Treatment of Low-Grade Fibrous Histiocytoma

Surgical Management

Wide local excision with negative margins is the cornerstone of treatment for all localized fibrous histiocytomas, and should be performed by a surgeon specifically trained in soft tissue tumor management, with the aim of achieving at least 1-2 cm margins 1
The biopsy tract and any cutaneous scar from previous procedures must be excised en bloc with the tumor 2
Re-operation at a reference center is mandatory for R1 or R2 resections if adequate margins can be achieved without major morbidity 1

Adjuvant radiotherapy is generally NOT required for low-grade tumors after complete excision with negative margins, but may be considered on a case-by-case basis for low-grade, superficial lesions >5 cm or low-grade, deep lesions <5 cm 1
For low-grade, deep lesions >5 cm, radiotherapy should be discussed considering anatomical site and expected sequelae versus histological aggressiveness 1
When indicated, postoperative radiotherapy should use the best available technique at 50-60 Gy in 1.8-2 Gy fractions, with possible boosts up to 66 Gy 1, 2

Patients should be monitored every 3 months with history and physical examination, and MRI of the resection site should be performed twice yearly for the first 2-3 years, then annually 2