Adult Soft Tissue Sarcomas

Abstract

A nationwide survey of the clinical presentation, pathology, and management of soft tissue sarcomas in adults was carried out under the auspices of the Commission on Cancer of the American College of Surgeons. Two separate 2-year periods were used to allow assessment of changes in patterns of care. Data were obtained from 504 hospitals in 1977-1978 (2355 patients) and 645 institutions in 1983-1984 (3457 patients). Pretreatment findings of interest included some evidence of physician delay in diagnosis, overuse of excisional biopsy as opposed to the generally preferred approach of incisional biopsy, a low rate of usage of the American Joint Committee for Cancer Staging (AJCSS) system, and major reliance on CT for pretreatment patient evaluation. Operation was the primary treatment, with or without adjuvant therapies, in approximately three fourths of the patients. The other one fourth were primarily patients with distant metastasis at the time of diagnosis. Some increase in multimodal therapy did occur in the second period but the rate of amputation was low (approximately 10%) in both periods studied. Survival curves support the prognostic validity of the AJCCS system and the value of complete resection of soft tissue sarcomas. Adverse prognostic factors included positive surgical margins, large tumors, retroperitoneal or mediastinal primary sites, some histologic types, and the perceived need for adjuvant therapy. Patients receiving adjuvant radiation or chemotherapy had less favorable survival data than those treated by operation alone due to criteria used for selecting patients for these therapies. Approximately one half of the treatment failures in the 1977-1978 series were locoregional, whereas 18% were limited to lung metastasis. Salvage therapy for these two forms of treatment failure yielded 61% and 21% 5-year survival rates.

The percutaneous needle biopsy is safe and recommended in the diagnosis of musculoskeletal masses

“…In a pattern-of-care survey by the American College of Surgeons that involved 3457 patients with sarcomas treated from 1983 to 1984, only 9% underwent a needle biopsy. 2 An informal survey at the 1999 American Academy of Orthopedic Surgeons annual meeting indicated that only 40% of respondents were using needle biopsy for diagnosis of mesenchymal tumors. Although this suggests increased use of needle biopsy over the last 15 years, it continues to indicate an underutilization of this technique.…”

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] These articles have focused on the sensitivity, specificity, positive and negative predictive values, and accuracy of these procedures. The utility of FNAB was the subject of a recent editorial by Akerman, who concluded that the benefits of FNAB in the definitive diagnosis of a soft tissue sarcoma outweigh the limitations.…”

Clinicopathological Study and Management of Peripheral Soft Tissue Tumours

“…In a study conducted by Lawrence et al, [10] in over 5800 patients, the most common presenting symptom was a swelling, followed by pain due to swelling. In our study, swelling was present in all the 74 patients.…”

Cuadro clínico - patológico y factores pronósticos de sobrevida en adultos con sarcomas de partes blandas.

“…Los sarcomas de tejidos blandos clínicamente se presentan como tumores palpables o visibles, típicamente indoloros o bien provocando dolor (13,14), o si son profundos, como síndromes comprensivos de órganos vitales o estructuras nerviosas (15). La conducta clínica de estos tumores está caracterizada por una tendencia a invadir extensamente tejidos blandos circundantes, así como una diseminación metastásica precoz especialmente a los pulmones (1,2,16).…”

“…Los tipos histológicos más frecuentes son el liposarcoma (32%), fibrohistiocitoma maligno (14.8%) y leiomiosarcoma (13.8%) (13).…”