What are the treatment options for soft tissue sarcoma of the thigh?

From the Guidelines

Surgery is the standard treatment for soft tissue sarcoma of the thigh, and it should be performed by a surgeon specifically trained in the treatment of this disease, with the goal of achieving wide excision with negative margins (R0) and preserving limb function whenever feasible 1.

Treatment Approach

The treatment of soft tissue sarcoma of the thigh involves a multidisciplinary approach that may include surgery, radiation therapy, and chemotherapy.

• The primary treatment is wide surgical resection to remove the tumor with negative margins.
• Radiation therapy is often administered either before surgery (preoperative) or after surgery (postoperative) to eliminate microscopic disease.
• Chemotherapy may be added for high-grade or large tumors.

Radiation Therapy

Radiation therapy is a standard treatment for intermediate-high grade, deep tumors with a diameter of >5 cm, and it can be administered preoperatively or postoperatively 1.

• Preoperative radiation therapy can be used to shrink the tumor, making it easier to remove surgically.
• Postoperative radiation therapy can be used to eliminate any remaining microscopic disease.

Chemotherapy

Adjuvant chemotherapy is not a standard treatment for soft tissue sarcoma, but it may be considered for high-risk patients with high-grade or large tumors 1.

• Chemotherapy may be used preoperatively to shrink the tumor, or postoperatively to eliminate any remaining microscopic disease.
• The decision to use chemotherapy should be made on a case-by-case basis, taking into account the patient's overall health and the specific characteristics of the tumor.

Follow-up

Regular follow-up with physical examinations, MRI of the primary site, and chest imaging is essential to monitor for recurrence 1.

• Follow-up should be scheduled at regular intervals, depending on the patient's individual risk factors and the specific characteristics of the tumor.
• Any signs of recurrence should be promptly evaluated and treated to prevent further progression of the disease.

From the FDA Drug Label

1. 2 Soft Tissue Sarcoma The efficacy of pazopanib was evaluated in VEG110727, a randomized, double-blind, placebo-controlled, multicenter trial ( NCT00753688). Patients with metastatic STS who had received prior chemotherapy, including anthracycline treatment, or were unsuited for such therapy, were randomized (2:1) to receive pazopanib 800 mg once daily or placebo Patients with gastrointestinal stromal tumors (GIST) or adipocytic sarcoma were excluded from the trial. Randomization was stratified by the factors of WHO performance status (WHO PS) 0 or 1 at baseline and the number of lines of prior systemic therapy for advanced disease (0 or 1 versus 2+). The major efficacy outcome measure was PFS assessed by independent radiological review Additional outcome measures were OS, ORR, and duration of response. The majority of patients were female (59%) with a median age of 55 years. Seventy-two percent of patients were white, 22% were Asian, and 6% were other. Forty-three percent of patients had leiomyosarcoma, 10% had synovial sarcoma, and 47% had other soft tissue sarcomas Fifty-six percent of patients had received 2 or more lines of prior systemic therapy and 44% had received 0 lines or 1 lines of prior systemic therapy. Efficacy results are presented in Table 9 and Figure 2. Table 9 Efficacy Results in STS Patients by Independent Assessment in VEG110727 Abbreviations: CI, confidence interval; CR, complete response; HR, hazard ratio; ITT, intent-to-treat; PFS, progression-free survival; PR, partial response; STS, soft tissue sarcoma. aPvalue < 0. 001. bThere were 11 partial responses and 0 complete responses. HR Endpoint/Trial populationPazopanibPlacebo(95% CI) PFS Overall ITTN = 246N = 1230.35 a Median (months)4.61.6(0.26,0.48) Leiomyosarcoma subgroupN = 109N = 490.37 Median (months)4.61.9(0.23,0.60) Synovial sarcoma subgroupN = 25N = 130.43 Median (months)4.10.9(0.19,0.98) ‘Other soft tissue sarcoma’ subgroupN = 112N = 610. 39 Median (months)4.61.0(0.25,0.60) Response rate (CR + PR) % (95% CI)4 (2.3,7.9) b0 (0.0,3.0)– Duration of response Median (months) (95% CI)9.0 (3.9.2)

The treatment for soft tissue sarcoma of the thigh is pazopanib 800 mg once daily.

• Key points:
  • The efficacy of pazopanib was evaluated in a randomized, double-blind, placebo-controlled trial.
  • Patients with metastatic STS who had received prior chemotherapy or were unsuited for such therapy were randomized to receive pazopanib or placebo.
  • The major efficacy outcome measure was progression-free survival (PFS) assessed by independent radiological review.
  • The median PFS was 4.6 months for patients randomized to pazopanib and 1.6 months for the placebo arm.
  • The response rate was 4% for pazopanib and 0% for placebo.
  • The duration of response was 9.0 months for pazopanib. 2

From the Research

Soft Tissue Sarcoma Thigh Treatment

• Soft tissue sarcoma (STS) is a group of rare and highly heterogeneous malignant tumors of mesenchymal origin, with most lesions arising in the extremities, including the thigh 3.
• Accurate histological diagnosis is critical for selecting appropriate treatment, which typically involves complete tumor resection, with radiotherapy and chemotherapy used in the adjuvant setting to improve oncological outcomes 3, 4.
• A multidisciplinary approach involving experts in various disciplines is vital for improving outcomes in patients with STS, from diagnosis to survivorship 3, 4.
• Radiation therapy is an integral component of local management with oncologic resection for STS, with preoperative delivery of radiation therapy preferred for most patients 5, 6.
• The use of radiation therapy for retroperitoneal sarcoma is controversial, but preoperative delivery of radiation is recommended when used 5.
• Limb-sparing surgery plus radiation therapy has been compared to amputation in the treatment of soft tissue sarcomas of the extremities, with no differences in disease-free survival rates or overall survival rates between the two groups 7.
• Adjuvant chemotherapy has been shown to have a marked advantage in patients with high-grade soft-tissue sarcomas of the extremities, with improved disease-free and overall survival rates 7.