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__NOTOC__
__NOTOC__
{{Liposarcoma}}
{{Liposarcoma}}
{{CMG}} ; {{AE}} {{Ammu}}
==Overview==
==Overview==
Surgery is the primary treatment of liposarcoma. It may be integrated with chemotherapy and radiation therapy depending on the site, stage and recurrence of the tumors.
 
The predominant [[therapy]] for liposarcoma is [[Resection|surgical resection]]. Adjunctive [[chemotherapy]] and [[Radiation therapy|radiation]] may be required.


==Surgery==
==Surgery==
Surgery is the key treatment for liposarcoma that has not metastasized into other organs. Tumor along with a wide margin of healthy tissue is removed to ensure that only healthy tissue is retained. Stage 1 of lims, trunk, head and neck are treated with surgery. Stage 2 and 3 may require radiation and chemotherapy along with surgery for treatment.
* [[Surgery]] is the key treatment of [[Metastasis|non-metastasized]] liposarcoma.  
Following is a classification for surgical resection. <ref name="pmid7449206     [">{{cite journal| author=Enneking WF, Spanier SS, Goodman MA| title=A system for the surgical staging of musculoskeletal sarcoma. | journal=Clin Orthop Relat Res | year= 1980 | volume=  | issue= 153 | pages= 106-20 | pmid=7449206    [ | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7449206  }} </ref>
* [[Tumor]] along with a wide margin of healthy [[tissue]] is removed to ensure that only healthy [[Tissue (biology)|tissue]] is retained.  
{| style="border: 0px; font-size: 90%; margin: 3px; width:600px" align=center
* [[Cancer staging|Stage 1]] liposarcomas of [[Limb (anatomy)|limbs]], [[trunk]], [[head]] and [[neck]] are treated with [[surgery]].  
|valign=top|
* [[Cancer staging|Stage 2]] and [[Cancer staging|3]] may require [[radiation]] and [[chemotherapy]] along with [[surgery]].
* Following is a [[classification]] for surgical resection:<ref name="pmid7449206 [">{{cite journal| author=Enneking WF, Spanier SS, Goodman MA| title=A system for the surgical staging of musculoskeletal sarcoma. | journal=Clin Orthop Relat Res | year= 1980 | volume=  | issue= 153 | pages= 106-20 | pmid=7449206    [ | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7449206  }} </ref>
{| style="border: 0px; font-size: 90%; margin: 3px; width:600px" align="center"
| valign="top" |
|+
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Surgical resection}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Surgical resection}}
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Intraleisional
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Intraleisional
| style="padding: 5px 5px; background: #F5F5F5;" |Curettage, Partial tumor removal
| style="padding: 5px 5px; background: #F5F5F5;" |[[Curettage]], partial [[tumor]] removal
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Marginal
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Marginal
| style="padding: 5px 5px; background: #F5F5F5;" |May leave microscopic tumor behind
| style="padding: 5px 5px; background: #F5F5F5;" |May leave [[microscopic]] [[tumor]] behind
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Wide
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Wide
| style="padding: 5px 5px; background: #F5F5F5;" |Remove tumor and surrounding cuff of tissue
| style="padding: 5px 5px; background: #F5F5F5;" |Remove [[tumor]] and surrounding cuff of [[Tissue (biology)|tissue]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Radical
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |Radical
| style="padding: 5px 5px; background: #F5F5F5;" |Remove entire compartment including amputation
| style="padding: 5px 5px; background: #F5F5F5;" |Remove entire [[Compartment (anatomy)|compartment]], includes [[amputation]]
|}
|}


===Treatment by stage===
===Treatment by Stage===
Treatment by stage involves some basic criteria.<ref name=NCCN>{{cite web | title = NCCN | url = http://www.nccn.org/professionals/physician_gls/f_guidelines.asp }}</ref>. Some of them are given below.
* Treatment by [[Cancer staging|stage]] involves some basic criteria given below:<ref name="NCCN">{{cite web | title = NCCN | url = http://www.nccn.org/professionals/physician_gls/f_guidelines.asp }}</ref>


