RECENT TRENDS IN THE MANAGEMENT OF SOFT TISSUE SARCOMAS
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 1
Abstract
BACKGROUND Soft tissue sarcomas are a heterogeneous group of tumours arising from primitive multipotent mesenchymal cells undergoing differentiation into one or more cell lines. They constitute 1% of human cancers.[1] Most cases of soft tissue sarcoma are sporadic and the cause is unknown. Soft tissue sarcomas are one of the most common radiation associated tumours[2] and they develop from any site and have more than 50 histological types and subtypes. The aim of this study is to provide an overview of its distribution and to emphasise the recent trends in the management of soft tissue sarcoma with considerable change towards limb and organ saving attitude.[3] MATERIALS AND METHODS This study was conducted in KAPV Government Medical College and Mahatma Gandhi Memorial Government Hospital, Trichy between January 2014 and December 2016 over a period of 2 years. This study included 50 cases of soft tissue sarcoma, who were all inpatients in KAPV Government Medical College and Mahatma Gandhi Memorial Hospital, Trichy. Patients were descriptively studied for the distribution of soft tissue sarcoma and the mode of management adopted towards them. RESULTS The study shows the gender distribution of soft tissue sarcoma among 50 cases with 33 males (66%) and 17 females (34%). Among the 50 cases the incidence is higher in 51 - 60 years of age 10 cases (20%), incidence is equal in 21 to 30 years and 31 - 40 years’ age group, both having 9 cases with 18% incidence. The lowest incidence is in above 70 years’ age group, 1 case only (2%). Lower limb is the site mostly affected with 20 cases (40%). Upper limb and abdomen show equal numbers with 11 cases each (22%) and lowest incidence is in gluteal site soft tissue sarcoma 1 case (2%). Among the 14 types of soft tissue sarcoma studied, fibrosarcoma shows higher incidence with 17 cases (34%) followed by malignant fibrous histiocytoma (MFH) 8 cases (16%), chondrosarcoma, malignant haemangioendothelioma, GIST and spindle cell sarcoma have 1 case each (2%). 27 cases were found to have stage 3 disease (54%) and stage 4 disease among 3 cases (6%). Regarding the treatment given, surgery alone was done in 3 cases (6%). Surgery with chemotherapy and radiotherapy were done on 39 cases (78%). Among the surgical procedures, wide local excision was done in 34 cases (68%) and radical hysterectomy was done in 1 case (2%). The recent trend in management of soft tissue sarcoma is towards organ saving attitude with the advent of multimodality approach. Surgery is the primary modality. Patients mostly underwent wide local excision and compartmental excision followed by postoperative radiotherapy and chemotherapy. Postoperative radiotherapy is given with external beam radiotherapy. Adjuvant chemotherapy was given with Vincristine, Adriamycin and Cyclophosphamide (VAC regimen). Out of 50 cases, 3 cases had recurrence in 2 years follow-up period. CONCLUSION Soft tissue sarcomas are rare tumours of mesenchymal origin. Multimodality approach in the management is the recent trend aimed at organ salvage. Surgery is the mainstay of management. Wide local excision and compartmental excision with postoperative adjuvant radiotherapy and chemotherapy gives good survival rates. Out of 50 cases only 3 cases had recurrence, thus showing the effectiveness of multimodality approach with surgery, radiotherapy and chemotherapy
Authors and Affiliations
Mahalakshmi Ashokkumar, Yeganathan Rajappan, Manimaran Thangavelu, Anandan Kanthan, Rajeswari Appanamuthumari
Keywords
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- EP ID EP283349
- DOI 10.14260/jemds/2018/11
- Views 78
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