Liposarcoma surgery
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Liposarcoma surgery On the Web |
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American Roentgen Ray Society Images of Liposarcoma surgery |
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
- Surgery is the key treatment of non-metastasized liposarcoma.
- Tumor along with a wide margin of healthy tissue is removed to ensure that only healthy tissue is retained.
- Stage 1 liposarcomas of limbs, trunk, head and neck are treated with surgery.
- Stage 2 and 3 may require radiation and chemotherapy along with surgery.
- Following is a classification for surgical resection:[1]
| 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 of Stage 1 Sarcoma
- 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
- Medical history and physical examination every 3 - 6 months for every 2 - 3 years
- Chest imaging every 6 - 12 months
- 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 consider radiation therapy.
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 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 tumors which cannot be surgically resected, radiation therapy/chemoradiation/chemotherapy/isolated limb chemotherapy is given as primary treatment.
- It is followed by surgery if possible and radiation boost/chemotherapy as a follow up treatment option.
- If surgery is still not feasible, radiation/palliative chemotherapy or surgery/amputation/supportive care are the treatment options.
Treatment of Stage 4 Sarcoma
Confined Cancer Spread
| For confined cancer spread |
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| 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:
| Cancer spread | Treatment options |
|---|---|
| Tumor in one organ | Surgery with chemotherapy/radiation before and after surgery |
| Confined area |
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| Widespread | Palliative chemotherapy Palliative radiation therapy Palliative surgery Stereotactic Body Radiation Therapy (SBR) Embolization Ablation |
References
- ↑ 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). - ↑ "NCCN".