Skip to main content
SpringerLink
Log in
Book cover

Soft Tissue Sarcomas in Adults pp 95–108Cite as

Local Recurrences of Soft Tissue Sarcomas — A Therapeutic Challenge

  • Conference paper

Part of the book series: Recent Results in Cancer Research ((RECENTCANCER,volume 138))

Abstract

The occurrence of local failures in soft tissue sarcomas, though frequently seen only after inadequate surgery and radiation, remains a major problem, since it compromises local control and overall survival (Suit 1992). The impact of local recurrences on the development of metastases and overall survival is stressed below. Locally recurrent tumors showed histologic changes, compared with the primary tumor, which were expressed as increased cellularity and mitotic counts in 30% and 43% of the cases investigated, respectively, and these histologic conversions carry an adverse prognosis (Tsujimoto et al. 1988). The natural genetic shift of human soft tissue sarcomas was also observed in an experimental model system (Donhuijsen et al. 1988): xenotransplanted tumors showed differentiation as well as dedifferentiation and the occurrence of new cell lines in more than 30% of 22 investigated xenografts. Wilson et al. (1984) found recurrent tumors to be of low-grade malignancy after previous adjuvant therapies, e.g., radiation or chemotherapy. After surgery alone, local failures were generally highly malignant. The authors conclude that chemoradiotherapy kills high-grade subclones of the tumors, leaving low-grade remnants from which relapses originate.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Abbatucci JS, Levy C, Boulier N, de Ranieri J, Mandard AM, Tanguy A, Vernhes JC, Lozier JC (1989) A systematic radio-surgical combination in the treatment of sarcoma of soft tissues in adults. Results in 106 cases at the Centre Francois Baclesse. Ann Radiol (Paris) 32:117–122

    CAS  Google Scholar 

  • Abe M, Takahashi M, Ono K (1988) Japan gastric trials in intraoperative radiation therapy. Int J Radiat Oncol Biol Phys 15:1431–1433

    Article  PubMed  CAS  Google Scholar 

  • Alho A, Alvegard TA, Berlin O, Ranstam J, Rydholm A, Rooser B, Stener B (1989) Surgical margin in soft tissue sarcoma. The Scandinavian Sarcoma Group experience. Acta Orthop Scand 60(6):687–692

    Article  PubMed  CAS  Google Scholar 

  • Azzarelli A (1993) Surgery in soft tissue sarcomas. Eur J Cancer 29A:618–623

    Article  PubMed  CAS  Google Scholar 

  • Azzarelli A, Quagliuolo V, Fissi S, Casali P, Garbuglia A, Bignami P, Santoro A, Andreola S, Gennari L (1992) Intra-arterial induction chemotherapy for soft tissue sarcomas. Ann Oncol 3 Suppl 2:67–70

    Google Scholar 

  • Azzarelli A, Quagliuolo V, Casali P, Fissi S, Montalto F, Santoro A (1993) Preoperative doxorubicin plus ifosfamide in primary soft-tissue sarcomas of the extremities. Cancer Chemother Pharmacol 31 Suppl 2:S210-S212

    Google Scholar 

  • Brennan MF, Hilaris B, Shiu MH, Lane J, Magill G, Friedrich C, Hajdu SI (1987) Local recurrence in adult soft-tissue sarcoma. A randomized trial of brachy-therapy. Arch Surg 122:1289–1293

    PubMed  CAS  Google Scholar 

  • Brennan MF, Casper ES, Harrison LB, Shiu MH, Gaynor J, Hajdu SI (1991) The role of multimodality therapy in soft-tissue sarcoma. Ann Surg 214(3):328–336

    Article  PubMed  CAS  Google Scholar 

  • Cadman NL, Soule EH, Kelly PJ (1965) Synovial sarcoma - an analysis of 134 tumors. Cancer 18(5):613–627

    Article  PubMed  CAS  Google Scholar 

  • Cantin J, Meer GP, Chu FC, Booher RJ (1968) The problem of local recurrence after treatment of soft tissue sarcoma. Ann Surg 168(1):47–53

    Article  PubMed  CAS  Google Scholar 

  • Castro EB, Hajdu SI, Fortner JG (1973) Surgical therapy of fibrosarcoma of extremities. Arch Surg 107:284–286

