Selection of Patients With Localized Extremity Soft Tissue Sarcoma for Treatment With Perioperative Chemotherapy

Soft tissue sarcoma (STS) is a heterogeneous disease, in terms of histologic subtype, body site of presentation, and behavior. Localized soft tissue sarcoma may be cured with complete tumor excision, but overall, outcomes are sub-optimal. Metastatic disease is associated with shortened survival. Systemic therapy has been studied for several decades as adjunctive therapy, but the use of adjuvant and neo-adjuvant chemotherapy remains controversial. The heterogeneity of patients included in clinical trials, and of sarcoma in general, has made it difficult to draw conclusions about which patients with localized STS should be treated with chemotherapy. Over time, published outcomes for STS of the extremities have improved, and one of the factors that contributes to this improvement may be selection of patients most likely to benefit from the prescribed treatment. Recent studies of neo-adjuvant and adjuvant chemotherapy have recruited patients with the highest recurrence risk-those with large, high-grade, deep tumors. It is reasonable, in practice, to apply similar criteria in deciding whether to recommend treatment. Looking ahead, it will be important to refine our ability to identify patients at highest risk of recurrence, and to develop tools to predict which patients and tumors will respond to chemotherapy.