Feasibility of Preoperative Chemotherapy With or Without Radiation Therapy in Localized Soft Tissue Sarcomas of Limbs and Superficial Trunk in the Italian Sarcoma Group/Grupo Español de Investigación en Sarcomas Randomized Clinical Trial: Three Versus Five Cycles of Full-Dose Epirubicin Plus Ifosfamide

Palassini, Elena; Ferrari, Stefano; Verderio, Paolo; Paoli, Antonino De; Martin‐Broto, Javier; Quagliuolo, Vittorio; Comandone, Alessandro; Sangalli, Claudia; Palmerini, Emanuela; Pousa, Antonio López; Sanctis, Rita De; Bottelli, Stefano; Libertini, Michela; Picci, Piero; Casali, Paolo G.; Gronchi, Alessandro

doi:10.1200/jco.2015.62.9394

Cited by 66 publications

(43 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, this study provides important information on response to preoperative chemotherapy: in the standard arm, 81% of patients had stable disease and 16% of patients obtained a partial response by Response Evaluation Criteria in Solid Tumors. The R0‐resection rate was 90% in the standard chemotherapy arm and comparable to a previous study assessing the same preoperative chemotherapy regimen . In contrast, the R0‐resection rate in the French Sarcoma study group investigating adjuvant chemotherapy was only 50% .…”

Section: Discussionsupporting

confidence: 75%

“…Pre‐ or postoperative radiotherapy was considered by all experts and is an undisputed component of the treatment in high‐risk extremity STS; however, it was not within the scope of this survey to assess this treatment modality. Nevertheless, the sequence of treatments is of interest: whereas in most centers preoperative chemotherapy is followed by surgery and adjuvant radiotherapy, in one center concomitant preoperative radiochemotherapy is standard . Among centers that consider adjuvant chemotherapy, this is given prior to adjuvant radiotherapy in four centers.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Pre- and Postoperative Chemotherapy in Localized Extremity Soft Tissue Sarcoma: A European Organization for Research and Treatment of Cancer Expert Survey

et al. 2017

View full text Add to dashboard Cite

The management of localized extremity soft tissue sarcomas (STS) is challenging and the role of pre- and postoperative chemotherapy is unclear and debated among experts. This study analyzed the decision-making process among 12 European experts on systemic therapy for STS. A wide range of recommendations among experts regarding the use of perioperative chemotherapy was discovered. Discrepancies in the use of decision criteria were also uncovered, including the definition of what constitutes high-risk cancer, which is a basis for many to recommend chemotherapy. Before any standardization is possible, a common use of decision criteria is necessary.

show abstract

Section: Discussionsupporting

confidence: 75%

Section: Resultsmentioning

confidence: 99%

Pre- and Postoperative Chemotherapy in Localized Extremity Soft Tissue Sarcoma: A European Organization for Research and Treatment of Cancer Expert Survey

et al. 2017

View full text Add to dashboard Cite

show abstract

“…However pre-operative chemotherapy, or chemoradiotherapy, may be considered for those patients with large high-grade tumours that are considered borderline resectable by the sarcoma MDT [69]. The age, and any comorbidity of the patient, together with the histology of the tumour need to be taken into account.…”

