Guidelines for Complications of Cancer Treatment Vol VIII Part B

Vessel Related Issues in Sarcoma:Evidence Based GuidelinesIncidenceVessel invasion by primary malignant musculoskeletalneoplasms is uncommon. Approx. 3-4% of bone sarcomas 1and 4.5%-10% of soft tissue sarcomas 1,2 demonstrate vascularinvolvement. Most of the time tumors juxtaposed to vesselswithout encasement are resectable by excising the tumor alongwith the vascular adventitia, provided that an effective adjuvantwas used (radiotherapy for soft tissue sarcomas orchemotherapy for osteosarcoma) or the tumor was of lowhistologic grade 3 . In these cases, the goal of the surgery wasto obtain wide or wide with focally marginal surgical margins 3 .If adequate margins are not obtainable, a vascular resectionand reconstruction or an amputation is necessary. Vascularresection typically is not needed until there is more than 50%encasement of major vessels by tumor 3 .ImagingNevertheless, decision making before surgical treatment inpatients with musculoskeletal tumors of the limb requiresaccurate delineation of the presence and level of vascular143