Management Strategies for Localized Epithelioid Sarcoma: The Role of Neoadjuvant and Adjuvant Therapies
Panelists discuss how neoadjuvant and adjuvant therapies, including chemotherapy and radiation, are used in localized epithelioid sarcoma (ES) to optimize surgical outcomes, reduce recurrence risk, and tailor treatment based on tumor characteristics and patient factors.
Summary for Physicians: Management Strategies for Localized ES
Neoadjuvant Therapy: For localized ES, neoadjuvant therapies may be considered in patients with large, resectable tumors or those at high risk for local recurrence. The goal of neoadjuvant therapy, which may include chemotherapy or radiation, is to shrink the tumor prior to surgical resection, making the tumor more amenable to complete surgical excision with clear margins. Neoadjuvant radiation is commonly used for tumors in areas difficult to resect completely or when a high risk of recurrence is anticipated. Chemotherapy in the neoadjuvant setting, though less frequently used, may be considered in high-risk cases with aggressive features.
Adjuvant Therapy: Adjuvant therapies are employed following surgical resection to reduce the risk of local recurrence and metastasis. Adjuvant radiation therapy is commonly used after surgery, particularly when margins are positive or close, or if the tumor is located in a high-risk area. Chemotherapy is sometimes considered in high-risk patients who have aggressive tumor features or if there is concern for micrometastatic disease. The choice between chemotherapy and radiation in the adjuvant setting is influenced by tumor characteristics, such as size, grade, and location, as well as the patient’s overall health and response to prior therapies.
In summary, the use of neoadjuvant and adjuvant therapies for localized ES aims to improve surgical outcomes and reduce the likelihood of recurrence, with the selection of therapy guided by tumor characteristics and patient factors.
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