Types of Soft Tissue Sarcoma
Soft Tissue Sarcoma (STS) is a group of different neoplasms with variable characteristics and different types of cells affected. It arises from soft tissues, such as muscle, fat, nerves, blood vessels, fibrous tissues, or deep skin tissues.
It may arise anywhere in the human body with limbs being the most common site. There are many different types of soft tissue tumors (abnormal growth of cells that remain confined to the site of origin) which are about 100 times more common than the STSs. Benign soft tissue tumors, such as fibroma, hemangioma, lipoma, leiomyoma, lymphangioma, myxoma, neurofibroma, neuroma, schwannoma, rhabdomyoma, and others are not discussed here.
Liposarcoma is cancer that arises from the adipose (fatty) tissue anywhere in the body. It accounts for about 20% of all STSs in adults. Most common location of liposarcoma includes thigh, behind the knee, and retroperitoneal (backside of the abdomen). It mostly occurs in individuals aged 50 to 65 years.
Liposarcoma can be further divided into 3 subgroups:
Well-differentiated and dedifferentiated
Well-differentiated liposarcoma is generally present as a deep-seated, painless, enlarging mass that may become very large over time but does not spread to a distant location. It has a good prognosis for limbs but a poor prognosis for retroperitoneum or mediastinal location. Dedifferentiated liposarcoma is characterized by the presence of non-lipogenic area(s) within the tumor.
It is considered as a high-grade tumor that usually consists of small, evenly dispersed round cells with a variable number of fat cells. Greater the number of round cells more aggressive is the disease.
It is a high-grade tumor that consists of different lipoblasts, tends to spread quickly to lungs and has a worse prognosis.
It arises from the fibrous tissue anywhere in the body, especially that of limbs, trunk, and head and neck region. It is relatively uncommon, accounting for about 1% of all STSs in adults. It mostly affects middle-aged and older adults with a few cases reported in children. It shows moderate aggressiveness with little tendency to spread to nearby tissues.
LMS mainly arises from the smooth muscles in the blood vessels, uterus, and other visceral organs/structures. They mostly affect middle-aged or older adults and may occur anywhere in the body. Presentation depends upon the type of tissue involved. When a blood vessel is involved, obstruction in the blood flow is common, with pain due to the involvement of the nearby nerves. Large size tumors and high-grade disease usually have a poor prognosis.
RMS mainly arises from the skeletal muscles (voluntary muscles that control the body movement at will). RMS cells resemble cells those are formed during an early phase of development in a 6- to 8-week old embryo and eventually give rise to skeletal muscles. It generally affects children with a few cases reported in adults. It can occur anywhere in the body.
RMS can be categorized into the following 3 subtypes:
It is the most common subtype that mainly affects the children less than 5 years of age with a few cases reported in adults. The most common locations include orbit (eyeball), head and neck area, bladder, vagina, prostate, and testicles.
It generally affects skeletal muscles of the limbs and trunk in adolescents and young adults. These are rare in younger children and have poor prognosis in this population
Anaplastic or Pleomorphic RMS
It is an inherently aggressive disease that mostly affects adults.
It may arise either from the blood vessels (hemangiosarcomas) or from lymph vessels (lymphangiosarcomas). Most angiosarcomas start in the superficial soft tissues including skin with less than one-fourth starting in the deeper soft tissues.
The incidence of these tumors has been linked with the history of radiation treatment, especially in the breast where these tumors generally occur after initial radiation therapy along with lymphedema. These tumors generally have a poor prognosis.
It arises from the cells lining the blood vessels and lymph vessels. It may develop anywhere in the body including the lymph nodes and visceral organs like lungs and those of digestive system. It mostly presents as a dark-colored, irregular tumor on the skin or on the mucosa of the mouth. It can be life-threatening when it involves visceral organs.
KS can be further divided into four classes:
t is the most common type of KS in the US. It occurs in individuals with AIDS, that is, when the immune system has been severely compromised due to the HIV infection.
It is mostly reported in Mediterranean, Eastern European, and Middle Eastern countries. It does not require prior significant immunosuppression and is mostly observed in old-aged individuals with relatively higher incidences reported in males. It usually presents as single or multiple tumors in the lower limbs.
It is common among individuals living in the Equatorial African countries. It mostly affects young adults and children. In children before attaining puberty, KS may occur as an aggressive form affecting lymph nodes. KS-related herpes virus infection is more common in Africa.
