds) Recent Concepts in Sarcoma Treatment. Boston: Kluwer, 1988;48–73.

    Google Scholar 

  17. Kawai A, Woodruff JM, Healey JH, et al. SYT-SSX gene fusion as a determinant of morphology and prognosis in synovial sarcoma. Nat Genet 1998;338:153–160.

    CAS  Google Scholar 

  18. Ladanyi M. The emerging molecular genetics of sarcoma translocations. Diagn Mol Pathol 1995;4:162–173.

    CAS  PubMed  Google Scholar 

  19. Hadju SI. Differential diagnosis of soft tissue and bone tumors. Philadelphia: Lea ⇐p; Febiger, 1986:402–404.

    Google Scholar 

  20. Demas BE, Heelan RT, Lane J, et al. Soft-tissue sarcomas of the extremities: comparison of MR and CT in determining extent of disease. AJR Am J Roentgenol 1988;150:615–620.

    CAS  PubMed  Google Scholar 

  21. Kern KA, Brunetti A, Norton JA, et al. Metabolic imaging of human extremity musculoskeletal tumors by PET. J Nucl Med 1988;29:181–186.

    CAS  PubMed  Google Scholar 

  22. Adler LP, Blair HF, Makley JT, et al. Noninvasive grading of musculoskeletal tumors using PET. J Nucl Med 1991;32:1508–1512.

    CAS  PubMed  Google Scholar 

  23. Shinkwin MA, Lenkinski RE, Daly JM, et al. Integrated magnetic resonance imaging and phosphorus spectroscopy of soft tissue tumors. Cancer 1991;67:1849–1858.

    CAS  PubMed  Google Scholar 

  24. Schwartz HS, Jones CK. The effect of gallium scintigraphy in detecting malignant soft tissue neoplasms. Ann Surg 1992;215:78–82.

    Article  CAS  PubMed  Google Scholar 

  25. Southee AE, Kaplan WD, Jochelson MS, et al. Gallium imaging in metastatic and recurrent soft-tissue sarcoma. J Nucl Med 1992;33:1594–1599.

    CAS  PubMed  Google Scholar 

  26. Geer RJ, Woodruff JM, Casper ES, et al. Management of small soft-tissue sarcoma of the extremity in adults. Arch Surg 1992;127:1285–1289.

    CAS  PubMed  Google Scholar 

  27. Fleming ID, Cooper JS, Henson DE, et al. Soft tissue sarcoma. In: AJCC Cancer Staging Manual. Philadelphia: Lippincott Williams & Wilkins, 1997:149–156.

    Google Scholar 

  28. Gadd MA, Casper ES, Woodruff JM, et al. Development and treatment of pulmonary metastases in adult patients with extremity soft tissue sarcoma. Ann Surg 1993;218:705–712.

    CAS  PubMed  Google Scholar 

  29. Fong Y, Coit DG, Woodruff JM, et al. Lymph node metastases from soft tissue sarcoma in adults: analysis of data from a prospective database of 1772 sarcoma patients. Ann Surg 1993;217:72–77.

    CAS  PubMed  Google Scholar 

  30. Rosenberg SA, Tepper J, Glatstein E, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of limb-sparing surgery plus radiation therapy in the management of sarcoma of the soft tissues. Ann Surg 1982;196:305–315.

    CAS  PubMed  Google Scholar 

  31. Lewis JJ, Brennan MF. Soft tissue sarcomas. In: Sabiston DC (ed) The Biological Basis of Modern Surgical Practice. Philadelphia: Saunders, 1996;528–534.

    Google Scholar 

  32. Lindberg RD. Soft tissue sarcoma. In: Fletcher CD (ed) Textbook of Radiotherapy. Philadelphia: Lea & Febiger, 1980:922–942.

    Google Scholar 

  33. Tepper JE, Suit HD. Radiation alone for sarcoma of soft tissue. Cancer 1985;56:475–479.

    CAS  PubMed  Google Scholar 

  34. Suit HD, Mankin HJ, Schiller AL. Results of treatment of sarcoma of soft tissue by radiation and surgery at Massachusetts General Hospital. Cancer Treat Symp 1985;3:33–47.

