SEOM Releases Clinical Management Guidelines for Soft-Tissue Sarcoma

12/05/16

The Sociedad Española de Oncología Médica (SEOM) has published updated guidelines for the treatment of soft-tissue sarcoma, which include recommendations for referrals, imaging, biopsy, radiotherapy, and adjuvant and neoadjuvant chemotherapy.

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The clinical guidelines for treating soft-tissue sarcoma (STS) were published in Clinical and Translational Oncology by a group of Spanish medical oncologists with focuses in sarcoma research, diagnosis, and therapy. The researchers conducted systematic reviews of published articles related to human studies, clinical trials, meta-analyses, clinical guidelines, and consensus statements, as well as abstracts of phase III studies focused on STS therapies presented at the American Society of Clinical Oncology (ASCO), European Society of Medical Oncology (ESMO), and Connective Tissue Oncology Society (CTOS) meetings. Together, the guidelines provides clear practical recommendations for management, therapeutic decision-making, and overall care of patients with STS.

Recommendations for diagnosis and staging for STS include early recognition and referral to a specialist center that provides multidisciplinary diagnostic and therapeutic approaches. Magnetic resonance imaging is the imaging method of choice for initial studies for tumors in limbs, trunk walls, and pelvises. Contrast-enhanced multi-slice computed tomography is the best option for intraabdominal or retroperitoneal STS. TNM system is the best option for STS staging.

The guidelines also detail treatment for localized and advanced STS. Surgical resection followed by complementary adjuvant radiotherapy (RT) is recommended to optimize local control in high grade (G2-3), deep, >5 cm sarcomas. Postoperative RT, at doses of 50 Gy, is considered an acceptable alternative to the commonly administered, postoperative RT. Adjuvant brachytherapy (BRT) and postoperative external beam RT (EBRT) are equally effective options, but recent studies have shown intensity-modulated RT (IMRT) to yield less toxicity and better local control. In regards to metastatic, advanced STS, the guidelines suggest surgery or stereotactic body RT (SBRT) for patients deemed unfit for surgery.

For systemic therapy, recommended first-line treatments include the anthracyclines doxorubicin, ifosfamide, and olaratumab in combination with doxorubicin. Recommended second-line treatments, which are always palliative, include trabectedin, pazopanib, eribulin, gemcitabine, docetaxel, and high-dose ifosfamide. For the majority of STS, researchers conclude of these options that “there is no evidence that a particular drug sequence is better than another”. The guidelines recommend that symptomatic patients with good performance status should always be considered for clinical trials.