Treatment for soft tissue sarcomas of the abdomen is determined mainly by the stage of the disease. Treatment options include surgery, radiation therapy, chemotherapy and pharmacological treatment. A multidisciplinary team of sarcoma specialists can help plan
the best treatment for the patient.
Treatment of localized disease
Surgical resection is the standard primary treatment for all patients with localized abdominal and pelvic sarcomas, including retroperitoneal, intra-abdominal, abdominal wall and gynecological sarcomas.
The requisite for cure is complete surgical resection with microscopic tumor-free margins in the first attempt. This predisposes that the tumor is removed without contamination of surrounding tissue and the abdominal cavity from inadvertent tumor rupture.
Treatment of metastastatic disease
The disease is not considered to be curable if the tumor is locally advanced and deemed unresectable. Even if it is not possible to achieve curative surgery, the possibility for palliative surgery should be assessed to reduce symptoms. Palliative surgery may also prolong survival in selected cases.
Patients with liver or lung metastases should be assessed for liver or lung resection and/or other appropriate treatment.
Chemotherapy and radiation are given in certain cases depending on histology, grade of malignancy and extent of disease. The principles for systemic treatment of soft tissue sarcomas localized in extremities are used as a guide.
Treatment of recurrent disease
Many recurrences occur in the same site as the primary tumor. In other cases, the recurrence is limited to one or a few well-defined lesions retroperitoneally or in the abdominal cavity.
The standard treatment for patients with recurrence is to repeat the surgical resection according to the same principles as for primary resection. The aim remains a curative operation with complete resection and tumor-free margins.
The ability to achieve this declines as the number of local recurrences increases. The optimal time for surgical treatment of recurrence depends on size, location and symptoms.
Treatment of GIST
Treatment of localized GIST follows the same surgical principles as for other soft tissue sarcomas of the abdomen. The goal of surgery is to resect the tumor with microscopic free margins in the organ of origin and without violating the pseudocapsule of the tumor.
Large primary and localized GIST can be treated with neoadjuvant pharmacological therapy with imatinib in order to attempt size reduction and organ preservation. Neoadjuvant treatment is usually given until peak response at about 6-12 months.
Resected high risk GIST is most often treated with adjuvant pharmacological therapy for 36 months.
For an inoperable tumor, local relapse, or metastases, pharmacological treatment with imatinib is the first-line of therapy.