Surgery for soft tissue sarcomas

Soft-tissue sarcomas are rare tumours of extreme heterogeneity. The degree of malignancy, the dimensions, the spontaneous necrosis and vascular invasion are important prognostic factors. Surgery, curative in more than 90 % of cases, is the main therapy. Obtaining adequate surgical margins (wide or radical) is essential. An important surgical aggressiveness however requires more complex reconstructions (free flaps, motor units transplants, nerves and tendons grafts etc.). Resection margins are must be adequate or if not, the use of radiotherapy will improve local control. The effect of radiotherapy does not differ significantly whether it is used pre- or post-operatively. The first, however, most frequently leads to local complications. Interstitial brachytherapy and intra-operative radiotherapy have special advantages. Currently, with surgery combined with radiation therapy, the risk of local recurrence is less than 10 %. Loco-regional treatment (infusion of hyperthermia with TNF, neo-adjuvant chemotherapy, etc.) are reserved for non-operable patients and may produce a reduction in the neoplastic mass which allows conservative surgery in 85 % of cases