Case management discussion: How would you manage recurrent liposarcoma of the chest wall?

Patient 1. A 46-year-old female presented with a huge benign lipoma of the left axilla/breast in 1977. Repeated excisions led to three recurrences, the first reported as an intramuscular lipoma, the latter two as well-differentiated liposarcoma. She presented in 1990 with a large recurrence partially fixed to the chest wall. Patient 2. A 58-year-old man with cardiorespiratory impairment due to long-standing valvular disease presented in 1982 with a large poorly differentiated sarcoma over the lower posterior rib cage. He was treated by wide local excision (not including the ribs), and cover with a latissimus dorsi flap to allow completion of a radical perioperative course of radiotherapy. Recurrences around the periphery of the excision occurred in 1984, 1985, 1986, 1987, each treated by relatively wide local excision. He presented again in 1989 with further peripheral recurrences attached to the rib cage, still without evidence of distant metastasis, at which stage a further plan of management was sought.