Soft tissue sarcoma

Risk factors: NF-1, retinoblastoma, Li-Fraumeni and Gardner syndromes; radiation, herbicides, vinyl chloride, arsenic.
Investigations: FBC, creatinine, ESR, LDH; CT/MRI of the primary and CT chest (abdomen for myxoid liposarcoma); MRI brain for alveolar types; PET/CT; core or incisional biopsy; cytogenetics.

Stage	Management
I extremity	Surgery; re-resect or post-op RT 60–66 Gy for close/positive margins
II–III extremity	Pre-op RT 60–66 Gy then surgery (or surgery then RT); chemotherapy for large, deep, high-grade tumours
IV	Resection with metastasectomy (≤4 lung lesions) or palliative care, chemotherapy, RT
Unresectable	Definitive RT 70–80 Gy, doxorubicin + ifosfamide, or chemoradiotherapy
Retroperitoneal	Surgery then EBRT 45–50 Gy, or pre-op RT ± chemotherapy then resection
GIST	Surgery then imatinib; imatinib first if marginally resectable

Regimens

AIM: doxorubicin 20–25 mg/m² IV days 1–3 + ifosfamide 2000–3000 mg/m² days 1–3 + mesna 225 mg/m² before and at 4 and 8 hours after ifosfamide, every 21–28 days × 6.
MAID: mesna 2.5 g/m²/day days 1–4 + doxorubicin 20 mg/m²/day + ifosfamide 2.5 g/m²/day + dacarbazine 300 mg/m²/day days 1–3, every 21 days × 6.
AD: doxorubicin 15 mg/m²/day + dacarbazine 250 mg/m²/day days 1–4, every 21 days × 6.
GD: gemcitabine 900 mg/m² days 1 and 8 + docetaxel 75–100 mg/m² day 8, every 21 days × 6.

Imeandikwa:

18 Oktoba 2026, 21:05:21

References:

Ministry of Health, United Republic of Tanzania. Standard Treatment Guidelines and National Essential Medicines List for Tanzania Mainland (STG & NEMLIT). 7th ed. Dodoma: Ministry of Health; 2026. Chapter 22, Malignant Disease Conditions: section 22.11.2 Soft tissue sarcoma, pp. 626–627.