Divison of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Curr Treat Options Oncol. 2023 May;24(5):515-527. doi: 10.1007/s11864-023-01075-2. Epub 2023 Mar 28.
Sarcoma is a complex and heterogeneous disease with a rapidly evolving treatment landscape. With a growing emphasis on neoadjuvant therapy as a way to improve surgical and oncologic outcomes, our approach to monitor treatment efficacy must also continue to evolve. This is paramount to both clinical trial design, where endpoints must accurately reflect disease outcomes, and individual patient, whose treatment response informs therapeutic decisions. In the era of personalized medicine, the response to neoadjuvant treatment in sarcoma remains most effectively gauged by pathologic review following surgical resection. Although measures of pathologic complete response most effectively predict outcome, the requisite surgical excision precludes their use in real-time monitoring of neoadjuvant treatment response. Current image-based metrics such as RECIST and PERCIST have been utilized in many trials; however, they are limited by their unilateral measurement approach. More effective tools are needed to better measure the response to therapy prior to neoadjuvant regimen completion, so that the medication or regimen may be best tailored to patient response in an ongoing fashion. Delta-radiomics and circulating tumor DNA (ctDNA) represent promising novel tools for real-time monitoring of treatment efficacy. These metrics have been shown to predict pathologic complete response and disease progression at a superior level to traditional CT-based guidelines. Delta-radiomics is currently being utilized in a clinical trial among soft tissue sarcoma patients in which radiation dosage is adjusted based on radiomic data. The ability of ctDNA to detect molecular residual disease is also under study in multiple clinical trials, although none in the field of sarcoma. Future directions in the field include the use of ctDNA and molecular residual disease testing among sarcoma patients, as well as increased utilization of delta-radiomics, to more effectively monitor neoadjuvant treatment response prior to surgical resection.
肉瘤是一种复杂且异质性的疾病，其治疗领域正在迅速发展。随着新辅助治疗作为改善手术和肿瘤学结果的方法的重要性不断增加，我们监测治疗效果的方法也必须继续发展。这对于临床试验设计至关重要，因为终点必须准确反映疾病结果，而对于接受治疗的患者，其治疗反应则为治疗决策提供信息。在个性化医疗时代，肉瘤新辅助治疗的反应仍然主要通过手术切除后的病理检查来评估。尽管病理完全缓解的测量最能有效地预测结果，但所需的手术切除排除了其在新辅助治疗反应的实时监测中的应用。目前基于影像学的指标，如 RECIST 和 PERCIST，已在许多试验中得到应用；然而，它们的单侧测量方法存在局限性。需要更有效的工具来更好地测量新辅助治疗方案完成前的治疗反应，以便以持续的方式根据患者的反应来最佳调整药物或方案。Delta 放射组学和循环肿瘤 DNA（ctDNA）是实时监测治疗效果的有前途的新工具。这些指标已被证明在预测病理完全缓解和疾病进展方面优于传统的基于 CT 的指南。Delta 放射组学目前正在软组织肉瘤患者的临床试验中得到应用，其中根据放射组学数据调整放射剂量。ctDNA 检测分子残留疾病的能力也在多项临床试验中进行研究，尽管肉瘤领域尚无临床试验。该领域的未来发展方向包括在肉瘤患者中使用 ctDNA 和分子残留疾病检测，以及更多地利用 delta 放射组学，在手术切除前更有效地监测新辅助治疗反应。
