The key role of pathology, surgery and radiotherapy in the initial management of soft tissue sarcoma

Soft tissue sarcomas are a heterogeneous group of rare malignancies. The diagnostic gold standard is conventional histomorphology with integrated immunohistochemistry. Molecular genetic profiling has identified new subgroups of undifferentiated sarcomas involving genetic rearrangements with creation of fusion genes. Accurate classification of sarcomas is critical for appropriate clinical decision-making which should involve a multidisciplinary team. A preoperative biopsy is necessary to confirm a diagnosis. Strategy is discussed in the multidisciplinary board. Reconstructive surgery must be planned in advance taking into account possible surgical morbidity. In high-risk situations, neo-adjuvant treatment could facilitate surgery in some cases, increase survival and provide indications of tumor biology. The decision is based on tumor subtype, grade and location, patient age and presence of comorbidities.