    PubMed  CAS  Google Scholar 

  • Clark RL Jr, Martin RG, White EC, Old JW (1957) Clinical aspects of soft tissue tumors. Arch Surg 74:859

    Google Scholar 

  • Collin C, Hadju SI, Godbold J, Shiu MH, Hilaris BI, Brennan MF (1986) Localized, operable soft tissue sarcoma of the lower extremity. Arch Surg 121:1425–1433

    PubMed  CAS  Google Scholar 

  • Dinges S, Budach V, Budach W, Feldmann HJ, Stuschke M, Sack H (1994) Local recurrences of soft tissue sarcomas in adults: a retrospective analysis of prognostic factors in 102 cases after surgery and radiation therapy. Eur J Cancer (in press)

    Google Scholar 

  • Donhuijsen K, Budach V, Van Beuningen D, Schmidt U (1988) Instability of xenotransplanted soft tissue sarcomas. Morphologic and flow cytometric results. Cancer 61:68–75

    Article  PubMed  CAS  Google Scholar 

  • Eilber FR, Eckhardt J, Morton DL (1984a) Advances in the treatment of sarcomas of the extremity. Current status of limb salvage. Cancer 54:2695–2701

    Article  PubMed  CAS  Google Scholar 

  • Eilber FR, Morton DL, Eckardt J, Grant T, Weisenburger T (1984b) Limb salvage for skeletal and soft tissue sarcomas. Multidisciplinary preoperative therapy. Cancer 53:2579–2584

    Article  PubMed  CAS  Google Scholar 

  • Essner R, Selch M, Eilber FR (1991) Reirradiation for extremity soft tissue sarcomas. Local control and complications. Cancer 67:2813–2817

    Article  PubMed  CAS  Google Scholar 

  • Gemer LS, Trowbridge DR, Neff J, Lin F, Reddy E, Evans RG, Hassanein R (1991) Local recurrence of soft tissue sarcoma following brachyherapy. Int J Radiat Oncol Biol Phys 20(3):587–592

    Article  PubMed  CAS  Google Scholar 

  • Gerner RE, Moore GE, Pickren JW (1975) Soft tissue sarcomas. Ann Surg 181: 803–808

    Article  PubMed  CAS  Google Scholar 

  • Giuliano AE, Eilber FR (1985) The rationale for planned reoperation after unplanned total excision of soft-tissue sarcomas. J Clin Oncol 3(10): 1344–1348

    PubMed  CAS  Google Scholar 

  • Giuliano AE, Eilber FR, Morton DL (1982) The management of locally recurrent soft-tissue sarcoma. Ann Surg 196(1):87–91

    Article  PubMed  CAS  Google Scholar 

  • Graham JD, Robinson MH, Harmer CL (1992) Re-irradiation of soft-tissue sarcoma. Br J Radiol 65(770): 157–161

    Article  PubMed  CAS  Google Scholar 

  • Habrand JL, Gerbaulet A, Pejovic MH, Contesso G, Durand S, Haie C, Genin J, Schwaab G, Flamant F, Albano M et al. (1991) Twenty years experience of interstitial iridium brachytherapy in the management of soft tissue sarcomas. Int J Radiat Oncol Biol Phys 20(3):405–411

    Article  PubMed  CAS  Google Scholar 

  • Heise HW, Myers MH, Russell WO, Suit HD, Enzinger FM, Edmonson JH, Cohen J, Martin RG, Miller WT, Hajdu SI (1986) Recurrence-free survival time for surgically treated soft tissue sarcoma patients. Multivariate analysis of five prognostic factors. Cancer 57:172–177

    Article  PubMed  CAS  Google Scholar 

  • Hoekstra HJ, Sindelar WF, Kinsella TJ (1988) Surgery with intraoperative radiotherapy for sarcomas of the pelvic girdle: a pilot experience. Int J Radiat Oncol Biol Phys 15:1013–1016

    Article  PubMed  CAS  Google Scholar 

  • Hoekstra HJ, Schraffordt Koops H, Molenaar WM, Mehta DM, Sleijfer DT, Dijkhuis G, Oldhoff J (1989) A combination of intraarterial chemotherapy, preoperative and postoperative radiotherapy, and surgery as limb-saving treatment of primarily unresectable high-grade soft tissue sarcomas of the extremities. Cancer 63:59–62

