From the Guidelines
Liposarcoma is a rare type of cancer that develops in fat cells, typically in deep soft tissues like those in the thigh, abdomen, or behind the abdominal cavity.
Definition and Treatment
Liposarcoma is characterized by its development in fat cells, and its treatment primarily involves surgical removal of the tumor with wide margins to ensure complete excision, as recommended by the most recent guidelines 1.
- The goal of surgery is to achieve macroscopically complete resection in one specimen bloc and minimize microscopically positive margins.
- For high-grade or large tumors, radiation therapy may be recommended either before surgery (to shrink the tumor) or after (to kill remaining cancer cells).
- Chemotherapy may be added for certain subtypes or advanced cases, commonly using doxorubicin and ifosfamide, though its effectiveness is limited, as noted in previous studies 1.
Prognosis and Follow-up
The prognosis varies significantly based on the subtype, with well-differentiated liposarcomas having better outcomes than dedifferentiated, myxoid, or pleomorphic variants.
- Regular follow-up imaging is essential after treatment, typically with MRI or CT scans every 3-6 months for the first 2-3 years, then annually, as recurrence is possible even years after initial treatment.
- Genetic testing may be valuable as certain subtypes have characteristic genetic alterations, such as MDM2 amplification in well-differentiated and dedifferentiated liposarcomas, which can help confirm diagnosis and may guide future targeted therapies.
Recent Guidelines
The most recent guidelines from 2025 1 emphasize the importance of extended surgical approaches for retroperitoneal liposarcomas to improve long-term local control, and recommend resection of the tumor and adjacent viscera, irrespective of involvement, to minimize microscopic positive margins.
- The guidelines also highlight the need for individualized treatment plans, taking into account the specific subtype and characteristics of the tumor, as well as the patient's overall health and preferences.
From the Research
Definition and Classification of Liposarcoma
- Liposarcoma is a subtype of sarcoma that arises from adipocytic tissue 2, 3.
- It is a heterogeneous group of rare malignancies that can occur anywhere in the body 2.
- Liposarcomas are divided into four main subtypes: atypical lipomatous tumor/well-differentiated liposarcoma, dedifferentiated liposarcoma, myxoid/round-cell liposarcoma, and pleomorphic liposarcoma 3.
Characteristics and Treatment of Liposarcoma
- Myxoid liposarcoma is the most common type of liposarcoma and has been classified as an intermediate-grade tumor with a definite metastatic potential but a relatively indolent natural history 4.
- Surgical resection is the mainstay of treatment for patients with localized liposarcoma, while radiotherapy is often used in conjunction with surgery for improving local control of liposarcoma 3.
- Chemotherapy can be effective in the treatment of liposarcoma, particularly for myxoid/round-cell liposarcoma and pleomorphic liposarcoma, with anthracycline-based chemotherapy regimens remaining the standard first-line treatment for unresectable/metastatic liposarcoma 3, 5.
- Trabectedin and eribulin are currently the two most promising and evidenced-based second-line treatment options for liposarcomas 5.
Current Management Options and Future Challenges
- Despite significant advancements in the management of liposarcoma, the treatment of this disease continues to be a challenge 5, 6.
- Current systemic treatment options include conventional chemotherapy with doxorubicin and ifosfamide, as well as novel strategies such as targeted agents and immunotherapy 6.
- Ongoing clinical trials are evaluating new treatment options for liposarcoma, including histotype-specific trials 5.