A multidisciplinary approach to soft-tissue sarcoma of the extremities

ABSTRACT

Introduction

Soft-tissue sarcoma (STS) denotes a group of rare and highly heterogeneous malignant tumors of mesenchymal origin. Accurate histological diagnosis is critical for selecting appropriate treatment. Complete tumor resection is the primary treatment for STS, and the efficacies of radiotherapy and chemotherapy have been tested in the adjuvant setting to improve oncological outcomes. Because most STS lesions arise in the extremities, preserving limb function and managing limb impairment after radical local treatment represent significant challenges.

Areas covered

This article reviews the current front-line treatments for patients with extremity STS and discusses the multidisciplinary team-based efforts needed to improve oncological outcomes and survivorship.

Expert opinion

Given the rarity, variety, and complexity of STS, a multidisciplinary approach involving experts in various disciplines is vital for improving outcomes in patients ranging from diagnosis to survivorship. A major challenge is building a sustainable system in each region permitting all patients with extremity STS to be treated at high-volume centers with multidisciplinary teams dedicated to this rare and complex disease.

KEYWORDS:

• Chemotherapy
• high-volume center
• limb salvage
• rare cancer
• radiotherapy
• rehabilitation
• soft-tissue sarcoma
• survivorship

Article highlights

• A multidisciplinary team-based approach involving sarcoma experts is critical for maximizing patients’ oncological outcomes and survivorship

• Accurate histological diagnosis by expert pathologists is essential for optimizing treatment

• Complete margin-negative tumor resection provides the highest likelihood of patient survival, whereas efforts have been made to achieve functional limb salvage

• Despite conflicting results from prior clinical trials, neoadjuvant chemotherapy featuring at least three cycles of anthracycline plus ifosfamide represents a reasonable treatment option for patients with high-risk STS at present

• As each line of treatment has a great impact on the survivorship of patients with extremity STS, a wide range of services, including rehabilitation and psychological support, sexual health services, pain management, and support for returning to work, should be considered

• Continued efforts should focus on optimizing patient access to high-volume centers that provide multidisciplinary care

Acknowledgments

The authors would like to thank Joe Barber from Edanz Group for editing a draft of this manuscript.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper received no funding.