Induction Treatment in Sarcomas

Soft tissue sarcomas (STS) and sarcoma of skeleton are rare aggressive malignant tumours representing around 1% of all malignancies. Early recognition avoiding unfortunate R1/R2 resections is a fundamental step. Due to the rarity of STS, treatment guidelines are difficult to assess. They are based on phase I/II trials and underpowered phase III randomised studies, some of them closed due to low accrual. Well-limited small low-risk STS may be directly resected with multi-organ resection. Limb amputation is rarely performed. Patients with large locally advanced unresectable or high-grade (high-risk) tumours must be presented in a multidisciplinary sarcoma board in order to discuss radiotherapy, chemotherapy, isolated limb perfusion (ILP), alone or in combination. Following ILP, limb salvage for unresectable STS can be achieved in 57–100% of patients. Retroperitoneal and trunk wall sarcomas may benefit from induction therapy after proper diagnosis. Pulmonary metastases are encountered in 20–38% of STS patients: no consensus regarding induction therapy exists and pulmonary resection is still the best available therapy. Induction therapy in rare ENT, liver, and breast sarcomas is still in investigation. In the near future, STS may be best treated according to biological properties able to select best treatment modality including new chemotherapeutic agents.