From the Guidelines
Surgical resection is the first-line therapy for patients with well-differentiated (WD) liposarcoma, aiming for complete removal of the tumor with a margin of normal tissue surrounding it, as it offers excellent rates of long-term local control 1. The goal of surgery is to achieve marginal resections as a complete en bloc specimen, even if classified histopathologically as R1, which can give excellent rates of long-term local control 1. In some cases, such as large tumors or those where clear margins are difficult to achieve, adjuvant radiotherapy may occasionally be considered 1. Key considerations in the management of WD liposarcoma include:
- The propensity for local recurrence, particularly in deep-seated tumors
- The importance of expert review of MRI scans to differentiate between large, deep lipomas and ALT/WDL
- The use of molecular demonstration by fluorescence in-situ hybridisation of amplification of the MDM-2 cell cycle oncogene to confirm the diagnosis of ALT/WDL
- The potential for radiological surveillance in older patients or those with significant comorbidities, where surgery may be morbid 1. It is essential to note that chemotherapy is not routinely used as first-line treatment for WD liposarcoma due to its limited sensitivity to conventional cytotoxic agents, and the primary goal of treatment is local disease control, with complete surgical excision offering the best chance for cure and long-term disease-free survival 1.
From the Research
First Line Therapy for WD Liposarcoma
- The first line therapy for patients with well-differentiated (WD) liposarcoma is primarily surgical resection, as it is the most effective treatment for localized disease 2, 3, 4, 5.
- Radiation therapy may be used in conjunction with surgery to improve local control, especially for patients with high-risk features or incompletely resected tumors 2, 3, 6.
- Chemotherapy has a limited role in the treatment of WD liposarcoma, with low response rates, but may be considered for patients with unresectable or metastatic disease 2, 3, 4, 5.
- Anthracycline-based chemotherapy regimens, such as doxorubicin, are commonly used as first-line treatment for unresectable or metastatic liposarcoma, including WD liposarcoma 4, 5.
Systemic Treatment Options
- Other systemic treatment options, including targeted therapies and experimental agents, are being investigated for the treatment of WD liposarcoma, but are not yet widely established as first-line therapies 2, 3, 4, 5.
- Novel agents, such as mouse double minute 2 homolog antagonists and cyclin-dependent kinase 4/6 inhibitors, are being tested in clinical trials and may offer promising new treatment options for WD liposarcoma 2, 3, 4, 5.