Neoadjuvant Treatment Options in Soft Tissue Sarcomas

Spałek, Mateusz; Kozak, Katarzyna; Czarnecka, Anna M.; Bartnik, Ewa; Borkowska, Aneta; Rutkowski, Piotr

doi:10.3390/cancers12082061

Cited by 27 publications

(26 citation statements)

References 129 publications

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“…Importantly, in this combined subgroup, only one patient received preoperative RT. It has been shown that preoperative RT alone or combined with systemic treatment may provide substantial benefits to locally advanced soft tissue sarcomas [ 25 , 26 , 27 ]. RT is not frequently used in previously irradiated volumes due to the risk of significant toxicity, lack of appropriate knowledge about tolerance doses, and unknown repair of healthy tissues several years after primary RT.…”

Section: Discussionmentioning

confidence: 99%

The Management of Radiation-Induced Sarcomas: A Cohort Analysis from a Sarcoma Tertiary Center

Spałek

Czarnecka

Rutkowski

2021

JCM

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(1) Background: Radiation-induced sarcomas (RIS) are rare diseases with poor prognoses. The aim of the study was to analyze outcomes and identify factors affecting survival in a cohort of patients with RIS. (2) Methods: We included consecutive patients with RIS that we found in the available electronic medical records of a sarcoma tertiary center. We analyzed patients’ RIS characteristics, management of RIS, the occurrence of local recurrence and distant metastases, the date of disease progression, the date of death, and the date of the last follow-up. (3) Results: Fifty-eight patients met the inclusion criteria. The most frequent sites of RIS development were the thorax and pelvis. The majority of RIS were poorly differentiated, high-grade tumors. Forty patients underwent surgery or radiotherapy with curative intent. The others were referred to palliative chemotherapy. Median progression-free survival and overall survival were 15 and 21 months, respectively. Treatment with curative intent and tumor localization on breasts and upper extremities were associated with a lower risk of death in univariate analysis. (4) Conclusions: The study confirms the poor prognosis of RIS. Treatments with locally curative intent at the tumor site are of prognostic value. Secondary radiotherapy is rarely used in RIS.

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Section: Discussionmentioning

confidence: 99%

The Management of Radiation-Induced Sarcomas: A Cohort Analysis from a Sarcoma Tertiary Center

Spałek

Czarnecka

Rutkowski

2021

JCM

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“…Moreover, metastatic diseases occur in 25% of patients with sarcomas after the radical treatment of primary tumors. There is an urgent need for new treatments for sarcomas ( 12 , 13 ). However, there are several limitations for the development and investigation of new treatments, such as the presence of various tumor subtypes, small available sample sizes, and heterogeneous patient populations.…”

Section: Introductionmentioning

confidence: 99%

Anlotinib: A Novel Targeted Drug for Bone and Soft Tissue Sarcoma

2021

Front. Oncol.

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Bone and soft tissue sarcomas account for approximately 15% of pediatric solid malignant tumors and 1% of adult solid malignant tumors. There are over 50 subtypes of sarcomas, each of which is notably heterogeneous and manifested by remarkable phenotypic and morphological variability. Anlotinib is a novel oral tyrosine kinase inhibitor (TKI) targeting c-kit, platelet-derived growth factor receptors, fibroblast growth factor receptor, and vascular endothelial growth factor receptor. In comparison with the placebo, anlotinib was associated with better overall survival and progression-free survival (PFS) in a phase III trial of patients with advanced non-small cell lung cancer (NSCLC), albeit with cancer progression after two previous lines of treatment. Recently, the National Medical Products Administration approved anlotinib monotherapy as a third-line treatment for patients with advanced NSCLC. Additionally, a phase IIB randomized trial substantiated that anlotinib is associated with a significant longer median PFS in patients with advanced soft tissue sarcoma. Moreover, anlotinib is also effective in patients with advanced medullary thyroid carcinoma and metastatic renal cell carcinoma. Anlotinib has similar tolerability to other TKIs targeting vascular endothelial growth factor receptors and other tyrosine kinase-mediated pathways. However, anlotinib has a notably lower rate of side effects ≥grade 3 relative to sunitinib. This review discussed the remarkable characteristics and major dilemmas of anlotinib as a targeted therapy for sarcomas.

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“…The recommended management of marginally resectable or unresectable soft tissue sarcomas (STS) is an attempt of neoadjuvant therapy, namely radiotherapy (RT) and chemotherapy [ 1 , 2 , 3 ]. Neoadjuvant chemotherapy was a preferred approach in the vast majority of European sarcoma tertiary centers as per the expert survey performed by the European Organization for Research and Treatment of Cancer [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

The Feasibility Study of Hypofractionated Radiotherapy with Regional Hyperthermia in Soft Tissue Sarcomas

Spałek

Borkowska

Telejko

et al. 2021

Cancers

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Introduction: Management of marginally resectable or unresectable soft tissue sarcomas (STS) in patients who are not candidates for neoadjuvant chemotherapy due to chemoresistant pathology or contraindications remains a challenge. Therefore, in these indications, we aimed to investigate a feasibility of 10x 3.25 Gy radiotherapy combined with regional hyperthermia (HT) that could be followed by surgery or 4x4 Gy radiotherapy with HT. Materials and methods: We recruited patients with locally advanced marginally resectable or unresectable STS who (1) presented chemoresistant STS subtype, or (2) progressed after neoadjuvant chemotherapy, or (3) were unfit for chemotherapy. The primary endpoint was the feasibility of the proposed regimen. Results: Thirty patients were enrolled. All patients received the first part of the treatment, namely radiotherapy with HT. Among them, 14 received the second part of radiotherapy with HT whereas 13 patients underwent surgery. Three patients did not complete the treatment protocol. The feasibility criteria were fulfilled in 90% of patients. Two patients developed distant metastases. One patient died due to distant progression. One patient developed rapid local recurrence after surgery. Conclusions: Hypofractionated radiotherapy with HT is a feasible treatment for marginally resectable or unresectable STS in patients who are not candidates for chemotherapy. Results of this clinical trial support the further validation of RT and HT combinations in STS.

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Neoadjuvant Treatment Options in Soft Tissue Sarcomas

Cited by 27 publications

References 129 publications

The Management of Radiation-Induced Sarcomas: A Cohort Analysis from a Sarcoma Tertiary Center

The Management of Radiation-Induced Sarcomas: A Cohort Analysis from a Sarcoma Tertiary Center

Anlotinib: A Novel Targeted Drug for Bone and Soft Tissue Sarcoma

The Feasibility Study of Hypofractionated Radiotherapy with Regional Hyperthermia in Soft Tissue Sarcomas

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