Abstract
Due to the heterogeneity of soft tissue sarcomas (STS), the choice of the proper perioperative treatment regimen is challenging. Neoadjuvant therapy has attracted increasing attention due to several advantages, particularly in patients with locally advanced disease. The number of available neoadjuvant modalities is growing continuously. We may consider radiotherapy, chemotherapy, targeted therapy, radiosensitizers, hyperthermia, and their combinations. This review discusses possible neoadjuvant treatment options in STS with an emphasis on available evidence, indications for each treatment type, and related risks. Finally, we summarize current recommendations of the STS neoadjuvant therapy response assessment.
Highlights
Due to the growing number of available treatment options and the rarity and heterogeneity of soft tissue sarcomas (STS), the decision-making process is very complex
It is recommended that: Post-RT imaging should not be performed earlier than four weeks post-RT; Images acquired in the same plane should be performed with identical planing and slice thickness to allow correlation between sequences; Except for myxoid liposarcomas, size and volume measurements should not be used to reflect histopathological response; Internal signal/density characteristics should be used in combination to assess response; Areas of new enhancement should be interpreted with caution as they can arise secondarily to vascular disruption following RT and do not necessarily reflect progression; Not all areas of diminished enhancement following RT represent necrosis and, attention to terminology is suggested
Meta-analysis of 21 studies comprising 1663 patients has confirmed that tumor necrosis
Summary
Due to the growing number of available treatment options and the rarity and heterogeneity of soft tissue sarcomas (STS), the decision-making process is very complex. RT and CHT, but it has not been widely adopted in clinical practice [3,4,5,6]. Another novel approach includes the radiosensitization of sarcoma cells by the targeted treatment given concurrently with. The introduction of neoadjuvant treatments in clinical practice was initially limited to challenging cases, such as unresectable STS, albeit currently it should be considered as an equal alternative to adjuvant therapy, bringing more advantages than risks. This article summarizes the available evidence, research directions, assessment of response, and practical aspects of neoadjuvant treatment that may be helpful in the management of patients with localized STS. Selected STS types, such as dermatofibrosarcoma protuberans, gastrointestinal stromal tumor, rhabdomyosarcoma, and Ewing sarcoma, have separate, established treatment strategies that are beyond the scope of this review
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