Soft Tissue Sarcoma

STS originates from

mesenchymal stem cells

STS originates from

connective tissue

median age STS

45-55

etiology STS

sporadic

prior RT complication

angiosarcoma (red skin spots)

are sarcomas related to injury

no

benign neoplasms compared to malignant

100 times more common

most common STS subtype

undifferentiated/unclassified STS

second most common histo

liposarcoma

presentation symptoms

few early, diagnosis and treatment often delayed

most common STS site

lower extremities

imaging for extremity, trunk, HN

MRI

imaging for retroperitoneal

CT

distant disease imaging

chest CT, PET, CNB after MRI

undifferentiated/unclassified STS grows in

direction of muscle fibers

liposarcoma arises from

precursors of fat cells

liposarcoma found in

extremities and retroperitoneum

extremity STSs

lipo, undiff, synovial, fibro, myxoid

retroperitoneal STS

liposarcoma, leiomyosarcoma

HN STS

the uns

STS grows by

local extension, infiltrate adjacent tissues, along tissue planes

most common site of STS mets

lung

retroperitoneal sarcomas more commonly met to the

liver

most STS does not spread to

lymph

low stage small tumor treatment

surgery alone (positive margins, post op RT)

stage 2-3 treatment

preop RT then surgery

stage 4 treatment

possible surgical resection or chemo

chemo not usually useful because of

variety of histologies

chemo offered to

high grade tumors bigger than 8cm

pre op RT preferred because

aids in local recurrence (seal off ability to extend)

pre op RT dose

5000 in 25

RT field

large with big margin

post op RT dose

5000, surgical bed with 2cm margin to 6000-7000

why spare 1-2cm strip of skin post op RT (and 1 joint)

lymph flow

IMRt for

bone sparing