Casali Paolo G
From the Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
Am Soc Clin Oncol Educ Book. 2015:e629-33. doi: 10.14694/EdBook_AM.2015.35.e629.
Adjuvant chemotherapy is not standard treatment in soft tissue sarcoma (STS). However, when the risk of relapse is high, it is an option for shared decision making with the patient in conditions of uncertainty. This is because available evidence is conflicting, even if several randomized clinical trials have been performed for 4 decades and also have been pooled into meta-analyses. Indeed, available meta-analyses point to a benefit in the 5% to 10% range in terms of survival and distant relapse rate. Some local benefit also was suggested by some trials. Placing chemotherapy in the preoperative setting may help gain a local advantage in terms of the quality of surgical margins or decreased sequelae. This may be done within a personalized approach according to the clinical presentation. Attempts to personalize treatment on the basis of the variegated pathology and molecular biology of STS subgroups are ongoing as well, according to what is done in the medical treatment of advanced STS. Thus, decision making for adjuvant and neoadjuvant indications deserves personalization in clinical research and in clinical practice, taking profit from all multidisciplinary clinical skills available at a sarcoma reference center, though with a degree of subjectivity because of the limitations of available evidence.
辅助化疗并非软组织肉瘤（STS）的标准治疗方法。然而，当复发风险较高时，在存在不确定性的情况下，它是与患者共同决策的一种选择。这是因为现有证据相互矛盾，尽管已经进行了40年的多项随机临床试验，并且也已汇总到荟萃分析中。事实上，现有的荟萃分析表明，在生存率和远处复发率方面有5%至10%的获益。一些试验也提示了局部获益。在术前进行化疗可能有助于在手术切缘质量或减少后遗症方面获得局部优势。这可以根据临床表现采用个性化方法来进行。根据晚期STS的医疗处理方式，基于STS亚组多样的病理学和分子生物学进行个性化治疗的尝试也在进行中。因此，辅助和新辅助治疗指征 的决策在临床研究和临床实践中都值得个性化，利用肉瘤参考中心现有的所有多学科临床技能，不过由于现有证据的局限性，存在一定程度的主观性。
