Skip to main content
SpringerLink
Log in

Soft Tissue Cancers

  • Chapter
  • First Online:
Absolute Clinical Radiation Oncology Review

  • 1388 Accesses

Abstract

This chapter discusses the general management of patients with sarcomas, particularly soft tissue sarcomas, with special focus on principles that guide radiotherapy management. Several key components of trimodality care and radiation field design are discussed.

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

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight 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

References

  1. Cahlon O, Brennan MF, Jia X, Qin LX, Singer S, Alektiar KM. A postoperative nomogram for local recurrence risk in extremity soft tissue sarcomas after limb-sparing surgery without adjuvant radiation. Ann Surg. 2012;255(2):343–7. https://doi.org/10.1097/SLA.0b013e3182367aa7.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Crago AM, Denton B, Salas S, Dufresne A, Mezhir JJ, Hameed M, Gonen M, Singer S, Brennan MF. A prognostic nomogram for prediction of recurrence in desmoid fibromatosis. Ann Surg. 2013;258(2):347–53. https://doi.org/10.1097/SLA.0b013e31828c8a30.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bylund A, Stattin P, Widmark A, et al. Predictive value of bcl-2 immunoreactivity in prostate cancer patients treated with radiotherapy. Radiother Oncol. 1998;49:143–8.

    Article  CAS  Google Scholar 

  4. Cook B DT. Wikibooks radiation oncology. https://en.wikibooks.org/wiki/Radiation_Oncology. Accessed April 2018.

  5. Edge S, Byrd D, Compton C, et al. AJCC cancer staging manual. New York: Springer; 2010.

    Google Scholar 

  6. Hansen EK, Long JD. Handbook of Evidence-Based Radiation Oncology. 2nd ed: Springer; 2018. ISBN-13: 9783319626413

    Google Scholar 

  7. Hristov B, Lin SH, Christodouleas JP. Radiation oncology – a question based review. 2nd ed: LWW; 2014.

    Google Scholar 

  8. Eilber F, Giuliano A, Eckardt J, et al. Adjuvant chemotherapy for osteosarcoma: a randomized prospective trial. J Clin Oncol. 1987;5:21–6.

    Article  CAS  Google Scholar 

  9. Link MP, Goorin AM, Miser AW, et al. The effect of adjuvant chemotherapy on relapse-free survival in patients with osteosarcoma of the extremity. N Engl J Med. 1986;314:1600–6.

    Article  CAS  Google Scholar 

  10. Ozaki T, Flege S, Kevric M, et al. Osteosarcoma of the pelvis: experience of the Cooperative Osteosarcoma Study Group. J Clin Oncol. 2003;21:334–41.

    Article  Google Scholar 

  11. Noel G, Feuvret L, Ferrand R, et al. Radiotherapeutic factors in the management of cervical-basal chordomas and chondrosarcomas. Neurosurgery. 2004;55:1252–60; discussion 1260–2.

    Article  Google Scholar 

  12. Amichetti M, Cianchetti M, Amelio D, et al. Proton therapy in chordoma of the base of the skull: a systematic review. Neurosurg Rev. 2009;32:403–16.

    Article  Google Scholar 

  13. Kano H, Lunsford LD. Stereotactic radiosurgery of intracranial chordomas, chondrosarcomas, and glomus tumors. Neurosurg Clin N Am. 2013;24:553–60.

    Article  Google Scholar 

  14. Bakst R, Wolden S, Yahalom J. Radiation therapy for chloroma (granulocytic sarcoma). Int J Radiat Oncol Biol Phys. 2012;82:1816–22.

    Article  Google Scholar 

  15. Machak GN, Tkachev SI, Solovyev YN, et al. Neoadjuvant chemotherapy and local radiotherapy for high-grade osteosarcoma of the extremities. Mayo Clin Proc. 2003;78:147–55.

