A 40-year-old woman presents with a slowly enlarging painless mass in the posterior thigh. MRI shows a 12 cm intramuscular mass with low signal on T1 and heterogeneous high signal on T2 with areas of hemorrhage. Biopsy reveals pleomorphic undifferentiated sarcoma (UPS). The standard of care for local control is:

• A Wide excision with 1 cm margins alone
• B Amputation to achieve clear margins
• C Isolated limb perfusion with melphalan followed by observation
• D Wide excision plus adjuvant external beam radiotherapy ✓

Explanation

For high-grade soft tissue sarcomas of the extremities >5 cm (such as UPS/MFH), standard of care for local control is wide excision combined with adjuvant radiotherapy (external beam or brachytherapy). This combination achieves local recurrence rates comparable to amputation while preserving the limb. Excision alone is inadequate for high-grade lesions due to high local recurrence risk. Amputation is reserved for cases where limb-sparing with adequate margins is genuinely impossible.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.