7 LATE SEQUELAE


7.1 Treatment late effects and sequelae

7.1.1
Late effects and sequelae in adequately treated soft tissue sarcomas obviously depend on the site of surgery and radiation therapy. Intuitively, limb amputations carry major adverse sequelae. One should not forget, however, that even conservative surgery may be associated with adverse sequelae, such as edema and suboptimal joint function. Surgical technique has improved over the last years and now conservative surgery often has a very good outcome. Some studies on quality of life showed some years ago that the functional and psychological status of conservatively operated patients was not necessarily better than amputated patients. Now technical improvements have occurred, but the physician can learn from those studies that quality of life of amputated patients may be quite satisfactory. This information can be given to those patients to whom a demolitive approach must still be proposed. Otherwise, limb sparing surgery is now standard practice whenever technically feasible with a curative intent and with a sufficiently good expected functional outcome. When radiotherapy is used it is important to reduce normal tissue radiation as much as possible and exclude the use of circular radiation as well as radiation of joints. Therefore radiation of these tumors should be performed by specialized radiotherapists by use of advanced treatment planning systems.


References

7.1.I
Chang AE, Steinberg SM, Culnane M, Lampert MH, Reggia AJ, Simpson CG, et al. Functional and psychosocial effects of multimodality limb-sparing therapy in patients with soft tissue sarcomas. J Clin Oncol 1989; 7: 1217-1228.

7.1.II
Robinson MH, Spruce L, Eeles R, Fryatt I, Harmer CL, Thomas JM, et al. Limb function following conservation treatment of adult soft tissue sarcoma. Eur J Cancer 1991; 12: 1567-1574.

7.1.III
Sugarbaker PH, Barofsky I. Rosenberg SA, Gianola FJ. Quality of life assessment of patients in extremity sarcoma clinical trials. Surgery 1982; 91: 17-23.

7.1.IV
Weddington WW, Segraves KB, Simon MA. Psychological outcome of extremity sarcoma survivors undergoing amputation or limb salvage. J Clin Oncol 1985; 3: 1393-1399.



7.2 Related and secondary tumors

7.2.1
Second tumors may occasionally arise in irradiated areas.


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European School of Oncology, 1996

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