What are the NCCN treatment guidelines for localized low-grade soft tissue sarcoma (STS) of the extremities, superficial trunk, or head and neck?

Updated: Sep 02, 2018
  • Author: Steven C Katz, MD, FACS; Chief Editor: Edwin Choy, MD, PhD  more...
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Answer

Answer

NCCN treatment recommendations for localized low-grade disease (stage IA, IB) are as follows [1] :

  • Surgical resection is definitive treatment if margins are >1cm or the fascial plane is intact.
  • Re-resection may be necessary when margins are ≤1 cm and are without an intact fascial plane.
  • Postoperative radiation therapy should be considered if final surgical margins are ≤1 cm and without an intact fascial plane (category 1 for stage IB).
  • Radiation therapy may be unnecessary with low-grade lesions ≤5 cm because local recurrence is infrequent and observation is an option.
  • The patient should undergo evaluation for rehabilitation therapy to achieve maximal function.
  • Follow-up includes a history and physical examination (H&P) every 3-6 months for 2-3 years and then annually thereafter. After 10 years, likelihood of recurrence is small and follow-up should be individualized by subtype.
  • Consider chest imaging and baseline/follow-up imaging of the primary site, based on histology.

Initial resection margins and decisions concerning re-resection should be tailored to individual subtype biologic features. For example, a well-differentiated liposarcoma or atypical lipomatous tumor may be adequately treated with a 1 cm margin or less. In contrast, a widely infiltrative dermatofibrosarcoma protuberans, myxofibrosarcoma, or angiosarcoma would require far wider resection margins to ensure adequate treatment, due to the locally infiltrative nature of these subtypes.

For extremity STS, the goal should be preservation of limb function to the extent that is possible without compromising appropriate oncologic resection. Prior to considering an amputation, patients should be evaluated by a multidisciplinary team with expertise in STS. Dissection should be through grossly normal tissue planes not involved with tumor. Radical compartmental approaches are not routinely required and offer no benefit in overall or disease-free survival. Close margins may be necessary to preserve critical neurovascular structures and hence function and quality of life.


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