It is observed in individuals with a suppressed immune system due to a prior organ/hematopoietic stem cell transplant and who are on immunosuppressants.
Alvolar Soft Part Sarcoma (ASPS)
It generally arises from the soft tissues in the lower limbs of young adults. It is a rare type of sarcoma accounting for less than 1% of all STSs. It generally presents as a painless slow-growing mass without any other symptom but can spread readily to distant body parts, causing a poor prognosis.
It generally arises from the tissue under the skin of upper and lower limbs in adolescent and young adults. The lesions are multinodular with a central region of tissue necrosis. These cancers can spread to lymph nodes and generally have a poor prognosis.
It arises from the fibrous tissue, with a variable myxoid component. It mostly presents as a painless mass in the limbs and/or trunk. It generally occurs as a low-grade disease that can progress to a high-grade variant, that may spread to lungs, lymph nodes, and bones.
Malignant Peripheral Nerve Sheath Tumor (MPNST)
This arises from the nerve sheath rather than from the nerve itself. It mostly affects the major nerves of the body, especially those in the lower limbs and the trunk of middle-aged adults. Most of these tumors are high-grade with a high tendency to spread to distant body parts.
It arises from osteoid cells not attached to the s keleton. The most common location for extraskeletal osteosarcoma is limbs with few cases reported in breast, urinary bladder, retroperitoneum, and other visceral organs. It mostly affects individuals older than 50 years.
Synovial sarcoma arises from deep soft tissue (not necessarily the synovial tissue) around the joints – hip, knee, ankle, and shoulder. It generally affects males aged between 15 to 35 yers. It is presented as a slow-growing painful (or sometimes painless) mass and can spread to nearby tissues.
Clear Cell Sarcoma
It mostly affects tendons in the lower and upper limbs of young adults and present with a painful or painless soft tissue mass composed of epithelioid-type cells that behave like melanoma (cancer of melanin-producing skin cells). The tumor cells contain melanin and tend to spread to nearby lymph nodes. Clear cell sarcoma cells typically contain translocation t(12;22) resulting in fusion of the EWSRI and ATF1 genes.
Undifferentiataed Pleomorphic Sarcoma (UPS)
It usually presents as a painless, deep-sited tumor that can grow locally and can spread to nearby tissues. It mostly affects individuals in their 60s. The most common loc ation is limbs and retroperitoneum.
Desmoplastic Small Round Cell Tumor
It contains monotonous cells that are stained by hematoxylin or eosin stains. Translocation t(11;22) resulting in fusion of the EWSRI and WT1 genes is the characteristic feature of this tumor. It is mostly seen in children and young adults with abdomen being the most common location.
Aggressive Fibromatosis/Desmoid Tumors
These tumors arise from the fibrous tissue and have characteristics intermediate between fibrosarcoma and fibroma. These can spread to a nearby tissue with less chances of spread to a distant body parts. Abdominal wall (specifically after pregnancy), mesentery of the small intestine, and limbs are the most common location for these tumors. They generally present as a painful slowly growing mass that may cause compression of nearby structures or obstruction, depending upon their location.
Dermatofibrosarcoma Protuberans (DFSP)
It is the sarcoma of the fibrous tissue beneath the skin including both dermis and subcutis. It mostly affects individuals aged between 30 to 50 years. It shows an infiltrative pattern, and spreads locally with multifocal nodules. The skin of the limbs and the trunk is the most common location. It grows slowly but have high recurrence due to it’s infiltrative nature.
Solitary Fibrous Tumor (SFT)/Hemangiopericytoma
It arises from the fibrous and/or fatty tissue and is characterized by the presence of branching vascular pattern within the tumor mass. It usually presents as a slow-growing painless mass in the thoracic cavity, retroperitoneum, pelvis, orbit, underarms and/or lower limbs. It mostly affects middle-aged adults, and is mostly benign but can be malignant. Previously called hemangiopericytomas, are now considered solitary fibrous tumors.
It is a tumor that arises in the blood vessels supplying to soft tissues or to internal organs, such as the liver or lungs. It is generally a slow-growing low-grade cancer that can spread to nearby tissues and sometimes to distant body parts.
Risk Factors for Sarcoma
Following are the risk factors for Soft Tissue Sarcoma. Presence of one or more of the following may increase the probability for development of sarcoma.
