Abstract
Surgical intervention is the mainstay treatment for soft tissue sarcomas (STSs). The significance of adjuvant and neoadjuvant therapies, such as chemotherapy, radiation, and isolated limb perfusion, remains under controversial discussion. The goal of this review is to discuss the effects of the aforementioned treatment modalities and their timing of application in plastic surgery techniques. Furthermore, options of reconstruction in cases of complications caused by adjuvant and neoadjuvant therapies are discussed. When compared with adjuvant radiation, neoadjuvant treatment can reduce negative side effects such as fibrosis and edema because radioderma can be removed during the subsequent surgical procedure. Furthermore, there have not been any reports of negative effects of neoadjuvant radiation on microsurgical procedures. However, the dose of neoadjuvant radiation correlates with increased risks of impaired wound healing postoperatively. Thus, a patient-specific approach to decide whether radiation should be performed adjuvant or neoadjuvant is necessary. Preoperative irradiation should be considered in cases where functional structures are exposed after tumor resection, in order to ensure the best possible functionality. Adjuvant radiation should be considered in all other cases because of its known superior wound healing. As for chemotherapy, no negative influence of its use adjuvant or neoadjuvant to reconstructive procedures, such as local or free flaps, has been reported. Lastly, small sample size studies have not shown increased risks of microsurgical failure or wound complications after isolated limb perfusion. The findings of this review suggest that the chronological order of the discussed therapeutic approaches is not a decisive factor in the surgical outcome of reconstructive procedures for STS.
Highlights
Arising from the mesenchymal connective tissues, the heterogeneous group of soft tissue sarcomas (STS) occurs subcutaneous or deep in the extremities in 60% of cases [1]
The goal of this review is to show the influence of the timing of introduction of additional treatments for STS, such as radiation, chemotherapy, and isolated limb perfusion, on the surgical techniques used for reconstruction following tumor resection
Interdisciplinary treatment involving pathologists, radiologists, surgeons, radiation therapists, and medical oncologists is mandatory in cases of STS
Summary
Arising from the mesenchymal connective tissues, the heterogeneous group of soft tissue sarcomas (STS) occurs subcutaneous or deep in the extremities in 60% of cases [1]. The goal of this review is to show the influence of the timing of introduction of additional treatments for STS, such as radiation, chemotherapy, and isolated limb perfusion, on the surgical techniques used for reconstruction following tumor resection. Preoperative treatment prevents the delay between irradiation and surgical resection that is caused by a possible compromised wound healing when radiotherapy is performed adjuvant. For first line therapy including Doxorubicin and Ifosfamide, a response rate of up to 30% is described while no benefit in relapsefree survival or overall survival could be shown [22, 23] Based on these findings, adjuvant chemotherapy should be limited to highrisk patients with extensive, highly malignant STS in the setting of controlled clinical studies [23]. Plastic surgical treatment enables early and complete remission of the lesions and reduces the delay in administration of further chemotherapy [27]
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