SOFT-TISSUE TUMORS

Any soft tissue swelling beneath the deep fascia should be considered a sarcoma until proven otherwise. As the most important factor in the primary treatment of these cancers is the adequacy of the primary surg ical resection, it is vital to diagnose these malignant tumours pre-op eratively. The modern treatment of soft tissue sarcomas may involve al l modalities, but the most important aspect of treatment of a primary localised sarcoma is wide excisional surgery preserving limb function. Radiotherapy is a vital adjunct in high-grade tumours, or in tumours whose resectability is limited either by size or anatomical proximity to vital structures. Apart from a few chemosensitive sarcomas, the rol e of chemotherapy is Limited to treatment of metastatic disease where documented no response rates are greater than 30%. As 50% of patients with high-grade sarcomas will die from metastatic disease, improvement s in survival rates will only come from improvements in response to sy stemic therapy. No controlled trials have shown any survival benefit f or adjuvant chemotherapy, although a recent meta-analysis of published data has shown a trend to increased survival at two years. Multicentr e randomised trials are ongoing. The prognosis of these lesions is hig hly variable, but is intimately related to the anatomical site tie, re sectability), and also the grade and size of the tumour.