Prior Radiation Exposure
History of exposure to radiation for the treatment of another tumor/cancer has been implicated for the development of STSs, especially fibrosarcoma, undifferentiated pleomorphic sarcoma (UPS), angiosarcoma, malignant peripheral nerve sheath tumor (MPNST), and osteosarcoma. It generally takes around 10 years from the initial radiation treatment for the development of secondary cancer.
Genetic cancer predisposition syndromes
Following are certain examples of such genetic syndromes:
- Neurofibromatosis type 1 or Von Recklinghausen disease (caused by a mutation in the NF1 gene) may elevate the risk of developing malignant peripheral nerve sheath tumors (MPNST) and gastrointestinal stromal tumors (GISTs)
- Gardner syndrome (caused by a mutation in the APC gene) may lead to the increased incidence of the desmoid tumors
- Li-Fraumeni syndrome (caused by a mutation in the TP53 gene) may increase the chances of developing STSs, especially after a prior radiation treatment
- Gorlin syndrome or nevoid basal cell carcinoma syndrome (caused by a mutation in the PTCH1 gene) may increase the chances of developing fibrosarcoma and rhabdomyosarcoma
- Tuberous sclerosis or Bourneville disease (caused by a mutation in the TSC1 or TSC2gene) may elevate the risk of developing rhabdomyosarcoma
- Werner syndrome or adult progeria (caused by a mutation in the RECQL2 gene) increases the possibility of developing STSs in children.
- Primary familial GIST syndrome (caused by a mutation in the KIT or PDGFRA gene) may increase the risk of developing GISTs.
Other syndromes, such as Beckwith-Wiedemann syndrome, Costello syndrome, Noonan syndrome, and Carney-Stratakis syndrome have also been implicated in enhancing the risk of developing STSs.
Higher risk of STSs has also been reported in individuals with chronic exposure to certain chemicals like vinyl chloride, arsenic, Agent Orange, chlorophenols, insecticides, herbicides that contain phenoxyacetic acid generally experienced by the workers of plastic, textile, dyestuffs, paint, leather, dry-cleaning, metal, wood, and agriculture industries.
Weakend Immune System
Individuals with a weak immune system that may be due to HIV infection, autoimmune disease, or immunosuppresants in patients who have undergone an organ/hematopoietic stem cell transplant are considered at higher risk of developing certain types of STSs, for example, Kaposi sarcoma (KS).
Kaposi sarcoma-associated herpesvirus (KSHV) infection
KSHV or Human herpesvirus 8 (HHV8) is responsible for the development of Kaposi sarcoma (KS). KSHV infection is common in some geographical location, like some areas in Africa. However, all individuals with KSHV infection do not develop KS. KSHV infection is more common in individuals infected with HIV. It may lead to suppression of the immune system and KS later in life.
Risk of developing certain STSs increases in an individual with a history of the same or a different type of STS. Also, certain studies have reported an increased incidence of STSs in individuals with a history of trauma, especially in limbs.
Age and Gender
Older age individuals, especially males, are generally at increased risk of developing STSs. However, there are certain exceptions, such as rhabdomyosarcoma (RMS) is more common in children.
Signs and Symptoms
The most common site for the development of STSs includes limbs (43%), visceral organs (19%), retroperitoneum (15%), the trunk (10%), and head and neck region (9%). Any one or more of the above symptoms if present may require further investigations to confirm the diagnosis-
- The most common symptom of STS is a painless slow-growing mass. In about one-third cases the mass may be painful.
- A pain in the abdomen or in the affected organ/tissue that usually gets worse over time.
- Blood in vomitus, urine, or stool depending upon the site of the tumor.
- Obstruction of the gastrointestinal tract by a tumor may lead to change in bowel habit, indigestion, feeling of fullness, loss of appetite, nausea, vomiting, and other related symptoms.
- Obstruction of blood vessels by a growing tumor may cause fluid retention, edema, or swelling in the related area drained by the affected blood vessel.
- Tumors affecting the eyes may cause blurred vision or other vision-related problems.
- Unexplained weight loss, anemia, fatigue, and weakness may develop in some cases due to chronic blood loss.
Sarcoma Staging Investigations
This test can distinguish between fluid-filled cysts (usually benign) and solid tumor masses. The ultrasound test does not use any ionizing radiation and is considered as safe.