    Article  Google Scholar 

  16. Souhami RL, Craft AW, Van der Eijken JW, et al. Randomised trial of two regimens of chemotherapy in operable osteosarcoma: a study of the European Osteosarcoma Intergroup. Lancet. 1997;350:911–7.

    Article  CAS  Google Scholar 

  17. Rosenberg AE, Nielsen GP, Keel SB, et al. Chondrosarcoma of the base of the skull: a clinicopathologic study of 200 cases with emphasis on its distinction from chordoma. Am J Surg Pathol. 1999;23:1370–8.

    Article  CAS  Google Scholar 

  18. Fernandez-Miranda JC, Gardner PA, Snyderman CH, et al. Clival chordomas: A pathological, surgical, and radiotherapeutic review. Head Neck. 2014;36:892–906.

    Article  Google Scholar 

  19. Carpentier A, Polivka M, Blanquet A, et al. Suboccipital and cervical chordomas: the value of aggressive treatment at first presentation of the disease. J Neurosurg. 2002;97:1070–7.

    Article  Google Scholar 

  20. Catton C, O'Sullivan B, Bell R, et al. Chordoma: long-term follow-up after radical photon irradiation. Radiother Oncol. 1996;41:67–72.

    Article  CAS  Google Scholar 

  21. Yamada Y, Laufer I, Cox BW, et al. Preliminary results of high-dose single-fraction radiotherapy for the management of chordomas of the spine and sacrum. Neurosurgery. 2013;73:673–80; discussion 680.

    Article  Google Scholar 

  22. Hug EB, Loredo LN, Slater JD, et al. Proton radiation therapy for chordomas and chondrosarcomas of the skull base. J Neurosurg. 1999;91:432–9.

    Article  CAS  Google Scholar 

  23. Fagundes MA, Hug EB, Liebsch NJ, et al. Radiation therapy for chordomas of the base of skull and cervical spine: patterns of failure and outcome after relapse. Int J Radiat Oncol Biol Phys. 1995;33:579–84.

    Article  CAS  Google Scholar 

  24. DeLaney TF, Spiro IJ, Suit HD, et al. Neoadjuvant chemotherapy and radiotherapy for large extremity soft-tissue sarcomas. Int J Radiat Oncol Biol Phys. 2003;56:1117–27.

    Article  Google Scholar 

  25. Kirova YM, Belembaogo E, Frikha H, et al. Radiotherapy in the management of epidemic Kaposi's sarcoma: a retrospective study of 643 cases. Radiother Oncol. 1998;46:19–22.

    Article  CAS  Google Scholar 

  26. Kraybill WG, Harris J, Spiro IJ, et al. Phase II study of neoadjuvant chemotherapy and radiation therapy in the management of high-risk, high-grade, soft tissue sarcomas of the extremities and body wall: Radiation Therapy Oncology Group Trial 9514. J Clin Oncol. 2006;24:619–25.

    Article  CAS  Google Scholar 

  27. Mendenhall WM, Zlotecki RA, Hochwald SN, et al. Retroperitoneal soft tissue sarcoma. Cancer. 2005;104:669–75.

    Article  Google Scholar 

  28. O'Sullivan B, Davis AM, Turcotte R, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002;359:2235–41.

    Article  Google Scholar 

  29. Pervaiz N, Colterjohn N, Farrokhyar F, et al. A systematic meta-analysis of randomized controlled trials of adjuvant chemotherapy for localized resectable soft-tissue sarcoma. Cancer. 2008;113:573–81.

    Article  Google Scholar 

  30. 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;14:859–68.

    Article  CAS  Google Scholar 

  31. Pollack A, Zagars GK, Goswitz MS, et al. Preoperative vs. postoperative radiotherapy in the treatment of soft tissue sarcomas: a matter of presentation. Int J Radiat Oncol Biol Phys. 1998;42:563–72.

    Article  CAS  Google Scholar 

  32. Rosenberg SA, Tepper J, Glatstein E, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg. 1982;196:305–15.

    Article  CAS  Google Scholar 

  33. Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16:197–203.

