Changes in the diagnosis and treatment of soft tissue sarcoma in Japan, 1977-2016

The treatment of soft tissue tumors has maderemarkable progress through advancements in diagnostic imaging and analysis ofsurgical materials. Changes in the treatment of soft tissue tumors are describedfrom my experience since 1977. Prior to the introduction of CT scans, radiography and angiography were the only methods for tumor localization. Wholebody CT, echography, and soft tissue radiography were introduced around 1980,and significant progress was seen in the localization of soft tissue tumors.Although the localization and diagnostic characteristics of tumors becameeasier with the introduction of MRI, radiography and ultrasound still remainedthe primary diagnostic method for soft tissue tumors. Since 1980, preoperative needle biopsy hasbecome a powerful diagnostic procedure by combining rapid cytological andpathological diagnosis at the Cancer Institute Hospital.The curative wide resection method, based on barrier theory, was an index forpreoperative planning. In addition, with the advent of evaluation methods forsurgical margins, the curability of wide resections can be discussed on acommon platform to open new possibilities in limited resection. However,because current evaluation methods for surgical margins were based onmacroscopic findings, diagnostic measures for invasive sarcomas are stillneeded in future investigations. The development of In Situ Preparation (ISP) isuseful for acquiring information that cannot be obtained with preoperativeimages as it allows for intraoperative evaluation of margins without the riskof tumor contamination, and the surgical technique could be consideredessential for limited resection. In most areas, the preservation of affectedlimbs was made possible by combining ISP with vascular reconstruction, flaptransplantation, joint arthroplasty, bone grafting, among other techniques. Inorder to improve the outcome for the treatment of sarcoma, which is a rarecancer, it is essential to consolidate facilities.