Management of locally recurrent soft tissue sarcoma after prior surgery and radiation therapy

Surgery and radiation therapy are the standard for local tumour control in the treatment of soft tissue sarcoma. Sarcoma recurrence within a previously irradiated area is one of the most problematic therapeutic challenges in soft tissue tumours. Any information on previous therapy needs to be available in detail. In case of recurrent sarcoma not amenable to surgical resection with wide and clear margins, a multimodality therapy needs to be applied. The armamentarium usually looks for a neoadjuvant downstaging of the sarcoma by radiotherapy, chemo-radiotherapy or isolated limb perfusion with all of those strategies bearing benefits, but also specific risks. The potential of repeated radiotherapy and the modality that can be used (intraoperative radiotherapy, brachytherapy) needs to be carefully evaluated. The pathologist saves these major problems in intraoperative frozen section histology or resection margins and thus needs to be aware of the type of cancer cells potentially present within the resection specimen. Plastic and reconstructive surgery to cover the area of re-resection with viable and well-v tissue is absolutely crucial to prevent lymphatic fistula. Thus, adequate treatment of those specific situations usually involves postoperative physiotherapy and a specific rehabilitation, which is extremely important.