Epidemiology and therapies for metastatic sarcoma

Abstract

Sarcomas are cancers arising from the mesenchymal layer that affect children, adolescents, young adults, and adults. Although most sarcomas are localized, many display a remarkable predilection for metastasis to the lungs, liver, bones, subcutaneous tissue, and lymph nodes. Additionally, many sarcoma patients presenting initially with localized disease may relapse at metastatic sites. While localized sarcomas can often be cured through surgery and often radiation, controversies exist over optimal management of patients with metastatic sarcoma. Combinations of chemotherapy are the most effective in many settings, and many promising new agents are under active investigation or are being explored in preclinical models. Metastatic sarcomas are excellent candidates for novel approaches with additional agents as they have demonstrated chemosensitivity and affect a portion of the population that is motivated toward curative therapy. In this paper, we provide an overview on the common sarcomas of childhood (rhabdomyosarcoma), adolescence, and young adults (osteosarcoma, Ewing sarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumor) and older adults (leiomyosarcoma, liposarcoma, and undifferentiated high grade sarcoma) in terms of the epidemiology, current therapy, promising therapeutic directions and outcome with a focus on metastatic disease. Potential advances in terms of promising therapy and biologic insights may lead to more effective and safer therapies; however, more clinical trials and research are needed for patients with metastatic sarcoma.

Serum microRNA-17 functions as a prognostic biomarker in osteosarcoma

“…Prior to the emergence of effective chemotherapy, 2-year overall survival rates following surgical resection and/or radiotherapy were 15–20% (4,5). Further advances in therapeutic strategies for OS, including wide tumor excision, neoadjuvant and adjuvant chemotherapy, and radiotherapy, have resulted in significantly improved clinical outcomes and long-term survival rates (2,6–9). However, >30% of patients with OS survive for <5 years and succumb due to pulmonary metastases following diagnosis (10,11).…”

Isolation, detection, and immunomorphological characterization of circulating tumor cells (CTCs) from patients with different types of sarcoma using isolation by size of tumor cells: a window on sarcoma-cell invasion

“…They are broadly classified as either soft-tissue sarcomas (STSs), including more than 50 histologic subtypes, or bone neoplasms. Sarcomas represent 1% of all cancers in adults, 10% in children, and 8% in adolescents and young adults 1. Despite their rarity, sarcomas contribute to a substantial loss of years of life compared to other cancers, because of the many children, adolescents, and young adults diagnosed.…”

“…However, they have been associated with exposure to radiation, chemotherapeutic agents, viral infections, occupational factors, and hereditary syndromes 1. Their prognosis is variable according to the histologic type, but often poor and presumably related to hematogenous spread.…”

“…Their prognosis is variable according to the histologic type, but often poor and presumably related to hematogenous spread. For instance, only 16% of patients surgically treated for osteosarcoma have long-term survival, suggesting that micrometastasis is present in an overwhelming majority of newly diagnosed patients 1. Many STSs display a remarkable predilection for metastasizing through hematogenous circulation to the lungs and/or other sites, such as the liver, bones, and subcutaneous tissue.…”

Diagnostic assessment of osteosarcoma chemoresistance based on Virtual Clinical Trials

“…Sequencing efforts have illustrated the key role of p53 mutation in this malignancy and investigated the structural variations that characterize this disease (12). Metastatic osteosarcoma continues to be a significant challenge and the most recent clinical trial demonstrated feasibility of adding zoledronic acid to the chemotherapeutic backbone in this setting (13, 14). Efforts to better incorporate the young adult population into clinical trials and discern outcomes in this group compared to the younger patients are underway as well (15–17).…”