The Use of Adjuvant or Neoadjuvant Chemotherapy in Extremity and Truncal Sarcoma

10.2310/7800.16100 ◽

2018 ◽

Author(s):

Robert J Canter

Keyword(s):

Soft Tissue ◽

Neoadjuvant Chemotherapy ◽

Soft Tissue Sarcoma ◽

Synovial Sarcoma ◽

Distant Recurrence ◽

Curative Intent ◽

Pleomorphic Sarcoma ◽

Level I ◽

Meta Analyses ◽

The Impact

Although neoadjuvant chemotherapy has been an established component of multimodality cancer care for patients with pediatric sarcomas for the past 25 years, the role of adjuvant or neoadjuvant chemotherapy in the management of adult patients with soft tissue sarcoma (STS) amenable to treatment with curative intent remains controversial. Overall, meta-analyses have revealed modest improvements in survival outcomes with the use of adjuvant or neoadjuvant chemotherapy, but individual trials have demonstrated inconsistent results leading some to question the robustness and external validity of the results. A recent randomized trial using anthracycline- and ifosfamide-based chemotherapy has provided further positive evidence in support of neoadjuvant chemotherapy for adult STS patients, but concerns persist regarding the risks of chemotherapy-related toxicities and the generalizability of the findings. Given the substantial risk of distant recurrence and disease-specific death for adult STS patients with tumors greater than 10 cm, especially those with synovial sarcoma and myxoid or round liposarcoma histologies, these patients should be strongly considered for neoadjuvant chemotherapy as part of a combined modality approach. The impact of recent level I data on the broader implementation of adjuvant or neoadjuvant chemotherapy in adult STS remains to be seen. This review contains 5 figures and 34 references Key Words: chemotherapy, limb salvage, myxoid/round cell liposarcoma, multimodality therapy, soft tissue sarcoma, surgery, survival, synovial sarcoma, undifferentiated pleomorphic sarcoma

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The analysis of characteristics of 1624 soft tissue sarcoma cases in 2006~2016 in Henan Province Cancer Hospital, China

10.21203/rs.2.14006/v1 ◽

2019 ◽

Author(s):

Peng Zhang ◽

Jinyan Liu ◽

Feifei Feng ◽

Qiao Zhang ◽

Guangcai Duan ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Synovial Sarcoma ◽

Henan Province ◽

Nerve Sheath Tumor ◽

Gender Ratio ◽

Pleomorphic Sarcoma ◽

Pathological Type ◽

Cancer Hospital ◽

Pathological Subtypes

Abstract Background To analyze the incidence characteristics of 1624 inpatients with soft tissue sarcoma (STS) during 2006 to 2016 in Henan Province Cancer Hospital.Methods The information of electronic medical record from the first hospitalized patients with STS in Henan Province Cancer Hospital during January 1, 2006 to December 31, 2016 was collected, and descriptive statistics was analyzed on age, gender and pathological type by using SPSS21.0 software.Results There were 1624 inpatients with STS in Henan Province Cancer Hospital in 2006~2016.The top nine pathological subtypes of STS with high constituent ratio were undifferentiated pleomorphic sarcoma (UPS,23.83%),synovial sarcoma(16.69%), liposarcoma(13.67%), fibrosarcoma(10.22%), sarcoma without definite type (8.99%), leiomyosarcoma(7.02%), dermatofibrosarcoma protuberant (5.79%),rhabdomyosarcoma (4.68%) and malignant peripheral nerve sheath tumor(4.25%). The average age of inpatients was 44.71±17.91, and the inpatients aged 35-59 accounted for 47.6%.The number of UPS inpatients reached the peak at the age of 55 to 64; The proportion of rhabdomyosarcoma between 0~4 and 5~9 years old can reach above 46%.In total 1624 inpatients of STS, the number of male and female inpatients were 923 and 701, respectively. The gender ratio was 1.32:1. The proportion of UPS in either male or female inpatients was the highest, accounting for 23.10% and 24.80%, respectively. The number of male inpatients was more than that of female in the top nine pathological subtypes of STS except leiomyosarcoma (the gender ratio was 0.84:1).Conclusion The top three pathological subtypes of STS with high constituent ratio were UPS, synovial sarcoma and liposarcoma.UPS should be paid more attention on the prevention, treatment and research in Henan in future for its highest proportion of STS.

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Neoadjuvant Chemotherapy, Concurrent Chemoradiation, and Adjuvant Chemotherapy for High-Risk Extremity Soft Tissue Sarcoma

American Society of Clinical Oncology Educational Book ◽

10.1200/edbk_201421 ◽

2018 ◽

pp. 910-915 ◽

Cited By ~ 5

Author(s):

Elizabeth H. Baldini ◽

Axel Le Cesne ◽

Jonathan C. Trent

Keyword(s):

High Risk ◽

Adjuvant Chemotherapy ◽

Soft Tissue ◽

Neoadjuvant Chemotherapy ◽

Soft Tissue Sarcoma ◽

Distant Recurrence ◽

Concurrent Chemoradiation ◽

Extremity Soft Tissue Sarcoma ◽

Risk Patients ◽

The Individual

Standard treatment of large intermediate- and high-grade extremity soft tissue sarcoma (ESTS) typically includes wide excision and radiation therapy. Many patients do well with this approach, but for those with unfavorable features, risk for distant recurrence and, ultimately, mortality can exceed 50%. Unfortunately, universally accepted data elucidating effective treatments to prevent recurrences and improve survival for such high-risk patients are lacking. Accordingly, opinions about the appropriate role of systemic therapy for patients with high-risk localized ESTS vary. This article reviews the current literature pertaining to neoadjuvant chemotherapy, concurrent chemoradiation, and adjuvant chemotherapy for high-risk ESTS. All of these approaches are feasible and reasonable to consider. Ultimately, the decision to incorporate chemotherapy into the treatment regimen is best reached by discussion among an experienced multidisciplinary sarcoma team and should be tailored to the individual patient risk profile.

