Oncology Department, Fundacion Jimenez Diaz University Hospital, Av Reyes Catolicos 2, 28040 Madrid (Spain)/Villalba University Hospital/Rey Juan Carlos I University Hospital/Infanta Elena University Hospital and Research Institute FJD-UAM, Madrid (Spain) and ATBsarc, CITIUS III, Seville, Spain.
Curr Opin Oncol. 2021 Jul 1;33(4):329-335. doi: 10.1097/CCO.0000000000000742.
The aim is to bring latest evidence of the role of perioperative chemotherapy in localized soft-tissue sarcomas (STS) of limbs and to review the risk classification systems of retroperitoneal and extremity STS.
High-risk subset of localized STS of limbs and trunk-wall, defined with classic prognostic factors, consistently obtained 5-year overall survival ranging from 69 to 76% in randomized patients treated with full-dose of anthracycline and ifosfamide. Validated nomograms accurately predict, on individual basis, the risk of death and recurrence in localized STS of retroperitoneum and limbs, enabling a better selection of high-risk patients (usually those with death risk of ≥40%) that potentially could benefit with perioperative systemic treatment. Nomograms have virtually converted a negative large perioperative trial into a positive, favouring chemotherapy arm in the high-risk selection.
Perioperative three cycles of full-dose of anthracycline and ifosfamide should be proposed on an individual basis, in reference sarcoma centres, to high-risk localized STS of limbs or trunk-wall in certain histologies.
旨在提供最新的证据，证明围手术期化疗在肢体局部软组织肉瘤（STS）中的作用，并回顾腹膜后和肢体 STS 的风险分类系统。
对于经典预后因素定义的肢体和胸壁局限性 STS 的高危亚组，接受大剂量蒽环类药物和异环磷酰胺治疗的随机患者 5 年总生存率始终在 69%至 76%之间。验证的列线图可在个体基础上准确预测腹膜后和肢体局限性 STS 的死亡和复发风险，从而更好地选择高危患者（通常是死亡风险≥40%的患者），这些患者可能受益于围手术期系统治疗。列线图实际上将一项大型围手术期阴性试验转化为阳性试验，在高危患者选择中有利于化疗组。
在参考肉瘤中心的情况下，对于某些组织学类型的肢体或胸壁局限性高危 STS，应根据个体情况提出围手术期三个周期的大剂量蒽环类药物和异环磷酰胺治疗。
