What is the role of surgery in the treatment of recurrent or metastatic soft-tissue sarcomas?

Updated: Dec 03, 2018
  • Author: Vinod B Shidham, MD, FRCPath; Chief Editor: Omohodion (Odion) Binitie, MD  more...
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As many as 35% of patients develop local recurrence or distant metastases following a combination of surgical resection and adjuvant therapy. [47] Eighty percent of local recurrences and disseminated metastases were observed within 5 years. [5]

Although removal of normal lymph nodes generally has no role in the treatment of soft-tissue sarcomas, dissection of biopsy-proven tumor-positive lymph nodes is recommended in the absence of metastatic disease elsewhere. Radical lymphadenectomy in patients who have nodal involvement without pulmonary metastases may yield better 5-year survival rates. [48]

Whenever it is technically amenable, surgical removal of pulmonary metastases is recommended following thorough evaluation for extrapulmonary tumor. In one study, resection of isolated pulmonary metastases achieved an actuarial 3-year survival rate of 38%. [5] The presence of fewer than three or four metastatic nodules, as observed with preoperative computed tomography (CT), is a favorable prognostic factor.

Because some clinical response has been achieved with neoadjuvant chemotherapy in soft-tissue sarcomas, studies to evaluate the use of high-dose therapy with autologous stem cell transplantation have been conducted. These studies have been pursued for patients with a high risk of metastatic disease at the time of diagnosis and as salvage therapy at the time of disease relapse. Most of this research has been conducted in children with small blue cell tumors (Ewing sarcomas, primitive neuroectodermal tumors). [49]

The results of these studies have been mixed. Randomized trials have not been reported. Some studies showed better survival rates for patients treated with the newer technique than for control patients treated with conventional therapy. Other research has failed to show any improvement in outcomes. Thus, the use of high-dose therapy in sarcomas remains controversial. This approach should be investigated further in well-designed, randomized clinical trials.

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