    Article  CAS  Google Scholar 

  34. Guadagnolo BA, Zagars GK, Araujo D, et al. Outcomes after definitive treatment for cutaneous angiosarcoma of the face and scalp. Head Neck. 2011;33:661–7.

    Article  Google Scholar 

  35. Lin PP, Schupak KD, Boland PJ, et al. Pathologic femoral fracture after periosteal excision and radiation for the treatment of soft tissue sarcoma. Cancer. 1998;82:2356–65.

    Article  CAS  Google Scholar 

  36. Holt GE, Griffin AM, Pintilie M, et al. Fractures following radiotherapy and limb-salvage surgery for lower extremity soft-tissue sarcomas. A comparison of high-dose and low-dose radiotherapy. J Bone Joint Surg Am. 2005;87:315–9.

    Article  Google Scholar 

  37. Gortzak Y, Lockwood GA, Mahendra A, et al. Prediction of pathologic fracture risk of the femur after combined modality treatment of soft tissue sarcoma of the thigh. Cancer. 2010;116:1553–9.

    Article  Google Scholar 

  38. Coindre JM, Terrier P, Guillou L, et al. Predictive value of grade for metastasis development in the main histologic types of adult soft tissue sarcomas: a study of 1240 patients from the French Federation of Cancer Centers Sarcoma Group. Cancer. 2001;91:1914–26.

    Article  CAS  Google Scholar 

  39. Lawrence W Jr, Donegan WL, Natarajan N, et al. Adult soft tissue sarcomas. A pattern of care survey of the American College of Surgeons. Ann Surg. 1987;205:349–59.

    Article  Google Scholar 

  40. Virtanen A, Pukkala E, Auvinen A. Incidence of bone and soft tissue sarcoma after radiotherapy: a cohort study of 295,712 Finnish cancer patients. Int J Cancer. 2006;118:1017–21.

    Article  CAS  Google Scholar 

  41. Stewart FW, Treves N. Lymphangiosarcoma in postmastectomy lymphedema; a report of six cases in elephantiasis chirurgica. Cancer. 1948;1:64–81.

    Article  CAS  Google Scholar 

  42. Gladdy RA, Qin LX, Moraco N, et al. Do radiation-associated soft tissue sarcomas have the same prognosis as sporadic soft tissue sarcomas? J Clin Oncol. 2010;28:2064–9.

    Article  Google Scholar 

  43. Bernier J. Potential risks and benefits of radiation therapy as adjuvant treatment in patients with low-risk carcinoma of the mammary gland: taking cutaneous postradiation angiosarcoma as an opportunity for a critical appraisal of postoperative radiotherapy. Ann Oncol. 2007;18:619–21.

    Article  CAS  Google Scholar 

  44. Coindre JM, Hostein I, Terrier P, et al. Diagnosis of clear cell sarcoma by real-time reverse transcriptase-polymerase chain reaction analysis of paraffin embedded tissues: clinicopathologic and molecular analysis of 44 patients from the French sarcoma group. Cancer. 2006;107:1055–64.

    Article  CAS  Google Scholar 

  45. Pisters PW, Leung DH, Woodruff J, et al. Analysis of prognostic factors in 1,041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol. 1996;14:1679–89.

    Article  CAS  Google Scholar 

  46. Toulmonde M, Le Cesne A, Mendiboure J, et al. Long-term recurrence of soft tissue sarcomas: prognostic factors and implications for prolonged follow-up. Cancer. 2014;120:3003–6.

    Article  Google Scholar 

  47. Delaney TF, Kepka L, Goldberg SI, et al. Radiation therapy for control of soft-tissue sarcomas resected with positive margins. Int J Radiat Oncol Biol Phys. 2007;67:1460–9.

    Article  Google Scholar 

  48. Folkert MR, Singer S, Brennan MF, et al. Comparison of local recurrence with conventional and intensity-modulated radiation therapy for primary soft-tissue sarcomas of the extremity. J Clin Oncol. 2014;32:3236–41.

