ASO Author Reflections: Moving the Needle in Extremity and Trunk Soft Tissue Sarcoma
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Moving the Needle in Extremity and Trunk Soft Tissue Sarcoma Christina L. Roland, MD, MS1, Winan van Houdt, MD2, and Alessandro Gronchi, MD3 1
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; 2Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; 3Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
PAST Data from seminal randomized trials over the last several decades has resulted in local control rates of 80–95% of patients with localized extremity and trunk sarcoma (ETSTS) undergoing limb-sparing surgery with pre- or postoperative radiation therapy (RT) and anthracyclinebased chemotherapy;1 however, up to 50% of patients with localized disease will develop distant metastases. Although doxorubicin (± ifosfamide) has remained the backbone of systemic chemotherapy for ETSTS over the last 40 years, it benefits only a subset of patients with sometimes significant toxicity, highlighting the need for novel therapies in this rare disease.
has improved the survival risk calculation of a single patient, helping select those who can benefit the most from the available systemic chemotherapy.3 Finally, a better understanding of the diverse behavior of the various histopathologic subtypes of soft tissue sarcoma has led to approval of multiple systemic agents in patients with recurrent and/or metastatic STS, such as eribulin (microtubule inhibitor) for adipocytic sarcomas, trabectedin (alkylating agent) for liposarcoma and leiomyosarcoma, and pazopanib (multiple kinase inhibitor including vascular endothelial growth factor receptor, platelet-derived growth factor receptor, c-KIT, and fibroblast growth factor receptor) for STS.4 However, whether these agents reduce the likelihood of developing metastases in patients with localized disease remains unanswered.
PRESENT FUTURE The observed long-term toxicity from high-dose RT has led to the identification of populations of ETSTS patients who may benefit from RT at lower doses (i.e. myxoid liposarcoma)2 or are able to omit RT altogether (tumors resected with widely negative margins) 1 while maintaining excellent local control rates. On the other hand, the concurrent administration of neoadjuvant chemoradiation is being increasingly considered for tumors of borderline resectability or when function preservation is the goal.1 In addition, the development of widely validated nomograms
Ó Society of Surgical Oncology 2020 First Received: 24 July 2020 Accepted: 9 August 2020; Published Online: 24 August 2020 A. Gronchi, MD e-mail: [email protected]
Currently, there are approximately 500 active clinical trials evaluating novel combinatorial strategies for patients with sarcoma,5 including combinations of RT with cytotoxic agents (trabectedin and RT in myxoid liposarcoma), molecular target therapy (pazopanib and RT), devices (nanoparticles and RT), and immunotherapy trials. With the emergence of nove
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