What is it about?

This review compares neoadjuvant chemotherapy (NAC) – given before surgery – and adjuvant chemotherapy (AC) – given after surgery – for adults with soft-tissue sarcomas (STS). It explains when chemotherapy helps most, how tools such as Sarculator can identify high-risk patients who are likely to benefit, and what clinical trials show about outcomes such as overall survival (OS), recurrence-free survival (RFS/DFS), and distant metastasis-free survival (DMFS). In particular, anthracycline-ifosfamide (AI) regimens may improve outcomes in carefully selected high-risk patients, while routine use for all STS is not recommended by European guidelines.

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Why is it important?

Perioperative chemotherapy in STS remains controversial and should be selective, not routine. European guidance does not recommend blanket AI for extremity/trunk STS; instead, treatment is targeted to high-risk patients – typically 10-year OS <60% by Sarculator or 5-year OS <33% by PERSARC – and to scenarios where tumour downsizing improves margins or function. Evidence supports AC in R1 resections (pooled OS benefit) and supports NAC ± regional hyperthermia in localised high-risk disease, while avoiding delays to definitive surgery. This review provides a practical, evidence-anchored framework for MDT decision-making.

Perspectives

Neoadjuvant chemotherapy in soft tissue sarcomas improves the chances of complete tumour removal, especially in large, high-grade tumours. It often reduces the need for more aggressive surgeries by shrinking tumours before surgery, leading to higher rates of successful resections with clear margins (R0). Sarculator and other nomograms assess patients with a predicted 10-year OS below 60% who will benefit from perioperative chemotherapy. Further research supports perioperative chemotherapy’s role.

Piotr Remiszewski
Maria Sklodowska- Curie National Research Institute of Oncology

Read the Original

This page is a summary of: Neoadjuvant or Adjuvant Chemotherapy in Soft-Tissue Sarcoma?, Current Oncology Reports, January 2025, Springer Science + Business Media,
DOI: 10.1007/s11912-024-01630-6.
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