Principes du traitement des sarcomes des tissus mous de l'adulte

[Epidemiological and histopathological aspects of sarcomas in Cotonou (Benin) from 2010 to 2020]

Aims

To study the epidemiological and histopathological characteristics of sarcomas.

Procedure

This was a multi-center, descriptive, retrospective study realized over a 10-year period. We systematically recruited all medical reports of patients with histologically confirmed sarcoma.

Results

159 reports of sarcoma were retained. The average age was 38.9 years. There was a female predominance with a 0.9 estimated sex ratio. Soft tissue sarcomas were the most common (65.4%). The most frequent location was the lower limbs (30.2%).

Conclusion

Better access to diagnosis would contribute to a better assessment of the burden of this pathology in Benin.

Chirurgie des sarcomes des tissus mous des membres chez l'adulte : historique et avancées thérapeutiques

In the seventies, limb-sparing surgery and radiation therapy appeared capable of successfully treating the great majority of adult patients with soft tissue sarcomas of the extremities. No survival benefit could be demonstrated in the patients selected for amputation. Microscopically positive surgical margins are related to a greater risk of local recurrence, whereas overall survival is compromised by high grade and large tumor size. Presurgery multidisciplinary discussion, management in reference center and management within cancer network independently predict conformity to the clinical practice guidelines. Reoperation should be a planned part of definitive management whenever the initial surgical procedure was done without a histologic diagnosis or was not planned to be a wide excision. Soft tissue flap reconstruction facilitates therapy for patients with locally advanced tumors so that patients with larger tumors can undergo resection, limiting complications and limb sacrifice. Vascular reconstruction is a feasible option in case of involvement of major vessels. Isolated limb perfusion (ILP) with TNF and chemotherapy is an efficient limb-sparing neoadjuvant therapy for locally advanced limb soft tissue sarcomas. Efficacy and safety of low-dose TNFalpha could greatly facilitate ILP procedures in the near future.