Optimizing local control in soft tissue sarcoma of the extremity.

Extremity soft tissue sarcoma is a rare malignancy in which a high rate of local control can be achieved with multimodal regimens and without excessive treatment-related morbidity. This article reviews the current status of evaluation, staging, and local treatment of these tumors. Evidence shows that surgical approaches that maximize local control have little effect on the development of distant metastasis and overall survival. The goal of local treatment, therefore, is a balance of adequate local control with limb salvage and minimal therapeutic morbidity. A variety of limb-sparing approaches using various adjuvant modalities in addition to conservative resection are discussed, including reported local control and complication rates. Treatment paradigms are then presented for the management of extremity soft tissue sarcoma of varying stages. Further studies are needed to define precisely the role, type, and timing of chemotherapy and radiotherapy in addition to surgery in the management of this disease with respect to local control and distant metastasis.