Minimal residual disease in soft-tissue sarcomas.
Soft-tissue sarcomas are characterized by the development of disease recurrence in a distinct subgroup of patients. Despite intense efforts in applying multimodal treatment, the risk of local recurrence or distant metastases remains a considerable threat to patients with soft-tissue sarcoma. This review focuses on the efforts aimed at defining local and systemic tumor extent at the level of minimal residual disease (MRD) tumor cell detection. Examination of MRD in soft-tissue sarcomas has experienced a significant boost from the definition of fusion transcripts resulting from stable chromosomal translocations. The sensitivity and exclusive specificity of the reverse-transcription polymerase chain reaction (RT-PCR) protocols have given insights into tumor cell residues in nearly all body compartments. The accumulated data demonstrates that even after oncologic resections most patients will still harbor a significant tumor burden. Clinical concepts arising out of these new data are under way. One of these concepts is the targeting of the fusion transcript for therapy. However, this approach is still restricted to the experimental setting. The development of clinical applications remains a challenging task, requiring the treatment of as many patients as possible in centers specializing in all of the affected disciplines.
Willeke
F
F
Department of Surgery, Klinikum Mannheim gGmbH, University of Heidelberg, Mannheim, Germany. frank.willeke@chir.ma.uni-heidelberg.de
Sturm
J W
JW
D000328:Adult; D002648:Child; D006801:Humans; D007150:Immunohistochemistry; D018365:Neoplasm, Residual / Q000235:genetics / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012509:Sarcoma / Q000235:genetics / Q000473:pathology* / Q000628:therapy