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Cohort Analysis of Patients With Localized, High-Risk, Extremity Soft Tissue Sarcoma Treated at Two Cancer Centers: Chemotherapy-Associated Outcomes

Journal of Clinical Oncology ◽

10.1200/jco.2004.02.057 ◽

2004 ◽

Vol 22 (22) ◽

pp. 4567-4574 ◽

Cited By ~ 111

Author(s):

Janice N. Cormier ◽

Xuelin Huang ◽

Yan Xing ◽

Peter F. Thall ◽

Xuemei Wang ◽

...

Keyword(s):

High Risk ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Local Therapy ◽

Distant Recurrence ◽

Hazard Ratio ◽

Stage Iii ◽

Clinical Benefits ◽

The Impact

Purpose Patients with American Joint Committee on Cancer stage III soft tissue sarcoma (STS) have high risks of distant recurrence and death. The role of chemotherapy for these patients remains controversial despite several randomized trials and a meta-analysis. Methods We reviewed the treatments and outcomes of 674 consecutive adult patients presenting with primary stage III extremity STS between 1984 and 1999. Pre- or postoperative doxorubicin-based chemotherapy was used in a nonrandomized fashion in approximately half of this high-risk population. The objective of this review was to evaluate the impact of chemotherapy while accounting for known prognostic variables. Results Among 674 patients, 338 (50%) were treated with local therapy only, and 336 (50%) were treated with local therapy plus chemotherapy. The median follow-up for survivors was 6.1 years. Five-year local and distant recurrence-free interval probabilities were 83% and 56%, respectively, for the two groups combined. The 5-year disease-specific survival (DSS) rate was 61%. Cox regression analyses showed a time-varying effect associated with chemotherapy. During the first year, the hazard ratio associated with DSS for patients treated with chemotherapy versus no chemotherapy was 0.37 (95% CI, 0.20 to 0.69; P = .002). Thereafter, this hazard ratio was 1.36 (95% CI, 1.02 to 1.81; P = .04). Conclusion It seems that the clinical benefits associated with doxorubicin-based chemotherapy in patients with high-risk extremity STS are not sustained beyond 1 year. These results suggest that caution should be used in the interpretation of randomized clinical trials of adjuvant chemotherapy that seem to demonstrate clinical benefits with relatively short-term follow-up.

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Faculty Opinions recommendation of Histologic alterations from neoadjuvant chemotherapy in high-grade extremity soft tissue sarcoma: clinicopathological correlation.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1108391.564433 ◽

2008 ◽

Author(s):

Stephen Lessnick

Keyword(s):

Soft Tissue ◽

Neoadjuvant Chemotherapy ◽

Soft Tissue Sarcoma ◽

High Grade ◽

Clinicopathological Correlation ◽

Extremity Soft Tissue Sarcoma

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Gemcitabine-Containing Chemotherapy for the Treatment of Metastatic Myxofibrosarcoma Refractory to Doxorubicin: A Case Series

Current Oncology ◽

10.3390/curroncol28010078 ◽

2021 ◽

Vol 28 (1) ◽

pp. 813-817

Author(s):

Arielle Elkrief ◽

Suzanne Kazandjian ◽

Thierry Alcindor

Keyword(s):

Overall Survival ◽

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Objective Response ◽

Case Series ◽

Progression Free Survival ◽

Distant Metastases ◽

First Line ◽

Pleomorphic Sarcoma ◽

Line Setting

Background: Myxofibrosarcoma is a type of soft-tissue sarcoma that is associated with high rates of local recurrence and distant metastases. The first-line treatment for metastatic soft-tissue sarcoma has conventionally been doxorubicin-based. Recent evidence suggests that myxofibrosarcoma may be molecularly similar to undifferentiated pleomorphic sarcoma (UPS), which is particularly sensitive to gemcitabine-based therapy. The goal of this study was to evaluate the activity of gemcitabine-containing regimens for the treatment of metastatic myxofibrosarcoma refractory to doxorubicin. Material and Methods: We retrospectively evaluated seven consecutive cases of metastatic myxofibrosarcoma at our institution treated with gemcitabine-based therapy in the second-line setting, after progression on doxorubicin. Baseline clinical and baseline characteristics were collected. Primary endpoints were objective response rate (ORR), progression-free survival (PFS) and overall survival (OS). Results: After progression on first-line doxorubicin, a partial, or complete radiological response was observed in four of seven patients who received gemcitabine-based chemotherapy. With a median follow-up of 14 months, median progression-free and overall survival were 8.5 months and 11.4 months, respectively. Conclusions: Gemcitabine-based chemotherapy was associated with encouraging response rates in this cohort, similar to those seen in UPS. Both entities could be studied together for novel gemcitabine-based regimens.

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