    Article  PubMed  CAS  Google Scholar 

  • Issels RD, Mittermuller J, Gerl A, Simon W, Ortmaier A, Denzlinger C, Sauer H, Wilmanns W (1991) Improvement of local control by regional hyperthermia combined with systemic chemotherapy (ifosfamide plus etoposide) in advanced sarcomas: updated report on 65 patients. J Cancer Res Clin Oncol 117 Suppl 4:S141-S147

    Article  Google Scholar 

  • Issels RD, Bosse D, Abdel Rahman S, Starck M, Panzer M, Jauch KW, Stiegler H, Berger H, Sauer H, Peter K et al. (1993) Preoperative systemic etoposide/ ifosfamide/doxorubicin chemotherapy combined with regional hyperthermia in high-risk sarcoma: a pilot study. Cancer Chemother Pharmacol 31 Suppl 2:233–237

    Google Scholar 

  • Jaques DP, Coit DG, Hajdu SI, Brennan MF (1990) Management of primary and recurrent soft-tissue sarcoma of the retroperitoneum. Ann Surg 212:51–59

    Article  PubMed  CAS  Google Scholar 

  • Kinsella TJ, Sindelar WF, Lack E, Glatstein E, Rosenberg SA (1988) Preliminary results of a randomized study of adjuvant radiation therapy in resectable adult retroperitoneal soft tissue sarcomas. J Clin Oncol 6:18–25

    PubMed  CAS  Google Scholar 

  • Klaase JM, Kroon BBR, Benckhuijsen C, van Geel AN, Albus-Lutter CE, Wieberdink J (1989) Results of regional isolation perfusion with cytostatics in patients with soft tissue sarcomas of the extremities. Cancer 64:616–621

    Article  PubMed  CAS  Google Scholar 

  • Kremitz ET, Shaver JO (1963) Behavior and treatment of soft tissue sarcomas. Ann Surg 157:770

    Article  Google Scholar 

  • Lawrence W Jr, Donegan WL, Natarajan N, Mettlin C, Beart R, Winchester D (1987) Adult soft tissue sarcomas. A pattern of care survey of the American College of Surgeons. Ann Surg 205:349–359

    Article  PubMed  Google Scholar 

  • Leibel SA, Transbaugh RF, Wara WM, Beckstead JH, Bovill EG, Phillips TL (1982) Soft tissue sarcomas of the extremities: survival and patterns of failure with conservative surgery and postoperative irradiation compared to surgery alone. Cancer 50:1076–1083

    Article  PubMed  CAS  Google Scholar 

  • Leopold KA, Harrelson J, Prosnitz L, Samulski TV, Dewhirst MW, Oleson JR (1989) Preoperative hyperthermia and radiation for soft tissue sarcomas: advantage of two vs one hyperthermia treatments per week. Int J Radiat Oncol Biol Phys 16(1): 107–115

    Article  PubMed  CAS  Google Scholar 

  • Lindberg RD, Martin RG, Romsdahl MM, Barkley HTJ (1981) Conservative surgery and postoperative radiotherapy in 300 adults with soft-tissue sarcomas. Cancer 47:2391–2397

    Article  PubMed  CAS  Google Scholar 

  • Mansson E, Willems J, Aparisi T, Jakobsson P, Nilsonne U, Ringborg U (1983) Preoperative radiation therapy of high malignancy grade soft tissue sarcoma. A preliminary investigation. Acta Radiol [Oncol] 22:461–464

    Article  CAS  Google Scholar 

  • Markhede G, Angervall L, Stener B (1982) A multivariate analysis of the prognosis after surgical treatment of malignant soft-tissue tumors. Cancer 49:1721–1733

    Article  PubMed  CAS  Google Scholar 

  • Menna WG, Barnes MM, Kinsella TJ, Rosenberg SA, Lack EE, Glatstein E (1987) Combined modality treatment of adult soft tissue sarcomas of the head and neck. Int J Radiat Oncol Biol Phys 13(8): 1127–1133

