title: Looking for answers: the current status of neoadjuvant treatment in localized soft tissue sarcomas.
abstract: OBJECTIVE
  Sarcomas are a rare and heterogeneous variant of cancer. The standard of care treatment involves surgical resection with radiation in high-risk patients. Despite appropriate treatment approximately 50 % of patients will suffer and die from recurrent disease. The purpose of this article is to review the current evidence concerning the use of neoadjuvant chemotherapy with or without radiation in soft tissue sarcomas.
  
  
  METHODS
  An in-depth literature search was conducted using Ovid Medline and PubMed.
  
  
  RESULTS
  The most active chemotherapeutic agents in sarcoma are anthracyclines and ifosfamide. Adjuvant chemotherapy trials show only minimal benefit. Neoadjuvant chemotherapy offers the potential advantage of reducing the extent of surgery, increasing the limb salvage rate, early exposure of micrometastatic disease to chemotherapy, and assessment of tumor response to chemotherapy. Some retrospective and phase II trials suggest a benefit to neoadjuvant chemotherapy. Unfortunately, no clearly positive phase III prospectively randomized trials exist for neoadjuvant therapy in soft tissue sarcomas.
  
  
  CONCLUSIONS
  The current neoadjuvant chemotherapy trials that do exist are heterogeneous resulting in conflicting results. However, neoadjuvant chemotherapy with or without radiation can be considered in patients with high-risk disease in an attempt to improve long-term outcomes.
authors.affiliation: Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA. mjnathenson@gmail.com.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Nathenson
authors.affiliation: Department of Medicine, University of Maryland Medical Center, 22 South Greene Street Suite 9d10, Baltimore, MD, 21201, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Sausville
mesh_terms: D017322:Clinical Trials, Phase II as Topic; D003131:Combined Modality Therapy; D006801:Humans; D020360:Neoadjuvant Therapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012509:Sarcoma / Q000188:drug therapy* / Q000532:radiotherapy
keywords: Chemotherapy; Neoadjuvant; Radiation; Sarcoma; Sarcoma soft tissue