Soft Tissue Sarcomas in Adults

Sarcomas represent a group of rare tumors which arise from the largest tissue compartment of the body, but account only for about 1 % of all malignancies. Among this group of tumors, soft tissue sarcomas in adults are, in addition to osteosarcomas, the most important. In the diagnostic workup of soft tissue sarcomas modern radiological investigation methods such as CT and MRI techniques are being critically evaluated. While it is widely accepted that the conventional, stained microscopic specimen is still the cornerstone for properly planned treatment stra­ tegies, immunohistochemistry has come to play an indis­ pensable role in accurate classification. Reviewing the surgical techniques, the treatment of musculo-skeletal malignancies, especially of soft tissue sarcomas, has changed considerably over the past decades. While amputation used to be the surgical treatment of choice limb-saving procedures have now become an im­ portant therapeutic modality in treating such lesions, particularly in combination with percutaneous or interstitial radiotherapy. Despite adequate local treatment, many patients with soft tissue sarcomas will ultimately develop metastatic disease, usually in the lungs. For this reason, effective ad­ juvant systemic treatment should be given simultaneously with or soon after treatment of local disease. The results of several randomized trials evaluating adjuvant chemotherapy have been reported in the meanwhile, indicating im­ proved, disease-free survival with a trend towards improved overall survival. In disseminated disease, drug combi- VI Preface nations or single agents are used as palliative treatment and might help to improve survival in selected subgroups.

Inhalt

I. Diagnostic Workup of Soft Tissue Sarcomas.- Imaging of Soft Tissue Sarcomas.- Classification, Grading, and Staging of Soft Tissue Sarcomas.- Immunohistochemistry in Diagnosis of Soft Tissue Sarcomas and New Techniques in Soft Tissue Tumour Pathology.- Surgical Biopsy Techniques and Differential Diagnosis of Soft Tissue Tumours.- II. Local Treatment of Soft Tissue Sarcomas.- Limb Salvage and Reconstructive Procedures in Soft Tissue Sarcomas of the Extremities.- Surgical Management of Truncal and Head/Neck Soft Tissue Tumours.- Combined Surgery and Radiotherapy for Conservative Management of Soft Tissue Sarcomas.- Role of Brachytherapy in the Treatment of Soft Tissue Sarcomas of the Extremities - Techniques and Results.- Radiotherapy in the Treatment of Inoperable and Advanced Soft Tissue Sarcomas in Adults.- Regional Hyperthermia Combined with Systemic Chemotherapy of Locally Advanced Sarcomas: Preclinical Aspects and Clinical Results.- III. Local Recurrences and Disseminated Disease.- Histological Characteristics of Local Recurrences in Soft Tissue Sarcomas.- Local Recurrences of Soft Tissue Sarcomas - A Therapeutic Challenge.- Histomorphological Characteristics of Metastases of Soft Tissue Sarcomas.- Radiotherapy in the Treatment of Metastases of Soft Tissue Sarcomas.- Results of Surgical Treatment of Pulmonary Metastases from Soft Tissue Sarcomas.- IV. Systemic Treatment.- Adjuvant Chemotherapy of Soft Tissue Sarcomas in North America.- Systemic Therapy of Disseminated Soft Tissue Sarcomas.- V. New Developments and Future Aspects.- Isolation Perfusion with Tumor Necrosis Factor-?, Interferon-?, and Hyperthermia in the Treatment of Localized and Metastatic Cancer.- Radiosensitivity and Local Tumor Control - Experimental Studies.