RadioGraphics 2008; 28:2069-2086
Emma Robinson, MD, FRCPC , Robert R. Bleakney, MB, BCH, FRCR, FRCPC , Peter C. Ferguson, MD, FRCSC , Brian O , Sullivan, MD, FRCPC
Soft-tissue sarcomas are rare tumors (1) that can affect any age, gender, and anatomic subsite. They have unique growth features, tending to extend within compartments and along fascial planes on a path of least resistance. The extremities are the site of 50% of soft-tissue sarcomas, with 80% of those occurring in the lower extremities. Malignant fibrous histiocytoma is the most common histologic subtype, followed by liposarcoma (2). In the retroperitoneum, leiomyosarcoma and liposarcoma predominate. The natural history in this location is often characterized by large size at presentation despite slow growth owing to delay in diagnosis. Local control and survival vary according to anatomic site, largely because resection is less feasible and radiation therapy less easily administered in some regions. In patients undergoing curative treatment, outcome is best for extremity soft-tissue sarcomas and worst for retroperitoneal sarcomas and those arising adjacent to critical nonexpendable anatomy (in the head and neck, in the pelvis, and juxtaposed to the spine) (3).
Management of soft-tissue sarcomas provides a paradigm of the multidisciplinary approach for the optimization of local control, function preservation, and limb salvage. This article focuses on the imaging features related to detection, staging, and characterization of the primary tumor, as well as assessment for regional lymph nodes and distant metastatic disease. The anatomic characteristics for patient selection for different locoregional approaches and combined-modality treatment approaches with radiation therapy and surgery are briefly reviewed.