    Google Scholar 

  35. Pisters PW, Leung DH, Woodruff J, et al. Analysis of prognostic factors in 1041 patients with localized soft tissue sarcoma of the extremities. J Clin Oncol 1996;14:1679–1689.

    CAS  PubMed  Google Scholar 

  36. Enneking WF, McAuliffe JA. Adjunctive preoperative radiation therapy in treatment of soft tissue sarcomas: a preliminary report. Cancer Treat Symp 1985;3:37–42.

    Google Scholar 

  37. Brant TA, Parsons JT, Marcus RBJ, et al. Preoperative irradiation for soft tissue sarcomas of the trunk and extremities in adults. Int J Radiat Oncol Biol Phys 1990;19:899–906.

    CAS  PubMed  Google Scholar 

  38. Barkley HT, Martin RG, Romsdahl MM, et al. Treatment of soft tissue sarcomas by preoperative irradiation and conservative surgical resection. Int J Radiat Oncol Biol Phys 1988;14:693–699.

    PubMed  Google Scholar 

  39. Lindberg RD, Martin RG, Romsdahl MM, et al. Conservation surgery and postoperative radiotherapy in 300 adults with soft-tissue sarcomas. Cancer 1981;47:2391–2397.

    CAS  PubMed  Google Scholar 

  40. Potter DA, Glenn J, Kinsella T, et al. Patterns of recurrence in patients with high-grade soft-tissue sarcomas. J Clin Oncol 1985;3:353–366.

    CAS  PubMed  Google Scholar 

  41. Leibel SA, Tranbaugh RF, Wara WM, et al. Soft-tissue sarcomas of the extremities: survival and patterns of failure with conservative surgery and postoperative irradiation compared to surgery alone. Cancer 1982;50:1076–1083.

    CAS  PubMed  Google Scholar 

  42. Suit HD, Mankin HJ, Wood W, et al. Preoperative, intraoperative, and post-operative radiation in the treatment of primary soft tissue sarcoma. Cancer 1985;55:2659–2667.

    CAS  PubMed  Google Scholar 

  43. Brennan MF, Hilaris B, Shiu MH, et al. Local recurrence in adult soft tissue sarcoma: a randomized trial of brachytherapy. Arch Surg 1987;122:1289–1293.

    CAS  PubMed  Google Scholar 

  44. Pisters PW, Harrison LB, Leung DH, et al. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 1996;14:859–868

    CAS  PubMed  Google Scholar 

  45. Casper ES, Gaynor JJ, Harrison LB, et al. Preoperative and postoperative adjuvant chemotherapy for adults with high-grade soft tissue sarcoma. Cancer 1994;73:1644–1651.

    CAS  PubMed  Google Scholar 

  46. Pezzi CM, Pollack RE, Evans HL, et al. Preoperative chemotherapy for so-ft-tissue sarcoma of the extremities. Ann Surg 1990;211:476–481.

    CAS  PubMed  Google Scholar 

  47. Ravaud A, Nguyen BB, Coindre JM, et al. Adjuvant chemotherapy with CyVADIC in high-grade soft tissue sarcoma: a randomized prospective trial. In: Salmon S (ed) Adjuvant Therapy of Cancer. Philadelphia: Saunders, 1990:556–566.

    Google Scholar 

  48. Gherlinzoni F, Bacci G, Picci P, et al. A randomized trial for the treatment of high-grade soft-tissue sarcomas of the extremities: preliminary observations. J Clin Oncol 1986;4:552–558.

    CAS  PubMed  Google Scholar 

  49. Rosenberg SA, Tepper J, Glatstein E, et al. Prospective randomized evaluation of adjuvant chemotherapy in adults with soft tissue sarcomas of the extremities. Cancer 1983;52:424–434.

    CAS  PubMed  Google Scholar 

  50. Eilber FR, Guilano JF, Huth JF, et al. Intravenous (IV) vs. intraarterial (IA) adriamycin, 2800r radiation and surgical excision for extremity soft tissue sarcomas: a randomized prospective trial, abstracted. Proc Am Soc Clin Oncol 1990;9:309.

