DIAGNOSIS AND MANAGEMENT OF SOFT-TISSUE SARCOMAS

Soft-tissue sarcomas are locally aggressive tumours with a tendency to spread haematogenously, especially to the lungs. Most patients present without obvious metastases. Their management is dependent on an adequate incisional biopsy to assess the grade of the tumour. The biopsy incision must be carefully placed so as not to compromise subsequent radical excision. Of patients so treated, 20 to 30% experience local recurrence within the first 3 years postoperatively. The use of adjuvant radiotherapy decreases the incidence of local recurrence to about 15%. Patients with retroperitoneal sarcomas have a greater tendency to suffer recurrence, with disseminated disease throughout the abdomen. The overall 5-year survival rate is about 50%. Patients may, however, have persistent disease or develop metastases beyond the 5-year period. The optimal timing of radiation and chemotherapy remains unresolved, but multimodality treatment at least allows the advocation of limb-sparing procedures for patients with soft-tissue sarcomas.