Soft-tissue sarcomas - prognostic factors and multimodal therapy

Soft-tissue sarcomas are a relatively rare disease accounting for approxima tely 1 % of adult malignancies. Various different histological subtypes exi st that behave similarly regarding their biological characteristics and res ponse to treatment. Soft-tissue sarcomas occur in up to 50 % of cases in th e extremities, followed by visceral/retroperitoneal and trunk tumors. Prima ry therapy is predicated on surgical resection with an adequate margin of n ormal tissue. Limb-sparing surgery for extremity lesions is possible in mor e than 90 % of patients. For high-risk patients, identified by tumor grade, size and site, local control is improved with postoperative adjuvant radia tion. Local recurrence rates vary, depending on the anatomic site. In the m ost common extremity lesions, one-third of the patients develop locally rec urrent disease with a median disease-free interval of 18 months. For viscer al sarcomas recurrence rates are up to 40-50 %. Treatment results for extre mity local recurrences may approach those for primary disease. Metastases o f extremity sarcomas predominantly spread to the lungs where isolated metas tases can be resected with 20-30 % 3-year survival rates. Patients with unr esectable pulmonary metastases or extra-pulmonary metastatic sarcoma have a uniformly poor prognosis and are best treated with systemic chemotherapy. In general, optimal treatment of soft-tissue sarcoma requires individual ca re tailored to the single patient.