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Cancer Chemotherapy and Pharmacology

, Volume 78, Issue 5, pp 895–919 | Cite as

Looking for answers: the current status of neoadjuvant treatment in localized soft tissue sarcomas

  • Michael J. NathensonEmail author
  • Edward Sausville
Review Article

Abstract

Purpose

Sarcomas are a rare and heterogeneous variant of cancer. The standard of care treatment involves surgical resection with radiation in high-risk patients. Despite appropriate treatment approximately 50 % of patients will suffer and die from recurrent disease. The purpose of this article is to review the current evidence concerning the use of neoadjuvant chemotherapy with or without radiation in soft tissue sarcomas.

Methods

An in-depth literature search was conducted using Ovid Medline and PubMed.

Results

The most active chemotherapeutic agents in sarcoma are anthracyclines and ifosfamide. Adjuvant chemotherapy trials show only minimal benefit. Neoadjuvant chemotherapy offers the potential advantage of reducing the extent of surgery, increasing the limb salvage rate, early exposure of micrometastatic disease to chemotherapy, and assessment of tumor response to chemotherapy. Some retrospective and phase II trials suggest a benefit to neoadjuvant chemotherapy. Unfortunately, no clearly positive phase III prospectively randomized trials exist for neoadjuvant therapy in soft tissue sarcomas.

Conclusions

The current neoadjuvant chemotherapy trials that do exist are heterogeneous resulting in conflicting results. However, neoadjuvant chemotherapy with or without radiation can be considered in patients with high-risk disease in an attempt to improve long-term outcomes.

Keywords

Sarcoma Neoadjuvant Radiation Chemotherapy Sarcoma soft tissue 

Notes

Acknowledgments

The authors thank Gabriela Steier for her support in the editing of this review.

Funding

NCI/NIH P30 CA134274.

Compliance with ethical standards

Conflict of interest

There are no conflicts of interests to report, and no disclaimers.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of Sarcoma Medical OncologyMD Anderson Cancer CenterHoustonUSA
  2. 2.Department of MedicineUniversity of Maryland Medical CenterBaltimoreUSA

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