Current diagnosis and therapy of soft tissue sarcomas in the adult

Soft tissue sarcomas embrace a wide variety of rare tumours. This often mea ns excision without wide margins, and the unexpected malignancy leads to di versity of postoperative treatment. As a rule all lesions of a soft tissue tumour should be biopsied if persisting for more than 6 weeks. The extent o f the biopsy is determined by the tumour characteristics, but should not ag gravate later resection of a malignant tumour. Preoperative diagnostic stud ies should be standardised and include MNR, while the tumour is characteris ed according to the recent edition of the UICC GTNM system. The primary tum our should be excised in a limb-sparing way with wide margins, if necessary including the neighbouring fascia. Local recurrence should be approached a ggressively like primary tumours, with curative intention. In cases of dist ant metastases, which usually occur in the lungs, a grading-associated appr oach is necessary. In G3 metastases chemo-therapy should be administered be fore the surgical intervention. Radiation therapy is saved for patients in whom the tumour cannot be resected with wide margins or is larger than 10 c m maximum diameter. In the light of current knowledge, radiation therapy sh ould be given as an adjuvant for patients whose tumour was resected without wide margins and for tumours larger than 10 cm in diameter. The use of pal liative chemotherapy is still controversial and identification of new progn ostic markers for patient selection is necessary. Since most patients with soft tissue sarcoma die from distant metastases and not the primary or loca lly recurrent tumour, the need for effective chemotherapy in an adjuvant se tting is obvious. Controlled studies with as many enrolled patients as poss ible are necessary if valid data are to be collected. The management of sof t tissue sarcoma patients is in principle multidisciplinary and should be c onfined to specialised centres.