    Article  Google Scholar 

  49. O’Sullivan B, Griffin AM, Dickie CI, et al. Phase 2 study of preoperative image-guided intensity-modulated radiation therapy to reduce wound and combined modality morbidities in lower extremity soft tissue sarcoma. Cancer. 2013;119:1878–84.

    Article  Google Scholar 

  50. Davis AM, O'Sullivan B, Turcotte R, et al. Late radiation morbidity following randomization to preoperative versus postoperative radiotherapy in extremity soft tissue sarcoma. Radiother Oncol. 2005;75:48–53.

    Article  Google Scholar 

  51. Pan E, Goldberg SI, Chen YL, et al. Role of post-operative radiation boost for soft tissue sarcomas with positive margins following pre-operative radiation and surgery. J Surg Oncol. 2014;110:817–22.

    Article  Google Scholar 

  52. Baldini EH, Lapidus MR, Wang Q, et al. Predictors for major wound complications following preoperative radiotherapy and surgery for soft-tissue sarcoma of the extremities and trunk: importance of tumor proximity to skin surface. Ann Surg Oncol. 2013;20:1494–9.

    Article  Google Scholar 

  53. Griffin AM, Dickie CI, Catton CN, et al. The influence of time interval between preoperative radiation and surgical resection on the development of wound healing complications in extremity soft tissue sarcoma. Ann Surg Oncol. 2015;22:2824–30.

    Article  Google Scholar 

  54. Stucky CC, Wasif N, Ashman JB, et al. Excellent local control with preoperative radiation therapy, surgical resection, and intra-operative electron radiation therapy for retroperitoneal sarcoma. J Surg Oncol. 2014;109:798–803.

    Article  Google Scholar 

  55. Wong P, Dickie C, Lee D, et al. Spatial and volumetric changes of retroperitoneal sarcomas during pre-operative radiotherapy. Radiother Oncol. 2014;112:308–13.

    Article  Google Scholar 

  56. Tzeng CW, Fiveash JB, Popple RA, et al. Preoperative radiation therapy with selective dose escalation to the margin at risk for retroperitoneal sarcoma. Cancer. 2006;107:371–9.

    Article  Google Scholar 

  57. Koshy M, Landry JC, Lawson JD, et al. Intensity modulated radiation therapy for retroperitoneal sarcoma: a case for dose escalation and organ at risk toxicity reduction. Sarcoma. 2003;7:137–48.

    Article  Google Scholar 

  58. Pawlik TM, Pisters PW, Mikula L, et al. Long-term results of two prospective trials of preoperative external beam radiotherapy for localized intermediate- or high-grade retroperitoneal soft tissue sarcoma. Ann Surg Oncol. 2006;13:508–17.

    Article  Google Scholar 

  59. Bahig H, Roberge D, Bosch W, et al. Agreement among RTOG sarcoma radiation oncologists in contouring suspicious peritumoral edema for preoperative radiation therapy of soft tissue sarcoma of the extremity. Int J Radiat Oncol Biol Phys. 2013;86:298–303.

    Article  Google Scholar 

  60. Wang D, Bosch W, Roberge D, et al. RTOG sarcoma radiation oncologists reach consensus on gross tumor volume and clinical target volume on computed tomographic images for preoperative radiotherapy of primary soft tissue sarcoma of extremity in Radiation Therapy Oncology Group studies. Int J Radiat Oncol Biol Phys. 2011;81:e525–8.

    Article  Google Scholar 

  61. Wang D, Zhang Q, Eisenberg BL, et al. Significant Reduction of Late Toxicities in Patients With Extremity Sarcoma Treated With Image-Guided Radiation Therapy to a Reduced Target Volume: Results of Radiation Therapy Oncology Group RTOG-0630 Trial. J Clin Oncol. 2015;33:2231–8.

