Neoadjuvant chemotherapy in localised soft-tissue sarcomas: where do we go from here?

[...]response assessment in sarcomas is challenging and response criteria incorporating only dimensional parameters have limitations, particularly for these large tumours (median diameter was 111·3 mm in the present trial).5 Data on pathological response in relation to outcome will be presented later, but again interpretation could be challenging.6 Few novel drugs are assessed in sarcomas compared with other more common tumours and pragmatically this trial randomly assigned patients to histotype-tailored chemotherapy consisting of several established drugs.7 Notably, none of the histotype-tailored schedules included an anthracycline and, as acknowledged by the authors, the evidence base for some of these schedules is limited. [...]it is important to be clear that the trial was not statistically designed to show that histotype-tailored therapy is inferior to standard therapy or that standard neoadjuvant chemotherapy is effective compared with no chemotherapy. [...]with the available data, we can conclude that histotype-tailored therapy is not superior to standard chemotherapy in the neoadjuvant setting. Sarcoma Meta-analysis Collaboration, Lancet, Vol. 350, 1997, 1647-1654 3 N Pervaiz, N Colterjohn, F Farrokhiar, A systematic meta-analysis of randomized controlled trials for adjuvant chemotherapy for localized resectable soft tissue sarcoma, Cancer, Vol. 113, 2008, 573-581 4 E Gortzak, A Azzarelli, J Buesa, Eur J Cancer,...