Local recurrence management of extremity soft tissue sarcoma

Abstract

Patients diagnosed with soft tissue sarcoma (STS) present a number of challenges for physicians, due to the vast array of subtypes and aggressive tumor biology. There is currently no agreed-upon management strategy for these tumors, which has led to the ongoing debate surrounding how frequently surveillance scans should be performed following surgery. However, advances in multidisciplinary care have improved patient outcomes over recent years. The early detection of local recurrence reflects a more aggressive tumor, even in association with the same histopathologic entity. Treating the local recurrence of extremity STS is a difficult clinical challenge. The goal should be to salvage limbs when possible, with treatments such as resection and irradiation, although amputation may be necessary in some cases. Regional therapies such as high-intensity, low-dose or interleukin-1 receptor antagonist treatment are appealing options for either definitive or adjuvant therapy, depending on the location of the disease's recurrence. The higher survival rate following late recurrence may be explained by variations in tumor biology. Since long-term survival is, in fact, inferior in patients with high-grade STS, this necessitates the implementation of an active surveillance approach.

Keywords: local recurrence; management of recurrence; soft tissue sarcoma; surgical resection.

Figure 1

A 77-year-old patient diagnosed approximately 2 years ago with liposarcoma is referred to our department with a rapidly increasing mass located at the root of the thigh (A). The MRI (coronal T1) revealed a tumor mass with a predominantly fatty structure, but inhomogeneous through gadolinophilic and cystic areas with contrast uptake at the level of walls and some septa, as well as left inguinal-femoral adenopathies (B).

Figure 2

A 46-year-old patient with a history of recurrent liposarcoma is referred to our department with a painless mass in the gluteal area. Sagittal view CT scan revealed a soft tissue lump with a high probability of relapse (A). We performed an en-bloc resection with negative margins (R0) (B). The HP finding revealed multiple groups of atypical adipoblasts ob 10 X with immature lipoblasts (signet ring-type cells) and mature adipocytes pledging for a well-differentiated liposarcoma (C). At 6 months postoperatively, the PET-CT scan revealed no local recurrence or distant metastases (D).