Perioperative Management of Extremity Soft Tissue Sarcomas

Rick L Haas, Alessandro Gronchi, Michiel A J van de Sande, Elizabeth H Baldini, Hans Gelderblom, Christina Messiou, Eva Wardelmann, Axel Le Cesne

Research output: Contribution to journalArticlepeer-review


Surgery is potentially curative for primary nonmetastatic extremity soft tissue sarcomas. After surgery alone, patients may remain at risk for local recurrences and/or metastatic disease. To reduce the likelihood of a local relapse, the addition of radiotherapy (RT) to limb-sparing surgery may result in higher local control rates of at least 85%. Generally, it can be stated that local control after both preoperative and postoperative RT is comparable, but that preoperative RT comes with a more favorable toxicity profile after prolonged follow-up, albeit at the cost of a higher wound complication rate. Furthermore, recent data suggest that preoperative RT is more cost effective. To reduce the risk of subsequent metastatic disease, systemic chemotherapy can be introduced early during the primary management of these patients. These systemic chemotherapy regimens can also be applied both preoperatively and postoperatively. Finally, with the aim of increasing the antitumor response of perioperative RT, these agents may even be combined with RT, concurrently and sequentially. While designing new preoperative combination regimens, responses should be carefully monitored by both sophisticated radiologic and pathologic evaluations. This article reviews all these aspects, in addition to limb-sparing surgery.

Original languageEnglish
Pages (from-to)118-124
Number of pages7
JournalJournal of clinical oncology : official journal of the American Society of Clinical Oncology
Issue number2
Publication statusPublished - Jan 10 2018


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