Limb-Sparing Treatment of Adult Soft-Tissue Sarcomas and Osteosarcomas

Abstract

Soft-tissue sarcomas and osteosarcomas are relatively rare tumors that represent less than 2% of all new adult cancer cases occurring each year in the United States. The number of new soft-tissue sarcomas and osteosarcomas diagnosed yearly is 4,800 and 1,900, respectively. Clinical advances in the treatment of these tumors are hampered by the difficulty of accruing adequate numbers of patients in valid prospective therapeutic trials. Surgical resection has always had a major role in the treatment of the primary lesion in adult patients with either soft-tissue sarcoma or osteosarcoma of the extremities. Amputation of an extremity has been a relatively frequent choice of resection for soft-tissue sarcomas in the past because of high local treatment failure rates when wide surgical margins could not be achieved by a limb-sparing resection as the only treatment. For osteosarcomas in the extremities of both young and older adults, amputation has been the mainstay of treatment of the primary extremity lesion in most patients. The recognition of the possible role of radiation therapy and/or regional or systemic chemotherapy in the treatment of both soft-tissue sarcomas and osteosarcomas has raised many questions regarding the preoperative evaluation, extent of surgical resection required when these modalities are employed, the results of this treatment in comparison with amputation, and the optimal treatment strategy. In an effort to resolve some of the questions surrounding these issues, the National Institutes of Health convened a Consensus Development Conference on Limb-Sparing Treatment of Adult Soft-Tissue and Osteosarcomas from Dec 3 to 5, 1984. During 1 1/2 days, presentations were made by experts in the field who reported their experience with the management of over 2,000 patients with high-grade extremity sarcomas. A consensus panel drawn from the medical professions and the general public considered the evidence and agreed on answers to the following key questions: What is the optimal pretreatment evaluation of the high-grade sarcoma patient regarding diagnosis, extent of disease workup, and staging? Are there types of patients for whom limb-sparing treatment should be considered appropriate therapy? If so, what is the optimal limb-sparing treatment strategy? (Consider the following: indications and contraindications, extent of surgical resection, need for and form of radiation therapy and/or chemotherapy, treatment morbidity and function of the limb, and end results.) Are there types of extremity sarcoma patients for whom adjuvant chemotherapy is indicated? What directions should be taken for future research on the treatment of extremity sarcomas? It should be stressed that the panel considered only issues related to high-grade soft-tissue sarcomas and osteosarcomas, since low-grade sarcomas do not pose the problems addressed in this conference. <h3>PANEL'S CONCLUSIONS</h3> High-grade extremity sarcomas are life-threatening and potentially disabling neoplasms that require aggressive management by an experienced multidisciplinary team. Data reviewed from recent clinical experience have shown the feasibility and appropriateness of limbsparing treatment for a significant proportion of these patients. The concepts of limb-sparing treatment for these sarcoma patients is a clearly established treatment option, but questions remain regarding optimal therapeutic strategies.