Multidisciplinary management of soft tissue sarcomas: it’s time to make a team!

Abstract

Musculoskeletal sarcomas are a heterogeneous group of malignant neoplasms derived from connective tissue. Sarcomas represent about 1% of cancer in adults. The annual incidence in adults in Europe is around 14,000 new cases of soft tissue sarcomas and 4,800 new cases of bone sarcomas [1]. Musculoskeletal sarcomas originate from elements of the mesodermal embryonic layer and are classifi ed according to the adult tissue resembled in the case of soft-tissue sarcomas (STS) and according to the type of matrix (i.e. osteoid or chondroid) produced in bone sarcoma (BS). Musculoskeletal tumours arise anywhere in the body, although lower extremities are the most common site of appearance followed by upper extremities, trunk, retroperitoneum and head and neck area [1‐5]. The most frequent presentation of STS is as an asymptomatic mass. However, sarcomas are locally invasive tumours with high propensity to recur locally. Higher-grade and larger sarcomas are more prone to metastasise in distant sites and more likely to be lethal. The adequate management STS is a stimulating challenge for oncologists. The aim of treatment should be focused on four main aspects: improving survival, avoiding local recurrence, maximising organ function and minimising morbidity. Surgery, radiotherapy and ‐sometimes, though increasingly‐ chemotherapy, are the pillars on which rests the modern treatment of sarcomas. The optimal management of musculoskeletal tumours requires multidisciplinary integration of these different approaches in treatment planning right from the initial diagnoses. Nevertheless, the timing and order of local resection, preoperative or postoperative, and even chemotherapy require a multidisciplinary and well-coordinated team. Surgical resection remains the mainstay of treatment for STS, and it is still considered the dominant curative