Publication:

Resecting the rigid and reconstructing the rest: a comprehensive review of chest wall sarcoma management

Primary chest wall sarcomas are rare malignancies, representing approximately 0.04% of new cancer diagnoses and requiring a complex multidisciplinary management strategy. A comprehensive Boolean search was conducted using PubMed/Medline, Google Scholar, Embase and Scopus to identify studies based on their relevance to the multidisciplinary management of adult patients with primary or secondary chest wall sarcomas. This review explores the clinical landscape of these heterogeneous tumors, differentiating between bone-derived and soft-tissue sarcomas. Diagnosis necessitates advanced imaging, including CT, MRI, and PET/CT, and precise biopsy techniques to facilitate accurate histopathological classification and surgical planning. Wide en bloc surgical resection achieving negative (R0) margins remains the primary curative modality, significantly impacting local control and overall survival. The integration of neoadjuvant and adjuvant systemic therapies and radiation is highly subtype-dependent, with chemosensitive tumors like Ewing sarcoma benefiting most from multimodality approaches. Furthermore, we detail the evolving science of chest wall reconstruction, where rigid prosthetic systems and advanced soft-tissue coverage are utilized to restore skeletal stability and respiratory function. Finally, this review highlights the emerging roles of targeted therapies and 3D intraoperative navigation. Ultimately, a coordinated multidisciplinary paradigm is essential to optimize oncological outcomes and preserve the quality of life for patients with these challenging thoracic neoplasms.