Treatment of soft tissue sarcomas

The results obtained in the treatment of 45 cases of soft tissue sarcomas are presented. All cases were reviewed and classified according to the modern criteria of malignancy. The treatment schedule comprised: (1) Preoperative irradiation: two sessions of 650 cGy in 48 hr—Target volume: whole limb segment; (2) Surgical excision 48 hr later with systematic intraoperative histologic verification, until healthy tissue margins are obtained; (3) Postoperative irradiation 3 weeks later delivering a cumulative total dose of 5000 cGy to the preoperative volume and 6000–7000 cGy to a reduced volume encompassing the surgical region with protection of vascular axes where possible; (4) Chemotherapy: Actinomycin D 0.3 mg/m² half an hour before the first 5 sessions of post-operative irradiation; (5) Bilateral lung irradiation: 4 sessions of 375 cGy in 7 days to the whole chest. The results were as follows: Local recurrence rate was 12% at 5 years. In 21 cases in whom surgical excision was deemed histologically adequate, no recurrences were seen at 2 years (minimum follow-up). Survival at 5 years was 76%. Deaths were due to metastatic spread, especially to the lungs. These results show an improvement as compared with historical series. New progress should be sought in combining a more aggressive type of chemotherapy for cases with high metastatic risk.