[Soft tissue sarcoma: prognostic factors and multimodal treatment].

Overview

Soft-tissue sarcomas are a relatively rare disease accounting for approximately 1% of adult malignancies. Various different histological subtypes exist that behave similarly regarding their biological characteristics and response to treatment. Soft-tissue sarcomas occur in up to 50% of cases in the extremities, followed by visceral/retroperitoneal and trunk tumors. Primary therapy is predicated on surgical resection with an adequate margin of normal tissue. Limb-sparing surgery for extremity lesions is possible in more than 90% of patients. For high-risk patients, identified by tumor grade, size and site, local control is improved with postoperative adjuvant radiation. Local recurrence rates vary, depending on the anatomic site. In the most common extremity lesions, one-third of the patients develop locally recurrent disease with a median disease-free interval of 18 months. For visceral sarcomas recurrence rates are up to 40-50%. Treatment results for extremity local recurrences may approach those for primary disease. Metastases of extremity sarcomas predominantly spread to the lungs where isolated metastases can be resected with 20-30% 3-year survival rates. Patients with unresectable pulmonary metastases or extra-pulmonary metastatic sarcoma have a uniformly poor prognosis and are best treated with systemic chemotherapy. In general, optimal treatment of soft-tissue sarcoma requires individual care tailored to the single patient.