How should I approach the management of a patient with a confirmed diagnosis of soft tissue sarcoma?

Management of a patient with a confirmed diagnosis of soft tissue sarcoma should begin with a multidisciplinary team (MDT) approach involving oncologists, surgeons, radiologists, and pathologists to tailor treatment based on tumour type, size, grade, and location ¹. Surgical excision with clear margins remains the cornerstone of treatment for localized soft tissue sarcoma, aiming for complete resection to reduce local recurrence risk ¹. Preoperative or postoperative radiotherapy is often recommended to improve local control, especially for high-grade or large tumours ¹.

Imaging, including MRI for local staging and CT for chest metastasis assessment, is essential to guide surgical planning and detect nodal or distant spread ¹. Although nodal metastases are uncommon in soft tissue sarcomas, certain histological subtypes and risk factors may increase this risk, warranting careful imaging and possible nodal evaluation (Rosenthal et al., 2020). Systemic chemotherapy may be considered in selected cases, such as high-grade or metastatic disease, but its role remains individualized and is best decided within the MDT ¹.

For rare subtypes like desmoid tumours, which are locally aggressive but non-metastatic, management may differ, often favouring active surveillance or medical therapies over surgery (Spolverato et al., 2022). Bone sarcomas require distinct protocols as outlined in SELNET guidelines and should be managed accordingly (Blay et al., 2022).

Overall, the approach integrates UK guideline recommendations prioritizing surgery and radiotherapy with nuanced imaging and systemic therapy decisions informed by recent literature on nodal metastases and tumour biology ¹; (Rosenthal et al., 2020); (Spolverato et al., 2022); (Blay et al., 2022).