Soft tissue sarcomas are a rare group of cancers arising from connective tissue such as muscle, fat, nerves, bone and vascular tissue, that can occur at any age. There are approximately 13,000 new cases of soft tissue sarcoma a year in the United States. A soft tissue sarcoma most commonly develops in the abdomen, arms, legs or pelvis and typically presents as a painless enlarging soft tissue mass. They can present as small (<5 cm) subcutaneous masses (just beneath the surface of the skin), or as very large, deep tumors covering the majority of the extremity. There are more than 50 subtypes of soft tissue sarcoma with variable clinical behavior ranging from slow growing tumors to aggressive tumors with potential for rapid growth and metastasis. At Parkview Cancer Institute we have a dedicated Sarcoma Care Team including radiation oncology, medical oncology, interventional radiology, pathology, plastic surgery, nurse navigation, genetics, nutrition, spiritual support, and financial support, led by our orthopedic oncologic surgeon.
Common Types of Soft Tissue Sarcoma:
- Undifferentiated pleomorphic sarcoma
- Myxoid liposarcoma
- Dedifferentiated liposarcoma
- Pleomorphic liposarcoma
- Synovial sarcoma
- Malignant peripheral nerve sheath tumor
- Clear cell sarcoma
- Epithelioid sarcoma
- Ewing sarcoma
- Extraskeletal osteosarcoma
Diagnostic Studies and Tests:
Any large (>5 cm) or deep soft tissue mass requires an MRI as it may potentially be a soft tissue sarcoma. At the Parkview Cancer Institute, we utilize a 3 Tesla MRI scan to obtain the highest quality and most detailed images possible. If the MRI image shows concern for a soft tissue sarcoma, typically a biopsy is obtained for pathologic analysis. Once pathology has confirmed the diagnosis of a soft tissue sarcoma, a CT chest scan will be obtained for evaluation of metastatic disease and staging purposes. In some clinical circumstances, a PET scan may also be attained for staging studies. Once a diagnosis is obtained and staging studies are completed, the case will be reviewed at Parkview Cancer Institute’s Multidisciplinary Sarcoma & Musculoskeletal Tumor Conference by our dedicated Sarcoma Care Team to develop a personalized treatment plan.
Soft Tissue Sarcoma Treatment:
After accurate diagnosis, staging, and multidisciplinary team review, treatment may begin. Treatment plans are derived from tumor anatomic location, sarcoma subtype, tumor grade and staging. In general, soft tissue sarcomas are often treated with radiation and surgery for tumor removal and local control. At the Parkview Cancer Institute, preoperative radiation therapy is often utilized as it requires lower radiation doses thus minimizing the adverse effects of radiation. Studies have demonstrated that combining surgical removal with radiation therapy for soft tissue sarcoma produces the best local control rates, minimizing local recurrence of soft tissue sarcomas. To maximize accuracy of radiation and minimize associated harm, we utilize Intensity Modulated Radiation Therapy (IMRT), which has been demonstrated in studies to result in optimal local control rates for soft tissue sarcomas. In some circumstances chemotherapy is utilized, depending upon sarcoma subtype, grade, anatomic location, feasibility of surgical resection, and the presence of metastatic disease. At the Parkview Cancer Institute, we utilize multi-agent chemotherapy and immunotherapy for soft tissue sarcoma treatment depending upon clinical scenarios. Surgical treatment requires a wide excision, meaning the tumor is removed covered with a barrier of normal tissue to minimize the risk of leaving microscopic cancer cells in the body. Greater than 90% of sarcoma cases can be treated with limb-sparing surgery, avoiding amputation, and thus optimizing function after tumor removal.
Surveillance and Survival:
After tumor removal and completion of adjuvant therapies with no detectable signs of active cancer, surveillance begins. Surveillance typically lasts for 5 – 10 years depending upon the sarcoma subtype and grade of the tumor. Surveillance is performed with periodic imaging of the chest utilizing CT scans or chest x-rays to asses for metastatic disease. In some clinical scenarios, periodic MRI scans of the affected area will be obtained to assess for local recurrence of the tumor. In general, with isolated soft tissue sarcomas of the extremity, treated with radiation and wide surgical excision, local sarcoma recurrence rates are 10-15%. During the surveillance period, patients undergo physical therapy, spiritual counseling, nutritional support, and financial support as needed, all of which is coordinated by our sarcoma nurse navigator.