Chirurgie des sarcomes des tissus mous des membres chez l'adulte : historique et avancées thérapeutiques

Translated title of the contribution: Function preserving surgery of limb sarcomas: history and improvements

S. Bonvalot, M. C. Missana, A. Le Cesne, G. Missenard, D. Vanel, P. Terrier, C. Le Péchoux

Research output: Contribution to journalArticlepeer-review

Abstract

In the seventies, limb-sparing surgery and radiation therapy appeared capable of successfully treating the great majority of adult patients with soft tissue sarcomas of the extremities. No survival benefit could be demonstrated in the patients selected for amputation. Microscopically positive surgical margins are related to a greater risk of local recurrence, whereas overall survival is compromised by high grade and large tumor size. Presurgery multidisciplinary discussion, management in reference center and management within cancer network independently predict conformity to the clinical practice guidelines. Reoperation should be a planned part of definitive management whenever the initial surgical procedure was done without a histologic diagnosis or was not planned to be a wide excision. Soft tissue flap reconstruction facilitates therapy for patients with locally advanced tumors so that patients with larger tumors can undergo resection, limiting complications and limb sacrifice. Vascular reconstruction is a feasible option in case of involvement of major vessels. Isolated limb perfusion (ILP) with TNF and chemotherapy is an efficient limb-sparing neoadjuvant therapy for locally advanced limb soft tissue sarcomas. Efficacy and safety of low-dose TNFα could greatly facilitate ILP procedures in the near future.

Translated title of the contributionFunction preserving surgery of limb sarcomas: history and improvements
Original languageFrench
Pages (from-to)416-424
Number of pages9
JournalCancer/Radiotherapie
Volume10
Issue number6-7
DOIs
Publication statusPublished - Nov 2006

Keywords

  • Isolated limb perfusion
  • Sarcoma
  • Surgery
  • TNF

ASJC Scopus subject areas

  • Oncology

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