====Treatment of stage 1 sarcoma====
====Treatment of Stage 1 Sarcoma====
*Primary treatment is surgery. If the margins are cut >1 cm sparing the fascia, Care after surgery adjuvant treatment. Care includes the following.
*Primary treatment is [[surgery]].  
*If the margins are cut >1 cm sparing the [[fascia]], "care" after [[surgery]] is the [[adjuvant treatment]].  
*"Care" includes the following.:
:*Rehabilitation if needed
:*Rehabilitation if needed
:*Medical history and physical examination every 3-6 months for every 2-3 years.
:*[[Medical history]] and [[physical examination]] every 3 - 6 months for every 2 - 3 years
:*Chest Imaging every 6-12 months
:*[[Chest]] [[imaging]] every 6 - 12 months
:*Tumor site imaging right after surgery and then at regular intervals of time.
:*[[Tumor]] site [[imaging]] right after [[surgery]] and then at regular intervals of time


*If the margins are cut <1 cm with the fascia, for stage 1A consider radiation therapy and Care after treatment and for stage 1B radiation treatment.
*If the margins are cut <1 cm with the [[fascia]], for [[Cancer staging|stage 1A]] consider [[radiation therapy]] and "care" after treatment and for [[Cancer staging|stage 1B]] consider [[radiation therapy]].


====Treatment of stage 2 and stage 3 sarcoma====
====Treatment of Stage 2 and Stage 3 Sarcoma====
* For stage 2A , radiation is given as neoadjuvant therapy followed by surgery as a primary treatment and then radiation boost as an adjuavant therapy
* For [[Cancer staging|stage 2A]], [[radiation]] is given as [[neoadjuvant therapy]] followed by [[surgery]] as a primary treatment and then [[Radiation therapy|radiation]] boost as an [[adjuvant therapy]].
* For stage 2B or 3, radiation/ chemotherapy/ chemoradiation are given as neoadjuvant therapy followed by surgery as a primary treatment and radiation boost or chemotherapy as an adjuvant therapy
* For [[Cancer staging|stage 2B or 3]], [[radiation]]/[[chemotherapy]]/[[chemoradiation]] are given as [[neoadjuvant therapy]] followed by [[surgery]] as a primary treatment and [[Radiation therapy|radiation]] boost or [[chemotherapy]] as an [[adjuvant therapy]].
* For tumors which cannot be surgically resected, radiaion therapy/chemoradiation/ chemotherapy/ isolated limb chemotherapy is given as primary treatment.
* For [[Tumor|tumors]] which cannot be [[Surgery|surgically]] [[Resection|resected]], [[radiation therapy]]/chemoradiation/[[chemotherapy]]/isolated [[Limb (anatomy)|limb]] [[chemotherapy]] is given as primary treatment.
:* It is followed by surgery if possible and radiation boost/ chemotherapy as a follow up treatment option.
:* It is followed by [[surgery]] if possible and [[Radiation therapy|radiation]] boost/[[chemotherapy]] as a follow up treatment option.
:* If surgery is still not feasible, observation if no symptoms/ radiation / palliative chemotherapy or surgery/ amputation / supportive care are the treatment options
:* If [[surgery]] is still not feasible, [[radiation]]/[[Palliative therapy|palliative]] [[chemotherapy]] or [[surgery]]/[[amputation]]/supportive care are the treatment options.


