Disease Stage 5-Year Survival, % Stage I A: G1,2; T1a,b; N0; M0 B: G1,2; T2a; N0; M0 Stage II A: G1,2; T2b; N0; M0 B: G3,4; T1; N0; M0 C: G3,4; T2a; N0; M0 Stage III G3,4; T2b; N0; M0 Stage IV | Chapter 094. Soft Tissue and Bone Sarcomas and Bone Metastases Part 3 Disease Stage 5-Year Survival Stage I A G1 2 T1a b N0 M0 B G1 2 T2a N0 M0 Stage II A G1 2 T2b N0 M0 B G3 4 T1 N0 M0 C G3 4 T2a N0 M0 Stage III G3 4 T2b N0 M0 Stage IV 20 A any G any T N1 M0 B any G any T any N Ml Soft Tissue Sarcomas Treatment AJCC stage I patients are adequately treated with surgery alone. Stage II patients are considered for adjuvant radiation therapy. Stage III patients may benefit from adjuvant chemotherapy. Stage IV patients are managed primarily with chemotherapy with or without other modalities. Surgery Soft tissue sarcomas tend to grow along fascial planes with the surrounding soft tissues compressed to form a pseudocapsule that gives the sarcoma the appearance of a well-encapsulated lesion. This is invariably deceptive because shelling out or marginal excision of such lesions results in a 50-90 probability of local recurrence. Wide excision with a negative margin incorporating the biopsy site is the standard surgical procedure for local disease. The adjuvant use of radiation therapy and or chemotherapy improves the local control rate and permits the use of limb-sparing surgery with a local control rate 85-90 comparable to that achieved by radical excisions and amputations. Limb-sparing approaches are indicated except when negative margins are not obtainable when the risks of radiation are prohibitive or when neurovascular structures are involved so that resection will result in serious functional consequences to the limb. Radiation Therapy External beam radiation therapy is an adjuvant to limb-sparing surgery for improved local control. Preoperative radiation therapy allows the use of smaller fields and smaller doses but results in a higher rate of wound complications. Postoperative radiation therapy must be given to larger fields as the entire surgical bed must be encompassed and in higher doses to compensate for hypoxia in the operated field. .