    Google Scholar 

  51. Anonymous. Adjuvant chemotherapy for localized resectable soft tissue sarcoma for adults: a meta-analysis of individual patient data. Lancet 1997;350:1647–1654.

    Google Scholar 

  52. Brennan MF, Casper ES, Harrison LB, et al. The role of multimodality therapy in soft tissue sarcomas. Ann Surg 1991;214:328–336.

    CAS  PubMed  Google Scholar 

  53. Nori D, Schupak K, Shiu MH, et al. Role of brachytherapy in recurrence extremity sarcoma in patients treated with prior surgery and irradiation. Int J Radiat Oncol Biol Phys 1991;20:1229–1233.

    CAS  PubMed  Google Scholar 

  54. Lienard D, Ewalenko P, Delmotte JJ, et al. High-dose recombinant tumor necrosis factor alpha in combination with interferon gamma and melphalan in isolation perfusion of limbs for melanoma and sarcoma. J Clin Oncol 1992;10:52–60.

    CAS  PubMed  Google Scholar 

  55. Pommier RF, Moseley HS, Cohen J, et al. Pharmacokinetics, toxicity, and short-term results of cisplatin hyperthermic isolated limb perfusion for soft-tissue sarcoma and melanoma of the extremities. Am J Surg 1988;155:667–671.

    CAS  PubMed  Google Scholar 

  56. Yang JC, Rosenberg SA. Surgery for adult patients with soft tissue sarcomas. Surgery 1990;65:1727–1729.

    Google Scholar 

  57. Lewis JJ, Leung D, Heslin MJ, et al. The association of local recurrence with subsequent survival in extremity soft tissue sarcoma. J Clin Oncol 1997;15:646–652.

    CAS  Google Scholar 

  58. Martini N, Huvos AG, Mike V, et al. Multiple pulmonary resections in the treatment of osteogenic sarcoma. Ann Thorac Surg 1971;12:271–280.

    Article  CAS  PubMed  Google Scholar 

  59. Verazin GT, Warneke JA, Driscoll DL, et al. Resection of lung metastases from soft-tissue sarcomas: a multivariate analysis. Arch Surg 1992;127:1407–1411.

    CAS  PubMed  Google Scholar 

  60. Casson AG, Putnam JB, Natarajan G, et al. Five-year survival after pulmonary metastasectomy for adult soft tissue sarcoma. Cancer 1992;69:662–668.

    CAS  PubMed  Google Scholar 

  61. Pogrebniak HW, Roth JA, Steinberg SM, et al. Reoperative pulmonary resection in patients with metastatic soft tissue sarcoma. Ann Thorac Surg 1991;52:197–203.

    Article  CAS  Google Scholar 

  62. Schoenfeld DA, Rosenbaum C, Horton J, et al. A comparison of adriamycin versus vincristine and adriamycin, and cyclophosphamide for advanced sarcoma. Cancer 1982;50:2757–2762.

    CAS  PubMed  Google Scholar 

  63. Gottlieb JA, Benjamin RS, Baker LH, et al. Role of DTIC (NSC-123127) in the chemotherapy of sarcomas. Cancer Treat Rep 1976;60:199–203.

    CAS  PubMed  Google Scholar 

  64. Wiltshaw E, Westbury G, Harmer C, et al. Ifosfamide plus mesna with and without adriamycin in soft tissue sarcoma. Cancer Chemother Pharmacol 1986;18:S10–S12.

    Article  PubMed  Google Scholar 

  65. Schutte J, Mouridsen HT, Stewart W, et al. Ifosfamide plus doxorubicin in previously untreated patients with advanced soft tissue sarcoma: the EORTC Soft Tissue and Bone Sarcoma Group. Eur J Cancer 1990;26:558–561.

    Article  CAS  PubMed  Google Scholar 

  66. Elias A, Ryan L, Sulkes A, et al. Response to mesna, doxorubicin, ifosfamide, and dacarbazine in 108 patients with metastatic or unresectable sarcoma and no prior chemotherapy. J Clin Oncol 1989;7:1208–1216.

