Presented by: dr.

Peri handayani
Adult soft tissue sarcomas rare
Incidence 5/100.000/year in Europe
Soft Tissue Sarcomas (STS) ubiquitous in the site
of origin and often treated with multimodality
treatment.
Multidisciplinary approach pathologist, radiologist,
surgeons, radiation therapists, medical oncologists,
paediatric oncologists.
All patients who suspected with sarcoma or with an
unexplained deep mass of soft tissues, or with a
superficial lesion of soft tissues having a diameter of
> 5 cm, or arising in paediatric age.

MR main imaging modality
CT
Multiple core needle biopsies
Excisional biopsy lesions of < 5cm
Open biopsy
Histological diagnosis based on the latest WHO
classification

The Federation Nationale des Centres de Lutte Contre
le Camcer (FNCLCC) grading system > generally
used based on differentiation, necrosis and mitotic
rate.
Tumour size and tumour depth recorded as a
prognostic value
Pathological report
The american joint committee on cancer
(AJCC)/International Union against cancer (UICC)
stage classification system important in
malignancy grade in sarcoma
In addition tumour size, depth and resectability
Surgical report contains of:
The preoperative and intraoperative diagnosis
The surgical conduct
Surgical actual completeness vis--vis planned quality
of margins
A chest spiral CT scan
Histological type and other clinical features
Limited disease
Surgery wide excision with negative margins (R0)
A marginal excision selected cases
Wide excision + radiation th/ high grade, deep
lesions, > 5 cm
Radiation Th/ addition in
The case of low grade, superficial, > 5cm
Low grade, deep, < 5cm soft tissue sarcoma.

Radiation th/
Dose 50-60 Gy
Fractions of 1,8 2 Gy
Possibly with boosts up to 66 Gy
Preoperatively 50 Gy
Intraoperative radiation theraphy (IORT) and
Brachytheraphy selected cases
R1 resections considered Re-operation
R2 surgery re-operation is mandatory
Adjuvant chemotheraphy
not standard treatment in adult-type soft tissue sarcomas
Proposed as an option to the high risk individual patient (
>G1, deep, > 5cm tumour)
Extensive disease
Metachronous resectable lung metastases without extra
pulmonary diseases complete excision
Chemotheraphy
may be added as an option
Extrapulmonary diseases standard treatment
Anthracyclines first line treatment
Anthracyclines + Ifosfamide trearment of choice

Angiosarcome taxanes are aan alternative option
Patients who have already received chemotheraphy without
ifosfamide option for giving high dose ifosfamide (-
14g/m2)
Trabectedin 2
nd
line option effective in
leiomyosarcoma and liposarcome
Gemcitabine + docetaxel 2
nd
line theraphy
Dacarzabine 2
nd
line th/
Core needle biopsies the standard procedure
Biopsies pathway should becarefull avoid
contamination and complication
Radiological imaging lipomatous tumours
Postoperative radiation th/ Not feasible

Includes leiomyosarcomas, endometrial stromal
sarcomas, undifferentiated endometrial sarcomas,
pure heterologous sarcomas
Total abdominal hysterectomy standard treatment
Radiation th/ not recommended in
leiomyosarcoma
Adjuvant in selected cases
Treatment consist of:
Surgery
Radiation th/
Observation
Isolated limb perfussion
Systemic th/
Hormonal th/ (tamoxifen, toremifene, GnRH analogues)
NSAID
Low dose chemotheraphy MTX + Vinblastine / MTX +
vinorelbine
Low dose interferon
Imatinib
Full dose chemotheraphy
Difficult anatomical loccation
Radiation th/ widely resorted to
Breast conserving surgery depending on the
quality of margins versus the size of the tumour and
the breast
Angiosarcoma of the mammary gland tendency to
recur that mastectomy is generally preferred
Adjuvant chemotheraphy is concerned