Soft Tissue Sarcoma

—Damron TA, Ward WG, Stewart A. Osteosarcoma, Chondrosarcoma, and Ewing's Sarcoma: National Cancer Data Base Report.  Clin Orthop Relat Res. 2007 Mar 22; [Epub ahead of print]

—Pollack RE, Karnell LH, Menck HR, Winchester DP. The National Cancer Data Base report on soft tissue sarcoma. Cancer 1996; 78:2247-2257. (!)

To identify patterns of treatment and outcome, all soft tissue sarcoma cases diagnosed in 1988 and 1993 as recorded in the National Cancer Data Base were analyzed on the basis of histology and anatomic site. There was an increase in sarcomas originating in the pleura with a concurrent increase in mesotheliomas. A shift toward more advanced disease was also noted. Limb-sparing surgical procedures are now standard. However, it appears from stage subset analysis that many Stage II and III patients are under-treated due to lack of multimodality therapy usage. Use of pretreatment multimodality planning conferences will increase the likelihood that stage-appropriate combinations of surgery, radiation therapy, and chemotherapy will be used. In turn, election of multimodality approaches should increase the possibility of improved overall and disease free survival in the future.

—Zaki A, Mettlin CJ. Soft tissue sarcomas in whites and blacks living in the United States of America. J Surg Oncol 1992; 50:130-133. (*)

—Lawrence W, Donegan WL, Natarajan N, Mettlin CJ, Beart R, Winchester DP. Adult soft tissue sarcomas: A pattern of care survey of the American College of Surgeons. Ann Surg 1987; 205:349-359. (*)

A nationwide survey of the clinical presentation, pathology, and management of soft tissue sarcomas in adults was carried out under the auspices of the Commission on Cancer of the American College of Surgeons. Two separate 2-year periods were used to allow assessment of changes in patterns of care. Data were obtained from 504 hospitals in 1977-1978 (2,355 patients) and 645 hospitals in 1983-1984 (3,457 patients). Pretreatment findings of interest included some evidence of physician delay in diagnosis, overuse of excisional biopsy as opposed to the generally preferred approach of incisional biopsy, a low rate of usage of the American Joint Committee for Cancer (AJCC) staging system, and major reliance on CT for pretreatment patient evaluation. Operation was the primary treatment, with or without adjuvant therapies, in approximately three-fourths of the patients. The other one fourth were primarily patients with distant metastasis at the time of diagnosis. Some increase in multimodal therapy did occur in the second period, but the rate of amputation was low (approximately 10%) in both periods studied. Survival curves support the prognostic validity of the AJCC system and the value of complete resection of soft tissue sarcomas. Adverse prognostic factors included positive surgical margins, large tumors, retroperitoneal or mediastinal primary sites, some histologic types, and the perceived need for adjuvant therapy. Patients receiving adjuvant radiation or chemotherapy had less favorable survival data than those treated by operation alone due to criteria used for selecting patients for these therapies. Approximately one half of the treatment failures in the 1977-1978 series were locoregional, whereas 18% were limited to lung metastasis. Salvage therapy for these two forms of treatment failure yielded 61% and 21% 5-year rates.

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