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Soft tissue sarcomas are rare malignancies
that usually arise from tissues of mesenchymal
origin (e.g. fat, muscle, and connective
tissue) and can occur throughout the
body. There are only about 8,000 new
cases of soft tissue sarcoma in the United
States per year, and the most common
sites include the extremity (arm and
leg), trunk (chest and abdominal wall),
abdomen (intra-abdominal and retroperitoneum),
and head/neck. Soft tissue sarcomas are
subclassifed into over 50 different histologic
subtypes with the most common subtypes
being liposarcoma, leiomyosarcoma, malignant
fibrous histiocytoma, synovial sarcoma,
and fibrosarcoma. These tumors are graded
based on their appearance under the microscope
as either low-grade tumors, (which tend
to grow slowly and are unlikely to spread
to distant sites), or high-grade tumors,
which tend to grow more rapidly and have
a higher risk of distant metastases).
Given soft tissue sarcomas are rare, occur
in several sites, and have numerous subtypes,
many physicians are unfamiliar with the
appropriate diagnostic procedures and
treatment of these tumors. Common diagnostic
radiology tests include computed tomography
(CT) scans and magnetic resonance imaging
(MRI). Positive emission tomography (PET)
scans and combined PET/CT scans are also
used in certain circumstances to rule
out spread of disease. Biopsies of suspected
soft tissue sarcomas should be undertaken
carefully so as to avoid the spread the
tumor cells and to orient the biopsy
scar/tract such that it is encompassed
by the definitive operation. Besides
surgery, additional treatment modalities
may be necessary to optimally treat soft
tissue sarcoma such as radiation therapy
and chemotherapy. There are instances
where the chemotherapy and radiation
therapy may be better given prior to
operation to obtain better local control
and limit the extent of the operation.
Soft tissue sarcomas arising in difficult
anatomic locations may require extensive
surgical expertise to remove in their
entirety with a negative surgical margin.
Such anatomic locations include:
- extremity adjacent to major nerves,
blood vessels, bones, and joints
- trunk requiring reconstruction of
the abdominal wall or chest wall
- abdomen (intra-abdominal and retroperitoneum)
adjacent to major organs, blood vessels,
nerves, ureters, and bones (Two examples of
difficult abdominal sarcomas are
presented below.)
Examples:
Intra-abdominal
sarcoma |
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Retroperitoneum |
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Reconstructed
CT scan demonstrating an
inferior vena cava sarcoma
that received preoperative
radiation therapy followed
by resection and intra-operative
radiation therapy to the
entire tumor bed to reduce
the possibility of local
recurrence. |
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CT scan demonstrating
a retroperitoneal tumor involving
the which required resection
of tumor along with the distal
pancreas, left kidney, spleen,
adrenal gland, and left colon.
Intra-operative radiation
therapy was delivered to
the closest retroperitoneal
margin to reduce the possibility
of local recurrence. |
Dr. Sam
S. Yoon received fellowship training
in surgical oncology and currently treats
a large volume of soft tissue sarcoma
patients. Dr. Yoon, in addition to concentrating
his clinical practice in the treatment
of patients with soft tissue sarcoma,
maintains an active basic science and
translational research laboratory focused
on developing new treatments for sarcomas.
In addition to extensive surgical experience,
advanced radiation therapy techniques
and chemotherapy may be required to obtain
optimal local control of certain sarcomas.
The Massachusetts General Hospital Cancer
Center has radiation oncologists, Dr.
Herman Suit, Dr.
Thomas DeLaney, and
Dr.
David Kirsch, who have been pioneers
in treatment of sarcomas with radiation.
They have access to the one of only a
handful of proton beam radiation therapy
facilities, Francis
H. Burr Proton Therapy Center, in
the United States as well the use of
an intra-operative
radiation therapy suite for the delivery
of intra-operative radiation. Dr. David
Harmon is a leader in the use of chemotherapy
and other novel drugs in the treatment
of sarcomas, and currently is examining
a number of new drugs in the treatment
of sarcoma patients.
In addition to surgical, radiation, and
medical oncologists with an expertise
in soft tissue sarcomas, the Massachusetts
General Hospital Cancer Center Center
for Sarcoma and Connective Tissue Oncology,
has an entire team of clinical specialists
to optimally care for sarcoma patients.
This team includes surgeons from other
subspecialties, radiologists, pathologists,
and nurses who are familiar with the
care of patients with soft tissue sarcoma.
The team meets weekly to review new patients
and formulate a treatment plan and also
reviews follow-up patients to determine
if additional treatment is needed.
If you feel that you may be a candidate
for sarcoma surgery, please contact:
Sam Yoon, MD
Assistant Professor of
Surgery, Harvard Medical School
Center for Sarcoma and Connective Tissue Oncology
617- 726-4241
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