What is your typical approach for soft tissue sarcomas of the buttock?

If post-op with clear margins would you prefer adjuvant RT or close observation with surgery for optimal reduction of local recurrence? This particular patient has a grade 2 undifferentiated spindle cell sarcoma, measuring 5 cm largest dimension with the closest margin being 0.9 cm. There was no LVSI.

1 Answer

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Radiation Oncology · The Ohio State University - James Cancer Hospital and Solove Research Institute

Answered on · Updated on

It is worthwhile remembering that the entire paradigm of conservative/limb-sparing surgery rather than radical surgery/amputation for extremity STS (as defined all the way back to Rosenberg et al., PMID 7114936 and Yang et al., PMID 9440743) *presupposes* that patients also receive RT.

Therefore, for high-grade (i.e., G2-3) STS of the extremity or superficial trunk undergoing conservative surgery, RT (either preop or postop) is really the default. If RT is omitted, it should typically be because of a specific and significant contra-indication to its use.

Additionally, for risk assessment in individual patients, the MSKCC sarcoma nomograms can be helpful: https://www.mskcc.org/nomograms/sarcoma.

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