Preoperative Multimodality Treatment of Localized Soft Tissue Sarcoma: Addition Through Subtraction?

Excerpt

In this issue of Annals of Surgical Oncology, Mack and colleagues 1 from the Tom Baker Cancer Center at The University of Calgary report their results with preoperative intravenous or intra-arterial doxorubicin and short-course, high-dose-per-fraction (10 fractions of 3 Gy each) radiotherapy followed by wide local resection for selected patients with extremity soft tissue sarcomas. The authors report remarkably low treatment-related complication rates, and in the subset of patients who underwent preoperative chemoradiation followed by macroscopically and microscopically complete (R0) surgical resection, a 97% 5-year local control rate was observed. Can this regimen serve as a therapeutic maquette, or are these results best regarded as aleatoric, as are many findings in clinical research? This report raises a number of important issues that warrant further consideration and discussion. These include the important issues of patient selection, complication rates, radiation fractionation and schedule, and the relative contributions of chemotherapy, radiation, and patient selection to these results. …