Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Casali, Paolo; Blay, Jean‐Yves; Bertuzzi, Alexia; Bielack, Stefan; Bjerkehagen, Bodil; Bonvalot, Sylvie; Boukovinas, I.; Bruzzi, Paolo; Tos, Angelo Paolo Dei; Dileo, Palma; Eriksson, Mikael; Fedenko, Alexander N.; Ferrari, Andrea; Ferrari, Stefano; Gelderblom, Hans; Grimer, R. J.; Gronchi, Alessandro; Haas, Rick L.; Hall, Kirsten Sundby; Hohenberger, Peter; Issels, Rolf D.; Joensuu, Heikki; Judson, Ian; Cesne, Axel Le; Litière, Saskia; Martin‐Broto, Javier; Merimsky, Ofer; Montemurro, Michael; Morosi, Carlo; Picci, Piero; Ray‐Coquard, Isabelle; Reichardt, Peter; Rutkowski, Piotr; Schlemmer, M.; Stacchiotti, Silvia; Torri, Valter; Trama, Annalisa; Coevorden, Frits van; Graaf, Winette van der; Vanel, D.; Wardelmann, Eva

doi:10.1093/annonc/mdu254

Cited by 438 publications

(207 citation statements)

References 61 publications

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“…Chemotherapy is still a matter of debate and must be discussed in a dedicated multidisciplinary committee with an individual approach basis 28. For all adult sarcoma in a localized phase, R0 surgery remains the cornerstone of treatment 29, 30, 31, 32, 33, 34, 35.…”

Section: Discussionmentioning

confidence: 99%

Outcome of 449 adult patients with rhabdomyosarcoma: an observational ambispective nationwide study

et al. 2018

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Five‐year overall survival (OS) of localized RMS exceeds 70% in children (<18) but is very poor in adult patients. We analyzed the outcome and prognostic factors (PF) of a national series of adult patients with RMS in a large study. The study population consisted of two different cohorts: a retrospective cohort (157 adult patients treated in 13 reference centers between 05/1981 and 02/2010) and the prospective cohort (292 patients with RMS diagnosed and treated between 01/2010 and 12/2014 in France) included in the NetSarc database. A descriptive analysis of patients’ characteristics and prognostic factors was conducted on both series which were compared. In the retrospective series, histological subtypes were embryonal (E‐RMS) for 21% of patients, alveolar (A‐RMS) for 35% of patients, and “adult‐type” P‐RMS (pleomorphic, spindle cell RMS, not otherwise specified) (P) for 44% patients. This distribution significantly differed in the prospective cohort: A‐RMS: 18%; E‐RMS: 17%; and P‐RMS 65%. With a median follow‐up of 8.5 years, 5‐year OS for localized RMS and advanced RMS (with nodes and/or metastases) was 43% and 5%, respectively, (P < 0.0001), and median OS was 51, 33, and 16 months for E‐RMS, A‐RMS, and P‐RMS, respectively, in the retrospective cohort. The median OS was less than 40 months for the prospective nationwide cohort for the entire population. In a multivariate analysis of the retrospective study, independent prognostic factors for OS were A‐RMS, R0 resection, and adjuvant radiotherapy (RT). For localized RMS, age and use of pediatric chemotherapy (CT) regimen are independent prognostic factors. Adult patients with RMS have a poorer overall survival than pediatric patients, and survival varies considerably across histological subtypes.

