Issues in the management of high-risk localized sarcomas

Limb-sparing surgery with the preservation of limb function, with or without radiation therapy, is the standard surgical approach for patients with STS of the extremity. In the current era of limb-sparing surgery, most modern series report a local recurrence rate of approximately 15%-20%. Numerous factors are independently associated with the development of a local recurrence, and therefore even in the face of a negative margin, patients are at risk for a local recurrence and decreased OS. Systemic chemotherapy for decreasing local recurrence rates and improving survival has been studied for decades. When the various disease entities within the classification of STS are grouped together and studied as one, the effect of chemotherapy on OS is modest at best. However, there are clearly patients who do benefit from such therapy and tools to better identify these patients may be on the horizon. New efficacious agents with improved toxicity profiles will also benefit this population significantly.