====Treatment of stage 4 sarcoma====
====Treatment of Stage 4 Sarcoma====
=====Confined cancer spread=====
=====Confined Cancer Spread=====
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 25%;"
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 25%;"
! style="width: 500px;background: #4479BA"|{{fontcolor|#FFF| '''''For confined cancer spread'''''}}
! style="width: 500px;background: #4479BA" |{{fontcolor|#FFF| '''''For confined cancer spread'''''}}
|-
|-
| style="width: 120px; background: #F5F5F5"| Surgery to remove metastasis with chemotherapy and radiation before and after surgery
| style="width: 120px; background: #F5F5F5" | [[Surgery]], to remove [[Metastasis|metastatic lesions]] with [[chemotherapy]] and [[Radiation therapy|radiation]] before and after [[surgery]]
|-
|-
| style="width: 120px;background: #DCDCDC"|Ablation
| style="width: 120px;background: #DCDCDC" |[[Ablation]]
|-
|-
| style="width: 120px;background: #F5F5F5"|Observation
| style="width: 120px;background: #F5F5F5" |Observation
|-
|-
| style="width: 120px;background: #DCDCDC"|Stereotactic Body Radiation Therapy (SBRT)
| style="width: 120px;background: #DCDCDC" |Stereotactic Body Radiation Therapy (SBRT)
|-
|-
| style="width: 120px;background: #F5F5F5"|Embolization
| style="width: 120px;background: #F5F5F5" |[[Embolization]]
|}
|}


=====Widespread cancer=====
=====Widespread cancer=====
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 25%;"
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 25%;"
! style="width: 500px;background: #4479BA"|{{fontcolor|#FFF| '''''For widespread cancer'''''}}
! style="width: 500px;background: #4479BA" |{{fontcolor|#FFF| '''''For widespread cancer'''''}}
|-
|-
| style="width: 120px; background: #F5F5F5"|Palliative chemotherapy
| style="width: 120px; background: #F5F5F5" |[[Palliative therapy|Palliative]] [[chemotherapy]]
|-
|-
| style="width: 120px;background: #DCDCDC"|Palliative radiation therapy
| style="width: 120px;background: #DCDCDC" |[[Palliative therapy|Palliative]] [[radiation therapy]]
|-
|-
| style="width: 120px;background: #F5F5F5"|Palliative surgery
| style="width: 120px;background: #F5F5F5" |[[Palliative therapy|Palliative]] [[surgery]]
|-
|-
| style="width: 120px;background: #DCDCDC"|Stereotactic Body Radiation Therapy (SBRT)
| style="width: 120px;background: #DCDCDC" |[[Stereotactic Body Radiation Therapy]] (SBRT)
|-
|-
| style="width: 120px;background: #F5F5F5"|Embolization
| style="width: 120px;background: #F5F5F5" |[[Embolization]]
|-
|-
| style="width: 120px;background: #DCDCDC"|Observation if no symptoms
| style="width: 120px;background: #DCDCDC" |Observation if [[asymptomatic]]
|-
|-
| style="width: 120px;background: #F5F5F5"|Ablation
| style="width: 120px;background: #F5F5F5" |[[Ablation]]
|-
|-
| style="width: 120px;background: #DCDCDC"|Supportive care
| style="width: 120px;background: #DCDCDC" |Supportive care
|}
|}