Computed tomography (CT) scan
This technique can accurately detect the tumor’s size, location, invasion to nearby structures (for example, the bones), and spread to distant body parts (for example, the lungs and the liver). Sometimes, it can distinguish between a benign and a cancerous change and can even reveal the type of tissue involved (and thus the type of STS). This is very helpful for planning the treatment in case radiation therapy is indicated for the treatment. It can also be used to guide a biopsy needle to collect biopsy samples from the affected area.
Magnetic resonance imaging (MRI) scan
This technique provides detailed images of soft tissues in the body using radio waves, strong magnetic field, and gadolinium – the contrast material, which is used via intravenous injection to improve the clarity of the MRI images.
Similar to CT, it can accurately diagnose the size, location, extent of invasion, and spread of disease to distant body parts, especially soft tissues like the muscles, eyeballs, blood vessels, brain, and spinal cord.
Sometimes, it can distinguish between a benign and a cancerous change and can even reveal the type of tissue involved (and thus the type of STS).
It is better than CT for the examination of soft tissues in the limbs, but inferior to CT for examining the bones. Additionally, similar to CT, it can be used in planning radiation treatment for STSs. It can also be used to guide a biopsy needle to collect biopsy samples from the affected area.
Positron emission tomography (PET) scan
The areas of higher radioactivity indicate cancerous tissue on the PET scan. This technique can be combined with CT scan (PET/CT) to accurately diagnose the extent of disease in distant body parts.
It can establish the diagnosis of STS, the type of STS, the severity of cancerous changes involved (grade of cancer), and the presence of specific defective genes. The detected defect(s) can be targeted with the help of an appropriate treatment approach.
Following are common techniques used for collecting the biopsy samples from the affected area/lymph nodes:
Core Needle Biopsy
In this technique, a hollow needle attached to a syringe is used to collect the biopsy sample from the affected area/lymph node. A small sample of tissue is usually obtained with this technique that can be tested to establish the diagnosis of the STS. A fine needle aspiration can be utilized to diagnose disease progression or recurrence in patients who have received treatment.
In this technique, a tissue sample from the affected site is removed surgically. When only a part of the affected tissue is removed, the procedure is known as the incisional biopsy. While in the case of excisional biopsy, the whole tumor is removed surgically. The magnitude of the procedure depends upon the location and the size of the tumor. Excisional biopsy is usually performed when the tumor is located at an accessible site and do not involve any critical structure. It usually combines both diagnosis and treatment for the STS.
Staging of Soft Tissue Sarcoma
TNM is the most commonly used system for staging STSs of the trunk, extremities (limbs), and retroperitoneum by the medical community. “T” stands for “Tumor Size”, “N” for “Lymph Nodes”, and “M” for “Metastasis”. Numbers and/or letters after T (1, 2, 3, and 4), N (0 and 1), and M (0 and 1) provide more details about each of these factors.
Additionally, STS of the trunk, extremities (limbs), and retroperitoneum is graded to assess the aggressiveness of the disease. A three-tiered French Federation of Cancer Centers Sarcoma Group (FNCLCC) grade system is the most commonly used system to grade the STS.
In this system, the grade of a tumor is determined with the help of 3 parameters: diﬀerentiation (appearance of cell morphology under the microscope), mitotic activity (rate of cancerous cell division), and extent of necrosis (extent of dead tissue present in the tumor mass).
Each parameter is scored as follows: diﬀerentiation (1–3), mitotic activity (1–3), and necrosis (0–2), where a higher score indicates abnormal cells morphology, high rate of cell division, and presence of high amount of dead tissue, respectively. The scores are added to assign the grade to a tumor, where G1 = a score of 2 or 3; G2 = a score of 4 or 5; and G3 = a score of 6 to 8.