Section: Management Of Localised Diseasementioning

confidence: 99%

UK guidelines for the management of soft tissue sarcomas

Dangoor¹,

et al. 2016

View full text Add to dashboard Cite

Soft tissue sarcomas (STS) are rare tumours arising in mesenchymal tissues, and can occur almost anywhere in the body. Their rarity, and the heterogeneity of subtype and location means that developing evidence-based guidelines is complicated by the limitations of the data available. However, this makes it more important that STS are managed by teams, expert in such cases, to ensure consistent and optimal treatment, as well as recruitment to clinical trials, and the ongoing accumulation of further data and knowledge. The development of appropriate guidance, by an experienced panel referring to the evidence available, is therefore a useful foundation on which to build progress in the field. These guidelines are an update of the previous version published in 2010 (Grimer et al. in Sarcoma 2010:506182, 2010). The original guidelines were drawn up following a consensus meeting of UK sarcoma specialists convened under the auspices of the British Sarcoma Group (BSG) and were intended to provide a framework for the multidisciplinary care of patients with soft tissue sarcomas. This current version has been updated and amended with reference to other European and US guidance. There are specific recommendations for the management of selected subtypes of disease including retroperitoneal and uterine sarcomas, as well as aggressive fibromatosis (desmoid tumours) and other borderline tumours commonly managed by sarcoma services. An important aim in sarcoma management is early diagnosis and prompt referral. In the UK, any patient with a suspected soft tissue sarcoma should be referred to one of the specialist regional soft tissues sarcoma services, to be managed by a specialist sarcoma multidisciplinary team. Once the diagnosis has been confirmed using appropriate imaging, plus a biopsy, the main modality of management is usually surgical excision performed by a specialist surgeon. In tumours at higher risk of recurrence or metastasis pre- or post-operative radiotherapy should be considered. Systemic anti-cancer therapy (SACT) may be utilized in some cases where the histological subtype is considered more sensitive to systemic treatment. Regular follow-up is recommended to assess local control, development of metastatic disease, and any late-effects of treatment. For local recurrence, and more rarely in selected cases of metastatic disease, surgical resection would be considered. Treatment for metastases may include radiotherapy, or systemic therapy guided by the sarcoma subtype. In some cases, symptom control and palliative care support alone will be appropriate.

show abstract

“…However, the simultaneous use of radioand chemotherapy doubles the risk of high-grade thrombocytopenia, which is observed in about one third of patients. 58 One in six patients also develop postoperative wound complications. The unclear effectiveness of simultaneous chemo-and radiotherapy balanced against toxicity has led to variations in practice and use of different treatment schedules.…”

Section: Neoadjuvant Chemoradiationmentioning

confidence: 99%

Neoadjuvant chemotherapy in soft tissue sarcomas: latest evidence and clinical implications

2017

Self Cite

View full text Add to dashboard Cite

Soft tissue sarcomas are a rare and multifaceted group of solid tumours. Neoadjuvant chemotherapy is increasingly used to limit loss of function after wide surgical excision with the ultimate aim of improving patient survival. Recently, advances in the identification of effective treatment strategies and improvements in patient risk stratification have been reached. A randomized trial demonstrated that neoadjuvant epirubicin and ifosfamide improves survival of patients affected by five high-risk soft tissue sarcoma histologies of trunk and extremities, including undifferentiated pleomorphic sarcoma, myxoid liposarcoma, synovial sarcoma, malignant peripheral nerve sheath tumours, and leiomyosarcoma. Selection of patients for these treatments is expected to be improved by the eighth edition of the American Joint Committee on Cancer (AJCC) TNM staging system, as it tailors T-stage categories on primary tumour site and considers a prognostic nomogram for retroperitoneal sarcoma, which also includes soft tissue sarcoma histology and other patient and tumour features not directly included in the TNM staging. Within this framework, this article will present neoadjuvant treatment strategies for high-risk soft tissue sarcoma, emphasizing the most recent advances and discussing the need for further research to improve the effectiveness of neoadjuvant treatments.

show abstract

Cited by 66 publications

References 29 publications

Pre- and Postoperative Chemotherapy in Localized Extremity Soft Tissue Sarcoma: A European Organization for Research and Treatment of Cancer Expert Survey

Pre- and Postoperative Chemotherapy in Localized Extremity Soft Tissue Sarcoma: A European Organization for Research and Treatment of Cancer Expert Survey

UK guidelines for the management of soft tissue sarcomas

Neoadjuvant chemotherapy in soft tissue sarcomas: latest evidence and clinical implications

Contact Info

Product

Resources

About