Low levels of evidence for neoadjuvant chemotherapy to treat soft-tissue sarcoma
A partir de données de divers essais cliniques, ces deux articles débattent de l'intérêt de la chimiothérapie néoadjuvante pour traiter les patients atteints d'un sarcome localisé des tissus mous
Neoadjuvant and adjuvant chemotherapy trials in localized soft-tissue sarcoma (STS) have been performed for the better part of the last 3 decades. Despite these long timelines, the relative benefit vs risks of adding chemotherapy to local control measures (surgery with or without irradiation) remains an ongoing topic of considerable discussion without a consensus in the national and international sarcoma community. This is because no randomized clinical trial designed to determine whether chemotherapy in addition to local control is superior to local control alone has definitively demonstrated a clinically significant and durable improvement in overall survival. Instead, we are left to rely on lower levels of evidence including retrospective and unplanned subanalyses of randomized studies, meta-analyses, expert opinion based on personal experience, and a strong desire to offer any approach that has the potential, even if unproven, to improve the outcome for patients.
JAMA Oncology 2018