Once T, N, and M categories and the overall grade of a tumor are determined through different diagnostic techniques, this information is combined to assign an overall stage (from 0 to IV) to the disease. Following table describes the characteristics of different stages assigned to the STS of the trunk, extremities (limbs), and retroperitoneum:
|STAGE||TNM and GRADE||Trunk & Extremities||Retroperitoneum|
|IA||T1 N0 M0 G1/X||The primary tumor is </=5 cm in size. No spread to nearby lymph nodes or distant body parts. The assigned grade is G1 or grade could not be assigned or is unknown.||The primary tumor is </=5 cm in size. No spread to nearby lymph nodes or distant body parts. The assigned grade is G1 or grade could not be assigned or is unknown.|
|IB||T2-4 N0 M0 G1/X||The primary tumor size may range from >5 cm to >15 cm. No spread to nearby lymph nodes or distant body parts. The assigned grade is G1 or grade could not be assigned or is unknown.||The primary tumor size may range from >5 cm to >15 cm. No spread to nearby lymph nodes or distant body parts. The assigned grade is G1 or grade could not be assigned or is unknown.|
|II||T1 N0 M0 G2-3||The primary tumor is </=5 cm in size. No spread to nearby lymph nodes or distant body parts. The assigned grade is G2 or G3.||The primary tumor is </=5 cm in size. No spread to nearby lymph nodes or distant body parts. The assigned grade is G2 or G3.|
|IIIA||T2 N0 M0 G2-3||The primary tumor is >5 cm but </=10 cm in size. No spread to nearby lymph nodes or distant body parts. The assigned grade is G2 or G3.||The primary tumor is >5 cm but </=10 cm in size. No spread to nearby lymph nodes or distant body parts. The assigned grade is G2 or G3.|
|IIIB||T3-4 N0 M0 G2-3||The primary tumor size may range from >10 cm to >15 cm. No spread to nearby lymph nodes or distant body parts. The assigned grade is G2 or G3.||The primary tumor size may range from >10 cm to >15 cm. No spread to nearby lymph nodes or distant body parts. The assigned grade is G2 or G3.|
|Any T N1 M0 Any G||N/A||The primary tumor of any size. The disease has spread to nearby lymph nodes. No spread to distant body parts. The assigned grade may have any value.|
|IV||Any T N1 M0 Any G||The primary tumor of any size. The disease has spread to nearby lymph nodes. No spread to distant body parts. The assigned grade may have any value.||N/A|
|Any T Any N M1 Any G||The primary tumor of any size that might or might not have spread to nearby lymph nodes. The disease has spread to distant body parts, such as the lungs. The assigned grade may have any value.||The primary tumor of any size that might or might not have spread to nearby lymph nodes. The disease has spread to distant body parts, such as the liver or lungs. The assigned grade may have any value.|
Stage grouping for STS in the abdomen, thoracic visceral organs, and Head & neck region require further data collection and has not been established yet.
Soft Tissue Sarcoma Treatment
The soft tissue sarcoma treatment usually depends on many factors, including but not limited to the type of sarcoma, stage of disease, the location of the disease, performance status, patient’s preference, along with other factors. Following are the preferred treatment approaches for different stages of soft tissue sarcoma, but the final decision is taken after clinical assessment of the patient by an oncologist.
Stage I STSs are low-grade tumors of any size. If possible, surgical resection with negative margins is considered as the standard treatment. In a case when negative margins were not obtained, further surgical resection to remove all cancerous tissue is the preferred approach. If further surgery is not possible, radiotherapy may be employed to decrease the chances of disease recurrence.
If the tumor is present at such a location (e.g. retroperitoneum, trunk, and head and neck,) that it cannot be entirely removed without functional disability, radiotherapy may be employed as the first-line treatment. This may cause the tumor to shrink sufficiently that it can be removed surgically.
Stage II or III
Most Stage II- and III STSs are high-grade tumors that tend to spread quickly and some of them have already spread to nearby lymph nodes. If possible (without any significant functional disability), surgical resection with negative margins is considered as the standard treatment. Any lymph node with the sign of disease spread should also be removed. Radiotherapy with/without chemotherapy may be considered after complete removal of the tumor.
If tumor is too large or present at such a location (e.g. retroperitoneum, trunk, and head and neck,) that it cannot be entirely removed without functional disability, or if surgery is not possible due to overall health of the patient, radiotherapy with or without chemotherapy may be employed as the first-line treatment.
This may cause the tumor to shrink sufficiently that it can be removed with surgery. Further treatment, such as more radiotherapy/chemotherapy and/or supportive care or any other treatment may be provided based on the response to initial treatment.
Stage IV STSs are cancers that have spread to a distant body parts.
