Neoadjuvant or Adjuvant Chemotherapy in Soft-Tissue Sarcoma?

IF 4.7 2区 医学 Q1 ONCOLOGY
Current Oncology Reports Pub Date : 2025-05-01 Epub Date: 2025-01-05 DOI:10.1007/s11912-024-01630-6
Piotr Remiszewski, Kinga Filipek, Agata Pisklak, Paulina Chmiel, Piotr Rutkowski, Anna M Czarnecka
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引用次数: 0

Abstract

Purpose of review: The review compares the effectiveness of neoadjuvant(pre-operative, NAC) and adjuvant(post-operative, AC) in Soft Tissue Sarcomas as this topic is controvesial and multiple new studies have been over the years.

Recent findings: Sarculator and other nomograms assess patients with a predicted 10-year OS below 60% who will benefit from perioperative chemotherapy. Further research supports perioperative chemotherapy's role. European guidelines do not recommend anthracycline and ifosfamide (AI) perioperative chemotherapy as a standard treatment for STS of the extremities and trunk. However, some studies show that AI chemotherapy can improve recurrence-free survival (RFS). The EORTC 62,771 trial found that the CYVADIC regimen (doxorubicin, dacarbazine, cyclophosphamide, vincristine) reduced RFS without affecting OS. Meanwhile, the EORTC 62,931 trial showed no effect of AI chemotherapy on RFS or OS, but a pooled analysis suggested an OS benefit for patients with R1 (microscopically positive) resections. The AI regimen shows further support from Sarculator-based data, with EORTC 62,931 analysis indicating an improvement in disease-free survival and OS in patients with low expected OS. Similar outcomes were seen in the ISG-STS 1001 study. Recently, PERSARC analysis revealed that AI chemotherapy significantly improves OS in high-grade STS patients with a low 5-year OS prediction (< 33%). NAC improves the chances of complete tumour removal, especially in large, high-grade tumours. It often reduces the need for more aggressive surgeries by shrinking tumours before surgery, leading to higher rates of successful resections with clear margins (R0). Sarculator and other nomograms assess patients with a predicted 10-year OS below 60% who will benefit from perioperative chemotherapy. Further research supports perioperative chemotherapy's role.

软组织肉瘤的新辅助还是辅助化疗?
综述目的:本综述比较了新辅助治疗(术前,NAC)和辅助治疗(术后,AC)在软组织肉瘤中的有效性,因为这个话题一直存在争议,并且近年来有多项新的研究。最近的研究发现:血管造影和其他心电图评估预测10年总生存率低于60%的患者,这些患者将受益于围手术期化疗。进一步的研究支持围手术期化疗的作用。欧洲指南不推荐蒽环类药物和异环磷酰胺(AI)围手术期化疗作为四肢和躯干STS的标准治疗。然而,一些研究表明,人工智能化疗可以提高无复发生存(RFS)。EORTC 62,771试验发现CYVADIC方案(多柔比星、达卡巴嗪、环磷酰胺、长春新碱)降低了RFS,但不影响OS。同时,EORTC 62,931试验显示AI化疗对RFS或OS没有影响,但一项汇总分析表明,R1(显微镜下阳性)切除患者的OS受益。基于sarculator的数据进一步支持AI方案,EORTC 62,931分析表明,低预期OS患者的无病生存期和OS改善。在ISG-STS 1001研究中也看到了类似的结果。最近,PERSARC分析显示,AI化疗可显著改善高级别STS患者的OS,但5年OS预测较低(
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来源期刊
CiteScore
8.50
自引率
0.00%
发文量
187
审稿时长
6-12 weeks
期刊介绍: This journal aims to review the most important, recently published clinical findings in the field of oncology. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care of those affected by cancer. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as cancer prevention, leukemia, melanoma, neuro-oncology, and palliative medicine. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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