Curative and palliative multimodal treatment concepts for soft tissue sarcomas

BackgroundPatients with locally advanced high-grade soft tissue sarcomas treated with tumor resection alone are at risk for both local recurrence and distant metastasis.ResultsThere are two phase III trials available for neoadjuvant chemotherapy. The ISG1001 trial showed that anthracycline-based chemotherapy is superior to histology-specific chemotherapy. The EORTC 62961/ESHO-RHT95 trial showed that the efficacy of anthracycline-based chemotherapy can be increased by adding regional deep hyperthermia. After both trials were conducted without a control arm using local therapy alone, the results of the retrospective analysis of the adjuvant EORTC 62931 trial are of particular importance. For patients with poor prognosis based on the Sarculator estimation, adjuvant anthracycline-based chemotherapy was associated with a significant survival benefit compared with local therapy alone. While the value of radiotherapy for high-grade extremity sarcomas is undoubted, the benefit of preoperative radiotherapy for retroperitoneal sarcomas has not been universally demonstrated.ConclusionsMultimodal therapy concepts that use chemotherapy, radiotherapy, and hyperthermia in addition to tumor resection improve the prognosis of patients with high-risk soft tissue sarcomas.