ASO Practice Guidelines Series: Soft Tissue Sarcoma of the Extremities and Superficial Trunk

Soft tissue sarcomas (STS) are a heterogeneous group of rare malignant tumors arising from mesenchymal tissues, with extremity and superficial trunk STS (eSTS) comprising the majority of cases. The management of localized eSTS requires a multidisciplinary approach to optimize oncologic and functional outcomes. This review outlines the natural history, diagnostic workup, and treatment principles for localized eSTS, emphasizing the role of histology-specific considerations in guiding management strategies. While surgery remains the mainstay of treatment, with the goal of achieving negative margins and preserving limb function, radiotherapy is frequently employed to reduce the risk of local recurrence. Systemic therapies, including chemotherapy and immunotherapy, are increasingly being explored in both the neoadjuvant and adjuvant settings. Recent evidence suggests that chemotherapy may provide a survival benefit in selected high-risk patients. Additionally, emerging data on immune checkpoint inhibitors indicate potential efficacy in specific histologic types and in combination with radiotherapy. Given the complexity of diagnosis and treatment, centralization of care in specialized sarcoma centers is critical to ensure optimal patient outcomes.