Management of Soft-Tissue Tumors Clinical Practice Guidelines (JOA, 2022)

Japanese Orthopaedic Association

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

April 29, 2022

Guidelines for the management of soft-tissue tumors were published in March 2022 by the Japanese Orthopaedic Association (JOA) in Journal of Orthopaedic Science.[1]

Diagnosis and Initial Management

Genetic testing for pathologic diagnosis is recommended, subject to conditions.

For malignant soft-tissue tumors, computed tomography (CT) is suggested to explore distant metastases; positron emission tomography (PET)-CT is suggested both before and after treatment.

For soft-tissue tumors ≥5 cm, preoperative biopsy is suggested; for tumors ≤ 2 cm, excisional biopsy is permissible, subject to conditions.

Surgical Treatment

For atypical lipomatous tumors of the extremity or the superficial location of the trunk, marginal excision is suggested over wide excision.

For malignant soft-tissue tumors, wide excision is suggested; for those with image-based findings of infiltration, a surgical margin that addresses the infiltration is suggested. Use of an ultrasonic scalpel to control bleeding is suggested.


For operable high-grade malignant soft-tissue tumors, perioperative adjuvant chemotherapy (ChT) is recommended, subject to conditions.

For infantile fibrosarcoma, perioperative ChT is recommended, subject to conditions.

For synovial sarcoma during childhood or adolescence, perioperative ChT is not recommended, subject to conditions.

Radiation Therapy

For malignant soft-tissue tumors, perioperative adjuvant radiation therapy (RT) is suggested; neither preoperative nor postoperative irradiation can be considered superior to the other as adjuvant RT.

Treatment of Advanced or Difficult Conditions

For malignant soft-tissue tumors with distant metastases, excision of the primary tumor and the metastatic tumors is suggested.

For locally recurring malignant soft-tissue tumors, wide excision of the tumor together with scarring from the previous surgery is suggested.

For unresectable advanced and/or recurrent malignant soft-tissue tumors, drug therapy is suggested; doxorubicin monotherapy is recommended as first-line treatment.

For unresectable malignant soft-tissue tumors, particle-beam RT is suggested.

For elderly patients with malignant soft-tissue tumors for which wide excision is indicated, avoidance of marginal excision plus RT is suggested.

For more information, please go to Benign and Malignant Soft-Tissue Tumors.


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