You have full access to this open access article. The standard treatment of high-risk localized extremity and trunk soft-tissue sarcoma is wide local excision and radiation therapy, which can be delivered pre- or postoperatively.
Improved care for sarcoma patients at expert centres with multidisciplinary tumour boards, specialized pathologists, surgeons, radio-oncologists, and medical oncologists, according to national or international guidelines, has improved outcomes. Yet, a substantial number of patients will experience disease recurrence with metastatic spread and ultimately die from their disease. Some centres demonstrated the feasibility and now treat with concomitant neoadjuvant chemoradiotherapy as standard.
This data has been widely adopted in the oncologic community. In breast cancer, guidance for the use of adjuvant chemotherapy is now provided by a gene recurrence score, supplementing clinical-risk stratification and thereby better selecting patients likely to benefit [ 12 ]. While patients with bone sarcomas e. Surgical resection and pre- or postoperative radiotherapy attain a high local control rate and are unopposed elements in the effort to cure STS [ 13 , 14 , 15 ].
Yet, the risk of distant recurrence remains high and a substantial number of patients succumb to advanced STS [ 16 ]. This elucidates the medical need to improve treatment strategies and ultimately outcome in STS. It is important to identify which patients are at risk for recurrence and effective strategies to prevent such recurrences [ 17 ]. The European Society of Medical Oncology guidelines state the following: There is no consensus on the current role of adjuvant chemotherapy.
Study results are conflicting, in the presence of negative results from the largest studies, though data are available from smaller studies suggesting that it might improve, or at least delay, distant and local recurrence in high-risk patients [ 18 ]. Due to the rarity [ 19 ] and the biologic heterogeneity [ 20 ] of STS good quality clinical trials have been difficult to perform.