    Article  Google Scholar 

  • Mills EE, Hering ER (1981) Management of soft tissue tumours by limited surgery combined with tumour bed irradiation using brachytherapy and supplementary teletherapy. Br J Radiol 54:312–317

    Article  PubMed  CAS  Google Scholar 

  • Nori D, Schupak K, Shiu MH, Brennan MF (1991) Role of brachytherapy in recurrent extremity sarcoma in patients treated with prior surgery and irradiation. Int J Radiat Oncol Biol Phys 20(6): 1229–1233

    Article  PubMed  CAS  Google Scholar 

  • O’Connor MI, Pritchard DJ, Gunderson LL (1993) Integration of limb-sparing surgery, brachytherapy, and external-beam irradiation in the treatment of soft- tissue sarcomas. Clin Orthop 289:73–80

    PubMed  Google Scholar 

  • Pack GT, Ariel IM (1985) End results in the treatment of sarcomas of the soft somatic tissues. In: Pack GT, Ariel IM (eds) Tumors of the soft somatic tissues. A clinical treatise. Hoeber, New York, pp 779–796

    Google Scholar 

  • Potter DA, Glenn J, Kinsella T, Glatstein E, Lack EE, Restrepo C, White DE, Seipp CA, Wesley R, Rosenberg SA (1985) Patterns of recurrence in patients with high-grade soft-tissue sarcomas. J Clin Oncol 3(3):353–366

    PubMed  CAS  Google Scholar 

  • Potter DA, Kinsella T, Glatstein E, Wesley R, White DE, Seipp CA, Chang AE, Lack EE, Costa J, Rosenberg SA (1986) High-grade soft tissue sarcomas of the extremities. Cancer 58:190–205

    Article  PubMed  CAS  Google Scholar 

  • Rich TA, Cady B, Mermott WV, Kase KR, Chaffey JT, Hellman S (1984) Orthovoltage intraoperative radiotherapy: a new look at an old idea. Int J Radiat Oncol Biol Phys 10:1957–1965

    Article  PubMed  CAS  Google Scholar 

  • Rouesse JG, Friedman S, Sevin DM, le Chevalier T, Spielmann ML, Contesso G, Sarrazin DM, Genin JR (1987) Preoperative induction chemotherapy in the treatment of locally advanced soft tissue sarcomas. Cancer 60:296–300

    Article  PubMed  CAS  Google Scholar 

  • Rydholm A, Gustafson P, Rooser B, Willen H, Akerman M, Herrlin K, Alvegard T (1991) Limb-sparing surgery without radiotherapy based on anatomic location of soft tissue sarcoma. J Clin Oncol 9:1757–1765

    PubMed  CAS  Google Scholar 

  • Sadoski C, Suit HD, Rosenberg A, Mankin H, Efird J (1993) Preoperative radiation, surgical margins, and local control of extremity sarcomas of soft tissues. J Surg Oncol 52:223–230

    Article  PubMed  CAS  Google Scholar 

  • Schraffordt Koops H, Eggermont AMM, Lienard D, Hoekstra HJ, van Geel B, Lejeune FJ (1993) Isolated limb perfusion (ILP) with high dose TNF-alpha, gamma-IFN and melphalan in patients with irresectable soft tissue sarcomas: a highly effective limb saving procedure (Abstr). Eur J Cancer 29A Suppl 6:183

    Article  Google Scholar 

  • Serpell JW, Ball AB, Robinson MH, Fryatt I, Fisher C, Thomas JM (1991) Factors influencing local recurrence and survival in patients with soft tissue sarcoma of the upper limb. Br J Surg 78(11): 1368–1372

    Article  PubMed  CAS  Google Scholar 

  • Shieber W, Graham P (1962) An experience with sarcomas of soft tissue in adults. Surgery 52:295

    PubMed  CAS  Google Scholar 

  • Shieber W, Graham P (1993) An experience with sarcomas of the soft tissues in adults. Surgery 52(2):295–299

    Google Scholar 

  • Shiu MH, Castro EB, Hajdu SI, Fortner JG (1975) Surgical treatment of 297 soft tissue sarcomas of the lower extremity. Ann Surg 182:597–602