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Section: Discussionmentioning

confidence: 99%

Outcome of 449 adult patients with rhabdomyosarcoma: an observational ambispective nationwide study

et al. 2018

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“…1 Surgery is the main treatment of early-stage STS in adult patients, but approximately 50% of them will develop postoperative recurrence and die. 2 Conventional chemotherapy benefits patients with advanced STS with objective response rates from 15 to 25% with drugs such as doxorubicin, ifosfamide, and dacarbazine. A current paradigm shift favors pathological subtype-specific chemotherapy regimen, 3 and recent drug approvals were linked with specific sarcoma subtypes, such as trabectedin for leiomyosarcomas and liposarcomas, first described in sarcoma patients, whose tumor regressed after an infection 10 or after local injections of streptococcal broth cultures.…”

Section: Introductionmentioning

confidence: 99%

PDL1 expression is a poor-prognosis factor in soft-tissue sarcomas

et al. 2017

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Soft-tissue sarcomas (STS) are a group of rare, heterogeneous, and aggressive tumors, with high metastatic risk and relatively few efficient systemic therapies. In the quest for new treatments, the immune system represents an attractive therapeutic target. Recently, PD1/PDL1 inhibitors showed very promising results in patients with solid tumors. PDL1 expression has been rarely studied in STS, in small series only, by using immunohistochemistry (IHC), and with non-concordant prognostic implications. Here, we have analyzed PDL1 mRNA expression in 758 clinical STS samples retrospectively profiled using DNA microarrays and RNAseq, and searched for correlations with clinicopathological variables including metastasis-free survival (MFS) after surgery. PDL1 expression was heterogeneous across the samples. PDL1-high samples (41%) were more frequently leiomyosarcomas and liposarcomas, and showed more frequently a complex genetic profile and a high-risk CINSARC signature. No correlation existed with other clinicopathological features such as tumor site, depth, and pathological tumor grade and size. In multivariate prognostic analysis, the PDL1-high class was associated with shorter MFS, independently of the pathological type and the CINSARC signature. Analysis of correlations with biological factors suggested the existence in tumors of the PDL1-high class of a strong and efficient cytotoxic T-cell response, however associated with some degree of T-cell exhaustion and negative regulation. In conclusion, we show that PDL1 expression refines the prediction of metastatic relapse in operated localized STS, and that PD1/PDL1 blockade holds potential to improve patient survival by reactivating inhibited T cells to increase the antitumor immune in PDL1-high tumors.

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“…In the National Comprehensive Cancer Network guidelines (NCCN-Breast Cancer, MS-24, 2007), hyperthermia is recommended in the treatment for breast recurrences. Hyperthermia has also been included in the clinical practice guidelines of the European Sarcoma Network Working Group (in the European Society for Medical Oncology (ESMO)) [47]. …”

Section: Discussionmentioning

confidence: 99%

Role of Hyperthermia in Breast Cancer Locoregional Recurrence: A Review

Maluta¹,

Kolff

2015

Breast Care

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In patients with locoregional recurrences of breast cancer not suitable for resection, subsequent local control is difficult to maintain in previously irradiated areas when reirradiation alone or reirradiation with chemotherapy is used. Due to the limited number of treatment options there is a high risk of subsequent failure and uncontrollable local disease. In this group of patients, local hyperthermia combined with radiotherapy increases the clinical response and local control, adding limited acute and late toxicity, as has been shown in randomized trials. Hyperthermia is an artificial elevation of tissue temperature (range 40-44°C for 30-60 min). If hyperthermia is applied shortly before or after radiation, the effect of radiation is enhanced by influencing intratumoral hypoxia and by inhibiting sublethal damage repair in the tumor. Moreover, hyperthermia combined with radiation reduces the total dose of radiation needed compared to radiation alone, of which a higher dose is needed to obtain the same effect. Few data are available on the combination of radiotherapy and hyperthermia with chemotherapy, although the results of trimodality treatment consisting of reirradiation and hyperthermia together with liposomal doxorubicin are promising. Therefore, this literature review was performed to provide more comprehensive data on the mechanism and use of hyperthermia in locoregional recurrence of breast cancer.

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Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Cited by 438 publications

References 61 publications

Outcome of 449 adult patients with rhabdomyosarcoma: an observational ambispective nationwide study

Outcome of 449 adult patients with rhabdomyosarcoma: an observational ambispective nationwide study

PDL1 expression is a poor-prognosis factor in soft-tissue sarcomas

Role of Hyperthermia in Breast Cancer Locoregional Recurrence: A Review

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