44-year-old patient with a rapidly growing lesion (16x8x12 cm) involving the soft tissues of the proximal third of the right thigh. He reports that he has started to notice the mass, which has a hard consistency and is adhered to deep planes, in the last 6 months. Previously, she had been a regular athlete and had even finished a marathon. On examination, collateral circulation was observed, but no right inguinal lymph nodes were palpable. After biopsy it was confirmed to be a high-grade undifferentiated pleomorphic sarcoma, which in the imaging studies was found proximal to the lesser trochanter. The extension CT scan is negative. What would be the therapeutic approach?
In resection margins, we have: intralesional → marginal (option 3) → Extended → Radical (options 1 and 4). This is a high-grade tumor, in which extended resection including tumor-free margins is indicated. Radical amputation surgery has not been shown to improve survival being reserved for selected cases (invasion of neurovascular structures, pathologic fracture...). Therefore, we discard both option 1 and 4; option 3 is also discarded, because it is a smaller margin than the extended one; by elimination we are left with option 2.
Hip disarticulation.
Treatment with ifosfamide and tamoxifen for 6 cycles prior to resection surgery to reduce the size of the lesion.
Marginal surgery removing the pseudocapsule that these tumors usually form in response to their rapid growth.
Modified right hemipelvectomy.
Radical amputation surgery has not been shown to improve survival being reserved for selected cases (invasion of neurovascular structures, pathologic fracture...). Therefore, we discard both option 1 and 4;
option 3 is also discarded, because it is a smaller margin than the extended one;
Radical amputation surgery has not been shown to improve survival being reserved for selected cases (invasion of neurovascular structures, pathologic fracture...). Therefore, we discard both option 1 and 4;