Bone and Soft Tissue Sarcomas

Prognostic Factors OS

• Tumor Grade & Histology
• Parosteal favorable; telangiectatic unfavorable
• Disease Extent
• metastatic disease unfavorable
• Tumor Size / Site
• axial skeletal primaries unfavorable
• Age
• < 10 yrs unfavorable
• Response of the primary tumor to pre-operative chemotherapy: very powerful predictor
• > 80-90% necrosis favorable

Treatment: Multimodal OS

• Surgery
• control of bulk disease
• Chemotherapy
• control of micrometastases
• Radiation
• Tumors not very radiosensitive, so this usually reserved for palliation

Treatment: Surgery OS

• Removal of all gross tumor with wide (>5cm) margins en bloc and biopsy site through normal tissue planes is required
• Type of surgical procedure depends on tumor location, size, extramedullary extent, presence of distant metastatic disease, age, skeletal development, and life-style preference
• limb-sparing
• amputation
• Metastatic sites must also be resected
• If/when relapse occurs, retrieval therapy must include resection

• Surgery alone 15-25% 5 year survival
• Recurrence with local and (50%) metastatic disease within 6 months of resection
• With multiagent chemotherapy  55-68%
• No difference between adjuvant or neoadjuvant chemotherapy
• Those with >90% tumor necrosis and complete resection  80-85%

Treatment: Chemotherapy OS

• Bulky disease is considered somewhat chemotherapy resistant
• Subclinical metastases are sensitive to chemotherapy
• Most active agents include
• adriamycin, cisplatinum, high-dose methotrexate, ifosfamide, etoposide
• Best # and schedule of chemotherapy unclear
• Role of intensification after local control unclear
• Immune modulators under study
• Role of adjuvant chemotherapy after thoracotomy for recurrent disease unclear