Multimodality Management of Sarcomas (2nd Edition)

Dear Colleagues,

This Special Issue is the second edition of "Multimodality Management of Sarcomas".

Due to their rarity and heterogeneity, with a wide variety of histological subtypes, biological behaviors, and tumor localization, the optimal management of sarcomas remains challenging. The treatment of sarcomas has to be individualized and typically consists of a combination of modalities. Currently, sarcomas are managed in a multimodal manner.

Initial appropriate imaging is of the utmost importance to demonstrate the exact localization and extension of the tumor, as well as its relation to adjacent structures, in order to facilitate the performance of a diagnostic core needle biopsy and the planning of a surgical procedure when systemic disease is excluded. A preoperative biopsy is of the utmost importance to differentiate between benign and malignant tumors and to define the sarcoma subtype. The pathological examination of those rare and heterogeneous sarcoma tumors is very demanding and a significant level of expertise is required. The treatment plan for each sarcoma is personalized according to its imaging and pathology.

Until recently, most extremity soft tissue sarcomas were locally treated with amputation; currently, the majority of patients receive a limb-salvage treatment with a wide excision of the tumor, along with radiotherapy. Current evidence shows that preoperative radiotherapy may be preferred over the typical postoperative radiotherapy, whereas in low-risk patients, radiotherapy may even be omitted. In selected cases, preoperative systemic chemotherapy or isolated limb perfusion may be indicated in an attempt to preserve the extremity. For retroperitoneal sarcomas, recently, a more aggressive surgical approach has been advocated for, whereas the exact role of preoperative radiotherapy or chemotherapy to facilitate resection and to reduce the high risk of local recurrence has still to be defined. The systemic therapy of soft tissue sarcomas, either as an adjuvant treatment or for metastatic disease, has evolved from the classical anthracycline-based regimen to a more individualized histology-driven chemotherapy, whereas novel drugs have been developed. Bone sarcomas are also usually managed in a multimodal manner, depending on the histological type. Although localized chondrosarcomas are initially treated by surgical excision and/or radiotherapy, Ewing sarcomas are traditionally treated with systemic chemotherapy, followed by local treatment, including surgery and/or radiotherapy, as well as the continuation of systemic chemotherapy. Similarly, osteosarcomas are usually treated with a combination of chemotherapy and surgery, with or without radiotherapy, and the continuation of chemotherapy.

As has been illustrated, the management of sarcomas is challenging and multimodal, including radiology and pathology for initial diagnosis and, subsequently, surgery, as well as the use of chemotherapy and/or radiotherapy for definite treatment, in order to achieve optimal oncological and functional outcomes. The various aspects of this multimodal management technique and its current role will be discussed in this Special Issue.

Prof. Dr. Eelco de Bree
Guest Editor

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• sarcomas
• multimodal
• pathology
• radiology
• surgery
• chemotherapy
• radiotherapy

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