Undifferentiated pleomorphic sarcoma, formerly known as malignant fibrous histiocytoma (MFH); is a rare tumor that exhibits a predisposition to aggressive clinical behavior that can invade soft tissue, retroperitoneum, bone, and other tissues. Limbs are the most common site of occurrence, followed by the retroperitoneum (1, 2). The cases of chest wall original and recurrence were reported rarely. This type of tumor has the characteristics of difficult diagnosis, strong invasiveness, prone to local recurrence or distant metastasis and poor prognosis. The management of all soft tissue sarcomas (STS), including MFH, is highly controversial; surgical resection is the mainstay, with adjuvant chemotherapy and radiotherapy (3). A retrospective study showed that approximately 15% of patients relapse after surgery (4). How to treat the patients who with recurrent MFH after surgery. The treatment of locally recurrent sarcoma has been controversial over the past few decades. There is currently no uniform standard of care. This case provides a therapeutic reference.
Adjuvant radiotherapy is indicated for STS, including undifferentiated pleomorphic sarcoma; for postoperative patients, adjuvant radiotherapy results in better local control rates (3). The patient did not receive adjuvant radiotherapy postoperatively, which may be one of the reasons for the early recurrence. We consider that this is an elderly patient, and on the one hand, it is difficult to tolerate extended resection of the lesion; on the other hand, there is still the possibility of residual reoperation. Therefore, radiotherapy is given in order to shrink the tumor and increase the effect of subsequent treatment. However, the tumor did not shrink; we considered that it may be related to the large size of the patient's recurrent tumor, and the radiation field was difficult to include the edge of 5 cm around the tumor bed (3). We believe that although radiotherapy has not achieved the original purpose, it has a certain killing effect on the tumor base and edge, and has a beneficial effect on subsequent treatment. At the same time, we believe that for patients with undifferentiated pleomorphic sarcoma of the chest wall, postoperative adjuvant radiotherapy can be used to obtain a better prognosis. For relapsed patients, extensive radiotherapy may be beneficial, but the rate of adverse effects of radiotherapy will be correspondingly increased, which needs to be evaluated by the attending physician.
Cryoablation has been reported to be used in various cancer treatments and is a safe and effective treatment modality for soft tissue sarcomas to achieve tumor shrinkage prior to surgical resection, but experience with this approach in recurrent soft tissue sarcomas is limited (5). In addition, the efficacy of radiofrequency ablation for recurrent soft tissue has been confirmed by previous cases (6), which can obtain long-term control, and is effective, safe, and reproducible. For this patient, we performed radiotherapy followed by CT-guided cryoablation. Radiotherapy has a certain killing effect on the tumor base and edge, thereby enhancing the effect of cryoablation. During cryoablation, the tumor base should be fully and thoroughly to kill the tumor. From the postoperative follow-up to the present, the patient's survival status is good; it shows that cryoablation is effective for recurrent pleomorphic sarcoma of the chest wall, and that the achievement of local control is crucial for the successful treatment of soft tissue sarcoma. It also suggests that for patients who cannot receive chemotherapy or radiotherapy, or whose tumors are too large or recur, cryoablation may be an appropriate treatment method to shrink the tumor, make the operation safer, improve local control of the tumor, and achieve successful tumor treatment. We believe that cryoablation reduces local recurrence rates and ultimately improves overall survival. At the same time, strict imaging follow-up is required after ablation treatment for early identification, detection of recurrence and treatment timely.