PURPOSE OF REVIEW: The aim of this study was to summarize developments in the adjuvant/neoadjuvant chemotherapy of high-risk adult-type soft tissue sarcomas (STS). RECENT FINDINGS: The role of adjuvant/neaodjuvant chemotherapy in these patients is controversial, with a meta-analysis suggesting a 10% survival benefit. Recently, a randomized controlled trial in high-risk STS of extremities and trunk wall showed a 20% improvement in progression-free and overall survival after three preoperative cycles of epirubicin along with ifosfamide compared with a histology-tailored chemotherapy. This study has major strengths, including the selected high-risk population and the full-dose chemotherapy regimen. However, this was an interim analysis with a short follow-up in a trial originally planned to test the superiority of a histology-driven chemotherapy. As to high-risk patient selection, the new AJCC TNM staging system adds primary tumour site as a stratifying factor, while available prognostic nomograms account for additional criteria. SUMMARY: A recent trial strengthens perioperative chemotherapy as an option for high-risk STS patients within a shared decision-making process. If the final analysis of this trial confirms the currently observed progression-free and overall survival benefits, perioperative chemotherapy may become a standard. Also, new staging tools may refine our ability to select patients with a risk high enough as to deserve chemotherapy.
PURPOSE OF REVIEW: The aim of this study was to summarize developments in the adjuvant/neoadjuvant chemotherapy of high-risk adult-type soft tissue sarcomas (STS). RECENT FINDINGS: The role of adjuvant/neaodjuvant chemotherapy in these patients is controversial, with a meta-analysis suggesting a 10% survival benefit. Recently, a randomized controlled trial in high-risk STS of extremities and trunk wall showed a 20% improvement in progression-free and overall survival after three preoperative cycles of epirubicin along with ifosfamide compared with a histology-tailored chemotherapy. This study has major strengths, including the selected high-risk population and the full-dose chemotherapy regimen. However, this was an interim analysis with a short follow-up in a trial originally planned to test the superiority of a histology-driven chemotherapy. As to high-risk patient selection, the new AJCC TNM staging system adds primary tumour site as a stratifying factor, while available prognostic nomograms account for additional criteria. SUMMARY: A recent trial strengthens perioperative chemotherapy as an option for high-risk STS patients within a shared decision-making process. If the final analysis of this trial confirms the currently observed progression-free and overall survival benefits, perioperative chemotherapy may become a standard. Also, new staging tools may refine our ability to select patients with a risk high enough as to deserve chemotherapy.
Authors: Victoria T Rizk; Arash O Naghavi; Andrew S Brohl; David M Joyce; Odion Binitie; Youngchul Kim; John P Hanna; Jennifer Swank; Ricardo J Gonzalez; Damon R Reed; Mihaela Druta Journal: Clin Sarcoma Res Date: 2020-07-09
Authors: Aaron R Weiss; Yen-Lin Chen; Thomas J Scharschmidt; Yueh-Yun Chi; Jing Tian; Jennifer O Black; Jessica L Davis; Julie C Fanburg-Smith; Eduardo Zambrano; James Anderson; Robin Arens; Odion Binitie; Edwin Choy; Justin W Davis; Andrea Hayes-Jordan; Simon C Kao; Mark L Kayton; Sandy Kessel; Ruth Lim; William H Meyer; Lynn Million; Scott H Okuno; Andrew Ostrenga; Marguerite T Parisi; Daniel A Pryma; R Lor Randall; Mark A Rosen; Mary Schlapkohl; Barry L Shulkin; Ethan A Smith; Joel I Sorger; Stephanie Terezakis; Douglas S Hawkins; Sheri L Spunt; Dian Wang Journal: Lancet Oncol Date: 2020-07-20 Impact factor: 41.316