What are the UK treatment guidelines for localized soft tissue sarcoma (STS)?

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

Answer

Recommendations are as follows:

  • Surgery is the standard treatment for most patients with localized soft tissue sarcoma.
  • For patients with resectable disease, a wide excision through normal uninvolved tissues is the surgical procedure of choice.
  • The definition of what constitutes a wide margin is controversial, but with the addition of adjuvant radiation therapy (RT), a close but tumor-free margin (R0) may be adequate.
  • Where a wide excision is not possible due to anatomic constraints, a planned marginal or microscopically positive margin against a critical structure, plus radiotherapy, for intermediate- and high-grade tumors, may be an appropriate means of achieving tumor control while maintaining function and quality of life.
  • Occasionally, amputation should be undertaken as the only surgical option to achieve adequate margins.
  • For patients with borderline resectable tumors, preoperative treatment with chemotherapy and/or RT should be considered, depending on histology.
  • Preoperative or postoperative RT is recommended along with surgical resection of the primary tumor for the majority of patients with high-grade tumors and for selected patients with large or marginally excised low-grade tumors.
  • The recommended dose for postoperative radiotherapy is 60–66 Gy.
  • Preoperative radiotherapy provides better long-term functional outcome and equivalent rates of disease control but greater risk of acute postoperative wound complications, compared with postoperative radiotherapy.
  • The recommended dose for preoperative RT is 50 Gy.
  • Adjuvant chemotherapy is not routinely recommended but could be considered in situations where achieving local control is likely to be compromised or where the risk of metastatic disease is particularly high, with a lower threshold for its use in the more chemosensitive sarcoma subtypes.

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