Soft tissue sarcomas, [s8]uncommon or rare

These include rhabdomyosarcomas, fibrosarcomas, liposarcomas, leiomyosarcomas (in the stomach and small gut), malignant synovioma, dermatofibrosarcomas (on the abdominal wall, especially near the umbilicus), histiocytomas, neurofibrosarcomas, and malignant schwannomas. They all arise from mesenchyme, are commonest from the second to the fourth decades, and vary considerably in malignancy. They spread by local infiltration, and lymphatic spread is usually late. In less differentiated tumours blood dissemination may occur early, especially to the lung.

Sarcomas are relatively radioresistant. Treatment is mainly surgical. The results of radical local excision with radiotherapy are at least as good as very radical surgery involving amputation. Chemotherapy is a doubtful supplement to surgery, and is not nearly so effective as with lymphoma or nephroblastoma. Only rhabdomyosarcoma, fibrosarcoma, and liposarcoma are common enough to be discussed further here.

CHEMOTHERAPY FOR SOFT TISSUE SARCOMAS. Assess the patient carefully, and only offer him chemotherapy if the tumour is inoperable, and causes distressing pressure symptoms. Don't continue it beyond the first two courses, unless the disease is responding. Use a triple drug regime consisting of vincristine, methotrexate, and cyclophosphamide. Adriamycin 50 mg m['2] every three weeks is the best single drug.