What are the Trans-Atlantic Retroperitoneal Sarcoma Working Group 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:

  • Surgical therapy of RPS should be undertaken with the primary goal of complete macroscopic (R0/R1) resection. Adherent structures and organs should be resected en bloc with the tumor.
  • Organ and critical structure preservation (eg, kidney, bladder, duodenum, sciatic nerve) should be prioritized on the basis of on anatomic issues, histologic subtype biologic features, and patient physiology.
  • Thorough preoperative planning is required to properly engage and prepare necessary subspecialists. RPS may require involvement of urology, vascular surgery, neurosurgery, and reconstructive surgery, in addition to a surgical oncologist with expertise in STS.
  • The surgical team must be familiar with the consequences of major neurovascular structure sacrifice and patients should be thoroughly counseled about potential functional loss prior to intervention.
  • Neoadjuvant chemotherapy or radiation therapy (RT) may be considered in patients with technically unresectable or borderline resectable disease. Intraoperative RT or brachytherapy are rarely useful.

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