Adult soft tissue sarcoma

Background: Soft tissue sarcomas (STS) are a group of anatomically and hist ologically diverse tumours. They account for about 1% of adult malignancies , and about 50% of patients diagnosed with sarcoma eventually die of the di sease. These tumours are grouped together because of shared biological char acteristics and treatment responses. Methods: A review of the key literature on STS was undertaken, complemented by data taken from the prospectively accumulated database of 3442 patients treated for STS at Memorial Sloan-Kettering Cancer Centre (MSKCC) from Jul y 1982 to December 1997. Results: Despite advances in knowledge of the molecular genetics of STS, th e aetiology in most cases remains elusive. Management has been gradually re lined over the last two decades. Core biopsy usually provides enough materi al for diagnosis. Computed tomography and magnetic resonance imaging provid e a similar amount of information, which is usually adequate for surgical p lanning. Amputation as standard treatment for extremity lesions has been re placed by limb-sparing surgery in about 90% of patients. The role of adjuva nt radiation has been further defined: it has been shown to be unnecessary for completely excised rumours less than 5 cm in diameter, but effective in decreasing local recurrence for others. Adjuvant chemotherapy has been con troversial for many years. Recent meta-analysis of randomized trial results has found a small reduction in local and distant relapse and a bend to bet ter overall survival. Recurrent or metastatic disease should be completely excised if possible. Conclusions: Soft tissue sarcoma requires multidisciplinary care tailored t o the individual patient and tumour for optimal results.