    Article  PubMed  CAS  Google Scholar 

  • Shiu MH, Hilaris BS, Harrison LB, Brennan MF (1991) Brachytherapy and function-saving resection of soft tissue sarcoma arising in the limb. Int J Radiat Oncol Biol Phys 21 (6): 1485–1492

    Article  PubMed  CAS  Google Scholar 

  • Simon MA, Enneking WF (1976) The management of soft-tissue sarcomas of the extremities. J Bone Joint Surg [Am] 58:317–327

    CAS  Google Scholar 

  • Singer S, Antman K, Corson JM, Eberlein TJ (1992) Long-term salvageability for patients with locally recurrent soft-tissue sarcomas. Arch Surg 127:548–553

    PubMed  CAS  Google Scholar 

  • Stephens FO, Tattersall MH, Marsden W, Waugh RC, Green D, Marthy SW (1987) Regional chemotherapy with the use of cisplatin and doxorubicin as primary treatment for advanced sarcomas in shoulder, pelvis, and thigh. Cancer 60:724–735

    Article  PubMed  CAS  Google Scholar 

  • Stout AP (1947) Sarcoma of the soft parts. Ann Surg 168(l):47–53

    Google Scholar 

  • Suit HD (1992) Local control and patient survival. Int J Radiat Oncol Biol Phys 23(3):653–660

    Article  PubMed  CAS  Google Scholar 

  • Suit HD, Proppe KH, Mankin HJ, Woods WC (1981) Preoperative radiation therapy for soft sarcoma of soft tissue. Cancer 47:2269–2274

    Article  PubMed  CAS  Google Scholar 

  • Suit HD, Mankin HJ, Wood WC, Proppe KH (1985) Preoperative, intraoperative, and postoperative radiation in the treatment of primary soft tissue sarcoma. Cancer 55:2659–2667

    Article  PubMed  CAS  Google Scholar 

  • Tsujimoto M, Aozasa K, Ueda T, Aoki Y, Orihara M, Mizushima T, Tsujimura T, Honda M (1988) Histological changes in recurrent soft tissue sarcomas: analysis of 56 patients. Jpn J Clin Oncol 18:135–142

    PubMed  CAS  Google Scholar 

  • Wanebo HJ, Temple WJ, Popp MB, Douvill CE, Yablonski M (1990) Combination regional therapy for extremity sarcoma. A tricenter study. Arch Surg 125:355–359

    CAS  Google Scholar 

  • Willett CG, Schiller AL, Suit HD, Mankin HJ, Rosenberg A (1987) The histologic response of soft tissue sarcoma to radiation therapy. Cancer 60:1500–1504

    Article  PubMed  CAS  Google Scholar 

  • Willett CG, Suit HD, Tepper JE, Mankin HJ, Convery K, Rosenberg AL, Wood WC (1991) Intraoperative electron beam radiation therapy for retroperitoneal soft tissue sarcoma. Cancer 68:278–283

    Article  PubMed  CAS  Google Scholar 

  • Wilson RE, Antman KH, Brodsky G, Greenberger JS (1984) Tumor-cell heterogeneity in soft tissue sarcomas as defined by chemoradiotherapy. Cancer 53:1420–1425

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Charité University Clinics, Schumannstr. 20/21, 10117, Berlin, Germany

    V. Budach

  2. University Clinics of Essen, Hufelandstr. 55, 45147, Essen, Germany

    M. Stuschke & W. Budach

Authors
  1. V. Budach
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Stuschke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. Budach
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Radiotherapy, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany

    M. Bamberg  & W. Hoffmann  & 

  2. Department of Hematology and Oncology, University of Hamburg, Martinistr. 52, 20246, Hamburg, Germany

    D. K. Hossfeld

Rights and permissions

Reprints and permissions

Copyright information

© 1995 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Budach, V., Stuschke, M., Budach, W. (1995). Local Recurrences of Soft Tissue Sarcomas — A Therapeutic Challenge. In: Bamberg, M., Hoffmann, W., Hossfeld, D.K. (eds) Soft Tissue Sarcomas in Adults. Recent Results in Cancer Research, vol 138. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-78768-3_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-78768-3_12

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-78770-6

  • Online ISBN: 978-3-642-78768-3

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation