First-Line Treatment of Undifferentiated Pleomorphic Sarcoma
Undifferentiated pleomorphic sarcoma (UPS) is an aggressive soft-tissue malignancy managed with a curative-intent multimodal strategy. The first-line protocol coordinates surgery and perioperative treatments to achieve local control and prevent distant spread.
Treatment Approach
The standard first-line approach involves limb-sparing surgery with curative intent combined with perioperative radiotherapy — the full sequence of decisions, timing options, and any additional interventions are set out in the complete protocol.
Treatment Goals
Key clinical objectives are an R0 resection margin (no residual tumour at the inked surgical surface), freedom from local recurrence at the extremity site, and absence of distant metastasis. Surgical margin status and radiotherapy are direct determinants of local control outcome.
References
DOI: 10.1016/j.ejso.2021.12.008
- Surgery in combination with radiotherapy (sporadically combined with chemotherapy in case of high-risk of development of metastasis) is the common therapy of choice for UPS, which is similar to the treatment of other STS.
- Patients with eUPS were significantly more often treated with limb-sparing surgery compared with other eSTS.
- Patients with R1-R2 margins treated with radiotherapy had about half the risk of developing LR compared with patients who were not treated with radiotherapy.
- Radiotherapy and surgical margins were considered as predictors for local control.
- Surgical margin was also a prognostic factor for DM.
- Margins were defined as follows: free (R0) when no residual tumour was found at the inked surface, marginal (R1) when microscopic residual tumour was found and intralesional (R2) when macroscopic residual tumour was detected.
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