For patients with a single site of disease spread and a small primary tumor that can be entirely removed with surgery, a surgical resection with the negative surgical margins for the primary tumor and the distant site is considered as the preferred treatment. As appropriate, tumor ablation, embolization, or radiotherapy may be employed instead of surgical resection for the secondary tumors.
For patients with a widespread disease or when the primary and secondary tumors cannot be removed by surgery, chemotherapy is usually employed. Any other suitable treatment may be employed as palliative treatment.
Targeted Therapy for Sarcoma
Targeted drugs works differently than chemotherapy drugs that they target a specific gene or protein characteristic of the cancer cells that help them to divide and grow indefinitely.
Tyrosine Kinase Inhibitors
Sorafenib is a kinase inhibitor that is active against a variety of kinases including KIT, VEGFR-1–3, and PGDFR beta.
It has shown clinical benefit for the treatment of patients with unresectable, KIT-positive GISTs who have received prior treatment with imatinib and sunitinib.
It is also used in patients with solitary fibrous tumor, advanced epithelioid hemangioendothelioma, desmoid tumors (aggressive fibromatosis), angiosarcoma, and solitary fibrous tumor (Hemangiopericytoma).
Pazopanib is a multitargeted TKI that inhibit several kinases including VEGFR-1–3, PDGFR alpha and beta, KIT and others. It has been approved for the treatment of advanced soft tissue sarcomas other than adipocytic tumors and GISTs that have not responded to chemotherapy.
Some clinical studies have reported that nilotinib can confer clinical benefit in patients with unresectable, KIT-positive GIST who have received imatinib and sunitinib and progressed on these drugs, especially with KIT exon 17 mutations and not with KIT exon 9 mutation.
Dasatinib is another kinase inhibitor that has demonstrated activity against PDGFRA D842V mutation that is commonly involved in the development of resistance to imatinib treatment. Thus, it could be a potentially effective treatment option for patients with imatinib-resistant GIST.
Perivascular epithelioid cell tumors (PEComas) are mostly benign but can be malignant or aggressive, such as in the case of advanced-sage or recurrent lymphangioleiomyomatosis or angiomyolipomas.
In most cases, PEComa tumors show dysregulated mammalian target of rapamycin (mTOR) signaling due to a mutation in the TSC1 or TSC2 genes leading to the tumor development and progression.
The mutation in the indicated genes may be inherited or sporadic. Targeted drugs directed towards mTOR, for example, sirolimus, temsirolimus, and everolimus have shown benefit in the treatment of advanced-stage PEComas. Sirolimus has been approved by US FDA for treatment of patients with pulmonary lymphangioleiomyomatosis.
Following are the 2 monoclonal antibodies which are currently recommended for the treatment of STSs:
Olaratumab is a novel monoclonal antibody that binds to and inhibits PDGFR alpha. The activation of PDGFR alpha is thought to drive tumorigenesis and disease progression in STSs.
Olaratumab, in combination with doxorubicin (a chemotherapeutic drug), has been approved for the treatment of patients with untreated, unresectable, or metastatic STS. Interestingly, the reported clinical benefit was consistent among all patients including those with the presence or absence of PDGFR alpha expression.
Side effects of combined treatment (olaratumab + doxorubicin) include infusion reactions, fatigue, nausea, musculoskeletal pain, hair loss, vomiting, diarrhea, decreased appetite, abdominal pain, neuropathy, and headache.
Bevacizumab is a monoclonal antibody that binds to vascular endothelial growth factor (VEGF) and inhibits its interaction with VEGFR.
The drug has shown clinical benefit as single agent treatment for patients with highly vascular tumors, such as angiosarcoma and solitary fibrous tumor (hemangiopericytoma), or in combination with temozolomide (a chemotherapeutic drug) in patients with malignant SFT.
Best Sarcoma Specialist in Delhi
Dr Sunny Garg is a renowned Medical Oncologist in New Delhi with an experience of around 10 years of treating sarcoma patients. He has treated soft tissue sarcoma patients with Chemotherapy, Targeted Therapy, Immunotherapy and Personalized Cancer Treatment. He is currently practicing at Manipal Hospital, Dwarka.
Diagnostic modalities available at our hospital include Ultrasound or CT guided Biopsy, Genetic/Molecular testing, Cytogenetics, Whole Body PET CT, etc. Other treatment facilities for Soft Tissue Sarcoma available are Surgical Resection, Radiation Therapy, etc.
Call +91 9686813020 for appointment.