Chest-wall resection can be performed with low morbidity and mortality rates and remains the primary treatment for most chest-wall
tumors. However, some lesions are best treated with a multimodality approach including preoperative
chemotherapy. Therefore, pretreatment tissue diagnosis is essential in planning. The biopsy should be done at the medical center where the definitive treatment will be undertaken, and frequently, a needle biopsy will be sufficient.
Osteosarcoma,
rhabdomyosarcoma,
Ewing's sarcoma, and other
small-cell sarcomas are sensitive to
chemotherapy, which should be given preoperatively, continued postoperatively, and modified according to the
tumor response.
Chondrosarcomas and most adult
soft-tissue sarcomas are well controlled by primary excision and selective use of adjuvant irradiation. Better systemic and local
therapy is needed for the recurrent
soft-tissue sarcomas and the aggressive unclassified
sarcomas. Chest-wall resection continues to play a primary role in the management of locally and regionally recurrent
breast cancer but is best combined with systemic
chemotherapy. Chest-wall resection can provide a long disease-free survival in patients with isolated
metastases from
sarcomas or
carcinomas. In addition, significant palliation can be afforded patients with symptomatic chest-wall
metastases and a shortened life expectancy.