Soft Tissue Sarcomas

5/26/2018 Soft Tissue Sarcomas

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Presented by: dr. Peri handayani


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Adult soft tissue sarcomas rare

Incidence 5/100.000/year in Europe


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Soft Tissue Sarcomas (STS) ubiquitous in the siteof origin and often treated with multimodality

treatment.

Multidisciplinary approach pathologist, radiologist,

surgeons, radiation therapists, medical oncologists,paediatric oncologists.

All patients who suspected with sarcoma or with an

unexplained deep mass of soft tissues, or with asuperficial lesion of soft tissues having a diameter of

> 5 cm, or arising in paediatric age.


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MR main imaging modality

CT

Multiple core needle biopsies

Excisional biopsy lesions of < 5cm

Open biopsy

Histological diagnosis based on the latest WHO

classification


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The Federation Nationale des Centres de Lutte Contrele Camcer (FNCLCC) grading system > generally

used based on differentiation, necrosis and mitotic

rate.

Tumour size and tumour depth recorded as a

prognostic value

Pathological report


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The american joint committee on cancer(AJCC)/International Union against cancer (UICC)

stage classification system important in

malignancy grade in sarcoma

In addition tumour size, depth and resectability


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Surgical report contains of:

The preoperative and intraoperative diagnosis

The surgical conduct

Surgical actual completeness vis--vis planned quality

of margins

A chest spiral CT scan

Histological type and other clinical features


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Limited disease

Surgery wide excision with negative margins (R0)

A marginal excision selected cases

Wide excision + radiation th/ high grade, deep

lesions, > 5 cm

Radiation Th/ addition in

The case of low grade, superficial, > 5cm

Low grade, deep, < 5cm soft tissue sarcoma.


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Radiation th/

Dose 50-60 Gy

Fractions of 1,8

2 Gy

Possibly with boosts up to 66 Gy

Preoperatively 50 Gy

Intraoperative radiation theraphy (IORT) and

Brachytheraphyselected cases


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R1 resections considered Re-operation

R2 surgery re-operation is mandatory

Adjuvant chemotheraphy

not standard treatment in adult-type soft tissue sarcomas

Proposed as an option to the high risk individual patient (

>G1, deep, > 5cm tumour)


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Extensive disease

Metachronous resectable lung metastases without extra

pulmonary diseases complete excision

Chemotheraphy

may be added as an option

Extrapulmonary diseases standard treatment

Anthracyclines first line treatment

Anthracyclines + Ifosfamide trearment of choice


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Angiosarcome taxanes are aan alternative option

Patients who have already received chemotheraphy without

ifosfamide option for giving high dose ifosfamide (-

14g/m2)

Trabectedin 2ndline option effective in

leiomyosarcoma and liposarcome

Gemcitabine + docetaxel 2ndline theraphy

Dacarzabine 2ndline th/


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Core needle biopsies the standard procedure

Biopsies pathway should becarefull avoid

contamination and complication

Radiological imaging lipomatous tumours

Postoperative radiation th/ Not feasible


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Includes leiomyosarcomas, endometrial stromalsarcomas, undifferentiated endometrial sarcomas,

pure heterologous sarcomas

Total abdominal hysterectomystandard treatment

Radiation th/ not recommended inleiomyosarcoma

Adjuvant in selected cases


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Treatment consist of:

Surgery

Radiation th/

Observation

Isolated limb perfussion


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Systemic th/

Hormonal th/ (tamoxifen, toremifene, GnRH analogues)

NSAID

Low dose chemotheraphy MTX + Vinblastine / MTX +

vinorelbine

Low dose interferon

Imatinib

Full dose chemotheraphy


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Difficult anatomical loccation

Radiation th/ widely resorted to


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Breast conserving surgerydepending on thequality of margins versus the size of the tumour and

the breast

Angiosarcoma of the mammary gland tendency to

recur that mastectomy is generally preferred

Adjuvant chemotheraphy is concerned


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Soft Tissue Sarcomas

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