(Neo)adjuvant treatment in localised soft tissue sarcoma: The unsolved affair

Area of Science:

• Oncology
• Surgical Oncology
• Medical Oncology

Background:

• Soft tissue sarcomas (STS) are rare, heterogeneous tumors requiring precise initial management for diagnosis, imaging, and prognosis.
• Despite advances, advanced STS still has a poor prognosis, with ongoing efforts to predict behavior and improve treatments.
• Surgery is the primary treatment for localized STS, but the roles of adjuvant and neoadjuvant therapies remain uncertain due to conflicting evidence.

Purpose of the Study:

• To review the current role of neoadjuvant chemotherapy (CT) in localized STS.
• To discuss the challenges and future directions in optimizing peri-operative treatments for STS.
• To emphasize the importance of understanding sarcoma subtypes for treatment selection.

Main Methods:

• Literature review focusing on neoadjuvant and adjuvant chemotherapy in localized soft tissue sarcomas.
• Analysis of current evidence and ongoing clinical trials.
• Discussion of the role of histology and tumor biology in treatment selection.

Main Results:

• Evidence for routine neoadjuvant CT in localized STS is often conflicting and insufficient for a standard strategy.
• Identifying subgroups of patients who benefit most from neoadjuvant therapies is a critical unmet need.
• New neoadjuvant trials are underway, exploring the value of histology in treatment selection.

Conclusions:

• Further research is needed to establish the optimal role and patient selection for neoadjuvant CT in localized STS.
• Understanding the diverse biology of sarcoma subtypes is crucial for developing effective peri-operative strategies.
• Improving outcomes in STS requires a refined approach to neoadjuvant therapies and continued investigation into novel treatments.