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Extremity Soft Tissue Sarcoma in Adults

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Technical Basis of Radiation Therapy

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

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Abstract

When treating soft tissue sarcomas (STSs) of the extremities, the major therapeutic goals are survival, local tumor control, optimal function, and minimal morbidity. Surgical resection of the primary tumor is the essential component of treatment for virtually all patients. A wide surgical margin is necessary for local tumor control when surgery is used without radiation, i.e., the cut should traverse normal tissue outside the reactive tumor zone. This is because sarcomas tend to infiltrate normal tissue adjacent to the evident lesion. Thus, removal of the gross lesion by a simple excision alone (only a narrow margin) is followed by relatively high rates of local recurrence. Radical resections are associated with a reduction in the local recurrence rate, but they may compromise limb function. The combination of function-sparing surgery and radiation achieves better rates of local control than either treatment alone, for nearly all patients with STSs, although combined treatment can be associated with acute wound complications in some patients and late normal tissue complications in others. Because both surgical and radiation techniques are both critically important for optimizing local control of tumor and functional outcome, it is important to manage these patients in dedicated multispecialty clinics comprised of physicians with expertise in sarcomas, including orthopedic and general oncology surgeons, radiation oncologists, medical oncologists, sarcoma pathologists, and bone and soft tissue diagnostic radiologists. Radiation therapy can be given by external beam radiation (EBRT) or brachytherapy or combination thereof. EBRT can be given either pre-operatively or post-operatively.

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References

  • Abbas JS, Holyoke ED, Moore R et al (1981) The surgical treatment and outcome of soft-tissue sarcoma. Arch Surg 116:765–769

    Article  PubMed  CAS  Google Scholar 

  • Abbatucci JS, Boulier N et al (1986) Local control and survival in soft tissue sarcomas of the limbs, trunk walls and head and neck: a study of 113 cases. Int J Radiat Oncol Biol Phys 12(4):579–586

    Article  PubMed  CAS  Google Scholar 

  • Al Yami A, Griffin AM et al (2010) Positive surgical margins in soft tissue sarcoma treated with preoperative radiation: is a postoperative boost necessary? Int J Radiat Oncol Biol Phys 77(4):1191–1197

    Article  PubMed  Google Scholar 

  • Alektiar KM, Zelefsky MJ, Brennan MF (2000) Morbidity of adjuvant brachytherapy in soft tissue sarcoma of the extremity and superficial trunk. Int J Radiat Oncol Biol Phys 47:1273–1279

    Article  PubMed  CAS  Google Scholar 

  • Alektiar KM, Brennan MF et al (2008) Impact of intensity-modulated radiation therapy on local control in primary soft-tissue sarcoma of the extremity. J Clin Oncol 26(20):3440–3444

    Article  PubMed  Google Scholar 

  • Al-Refaie WB, Andtbacka RH et al (2008) Lymphadenectomy for isolated lymph node metastasis from extremity soft-tissue sarcomas. Cancer 112(8):1821–1826

    Article  PubMed  Google Scholar 

  • Alvegard TA, Sigurdsson H, Mouridsen H et al (1989) Adjuvant chemotherapy with doxorubicin in high-grade soft tissue sarcoma: a randomized trial of the Scandinavian Sarcoma Group. J Clin Oncol 7:1504–1513

    PubMed  CAS  Google Scholar 

  • Aman P, Ron D, Fioretos T et al (1992) Rearrangement of the transcription factor gene CHOP in myxoid liposarcomas with t(12;16)(q13;p11). Genes Chromosom Cancer 5:278

    Article  PubMed  CAS  Google Scholar 

  • American joint committee on the staging of cancer staging system for soft tissue sarcomas (2010) AJCC cancer staging manual. Springer, Berlin

    Google Scholar 

  • Angervall L, Kindblom LG (1993) Principles for pathologic-anatomic diagnosis and classification of soft-tissue sarcomas. Clin Orthop 289:9–18

    PubMed  Google Scholar 

  • Antman KH (1997) Adjuvant therapy of sarcomas of soft tissue. Semin Oncol 24:556–560

    PubMed  CAS  Google Scholar 

  • Arbeit JM, Hilaris B, Brennan MF (1987) Wound complications in the multimodality treatment of extremity and superficial truncal sarcomas. J Clin Oncol 5:480–488

    PubMed  CAS  Google Scholar 

  • Austin-Seymour M, Munzenrider J, Goitein M et al (1989) Fractionated proton radiation therapy of chordoma and low grade chondrosarcoma of the base of skull. J Neurosurg 70:13–17

    Article  PubMed  CAS  Google Scholar 

  • Baldini EH, Goldberg J, Jenner C et al (1999) Long-term outcomes after function-sparing surgery without radiotherapy for soft tissue sarcoma of the extremities and trunk. J Clin Oncol 17:3252–3259

    PubMed  CAS  Google Scholar 

  • Bell RS, O’Sullivan B, Liu FF et al (1989) The surgical margin in soft tissue sarcoma. J Bone Joint Surg 71:370–375

    PubMed  CAS  Google Scholar 

  • Beltrami G, Rudiger HA et al (2008) Limb salvage surgery in combination with brachytherapy and external beam radiation for high-grade soft tissue sarcomas. Eur J Surg Oncol 34(7):811–816

    Article  PubMed  CAS  Google Scholar 

  • Benz MR, Czernin J et al (2009) FDG-PET/CT imaging predicts histopathologic treatment responses after the initial cycle of neoadjuvant chemotherapy in high-grade soft-tissue sarcomas. Clin Cancer Res 15(8):2856–2863

    Article  PubMed  CAS  Google Scholar 

  • Billingsley KG, Lewis JJ, Leung DHY et al (1999) Multifactorial analysis of the survival of patients with distant metastasis arising from primary extremity sarcoma. Cancer 85:389–395

    Article  PubMed  CAS  Google Scholar 

  • Bland KI, McCoy DM, Kinnard RE et al (1987) Application of magnetic resonance imaging and computerized tomography as an adjunct to the surgical management of soft tissue sarcomas. Ann Surg 205:473–481

    Article  PubMed  CAS  Google Scholar 

  • Blay JY, van Glabbeke M, Verweij J et al (2003) Advanced soft-tissue sarcoma: a disease that is potentially curable for a subset of patients treated with chemotherapy. Eur J Cancer 39:64–69

    Article  PubMed  Google Scholar 

  • Blay JY, von Mehren M et al (2008) Phase I combination study of trabectedin and doxorubicin in patients with soft-tissue sarcoma. Clin Cancer Res 14(20):6656–6662

