Multidisciplinary Treatment of Soft Tissue Sarcomas

The purpose of this book is to contribute to the further development of the multidisciplinary approach to the treatment of soft tissue sarcomas. A proper diagnosis and staging remains the cornerstone of the treatment strategy. Sophisticated histopathology techniques and growing consensus on grading systems have further increased the importance of the histopathologist in providing estimates of the prognosis of the patient as well as providing data for the planning of treatment strategy. The use of cytogenetics is relatively new in this field. This might enable distinction of subgroups in specific histological tumor types. Further to this, molecular biological studies not only help to reveal inherited predispositions and details in oncogenesis in tumor development, but they may also provide additional predictive factors for tumor behaviour. Further data for the treament strategy will be provided by diagnostic imaging, in which field the role of magnetic resonance imaging is rapidly developing. As far as actual treatment is concerned, surgery still provides the major chance for cure. In view of the endeavour to be as sparing as possible, the addition of radiotherapy to surgery is of utmost importance. Usually radiotherapy is given after surgery, but the optimal sequence of the two modalities yet needs to be defined. The combined use of surgery with radiotherapy and/or chemotherapy does have an impact on wound healing. A review on recent data concerning wound healing in these situations has thus been added. There appears to be growing consensus about the role of chemotherapy in metastatic disease, where only doxorubicin, ifosfamide and DTIC are known to be active. Although it may be different for subsets, in general, single-agent chemotherapy appears to be as effecive as standard doses of combination chemotherapy. The lack of efficacy of adjuvant chemotherapy with standard doses of the drugs presently available has been shown. Just as for radiotherapy, chemotherapy may have an important role in the preoperative treatment of advanced soft tissue sarcomas, where intravenous drug administration appears to be as effective as the more complicated intraarterial administration. Thermochemotherapy, another and still investigational approach to advanced local disease, also yields interesting preliminary results. Finally, clinical behaviour, treatment strategy and the outcome of treatment in childhood soft tissue sarcomas are quite different from those in adult soft tissue sarcomas.