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Soft tissue sarcoma

Key sources
The following summarized guidelines for the evaluation and management of soft tissue sarcoma are prepared by our editorial team based on guidelines from the American Society for Radiation Oncology (ASTRO 2021) and the European Society of Medical Oncology (ESMO 2018).
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Guidelines

1.Medical management

General principles
As per ASTRO 2021 guidelines:
Obtain expert pathology and radiology review and multidisciplinary evaluation before initiating treatment in patients with localized STS.
B
Determine the sequencing of surgery and radiotherapy in patients with primary, localized extremity and truncal STS based on multidisciplinary evaluation of patient and tumor characteristics.
B
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  • Neoadjuvant chemotherapy

  • Adjuvant chemotherapy

  • Definitive chemotherapy

2.Therapeutic procedures

Neoadjuvant radiotherapy: offer neoadjuvant radiotherapy in patients with primary, localized extremity and truncal STS at increased risk for local recurrence, planned to undergo oncologic resection.
A
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  • Adjuvant radiotherapy

  • Technical considerations for radiotherapy

3.Surgical interventions

Wide-local excision: as per ASTRO 2021 guidelines, perform oncologic resection, when feasible, in patients with primary, localized extremity and truncal STS undergone an unplanned excision.
B

4.Specific circumstances

Patients with lung metastasis: perform surgical resection as standard treatment of metachronous (disease-free interval ≥ 1 year), resectable lung metastases without extrapulmonary disease, if complete excision of all lesions is feasible.
B

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