Abstract
BackgroundThere is still no consensus regarding the management of patients with massive liposarcomas located in the extremities. Several discrepancies related to the aggressiveness of the surgery and the application of concomitant radiotherapy and chemotherapy treatments remain controversial. The purpose of this study was to analyse the clinicopathological characteristics, prognostic factors and outcomes of a series of patients with massive liposarcomas of the extremities who were treated at a referral hospital specializing in musculoskeletal oncology.MethodsThis was an observational, descriptive and retrospective case series covering 10 years of clinical practice. The records of 26 adults, 14 men and 12 women, with localized massive liposarcomas in the extremities were studied. The average age was 53 years. The patients were treated from January 2003 until January 2012. Wide surgical resections with limb-sparing surgeries were performed for most patients (96.2 %).ResultsThe average tumour size was 15.1 ± 6.8 cm in the greatest dimension. Regarding the histological subtypes, there were 11 well-differentiated or atypical lipomatous tumours (42.3 %), 10 myxoid (38.5 %) and 5 (19.2 %) round cell and pleomorphic liposarcomas. Regarding the malignancy grades, 19 cases (73 %) were classified as low grade. Among these low-grade tumours predominated the well-differentiated subtype (57.9 %). Within high-grade tumours, the round cell and pleomorphic subtype was most frequent (57.1 %; p = 0.011). Radiotherapy was additionally applied to 12 patients (46.2 %) and adjuvant chemotherapy to 5 (19.3 %). Tumour recurrence was observed in only 2 cases (7.7 %). Only 1 of these cases developed lung metastatic dissemination.ConclusionsAcross the entire series, these massive tumours did not compromise the survival of the patients. The histologic subtype and the malignancy degree were closely related. Proper and early diagnosis and therapeutic management of these patients via the application of wide-margin surgical excision are essential to ensure long-term survival.
Highlights
IntroductionThere is still no consensus regarding the management of patients with massive liposarcomas located in the extremities
Based on morphological and cytogenetic aberrations, liposarcomas are commonly classified into four subtypes: well-differentiated, dedifferentiated, myxoid and pleomorphic with round cells [5]
There is still no consensus regarding the management of patients with massive liposarcomas located in the extremities
Summary
There is still no consensus regarding the management of patients with massive liposarcomas located in the extremities. Based on morphological and cytogenetic aberrations, liposarcomas are commonly classified into four subtypes: well-differentiated, dedifferentiated, myxoid and pleomorphic with round cells [5]. The well-differentiated and dedifferentiated subtypes represent 43 and 16 % of all liposarcomas, respectively, and are most frequently located in the retroperitoneum. The myxoid and the pleomorphic with round cell subtypes account for 29 and 12 % of liposarcomas, respectively, and most often. The myxoid type exhibits an intermediate malignant behaviour and predominately occurs in adults and in the lower extremities, the thighs, buttocks and the popliteal fossae. The round cell and pleomorphic variants are typically aggressive and often develop metastatic dissemination [6,7,8,9]. Most cases appear in adults over the age of 50 years and without a sex predilection [6, 8,9,10]
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