    Article  PubMed  CAS  Google Scholar 

  • Blum RH, Edmonson J, Ryan L et al (1993) Efficacy of ifosfamide in combination with doxorubicin for the treatment of metastatic soft-tissue sarcoma. The Eastern Cooperative Oncology Group. Cancer Chemother Pharmacol 31(Suppl 2):S238–S240

    Google Scholar 

  • Boulad F, Kernan NA, LaQuaglia MP et al (1998) High-dose induction chemoradiotherapy followed by autologous bone marrow transplantation as consolidation therapy in rhabdomyosarcoma, extraosseous Ewing’s sarcoma, and undifferentiated sarcoma. J Clin Oncol 16:1697

    PubMed  CAS  Google Scholar 

  • Bramwell VH (1997) The role of chemotherapy in the management of non-metastatic operable extremity osteosarcoma. Semin Oncol 24:561

    PubMed  CAS  Google Scholar 

  • Bramwell VH, Mouridsen HT, Santoro A et al (1993) Cyclophosphamide versus ifosfamide: a randomized Phase 11 trial in adult soft-tissue sarcomas. The European Organization for Research and Treatment of Cancer [EORTC], Soft Tissue and Bone Sarcoma Group. Cancer Chemother Pharmacol 31(Suppl 2):S180–S184

    Google Scholar 

  • Brant TA, Parsons JT, Marcus RB et al (1990) Preoperative irradiation for soft tissue sarcomas of the trunk and extremities in adults. Int J Radiat Oncol Biol Phys 19:899–906

    Article  PubMed  CAS  Google Scholar 

  • Brodowicz T, Schwameis E, Widder J et al (2000) Intensified adjuvant IFADIC chemotherapy for adult soft tissue sarcoma. A prospective randomized feasibility trial. Sarcoma 4:151

    Article  PubMed  CAS  Google Scholar 

  • Bujko K, Suit HD, Springfield S et al (1992) Wound healing after surgery and preoperative radiation for sarcoma of soft tissues. Surg Gynecol Obstet 176:124–134

    Google Scholar 

  • Catton C, O’Sullivan B, Bell R et al (1996a) Chordoma: long-term follow-up after radical photon irradiation. Radiother Oncol 41:67–72

    PubMed  CAS  Google Scholar 

  • Catton C, Davis A, Bell R et al (1996b) Soft tissue sarcoma of the extremity. Limb salvage after failure of combined conservative therapy. Radiother Oncol 41:209–214

    Article  PubMed  CAS  Google Scholar 

  • Chan MF, Chui CS, Shupak K et al (2001) The treatment of large extraskeletal chondrosarcoma of the leg: comparison of IMRT and conformal radiotherapy techniques. J Appl Clin Med Phys 2:3–8

    Article  PubMed  CAS  Google Scholar 

  • Chibon F, Lagarde P et al (2010) Validated prediction of clinical outcome in sarcomas and multiple types of cancer on the basis of a gene expression signature related to genome complexity. Nat Med 16(7):781–787

    Article  PubMed  CAS  Google Scholar 

  • Christman KL, Casper ES, Schwartz JK et al (1993) High-intensity scheduling of ifosfamide in adult patients with soft-tissue sarcoma. Proc Ann Meet Am Soc Clin Oncol 12:A1642

    Google Scholar 

  • Clark J, Rocques PJ, Crew AJ (1994) Identification of novel genes, SYT and SSX, involved in the t(X;18)(p11.2;q11.2) translocation found in human synovial sarcoma. Nat Genet 7:502

    Article  PubMed  CAS  Google Scholar 

  • Clark MA, FIsher C, Judson I, Thomas JM (2005) Soft-tissue sarcomas in adults. N Engl J Med 22:591–604

    Google Scholar 

  • Cleator SJ, Cottril C, Harmer C et al (2001) Pattern of local recurrence after conservative surgery and radiotherapy for soft tissue sarcoma. Sarcoma 5:83–88

    Article  PubMed  CAS  Google Scholar 

  • Coindre JM, Terrier P, Bui B et al (1996) Prognostic factors in adult patients with locally controlled soft tissue sarcoma. A study of 546 patients from the French federation of cancer centers sarcoma group. J Clin Oncol 14:869–877

    PubMed  CAS  Google Scholar 

  • Collaboration SarcomaMeta-Analysis (1997) Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults: meta-analysis of individual data. Lancet 350:1647–1654

    Article  Google Scholar 

  • Cormier JN, Huang X, Xing Y et al (2004) Cohort analysis of patients with localized, high-risk, extremity soft tissue sarcoma treated at two cancer centers: chemotherapy-associated outcomes. J Clin Oncol 22:4567–4574

    Article  PubMed  Google Scholar 

  • Costa J, Wesley RA, Glatstein E et al (1984) The grading of soft tissue sarcomas. Results of a clinicohistopathologic correlation in a series of 163 cases. Cancer 53:530–541

    Article  PubMed  CAS  Google Scholar 

  • Crist WM, Anderson JR, Meza JL et al (2001) Intergroup rhabdomyosarcoma study-IV: results for patients with nonmetastatic disease. J Clin Oncol 19:3091–3102

    PubMed  CAS  Google Scholar 

  • Crozat A, Aman P et al (1993) Fusion of CHOP to a novel RNA-binding protein in human myxoid liposarcoma. Nature 363(6430):640–644

    Article  PubMed  CAS  Google Scholar 

  • Cruz AB, Thames EA Jr, Aust JB et al (1979) Combination chemotherapy for soft tissue sarcomas: a phase III study. J Surg Oncol 11:313–323

    Article  PubMed  Google Scholar 

  • Davis AM, Devlin M, Griffin AM et al (1999) Functional outcome in amputation versus limb sparing of patients with lower extremity sarcoma: a matched case-control study. Arch Phys Med Rehabil 80:615–618

    Article  PubMed  CAS  Google Scholar 

  • Davis AM, O’Sullivan B, Bell RS et al (2002) Function and health status outcomes in a randomized trial comparing preoperative and postoperative radiotherapy in extremity soft tissue sarcoma. J Clin Oncol 20:4472–4477

    Article  PubMed  CAS  Google Scholar 

  • DeChiara A, T’Ang A, Triche TJ (1993) Expression of the retinoblastoma susceptibility gene in childhood rhabdomyosarcomas. J Natl Cancer Inst 85:152–157

    Article  CAS  Google Scholar 

  • DeLaney TF, Rosenberg AE, Harmon DC et al (2003a) Soft tissue sarcomas. In: Price PM, Sikora K (eds) Treatment of cancer. Arnold, London, pp 869–907

    Google Scholar 

  • DeLaney TF, Spiro IJ, Suit HD et al (2003b) Neoadjuvant chemotherapy and radiotherapy for large extremity soft-tissue sarcomas. Int J Radiat Oncol Biol Phys 56:1117–1127

    Article  PubMed  Google Scholar 

  • Delattre O, Zucman J, Merlot T et al (1994) The Ewing family of tumors—a subgroup of small round cell tumors defined by specific chimeric transcripts. N Engl J Med 331:294–299

    Article  PubMed  CAS  Google Scholar 

  • Dewhirst MW, Boatman HD, Leopold KA et al (1990) Soft-tissue sarcomas: MR imaging and MR spectrosopy for prognosis and therapy monitoring. Radiology 174:847–853

    PubMed  CAS  Google Scholar 

  • Dias P, Dealing M, Houghton P (1994) The molecular basis of skeletal muscle differentiation. Semin Diagn Pathol 11:3–14

    PubMed  CAS  Google Scholar 

  • Dickie CI, Parent A et al (2009) A device and procedure for immobilization of patients receiving limb-preserving radiotherapy for soft tissue sarcoma. Med Dosim 34(3):243–249

    Article  PubMed  Google Scholar 

  • Dumontet C, Biron P, Bouffet E et al (1992) High dose chemotherapy with ABMT in soft tissue sarcomas: a report of 22 cases. Bone Marrow Transpl 10:405

    CAS  Google Scholar 

  • Edmonson JH, Ryan LM, Blum RH et al (1993) Randomized comparison of doxorubicin alone versus ifosfamide plus doxorubicin or mitomycin, doxorubicin, and cisplatin against advanced soft tissue sarcomas. J Clin Oncol 11:1269–1275

    PubMed  CAS  Google Scholar 

  • Eilber FR, Eckardt J (1997) Surgical management of soft tissue sarcomas. Semin Oncol 24:526–533

    PubMed  CAS  Google Scholar 

  • Eilber F, Eckardt J, Rosen G et al (1995) Preoperative therapy for soft tissue sarcoma. Hematol Oncol Clin North Am 9:817–823

    PubMed  CAS  Google Scholar 

  • Eilber FC, Rosen G, Eckardt J et al (2001) Treatment-induced pathologic necrosis: a predictor of local recurrence and survival in patients receiving neoadjuvant therapy for high-grade extremity soft tissue sarcomas. J Clin Oncol 19:3203–3209

    PubMed  CAS  Google Scholar 

  • Eilber FC, Rosen G, Nelson SD et al (2003) High-grade extremity soft tissue sarcomas: factors predictive of local recurrence and its effect on morbidity and mortality. Ann Surg 237:218–226

    PubMed  Google Scholar 

  • Elias AD, Antman KH (1986) Doxorubicin, ifosfamide, and dacarbazine (AID) with mesna uroprotection for advanced untreated sarcoma: a phase I study. Cancer Treatment Rep 70:827–833

    CAS  Google Scholar 

  • Elias A, Ryan L, Sulkes A et al (1989) Response to mesna, doxorubicin, ifosfamide and dacarbazine in 108 patients with metastatic or unresectable sarcoma and no prior chemotherapy. J Clin Oncol 7:1208–1216

    PubMed  CAS  Google Scholar 

  • Engellau J (2004) Prognostic factors in soft tissue sarcoma: tissue microarray for immunostaining, the importance of whole-tumor sections and time-dependence. Acta Orthop Scand 75(Suppl 314):1–52

    Google Scholar 

  • Fata F, O’Reilly E, Ilson D et al (1999) Paclitaxel in the treatment of patients with angiosarcoma of the scalp or face. Cancer 86:2034–2037

    Article  PubMed  CAS  Google Scholar 

  • Fein DA, Lee WR, Lanciano RM et al (1995) Management of extremity soft tissue sarcomas with limb-sparing surgery and postoperative irradiation: do total dose, overall treatment time, and the surgery-radiotherapy interval impact on local control? Int J Radiat Oncol Biol Phys 32:969–976

    Article  PubMed  CAS  Google Scholar 

  • Ferrari A, Gronchi A, Casanova M et al (2004) Synovial sarcoma: a retrospective analysis of 271 patients of all ages treated at a single institution. Cancer 101:627–634

    Article  PubMed  Google Scholar 

  • Fong Y, Coal DG, Woodruff JM et al (1993) Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective data base of 1772 sarcoma patients. Ann Surg 217:72–77

    Article  PubMed  CAS  Google Scholar 

  • Frustaci S, Gherlinzoni F, DePaoli A et al (2001) Adjuvant chemotherapy for adult soft tissue sarcomas of the extremities and girdles: results of the Italian cooperative trial. J Clin Oncol 19:1238–1247

    PubMed  CAS  Google Scholar 

  • Gadd MA, Casper ES, Woodruff J et al (1993) Development and treatment of pulmonary metastases in adult patients with extremity soft tissue sarcoma. Ann Surg 218:705–712

    Article  PubMed  CAS  Google Scholar 

  • Garcia-Carbonero R, Supko JG et al (2005) Ecteinascidin-743 (ET-743) for chemotherapy-naive patients with advanced soft tissue sarcomas: multicenter phase II and pharmacokinetic study. J Clin Oncol 23(24):5484–5492

    Article  PubMed  CAS  Google Scholar 

  • Gerrand CH, Wunder JS, Kandel A et al (2004) The influence of anatomic location on functional outcome in lower-extremity soft-tissue sarcoma. Ann Surg Oncol 11:476–482 Epub 12.4.2004

    Article  PubMed  CAS  Google Scholar 

  • Goffman T, Tochner Z, Glatstein E et al (1991) Primary treatment of large and massive adult sarcomas with iododeoxyuridine and aggressive hyperfractionated irradiation. Cancer 67:572–576

    Article  PubMed  CAS  Google Scholar 

  • Gossot D, Radu C et al (2009) Resection of pulmonary metastases from sarcoma: can some patients benefit from a less invasive approach? Ann Thorac Surg 87(1):238–243

    Article  PubMed  Google Scholar 

  • Gottlieb JA, Baker LH, Quagliana JM et al (1972) Chemotherapy of sarcomas with a combination of adriamycin and dimethyl triazeno imidazole carboxamide. Cancer 30:1632–1638

    Article  PubMed  CAS  Google Scholar 

  • Gottlieb JA, Benjamin RS, Baker LH et al (1976) Role of DTIC (NSC45388) in the chemotherapy of sarcomas. Cancer Treat Rep 60:199–203

    PubMed  CAS  Google Scholar 

  • Grabois M, Frappaz D, Bouffet E et al (1994) High-dose VP-16 cisplatinum in soft tissue sarcomja of children. Cancer Chemother Pharmacol 33:355–357

    Article  PubMed  CAS  Google Scholar 

  • Grobmyer SR, Maki RG, Demetri GD et al (2004) Neo-adjuvant chemotherapy for primary high-grade extremity soft tissue sarcoma. Ann Oncol 15:1667–1672

    Article  PubMed  CAS  Google Scholar 

  • Gronchi A, Casali PG, Mariani L et al (2005) Status of surgical margins and prognosis in adult soft tissue sarcomas of the extremities: a series of patients treated at a single institution. J Clin Oncol 23:96–104

    Article  PubMed  CAS  Google Scholar 

  • Gronchi A, Lo Vullo S et al (2010) Extremity soft tissue sarcoma in a series of patients treated at a single institution: local control directly impacts survival. Ann Surg 251(3):506–511

    Article  PubMed  Google Scholar 

  • Gustafson P, Herrlin K, Biling L et al (1992) Necrosis observed on CT enhancement is of prognostic value in soft tissue sarcoma. Acta Radiol 33:474–476

    PubMed  CAS  Google Scholar 

  • Harrison LB, Franzese F, Gaynor JJ et al (1993) Long-term results of a prospective randomized trial of adjuvant brachytherapy in the management of completely resected soft tissue sarcomas of the extremity and superficial trunk. Int J Radiat Oncol Biol Phys 27:259–265

    Article  PubMed  CAS  Google Scholar 

  • Hensley ML, Maki RG, Venkatraman E et al (2002) Gemcitabine and docetaxel in patients with unresectable leiomyosarcoma: results of a phase II trial. J Clin Oncol 20:2824–2831

    Article  PubMed  CAS  Google Scholar 

  • Hong L, Alektiar KM, Hunt M et al (2004) Intensity-modulated radiotherapy for soft tissue sarcoma of the thigh. Int J Radiat Oncol Biol Phys 59:752–759

    Article  PubMed  Google Scholar 

  • Italiano AF, Delva, et al (2010) Effect of adjuvant chemotherapy on survival in FNCLCC grade 3 soft tissue sarcomas: a multivariate analysis of the French sarcoma group database. Ann Oncol

    Google Scholar 

  • Jakob J, Wenz F et al (2009) Preoperative intensity-modulated radiotherapy combined with temozolomide for locally advanced soft-tissue sarcoma. Int J Radiat Oncol Biol Phys 75(3):810–816

    Article  PubMed  CAS  Google Scholar 

  • Jebsen NL, Trovik CS et al (2008) Radiotherapy to improve local control regardless of surgical margin and malignancy grade in extremity and trunk wall soft tissue sarcoma: a Scandinavian sarcoma group study. Int J Radiat Oncol Biol Phys 71(4):1196–1203

    Article  PubMed  Google Scholar 

  • Jemal A, Siegel R, Xu J et al (2010) Cancer statistics, 2010. CA Cancer J Clin 60:277–300

    Article  PubMed  Google Scholar 

  • Johnstone PAS, Wexler LH, Venzon DJ et al (1994) Sarcomas of the hand and foot: analysis of local control and functional result with combined modality therapy in extremity preservation. Int J Radiat Oncol Biol Phys 29:735–745

    Article  PubMed  CAS  Google Scholar 

  • Judson I (2004) Systemic therapy of soft tissue sarcoma: an improvement in outcome. Ann Oncol 15(Suppl 4):iv193–iv196

    Google Scholar 

  • Karakousis CP, Driscoll DL (1999) Treatment and local control of primary extremity soft tissue sarcomas. J Surg Oncol 71:155–161

    Article  PubMed  CAS  Google Scholar 

  • Karakousis CP, Holtermann OA, Holyoke ED (1979) Cis-dichlorodiammineplatinum (II) in metastatic soft tissue sarcomas. Cancer Treat Rep 63:2071–2072

    PubMed  CAS  Google Scholar 

  • Karakousis CP, Emrich LJ, Rao U et al (1986) Feasibility of limb salvage and survival in soft tissue sarcomas. Cancer 57:484–491

    Article  PubMed  CAS  Google Scholar 

  • Karakousis CP, Proimakis C, Rao U et al (1996) Local recurrence and survival in soft-tissue sarcomas. Ann Surg Oncol 3:255–260

    Article  PubMed  CAS  Google Scholar 

  • Karakousis CP, de Young C, Driscoll DL et al (1998) Soft tissue sarcomas of the hand and foot: management and survival. Ann Surg Oncol 5:238–240

    Article  PubMed  CAS  Google Scholar 

  • Kepka L, DeLaney TF, Goldberg SI et al (2005) Results of radiation therapy for unresected soft tissue sarcomas. Int J Radiat Oncol Biol Phys 63:852–859

    Article  PubMed  Google Scholar 

  • Kim B, Chen YL et al (2010) An effective preoperative three-dimensional radiotherapy target volume for extremity soft tissue sarcoma and the effect of margin width on local control. Int J Radiat Oncol Biol Phys 77(3):843–850

    Article  PubMed  Google Scholar 

  • Koutcher JA, Ballon D, Graham M et al (1990) 31P NMR spectra of extremity sarcomas: diversity of metabolic profiles and changes in response to chemotherapy. Magn Reson Imaging Med 16:19–34

    Article  CAS  Google Scholar 

  • Kransdorf MJ, Jelinek JS, Moser RP et al (1993) Imaging of soft tissue tumors. Radiol Clin North Am 31:359–371

    PubMed  CAS  Google Scholar 

  • Kraybill WG, Harris J et al (2006) Phase II study of neoadjuvant chemotherapy and radiation therapy in the management of high-risk, high-grade, soft tissue sarcomas of the extremities and body wall: radiation therapy oncology group trial 9514. J Clin Oncol 24(4):619–625

    Article  PubMed  CAS  Google Scholar 

  • Kretzler A, Molls M, Gradinger R et al (2004) Intraoperative radiotherapy of soft tissue sarcoma of the extremity. Perioperative fractionated high-dose rate brachytherapy in the treatment of soft tissue sarcomas. Strahlenther Onkol 180:365–370

    Article  PubMed  Google Scholar 

  • Krikelis D, Judson I (2010) Role of chemotherapy in the management of soft tissue sarcomas. Expert Rev Anticancer Ther 10(2):249–260

    Article  PubMed  CAS  Google Scholar 

  • Kulander BG, Polissar L, Yang CY et al (1989) Grading of soft tissue sarcomas: necrosis as a determinate of survival. Modern Pathol 2:205–208

    CAS  Google Scholar 

  • Lack EE, Steinberg SM, White DE et al (1989) Extremity soft tissue sarcomas: analysis of prognostic variables in 300 cases and evaluation of tumor necrosis as a factor in stratifying higher grade sarcomas. J Surg Oncol 263:73

    Google Scholar 

  • Ladanyi M, Lui MY et al (2001) The der(17)t(X;17)(p11;q25) of human alveolar soft part sarcoma fuses the TFE3 transcription factor gene to ASPL, a novel gene at 17q25. Oncogene 20(1):48–57

    Article  PubMed  CAS  Google Scholar 

  • Lang H, Nussbaum KT, Kaudel P et al (2000) Hepatic metastases from leiomyosarcoma: a single-center experience with 34 liver resections during a 15-year period. Ann Surg 231:500

    Article  PubMed  CAS  Google Scholar 

  • Lawrence W Jr, Donegan WL, Natarajan N et al (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 

  • Le Cesne A, Judson I, Crowther D et al (2000) Randomized phase III study comparing conventional-dose doxorubicin plus ifosfamide versus high-dose doxorubicin plus ifosfamide plus recombinant human granulocyte-macrophage colony-stimulating factor in advanced soft tissue sarcomas: a trial of the European organization for research and treatment of cancer/soft tissue and bone sarcoma group. J Clin Oncol 18:2676–2684

    PubMed  CAS  Google Scholar 

  • Lee N, Chuang C, Quivey JM et al (2002) Skin toxicity due to intensity-modulated radiotherapy for head-and-neck carcinoma. Int J Radiat Oncol Biol Phys 53:630–637

    Article  PubMed  Google Scholar 

  • LeVay J, O’Sullivan B, Catton C et al (1993) Outcome and prognostic factors in soft tissue sarcoma in the adult. Int J Radiat Oncol Biol Phys 27:1091

    Article  PubMed  CAS  Google Scholar 

  • Levin WP, Kooy H, Loeffler JS, DeLaney TF (2005) Proton beam therapy. Br J Cancer 93:849–854

    Article  PubMed  CAS  Google Scholar 

  • Lindberg RD, Martin R, Romsdahl M et al (1981) Conservative surgery and postoperative radiotherapy in 300 adults with soft-tissue sarcomas. Cancer 47:2391–2397

    Article  PubMed  CAS  Google Scholar 

  • Lorigan P, Verweij J et al (2007) Phase III trial of two investigational schedules of ifosfamide compared with standard-dose doxorubicin in advanced or metastatic soft tissue sarcoma: a European organisation for research and treatment of cancer soft tissue and bone sarcoma group study. J Clin Oncol 25(21):3144–3150

    Article  PubMed  CAS  Google Scholar 

  • Markhede G, Angervall L, Stener B et al (1981) A multivariate analysis of the prognosis after surgical treatment of malignant soft tissue tumors. Cancer 40:1721–1733

    Google Scholar 

  • Mazeron JJ, Suit HD (1987) Lymph nodes as sites of metastasis from sarcomas of soft tissue. Cancer 60:1800–1808

    Article  PubMed  CAS  Google Scholar 

  • Merimsky O, Meller I, Issakov J et al (1999) Adriamycin-ifosfamide induction chemotherapy for extremity soft tissue sarcoma: comparison of two non-randomized protocols. Oncol Rep 6:913–920

    PubMed  CAS  Google Scholar 

  • Mundt AJ, Awan A, Sibley S et al (1995) Conservative surgery and adjuvant radiation therapy in the management of adult soft tissue sarcoma of the extremities: clinical and radiobiological results. Int J Radiat Oncol Biol Phys 32:977–985

    Article  PubMed  CAS  Google Scholar 

  • Myhre-Jensen M, Kaae S, Madsen EH et al (1975) Histopathological grading in soft tissue tumors. Acta Pathol Microbiol Immunol Scand 91:145–150

    Google Scholar 

  • Nag S, Shasha D, Janjan N et al (2001) The American brachytherapy society recommendations for brachytherapy of soft tissue sarcomas. Int J Radiat Oncol Biol Phys 49:1033–1043

    Article  PubMed  CAS  Google Scholar 

  • Negendank WG, Crowley MG, Ryan JR et al (1989) Bone and soft tissue lesions: diagnosis with combined H-1 MR imaging and P-31 spectroscopy. Radiology 173:181–187

    PubMed  CAS  Google Scholar 

  • Niewald M, Berberich W, Schnabel K et al (1990) A simple method for positioning and fixing the extremities during the radiotherapy of soft-tissue sarcomas. Strahlenther Onkol 166:295–296

    PubMed  CAS  Google Scholar 

  • Nieweg OE, Pruim J, van Ginkel J et al (1996) Fluorine-18-Flurodeoxyglucose PET imaging of soft-tissue sarcoma. J Nucl Med 37:257–261

    PubMed  CAS  Google Scholar 

  • Noria S, Davis A, Krandel R et al (1996) Residual disease following unplanned excision of soft-tissue sarcoma of an extremity. J Bone Joint Surg Am 78:650–655

    PubMed  CAS  Google Scholar 

  • O’Bryan RM, Baker LH, Gottleib JE et al (1977) Dose response evaluation of adriamycin in human neoplasia. Cancer 39:1940–1948

    Article  PubMed  Google Scholar 

  • O’Keefe F, Lorigan JG, Wallace S et al (1990) Radiological features of extraskeletal Ewing sarcoma. Br J Radiol 63:456–460

    Article  Google Scholar 

  • O’Sullivan B, Davis A, Bell R et al (1999) Phase III randomized trial of pre-operative versus post-operative radiotherapy in the curative management of extremity soft tissue sarcoma. A Canadian sarcoma group and NCI Canada clinical rials group study. Proc ASCO 18:2066A

    Google Scholar 

  • O’Sullivan B, Davis AM, Turcotte R et al (2002) Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomized trial. Lancet 359:2235–2241

    Article  PubMed  Google Scholar 

  • O’Sullivan B, Davis AM, Turcotte R et al (2004) Five-year results of a randomized phase III trial of pre-operative vs. post-operative radiotherapy in extremity soft tissue sarcoma. Proc Am Soc Clin Oncol 23:815

    Google Scholar 

  • Panagopoulos I, Hoglund M, Mertens F et al (1996) Fusion of EWS and CHOP genes in myxoid liposarcoma. Oncogene 12:489–494

    PubMed  CAS  Google Scholar 

  • Pao WJ, Pilepich MV (1990) Postoperative radiotherapy in the treatment of extremity soft tissue sarcomas. Int J Radiat Oncol Biol Phys 19:907–911

    Article  PubMed  CAS  Google Scholar 

  • Pappo AS, Lyden E et al (2007) Two consecutive phase II window trials of irinotecan alone or in combination with vincristine for the treatment of metastatic rhabdomyosarcoma: the children’s oncology group. J Clin Oncol 25(4):362–369

    Article  PubMed  CAS  Google Scholar 

  • Parham DM, Shapiro DN, Downing R et al (1994) Solid alveolar rhabdomyosarcomas with the t(2;13). Report of two cases with diagnostic implications. Am J Surg Pathol 18:474–478

    Article  PubMed  CAS  Google Scholar 

  • Pawlik TM, Vauthey JN et al (2006) Results of a single-center experience with resection and ablation for sarcoma metastatic to the liver. Arch Surg 141(6):537–543 discussion 543–534

    Article  PubMed  Google Scholar 

  • Pearlstone DB, Janjan NA, Feig W et al (1999a) Re-resection with brachytherapy for locally recurrent soft tissue sarcoma arising in a previously radiated field (see comments). Cancer J Sci Am 5:26–33

    PubMed  CAS  Google Scholar 

  • Pearlstone DB, Pisters PW, Bold J et al (1999b) Patterns of recurrence in extremity liposarcoma: Implications for staging and follow-up. Cancer 85:85–92

    Article  PubMed  CAS  Google Scholar 

  • Petera J, Neumanova R, Odrazka K et al (2004) Perioperative fractionated high-dose rate brachytherapy in the treatment of soft tissue sarcomas. Neoplasma 51:59–63

    PubMed  CAS  Google Scholar 

  • Petrioli R, Coratti A, Correale P et al (2002) Adjuvant epirubicin with or without Ifosfamide for adult soft-tissue sarcoma. Am J Clin Oncol 25:468–473

    Article  PubMed  Google Scholar 

  • Peuchot M, Libshitz HI (1987) Pulmonary metastatic disease: radiologic-surgical correlation. Radiology 164:719–722

    PubMed  CAS  Google Scholar 

  • Pickering DG, Stewart JS, Rampling R et al (1987) Fast neutron therapy for soft tissue sarcoma. Int J Radiat Oncol Biol Phys 13:1489–1495

    Article  PubMed  CAS  Google Scholar 

  • Pinedo HM, Verweij J (1986) The treatment of soft tissue sarcomas with a focus on chemotherapy: a review. Radiother Oncol 6:193–205

    Article  Google Scholar 

  • Pisters PW, Harrison LB, Leung DH et al (1996a) Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 14:859–868

    PubMed  CAS  Google Scholar 

  • Pisters PW, Leung DH, Woodruff J et al (1996b) Analysis of prognostic factors in 1041 patients with localized soft tissue sarcomas of the extremities. J Clin Oncol 14:1679–1689

    PubMed  CAS  Google Scholar 

  • Pisters PW, Pollock RE et al (2007) Long-term results of prospective trial of surgery alone with selective use of radiation for patients with T1 extremity and trunk soft tissue sarcomas. Ann Surg 246(4):675–681 discussion 681–672

    Article  PubMed  Google Scholar 

  • Pogrebniak HW, Roth JA, Steinberg M et al (1991) Reoperative pulmonary resection in patients with metastatic soft tissue sarcoma. Ann Thorac Surg 52:197–203

    Article  PubMed  CAS  Google Scholar 

  • Potter DA, Glenn J, Kinsella T et al (1985) Patterns of recurrence in patients with high-grade soft tissue sarcomas. J Clin Oncol 3:353–366

    PubMed  CAS  Google Scholar 

  • Pradhan A, Cheung YC et al (2008) Soft-tissue sarcomas of the hand: oncological outcome and prognostic factors. J Bone Joint Surg Br 90(2):209–214

    Article  PubMed  CAS  Google Scholar 

  • Prosnitz LR, Maguire P, Anderson JM et al (1999) The treatment of high-grade soft tissue sarcomas with preoperative thermoradiotherapy. Int J Radiat Oncol Biol Phys 45:941–949

    Article  PubMed  CAS  Google Scholar 

  • Redmond OM, Bell E, Stack JP et al (1992) Tissue characterization and assessment of preoperative chemotherapeutic response in musculoskeletal tumors by in vivo 31p magnetic resonance spectroscopy. Magn Reson Med 27:226–237

    Article  PubMed  CAS  Google Scholar 

  • Rhomberg W, Hassenstein EO, Gefeller D et al (1996) Radiotherapy vs. radiotherapy and razoxane in the treatment of soft tissue sarcomas: final results of a randomized study. Int J Radiat Oncol Biol Phys 36:1077–1084

    Article  PubMed  CAS  Google Scholar 

  • Robinson M, Barr L, Fisher C et al (1990) Treatment of extremity soft tissue sarcomas with surgery and radiotherapy. Radiother Oncol 18:221–233

    Article  PubMed  CAS  Google Scholar 

  • Robinson MH, Spruce L, Eeles R et al (1991) Limb function following conservation treatment of adult soft tissue sarcoma. Eur J Cancer 27:1567–1574

    Article  PubMed  CAS  Google Scholar 

  • Robinson MH, Ball AB, Schofield J et al (1992) Preoperative radiotherapy for initially inoperable extremity soft tissue sarcomas. Clin Oncol (R Coll Radiol) 4:36–43

    Article  CAS  Google Scholar 

  • Rosen G, Caparros B, Nirenberg A et al (1981) Ewing’s sarcoma: ten-year experience with adjuvant chemotherapy. Cancer 47:2204–2213

    Article  PubMed  CAS  Google Scholar 

  • Rosenberg SA, Tepper J, Glatstein E et al (1982) The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg 196:305–315

    Article  PubMed  CAS  Google Scholar 

  • Rubin BP, Fletcher CD et al (2006) Protocol for the examination of specimens from patients with soft tissue tumors of intermediate malignant potential, malignant soft tissue tumors, and benign/locally aggressive and malignant bone tumors. Arch Pathol Lab Med 130(11):1616–1629

    PubMed  Google Scholar 

  • Ruka W, Taghian A, Gioioso D et al (1996) Comparison between the in vitro intrinsic radiation sensitivity of human soft tissue sarcoma and breast cancer cell lines. J Surg Oncol 61:290–294

    Article  PubMed  CAS  Google Scholar 

  • Russell WO, Cohen J, Enzinger F et al (1977) A clinical and pathological staging system for soft tissue sarcomas. Cancer 40:1562–1570

    Article  PubMed  CAS  Google Scholar 

  • Rydholm A, Berg NO, Gullberg B et al (1984) Epidemiology of soft tissue sarcoma in the locomotor system. Acta Pathol Microbiol Immunol Scand [A] 92:363–374

    CAS  Google Scholar 

  • Rydholm A, Gustafson P, Rooser B et al (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 et al (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 

  • Sanchez RB, Quinn SF, Walling A et al (1990) Musculoskeletal neoplasms after intraarterial chemotherapy: correlation of MR images with pathologic specimens. Radiology 174:237–240

    PubMed  CAS  Google Scholar 

  • Santoro A, Tursz T, Mouridsen H et al (1995) Doxorubicin versus CYVADIC versus doxorubicin plus ifosfamide in first-line treatment of advanced soft tissue sarcomas: a randomized study of the European organization for research and treatment of cancer soft tissue and bone sarcoma group. J Clin Oncol 13:1537–1545

    PubMed  CAS  Google Scholar 

  • Schmitt G, Pape H, Zamboglou M et al (1990) Long term results of neutron- and neutron-boost irradiation of soft tissue sarcomas. Strahlenther Onkol 166:61–62

    PubMed  CAS  Google Scholar 

  • Schoenfeld DA, Rosenbaum C, Horton J et al (1982) A comparison of adriamycin versus vincristine and adriamycin, and cyclophosphamide versus vincristine, actinomycin-D, and cyclophosphamide for advanced sarcoma. Cancer 50:2757–2762

    Article  PubMed  CAS  Google Scholar 

  • Schray MF, Gunderson LL, Sim FH et al (1990) Soft tissue sarcomas. Integration of brachytherapy, resection, and external irradiation. Cancer 66:451–456

    Article  PubMed  CAS  Google Scholar 

  • Schuetze SM, Rubin BP, Vernon C et al (2005) Use of positron emission tomoography in localized extremity soft tissue sarcoma treated with neoadjuvant chemotherapy. Cancer 103:339–348

    Article  PubMed  Google Scholar 

  • Schutte J, Mouridsen HT, Steward W et al (1993) Ifosfamide plus doxorubicin in previously untreated patients with advanced soft-tissue sarcoma. Cancer Chemother Pharmacol 31(Suppl 2):S204–S209

    Google Scholar 

  • Schwella N, Rick O, Meyer O et al (1998) Mobilization of peripheral blood progenitor cells by disease-specific chemotherapy in patients with soft tissue sarcoma. Bone Marrow Transpl 21:863–868

    Article  CAS  Google Scholar 

  • Scurr M, Juson I (2005) Neoadjuvant and adjuvant therapy for extremity soft tissue sarcoma. Hematol Oncol Clin North Am 19:489–500

    Article  PubMed  Google Scholar 

  • Segal NH, Pavlidis P et al (2003) Classification and subtype prediction of adult soft tissue sarcoma by functional genomics. Am J Pathol 163(2):691–700

    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

    PubMed  CAS  Google Scholar 

  • Spillane AJ, Fisher C, Thomas JM et al (1999) Myxoid liposarcoma - the frequency and the natural history of nonpulmonary soft tissue metastases. Ann Surg Oncol 6:389–394

    Article  PubMed  CAS  Google Scholar 

  • Steingraber M, Lessel A, Jahn U et al (1996) Fast neutron therapy in treatment of soft tissue sarcoma - the Berlin-Buch study. Bull Cancer Radiother 83(Suppl):122s–124s

    Google Scholar 

  • Stenman G, Andersson H et al (1995) Translocation t(9;22)(q22;q12) is a primary cytogenetic abnormality in extraskeletal myxoid chondrosarcoma. Int J Cancer 62(4):398–402

    Article  PubMed  CAS  Google Scholar 

  • Steward WP, Verweij J, Somers R et al (1993) Granulocyte-macrophage colony-stimulating factor allows safe escalation of dose-intensity of chemotherapy in metastatic adult soft tissue sarcomas: a study of the European organization for research and treatment of cancer soft tissue and bone sarcoma group. J Clin Oncol 11:15–21

    PubMed  CAS  Google Scholar 

  • Stinson SF, DeLaney TF, Greenberg J et al (1991) Acute and long term effects on limb function of combined modality limb sparing therapy for extremity soft tissue sarcomas. Int J Radiat Oncol Biol Phys 21:1493–1499

    Article  PubMed  CAS  Google Scholar 

  • Subramanian S, Wiltshaw E (1978) Chemotherapy of sarcoma. Lancet 1:683–686

    Article  PubMed  CAS  Google Scholar 

  • Sugarbaker PH, Barofsky I, Rosenberg SA et al (1982) Quality of life assessment of patients in extremity sarcoma clinical trials. Surgery 91:17–23

    PubMed  CAS  Google Scholar 

  • Suit HD, Russell WO, Martin RG et al (1975) Sarcoma of soft tissue: clinical and histopathologic parameters and response to treatment. Cancer 35:1478–1483

    Article  PubMed  CAS  Google Scholar 

  • Suit HD, Mankin HJ, Wood WC et al (1988) Treatment of the patient with stage M0 sarcoma of soft tissue. J Clin Oncol 6:854–862

    PubMed  CAS  Google Scholar 

  • Talbert ML, Zagars GK, Sherman NE et al (1990) Conservative surgery and radiation therapy for soft tissue sarcoma of the wrist, hand, ankle, and foot. Cancer 66:2482–2491

    Article  PubMed  CAS  Google Scholar 

  • Tanabe KK, Pollock RE, Ellis LM et al (1994) Influence of surgical margins on outcome in patients with preoperatively irradiated extremity soft tissue sarcomas. Cancer 73:1652–1659

    Article  PubMed  CAS  Google Scholar 

  • Tepper JE, Suit HD (1985) Radiation therapy alone for sarcoma of soft tissue. Cancer 56:475–479

    Article  PubMed  CAS  Google Scholar 

  • Tepper J, Rosenberg SA, Glatstein E et al (1982) Radiation therapy technique in soft tissue sarcomas of the extremity - policies of treatment at the National Cancer Institute. Int J Radiat Oncol Biol Phys 8:263–273

    Article  PubMed  CAS  Google Scholar 

  • The NCCN Clinical practice guidelines in oncology (NCCN Guidelinesâ„¢) soft tissue sarcoma (Version 2.2010). © 2010 National Comprehensive Cancer Network, Inc. Available at: NCCN.org. Accessed November 1, 2010. To view the most recent and complete version of the NCCN Guidelinesâ„¢, go on-line to NCCN.org

    Google Scholar 

  • Todoroki T, Suit HD (1985) Therapeutic advantage in preoperative single-dose radiation combined with conservative and radical surgery in different-size murine fibrosarcomas. J Surg Oncol 29:207–215

    Article  PubMed  CAS  Google Scholar 

  • Torosian MH, Friedrich C, Godbold J et al (1988) Soft-tissue sarcoma: initial characteristics and prognostic factors in patients with and without metastatic disease. Semin Surg Oncol 4:13–19

    Article  PubMed  CAS  Google Scholar 

  • Torres MA, Ballo MT et al (2007) Management of locally recurrent soft-tissue sarcoma after prior surgery and radiation therapy. Int J Radiat Oncol Biol Phys 67(4):1124–1129