    Article  Google Scholar 

  62. Stelzer KJ, Griffin TW. A randomized prospective trial of radiation therapy for AIDS-associated Kaposi's sarcoma. Int J Radiat Oncol Biol Phys. 1993;27:1057–61.

    Article  CAS  Google Scholar 

  63. Singh NB, Lakier RH, Donde B. Hypofractionated radiation therapy in the treatment of epidemic Kaposi sarcoma--a prospective randomized trial. Radiother Oncol. 2008;88:211–6.

    Article  Google Scholar 

  64. Crago AM, Denton B, Salas S, et al. A prognostic nomogram for prediction of recurrence in desmoid fibromatosis. Ann Surg. 2013;258:347–53.

    Article  Google Scholar 

  65. Nuyttens JJ, Rust PF, Thomas CR Jr, et al. Surgery versus radiation therapy for patients with aggressive fibromatosis or desmoid tumors: A comparative review of 22 articles. Cancer. 2000;88:1517–23.

    Article  CAS  Google Scholar 

  66. Keus RB, Nout RA, Blay JY, et al. Results of a phase II pilot study of moderate dose radiotherapy for inoperable desmoid-type fibromatosis--an EORTC STBSG and ROG study (EORTC 62991-22998). Ann Oncol. 2013;24:2672–6.

    Article  CAS  Google Scholar 

  67. Quintini C, Ward G, Shatnawei A, et al. Mortality of intra-abdominal desmoid tumors in patients with familial adenomatous polyposis: a single center review of 154 patients. Ann Surg. 2012;255:511–6.

    Article  Google Scholar 

  68. Rutenberg MS, Indelicato DJ, Knapik JA, et al. External-beam radiotherapy for pediatric and young adult desmoid tumors. Pediatr Blood Cancer. 2011;57:435–42.

    Article  Google Scholar 

  69. Guadagnolo BA, Zagars GK, Ballo MT. Long-term outcomes for desmoid tumors treated with radiation therapy. Int J Radiat Oncol Biol Phys. 2008;71:441–7.

    Article  Google Scholar 

  70. Suarez C, Rodrigo JP, Bodeker CC, et al. Jugular and vagal paragangliomas: Systematic study of management with surgery and radiotherapy. Head Neck. 2013;35:1195–204.

    Article  Google Scholar 

  71. Combs SE, Salehi-Allameh B, Habermehl D, et al. Clinical response and tumor control based on long-term follow-up and patient-reported outcomes in patients with chemodectomas of the skull base and head and neck region treated with highly conformal radiation therapy. Head Neck. 2014;36:22–7.

    Article  Google Scholar 

  72. Guss ZD, Batra S, Limb CJ, et al. Radiosurgery of glomus jugulare tumors: a meta-analysis. Int J Radiat Oncol Biol Phys. 2011;81:e497–502.

    Article  Google Scholar 

  73. Jackson CG, Glasscock ME 3rd, Nissen AJ, et al. Glomus tumor surgery: the approach, results, and problems. Otolaryngol Clin N Am. 1982;15:897–916.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Penn State Cancer Institute, Hershey, PA, USA

    Nicholas G. Zaorsky & Heath B. Mackley

  2. Mayo Clinic, Jacksonville, FL, USA

    Daniel M. Trifiletti

Authors
  1. Nicholas G. Zaorsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel M. Trifiletti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heath B. Mackley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicholas G. Zaorsky .

Editor information

Editors and Affiliations

  1. Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA

    Daniel M. Trifiletti

  2. Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA

    Nicholas G. Zaorsky

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Zaorsky, N.G., Trifiletti, D.M., Mackley, H.B. (2019). Soft Tissue Cancers. In: Trifiletti, D., Zaorsky, N. (eds) Absolute Clinical Radiation Oncology Review. Springer, Cham. https://doi.org/10.1007/978-3-319-96809-4_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-96809-4_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-96808-7

  • Online ISBN: 978-3-319-96809-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation