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Soft Tissue Sarcoma — RACP Adult Medicine MCQ

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HardMedical OncologySoft Tissue SarcomaRACP Adult Medicine

A 45-year-old man presents with a 10 cm mass in the right thigh that has been slowly growing over 6 months. MRI shows a deep-seated, heterogeneous soft tissue mass. Core biopsy reveals a high-grade undifferentiated pleomorphic sarcoma. CT staging shows no distant metastases. What is the standard management approach?

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Correct answer: D — Neoadjuvant radiation followed by wide surgical excision

For large (>5 cm), deep, high-grade soft tissue sarcomas of the extremity, the standard approach is neoadjuvant radiation therapy followed by wide surgical excision with negative margins. This reduces local recurrence while preserving the limb. Adjuvant chemotherapy (doxorubicin ± ifosfamide) may be considered for high-risk tumours. Sarcoma management requires a specialist multidisciplinary team. Amputation is rarely needed with modern reconstructive techniques.

Reference: Cancer Council Australia – 2020 – Soft Tissue Sarcoma Guidelines; NCCN – 2025 – Sarcoma