This is a new edition of the original text of the same name, by Das Gupta, published in 1983. Since then, much has happened to expand the knowledge base with regard to both soft-tissue conditions and their treatment. The current edition is not merely an updated text; it has been substantially revised and reworked with new material and the addition of many new authors. Soft-tissue sarcoma represents a small fraction of the entire spectrum of cancers, and only a few texts cover this entity exclusively. Often, it is lumped together with other topics in books focusing on the broader subjects of musculoskeletal tumors and general oncology, resulting in only brief, superficial coverage. Several of the existing texts that are devoted exclusively to soft-tissue tumors are already highly regarded; however, these consist mainly of comprehensive pathology texts and radiographic and surgical atlases. This book is unique in that it fills a niche by bridging the gap between the basic pathology and the clinical treatment of these tumors. Therefore, it will be most useful to clinicians as a reference for making treatment decisions. No other comprehensive text within the field fulfills this need as effectively.
The text is organized in a logical fashion. Das Gupta and Chaudhuri wrote most of the chapters, including those on the characteristics of soft-tissue sarcomas, the natural history of individual tumors, and the principles of treatment. A fourth section, by Jaffe, is devoted to tumors in children, which is appropriate as these lesions are quite different from their counterparts in adults.
Major additions to this edition include chapters on imaging and molecular biology. Unfortunately, a chapter on rehabilitation has been deleted. Perhaps it will be restored in a future edition after more data on oncological and functional outcomes and on patient satisfaction become available. Chapters on pathology, radiation therapy, chemotherapy, and immunotherapy have been rewritten by new authors.
The subject of metastatic soft-tissue sarcomas and their treatment has not been addressed adequately in this or most other texts. While it is discussed to a limited extent in the chapter on combined modalities, the growing number of patients who survive sarcoma as a result of strides in treatment has led to an increasing number of patients with metastatic disease. Expanded coverage of this topic would be a major asset in future editions.
The chapter on imaging is welcome, as the advent of magnetic resonance imaging has revolutionized several areas of treatment by providing major improvements in the detection, anatomical localization, and surveillance of these tumors. The reproductions of the images are of excellent quality. The headings are divided according to specific histological categories, which may pose some difficulty for the reader because, with the exception of a few specific lesions, such as hemangiomas, lipomas, and ganglion cysts, magnetic resonance imaging cannot establish the histological diagnosis but, rather, can only suggest a diagnosis. As the authors note, a distinction between benign and malignant lesions is not readily made on the basis of the margins or the appearance of the tumor. Topics that should be addressed in future editions include the appearance of myxoid neoplasms on magnetic resonance imaging, fibromatosis, and the usefulness of magnetic resonance imaging or even spectroscopy for the assessment of the response to treatment.
The chapter on clinical diagnosis, staging, and prognosis is important for practitioners who do not regularly manage patients who have soft-tissue sarcomas. Unfortunately, the section on staging is already outdated. The chapter does not incorporate the recent addition of a new modification to the guidelines of the American Joint Committee on Cancer that integrates the depth of the tumor as a major prognostic variable1. Most readers of The Journal of Bone and Joint Surgery will probably be more familiar with the Musculoskeletal Tumor Society staging system of Enneking et al.2, which is not reviewed in this chapter, although the system of the American Joint Committee on Cancer is more widely used in the literature. Controversial issues regarding prognosis, such as the relationship between local control and survival, are discussed in detail.
The chapters on molecular biology and immunotherapy are excellent and welcome additions. Knowledge in this area is increasing substantially, and these chapters hit their target, providing enough detail without being overly technical or confusing to the reader who is not a molecular biologist. The discussions on oncogenes, tumor-suppressor genes, and drug-resistant genes are an excellent source for gaining a foothold in this advancing field. Immunotherapy has yet to have any meaningful impact on the treatment of soft-tissue sarcomas, and the information in this chapter undoubtedly will undergo many changes in the next decade.
In summary, this textbook is a superb resource on soft-tissue neoplasms. Compared with the few other texts devoted to the topic, this text is unique in that it addresses treatment from the vantage point of multiple specialties. While the book will be most useful to oncologists in the fields of surgery, chemotherapy, and radiation, non-oncologists and pathologists will find it helpful as well. I know that it will occupy a prominent position on my bookshelf.
Edward Y. Cheng, M.D.
Department of Orthopaedic Surgery
University of Minnesota Cancer Center
Minneapolis, Minnesota