title: [Neoadjuvant chemotherapy in sarcoma].
abstract: This document describe s the proposed clinical practices guidelines for neoadjuvant chemotherapy in soft tissue sarcomas proposed by the French Sarcoma Group.Neo-adjuvant chemotherapy remains an experimental therapeutic procedure in soft tissue sarcomas. Neo-adjuvant chemotherapy may be proposed in three different types of situations: 1) a locally advanced tumor, non accessible to R0 or 1 removal of the lesion. Its objective is there to allow for R0 or R1 surgical removal of the tumor. 2) A locally advanced tumor, accessible to R0 or 1 removal of the lesion, but with a mutilating surgery (amputation). Its objective is there to allow for R0 or R1 conservative surgical removal of the tumor. In both situation, the strategy should be discussed beforehand in a multidisciplinary specialized consultation for sarcoma. 3) In the case where complete (R0 or R1) surgical removal of the tumor can be performed, neooadjuvant chemotherapy has no demonstrated role. The only randomized phase III clinical trial testing neo-adjuvant chemotherapy in this setting, i.e. the STBSG 62871 STBSG trial, failed to demonstrate any benefit in terms of overall or progression free survival. The selection of the type of chemotherapy regimen given in the neoadjuvant setting should be discussed in a multidisciplinary setting, considering the age and the general status of the patient; young patients, without associated concomittent illnesses should be proposed for a combined chemotherapy regimen, combining doxorubicin (> or = 50 mg/m2) and ifosfamide (> 5 g/m2) on the basis of randomized trials demonstrating an improvement of response rate versus single agent therapy with doxorubine. In elderly and/or frail patients, conversely, single agent doxorubicin may be the preferred option.
authors.affiliation: Hôpital Edouard-Herriot et Unité Inserm U590, Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon. blay@lyon.fnclcc.fr
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Blay
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bonvalot
authors.forename: Jérôme
authors.initials: J
authors.lastname: Fayette
authors.forename: Eberhart
authors.initials: E
authors.lastname: Stockle
authors.forename: Isabelle
authors.initials: I
authors.lastname: Ray-Coquard
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Coindre
authors.forename: Florence
authors.initials: F
authors.lastname: Duffaud
authors.forename: Sophie
authors.initials: S
authors.lastname: Taieb
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Sunyach
authors.forename: Dominique
authors.initials: D
authors.lastname: Ranchere
authors.forename: Pierre
authors.initials: P
authors.lastname: Meeus
authors.forename: Axel
authors.initials: A
authors.lastname: Le Cesne
authors.forename: Binh Nguyen
authors.initials: BN
authors.lastname: Bui
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D004317:Doxorubicin / Q000008:administration & dosage; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000379:methods; D020360:Neoadjuvant Therapy / Q000379:methods*; D012509:Sarcoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage
chemical_list: D000970:Antineoplastic Agents; D014409:Tumor Necrosis Factor-alpha; D004317:Doxorubicin