    Article  PubMed  Google Scholar 

  • Trojani M (1984) Staging system for soft tissue and bone. Int J Cancer 33:37–42

    Article  PubMed  CAS  Google Scholar 

  • Trovik CS, Bauer HC, Alvegard A et al (2000) Surgical margins, local recurrence and metastasis in soft tissue sarcomas: 559 surgically-treated patients from the Scandinavian sarcoma group register. Eur J Cancer 36:710–716

    Article  PubMed  CAS  Google Scholar 

  • Tseng JF, Ballo MT et al (2006) The effect of preoperative radiotherapy and reconstructive surgery on wound complications after resection of extremity soft-tissue sarcomas. Ann Surg Oncol 13(9):1209–1215

    Article  PubMed  Google Scholar 

  • Ueda T, Yoshikawa H, Mori S et al (1997) Influence of local recurrence on the prognosis of soft-tissue sarcomas. J Bone Joint Surg Br 79:553–557

    Article  PubMed  CAS  Google Scholar 

  • Van Oosterom AT, Mouridsen HT, Nielsen S et al (2002) EORTC soft tissue and bone sarcoma group. Results of randomised studies of the EORTC soft tissue and bone sarcoma group (STBSG) with two different ifosfamide regimens in first- and second-line chemotherapy in advanced soft tissue sarcoma patients. Eur J Cancer 38:2397–2406

    Article  PubMed  Google Scholar 

  • Vanel D, Lacombe MJ, Couanet D et al (1987) Musculoskeletal tumors follow-up with MR imaging after treatment with surgery and radiation therapy. Radiology 164:243–245

    PubMed  CAS  Google Scholar 

  • Verhey LJ (1999) Comparison of three-dimensional conformal radiation therapy and intensity-modulated radiation therapy systems. Semin Radiat Oncol 9:78–98

    Article  PubMed  CAS  Google Scholar 

  • Wanebo HJ, Temple WJ, Popp MB et al (1995) Preoperative regional therapy for extremity sarcoma. A tricenter update. Cancer 75:2299–2306

    Article  PubMed  CAS  Google Scholar 

  • Weddington WW Jr, Segraves KB, Simon MA et al (1985) Psychological outcome of extremity sarcoma survivors undergoing amputation or limb salvage. J Clin Oncol 3:1393–1399

    PubMed  Google Scholar 

  • Weiss SW, Goldblum JR (2008) Enzinger and Weiss’s soft tissue tumors. Mosby, Philadelphia

    Google Scholar 

  • White LM, Wunder JS et al (2005) Histologic assessment of peritumoral edema in soft tissue sarcoma. Int J Radiat Oncol Biol Phys 61(5):1439–1445

    Article  PubMed  Google Scholar 

  • Williard WC, Hajdu SI, Casper ES et al (1992) Comparison of amputation with limb-sparing operations for adult soft tissue sarcoma of the extremity269. Ann Surg 215:389–396

    Google Scholar 

  • Wilson RR (1946) Radiological uses of fast protons. Radiology 47:487–491

    PubMed  CAS  Google Scholar 

  • Wilson AN, Davis A et al (1994) Local control of soft tissue sarcoma of the extremity: the experience of a multidisciplinary sarcoma group with definitive surgery and radiotherapy. Eur J Cancer 30A(6):746–751

    Article  PubMed  CAS  Google Scholar 

  • Woll PJ, van Glabbeke M, Hohenberger P, et al. (2007) Adjuvant chemotherapy with doxorubicin and ifosfamide in resected soft tissue sarcoma: intermin analysis of a randomised phase III trial. J Clin Oncol 25 (18S): Abstract 10008

    Google Scholar 

  • Yang JC, Chang AE, Baker AR et al (1998) Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 16:197–203

    PubMed  CAS  Google Scholar 

  • Yovine A, Riofrio M, Blay JY et al (2004) Phase II study of ecteinascidin-743 in advanced pretreated soft tissue sarcoma patients. J Clin Oncol 22:890–899

    Article  PubMed  CAS  Google Scholar 

  • Zagars GK, Ballo MT (2003) Significance of dose in postoperative radiotherapy for soft tissue sarcoma. Int J Radiat Oncol Biol Phys 56:473–481

    Article  PubMed  Google Scholar 

  • Zagars GK, Ballo MT, Pisters PW et al (2003a) Surgical margins and reresection in the management of patients with soft tissue sarcoma using conservative surgery and radiation therapy. Cancer 97:2544–2553

    Article  PubMed  Google Scholar 

  • Zagars GK, Ballo MT, Pisters PW et al (2003b) Prognostic factors for patients with localized soft-tissue sarcoma treated with conservation surgery and radiation therapy: an analysis of 225 patients. Cancer 97:2530–2543

    Article  PubMed  Google Scholar 

  • Zucman J, Delattre O et al (1993) EWS and ATF-1 gene fusion induced by t(12;22) translocation in malignant melanoma of soft parts. Nat Genet 4(4):341–345

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Radiation Oncology Branch, National Cancer Institute, 10 Center Drive, Building 10/CRC, Bethesda, MD, 20892, USA

    Karl E. Haglund

  2. Francis H. Burr Proton Therapy Center, Massachusetts General Hospital, Harvard Medical School, 30 Fruit Street, Boston, MA, 02114, USA

    Thomas F. DeLaney

  3. Hematology Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Yawkey 7944, 30 Fruit Street, Boston, MA, 02114, USA

    David C. Harmon

  4. Surgical Pathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Warren 2, 30 Fruit Street, Boston, MA, 02114, USA

    Andrew E. Rosenberg

  5. Orthopedic Oncology, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Yawkey 3B, 30 Fruit Street, Boston, MA, 02114, USA

    Francis J. Hornicek

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Correspondence to Karl E. Haglund .

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  1. Institutet Stockholm Sweden, MMC 436, Dept.of Oncol-Pathol Karolinska, Delaware St. SE 420, Minneapolis, 55455, Minnesota, USA

    Seymour H. Levitt

  2. UC Davis Cancer Center, Dept. Radiation Oncology, University of California, Davis, X Street 4501, Sacramento, 95817, California, USA

    James A. Purdy

  3. School of Medicine, Dept. Radiation Oncology, Washington University, Forest Park Ave. 4511, St. Louis, 63108-2138, Michigan, USA

    Carlos A. Perez

  4. Instituut Verbeeten, Tilburg, 5042 SB, Netherlands

    Philip Poortmans

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Haglund, K.E., DeLaney, T.F., Harmon, D.C., Rosenberg, A.E., Hornicek, F.J. (2011). Extremity Soft Tissue Sarcoma in Adults. In: Levitt, S., Purdy, J., Perez, C., Poortmans, P. (eds) Technical Basis of Radiation Therapy. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2011_166

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