The Management of Soft Tissue Sarcoma in the Elderly

Chapter

Abstract

Soft tissue sarcomas (STSs) are a diverse group of malignant tumors that originate from mesenchymal tissue. There are more than 70 different subtypes of STS subcategorized by their histological appearance, although overall the group remains relatively rare compared to their benign soft tissue tumor counterparts (100:1). The most common histologic subtypes in elderly people are liposarcomas, leiomyosarcomas, and synovial sarcomas.

Surgery is the only potentially curative therapy in the management of STSs in elderly patients. The standard of care is the en bloc removal of the tumor with a cuff of healthy tissue all around, to avoid cell spillage from its surface (as far as no real capsule is present but a pseudocapsule of compressed cells) and allow removal of microimplants which may be present around the pseudocapsule itself. The extent of resection (and the subsequent prognostic adequacy of margins) depends on a variety of factors, including histology and the presence of an intact biologic barrier (muscular fascia, vascular adventitia, periosteum, or epineurium).

Extended surgery may be challenging due to the high frequency of coexisting multiple or complex medical problems and geriatric syndromes (such as dementia, falls, malnutrition, sensory impairments), impaired physiologic and functional reserves, and restrictions in personal and social resources. For this reason, this kind of patient deserves a personalized treatment after an accurate multidisciplinary evaluation by a surgical, medical, and radiation oncologist jointly with other specialists (plastic surgeon, orthopedist, physiotherapist, pathologist, palliative care specialist), in order to select the best therapeutic strategy in cases in which a decreased ability to tolerate proper treatments may result.

Keywords

Extremity soft tissue sarcoma Soft tissue and trunk sarcoma Surgery Elderly Amputation Limb-sparing surgery Retroperitoneum Chemotherapy Radiotherapy 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Sarcoma Unit, Città Della Salute e della ScienzaS. Giovanni Battista Hospital, University of TurinTurinItaly

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