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Stage I Adult Soft Tissue Sarcoma
Current Clinical Trials
Low-grade soft tissue sarcomas (grade 1 or 2) have little metastatic potential,
but they may recur locally if they are inadequately treated. Accordingly,
surgical excision with negative tissue margins of 2 cm or larger in all directions is the treatment of choice for patients with these early-stage
sarcomas.[1] Mohs surgical technique may be considered as an alternative to wide
surgical excision for small, well-differentiated sarcomas when cosmetic results
are considered to be very important, as margins can be assured with minimal
normal tissue removal.[2,3]
Carefully executed high-dose radiation therapy using a shrinking
field technique may be beneficial for unresectable tumors or for resectable
tumors in which a high likelihood of residual disease is thought to be present,
when margins are known to be smaller than 2 cm, and when wider resection
would require either an amputation or the removal of a vital organ.[4] Because
of the low metastatic potential of these tumors, chemotherapy is usually not
given.[5]
Standard treatment options:
- Surgical excision with negative tissue margins of several centimeters in
all directions.
- Conservative surgical excision with preoperative or postoperative radiation
therapy.[6,7]
- If the tumor is unresectable, high-dose preoperative radiation therapy may
be used, followed by surgical resection and postoperative radiation
therapy.[4,8]
- For tumors of the retroperitoneum, trunk, and head and neck:
- Surgical resection with the option of postoperative radiation
therapy if negative margins cannot be obtained. Wide margins are unusual in these sites, and radiation therapy is usually
advocated for trunk and head and neck primary sites.[3]
- Preoperative radiation therapy followed by maximal surgical
resection. Radiation therapy is usually used to maximize local
control because of the inability to obtain wide surgical margins.
- Fast neutron therapy.[9]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I adult soft tissue sarcoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References
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Pearlstone DB, Pisters PW, Bold RJ, et al.: Patterns of recurrence in extremity liposarcoma: implications for staging and follow-up. Cancer 85 (1): 85-92, 1999.
[PUBMED Abstract]
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Fish FS: Soft tissue sarcomas in dermatology. Dermatol Surg 22 (3): 268-73, 1996.
[PUBMED Abstract]
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Brennan M, Singer S, Maki R, et al.: Sarcomas of the soft tissues and bone. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2005, pp 1581-1631.
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Temple WJ, Temple CL, Arthur K, et al.: Prospective cohort study of neoadjuvant treatment in conservative surgery of soft tissue sarcomas. Ann Surg Oncol 4 (7): 586-90, 1997 Oct-Nov.
[PUBMED Abstract]
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Geer RJ, Woodruff J, Casper ES, et al.: Management of small soft-tissue sarcoma of the extremity in adults. Arch Surg 127 (11): 1285-9, 1992.
[PUBMED Abstract]
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Tepper JE, Suit HD: Radiation therapy of soft tissue sarcomas. Cancer 55 (9 Suppl): 2273-7, 1985.
[PUBMED Abstract]
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Yang JC, Chang AE, Baker AR, et al.: Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 16 (1): 197-203, 1998.
[PUBMED Abstract]
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Schmidt RA, Conrad EU 3rd, Collins C, et al.: Measurement and prediction of the short-term response of soft tissue sarcomas to chemotherapy. Cancer 72 (9): 2593-601, 1993.
[PUBMED Abstract]
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Schwartz DL, Einck J, Bellon J, et al.: Fast neutron radiotherapy for soft tissue and cartilaginous sarcomas at high risk for local recurrence. Int J Radiat Oncol Biol Phys 50 (2): 449-56, 2001 Jun 1.
[PUBMED Abstract]
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