COSA 2015* Clinical management of sarcoma (#30)
This presentation reviews current concepts in the diagnosis, staging, and multidisciplinary management of patients with sarcomas of nonosseous tissues. Although histopathologic aspects of sarcomas are increasingly important in categorizing these tumors, the anatomic site and characteristics of primary disease remains the most important variable on which treatment and outcome may depend. The focus should be on the principles of management of this group of over 50 cancer subtypes to highlight commonalities and differences from anatomical constraints of surgery to specifics of adjuvant radiation to identification of systemic therapeutics that are appropriate for each histology. Extremity sarcomas account for approximately 50% of all sarcomas and will receive the greatest focus in this presentation. Retroperitoneal sarcomas (RPS), gastrointestinal stromal tumors (GIST), and dermatofibrosarcoma protuberans (DFSP) will also be addressed briefly. Surgery remains paramount to achieve cure for the vast majority of sarcomas. Radiation therapy is used for larger tumors in the appropriate clinical context. Regarding systemic therapy, we at a time in which 1st line therapies for soft tissue sarcomas may change, raising questions about adjuvant therapy that remain unanswered. The evolving contributions of molecular biology and basic scientific principles underlying the varied differentiation and clinical behavior of these tumors will be mentioned. Where appropriate, we need to attempt to link specific histologies or molecular changes to therapeutic suggestions, with the understanding and hope that novel agents will supplant the medications that are available. To date these have not materially affected outcomes for few diagnoses other than GIST in the last several years. Throughout the discussion there will be emphasis on identifying what is known from definitive data and what requires additional research.