    CAS  PubMed  Google Scholar 

  67. Burt ME, Liu D, Abolhoda A, et al. Isolated long perfusion with unresectable metastases from sarcoma: a phase I trial. Ann Thorac Surg 2000;69(5):1542–1549.

    Article  CAS  PubMed  Google Scholar 

  68. Fine G, Hadju SI, Morton DL, et al. Soft tissue sarcomas: classification and treatment (a symposium). Pathol Annu 1982;17:155–195.

    PubMed  Google Scholar 

  69. Smith WG. Multiple polyposis, Gardner’s syndrome and desmoid tumors. Dis Colon Rectum 1958;1:323–332.

    CAS  PubMed  Google Scholar 

  70. Hayry P, Reitamo JJ, Totterman S, et al. The desmoid tumor. II. Analysis of factors possibly contributing to the etiology and growth behavior. Am J Clin Pathol 1982;77:674–680.

    CAS  PubMed  Google Scholar 

  71. Geschickter GF, Lewis D. Tumors of connective tissue. Am J Cancer 1935;25:630–655.

    Google Scholar 

  72. Posner MC, Shiu MH, Newsome JL, et al. The desmoid tumor: not a benign disease. Arch Surg 1989;124:191–196.

    CAS  PubMed  Google Scholar 

  73. Angerwall L, Enzinger FM. Extraskeletal neoplasm resembling Ewing’s sarcoma. Cancer 1975;36:240–251.

    Google Scholar 

  74. Gillespie JJ, Roth LM, Wells ER, et al. Extraskeletal Ewing’s sarcoma. Am J Surg Pathol 1979;3:99–108.

    Article  CAS  PubMed  Google Scholar 

  75. Ordonez NG, Ro JY, Mackay B. Alveolar soft part sarcoma: an ultrastructural and immunocytochemical investigation of its histogenesis. Cancer 1989;63:1721–1736.

    CAS  PubMed  Google Scholar 

Download references

Authors
  1. Daniel M. Labow
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Murray F. Brennan
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Rush Medical College, Chicago, IL, 60612, USA

    Theodore J. Saclarides M.D. (Professor of Surgery, Head), Keith W. Millikan M.D. (Associate Professor of Surgery, Director of Undergraduate Surgical Education, Director) & Constantine V. Godellas M.D. (Associate Professor of Surgery, Academic Program Coordinator) (Professor of Surgery, Head),  (Associate Professor of Surgery, Director of Undergraduate Surgical Education, Director) &  (Associate Professor of Surgery, Academic Program Coordinator)

  2. Section of Colon and Rectal Surgery Department of General Surgery, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, IL, 60612, USA

    Theodore J. Saclarides M.D. (Professor of Surgery, Head) (Professor of Surgery, Head)

  3. Nutrition Consultation Service Department of General Surgery, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, IL, 60612, USA

    Keith W. Millikan M.D. (Associate Professor of Surgery, Director of Undergraduate Surgical Education, Director) (Associate Professor of Surgery, Director of Undergraduate Surgical Education, Director)

  4. Department of General Surgery, Rush-Presbyterian-St. Luke’s Medical Center, Chicago, IL, 60612, USA

    Constantine V. Godellas M.D. (Associate Professor of Surgery, Academic Program Coordinator) (Associate Professor of Surgery, Academic Program Coordinator)

Rights and permissions

Reprints and permissions

Copyright information

© 2003 Springer-Verlag New York, Inc.

About this chapter

Cite this chapter

Labow, D.M., Brennan, M.F. (2003). Extremity Soft Tissue Sarcomas. In: Saclarides, T.J., Millikan, K.W., Godellas, C.V. (eds) Surgical Oncology. Springer, New York, NY. https://doi.org/10.1007/0-387-21701-0_43

Download citation

  • DOI: https://doi.org/10.1007/0-387-21701-0_43

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-95201-7

  • Online ISBN: 978-0-387-21701-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation