Local recurrence management of extremity soft tissue sarcoma

Abstract

Patients diagnosed with soft tissue sarcoma (STS) present a number of challenges for physicians, due to the vast array of subtypes and aggressive tumor biology. There is currently no agreed-upon management strategy for these tumors, which has led to the ongoing debate surrounding how frequently surveillance scans should be performed following surgery. However, advances in multidisciplinary care have improved patient outcomes over recent years. The early detection of local recurrence reflects a more aggressive tumor, even in association with the same histopathologic entity. Treating the local recurrence of extremity STS is a difficult clinical challenge. The goal should be to salvage limbs when possible, with treatments such as resection and irradiation, although amputation may be necessary in some cases. Regional therapies such as high-intensity, low-dose or interleukin-1 receptor antagonist treatment are appealing options for either definitive or adjuvant therapy, depending on the location of the disease’s recurrence. The higher survival rate following late recurrence may be explained by variations in tumor biology. Since long-term survival is, in fact, inferior in patients with high-grade STS, this necessitates the implementation of an active surveillance approach.

Review on Lymph Node Metastases, Sentinel Lymph Node Biopsy, and Lymphadenectomy in Sarcoma

“…The predilection of certain histological types of sarcomas to lymphogenous dissemination should be the starting point for the consideration of probable therapeutic implications. Some histological forms, such as clear cell sarcoma, angiosarcoma, rhabdomyosarcoma, and epithelioid sarcoma (which together form the acronym CARE), show a predilection for lymph node involvement [36]. The reported incidence of lymph node disease in these high-risk histologies is 25% on average, with the highest range up to 55% [29,34,37,38].…”