 
==== Recurrent Sarcoma in Distant Sites is Treated with the Following Options: ====
Recurrent sarcoma in distant sites are treated with the following options
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 60%;"
{| style="border: 2px solid #DCDCDC; font-size: 90%; width: 60%;"
|+ '''Recurrent tumor'''
|+ '''Recurrent Tumor'''
|-
|-
! style="width: 80px; background: #4479BA; text-align: center;"|{{fontcolor|#FFF|Cancer spread}}
! style="width: 80px; background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Cancer spread}}
! style="width: 720px; background: #4479BA; text-align: center;"| {{fontcolor|#FFF|Treatment options}}
! style="width: 720px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Treatment options}}
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| Tumor in one organ
| style="background: #F5F5F5; padding: 5px; text-align: center;" | [[Tumor]] in one [[Organ (anatomy)|organ]]
| style="background: #DCDCDC; padding: 5px;"| Surgery with chemotherapy/radiation before and after surgery
| style="background: #DCDCDC; padding: 5px;" | [[Surgery]] with [[chemotherapy]]/[[radiation]] before and after [[surgery]]
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| Confined area
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Confined area
| style="background: #DCDCDC; padding: 5px;"|<br>&nbsp;&nbsp;&nbsp;Lymph nde surgery with chemotherapy/radiation<br>&nbsp;&nbsp;&nbsp;Surgery to remove metastasis with chemotherapy/radiation<br>&nbsp;&nbsp;&nbsp;Stereotactic Body Radiation Therapy (SBRT)
| style="background: #DCDCDC; padding: 5px;" |
* [[Lymph node]] [[surgery]] with [[chemotherapy]]/[[radiation]]&nbsp;
* [[Surgery]] to remove [[metastasis]] with [[chemotherapy]]/[[radiation]]
* Stereotactic Body Radiation Therapy (SBRT)
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| Widespread
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Widespread
| style="background: #DCDCDC; padding: 5px;"|<br>&nbsp;&nbsp;&nbsp;Palliative chemotherapy<br>&nbsp;&nbsp;&nbsp;Palliative radiation therapy<br>&nbsp;&nbsp;&nbsp;Palliative surgery<br>&nbsp;&nbsp;&nbsp;Stereotactic Body Radiation Therapy (SBR)<br>&nbsp;&nbsp;&nbsp;Embolization<br>&nbsp;&nbsp;&nbsp;Ablation
| style="background: #DCDCDC; padding: 5px;" |<br>&nbsp;&nbsp;&nbsp;[[Palliative therapy|Palliative]] [[chemotherapy]]<br>&nbsp;&nbsp;&nbsp;[[Palliative therapy|Palliative]] [[radiation therapy]]<br>&nbsp;&nbsp;&nbsp;[[Palliative therapy|Palliative]] [[surgery]]<br>&nbsp;&nbsp;&nbsp;Stereotactic Body Radiation Therapy (SBR)<br>&nbsp;&nbsp;&nbsp;[[Embolization]]<br>&nbsp;&nbsp;&nbsp;[[Ablation]]
|}
|}


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[[Category:Disease]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Types of cancer]]
[[Category:Oncology]]
[[Category:Surgery]]
[[Category:Surgery]]


{{WikiDoc Sources}}
{{WikiDoc Sources}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]

Latest revision as of 20:29, 29 May 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Overview

The predominant therapy for liposarcoma is surgical resection. Adjunctive chemotherapy and radiation may be required.

Surgery
Surgical resection Proceedure
Intraleisional Curettage, partial tumor removal
Marginal May leave microscopic tumor behind
Wide Remove tumor and surrounding cuff of tissue
Radical Remove entire compartment, includes amputation

Treatment by Stage

  • Treatment by stage involves some basic criteria given below:[2]

Treatment of Stage 1 Sarcoma

Treatment of Stage 2 and Stage 3 Sarcoma

Treatment of Stage 4 Sarcoma

Confined Cancer Spread
For confined cancer spread
Surgery, to remove metastatic lesions with chemotherapy and radiation before and after surgery
Ablation
Observation
Stereotactic Body Radiation Therapy (SBRT)
Embolization
Widespread cancer
For widespread cancer
Palliative chemotherapy
Palliative radiation therapy
Palliative surgery
Stereotactic Body Radiation Therapy (SBRT)
Embolization
Observation if asymptomatic
Ablation
Supportive care

Recurrent Sarcoma in Distant Sites is Treated with the Following Options:

Recurrent Tumor
Cancer spread Treatment options
Tumor in one organ Surgery with chemotherapy/radiation before and after surgery
Confined area
Widespread
   Palliative chemotherapy
   Palliative radiation therapy
   Palliative surgery
   Stereotactic Body Radiation Therapy (SBR)
   Embolization
   Ablation

References

  1. ↑ Enneking WF, Spanier SS, Goodman MA (1980). "A system for the surgical staging of musculoskeletal sarcoma". Clin Orthop Relat Res (153): 106–20. PMID [ 7449206 [ Check |pmid= value (help).
  2. ↑ "NCCN".

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