Neoadjuvant treatment of soft-tissue sarcoma: a multimodality approach.
Unlike epithelial cancers that are both more homogeneous and easily categorized by their respective tissues of origin (e.g., breast or lung cancer), sarcomas represent a diverse class of molecularly distinct bone and soft-tissue mesenchymal neoplasms of more than 50 subtypes. This diversity, as well as the relative rarity of sarcomas as a whole, has presented challenges in conducting prospective randomized clinical trials to assess the value of neoadjuvant chemotherapy for any given subtype. Most clinical trials and meta-analyses have neglected the phenotypic and molecular heterogeneity differentiating one sarcoma subtype from another in favor of a simplified grouping that ensures timely trial completion. As the success of treating gastrointestinal stromal tumors (GISTs) with imatinib demonstrates, a decision to provide neoadjuvant chemotherapy must take into consideration both the subtype being treated and the effect such treatment would be expected to exert upon that subtype.
Reynoso
David
D
Department of Sarcoma Medical Oncology, M.D. Anderson Cancer Center, The University of Texas, Houston, Texas 77030, USA.
Subbiah
Vivek
V
Trent
Jonathan C
JC
Guadagnolo
B Ashleigh
BA
Lazar
Alexander J
AJ
Benjamin
Robert
R
Pollock
Raphael E
RE
Ludwig
Joseph A
JA
D000970:Antineoplastic Agents / Q000008:administration & dosage; D006801:Humans; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018579:Patient Selection; D018714:Radiotherapy, Adjuvant; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*
D000970:Antineoplastic Agents