Regional Hyperthermia as Targeted Therapy in the Management of High-risk Soft-tissue Sarcoma

Abstract

For high-risk soft-tissue sarcomas (HR-STS) in adults, new treatment strategies are needed to improve outcome with regard to local control and overall survival. Systemic chemotherapy has been integrated either after (adjuvant) or before (neoadjuvant) optimal local treatment by surgery and radiotherapy in HR-STS. This short article summarises the results of this combination with regional hyperthermia (RHT) as a targeted treatment strategy.The optimal treatment for HR-STS in adults remains a challenge for the multidisciplinary approach in modern oncology. Patients with large primary or recurrent STS (>5cm in diameter, grade 2-3) remain at increased risk of distant metastases and tumour-related mortality. Nearly all deaths are due to metastatic disease (e.g. lung, liver). The tendency for early haematogenous spread of STS may explain why distant metastases still occur in these patients despite optimal local treatment. Also, the invasiveness or anatomical location of locally advanced tumours often prevents resection with adequate margins, and the toxicity of radiotherapy limits the use of potentially therapeutic doses with a negative impact on local control. Innovative Treatment StrategyWith regard to prognostic factors, it can be concluded that for each A programme of aggressive chemotherapy interdigitated with radiotherapy for patients with large, high-grade extremity sarcomas used as neoadjuvant chemotherapy mesna-doxorubicin-ifosfamidedacarbazine (MAID) with split-course radiotherapy followed by resection and post-operative adjuvant MAID chemotherapy. 4 On the basis of these data, the Radiation Therapy Oncology Group (RTOG) initiated a phase II trial to evaluate the efficacy and toxicity of a modified MAID regimen in similar patients in a multi-institutional setting. Efficacy results showed three-year rates for disease-free and overall survival of 56.5, 64.5 and 75.1%, respectively, but 83% of patients experienced grade 4 toxicities and another 5% fatal grade 5 toxicities. 5 The only randomised trial of neoadjuvant chemotherapy for patients with resectable, high-risk sarcoma was performed by the European Organisation for Research and Treatment of Cancer (EORTC), but this trial was stopped because of low recruitment. Neoadjuvant treatment showed an objective response rate of 29%, but after a median follow-up of

Retrospective Analysis of Spectrum of Presentation and Treatment Outcome in Extremity Sarcomas: A Single-Centre Experience

“…For locally advanced STS, reports of regional hyperthermia in combination of chemotherapy have shown better local control and outcome as well. Similarly, option of isolated limb perfusion of affected extremity with chemotherapeutic agents has been reported for primary inoperable limb sarcomas [ 24 – 26 ].…”