Treatment of soft tissue sarcomas: global trends and the current Japanese situation
Authors: Akira Kawai
Journal: Annals of Oncology (2015)

Soft tissue sarcomas (STS) are a rare and highly heterogeneous group of tumors of mesenchymal origin. There are particular challenges in managing patients with these rare cancers, necessitating specialized multidisciplinary surgical and medical treatment. Adequate surgery can cure localized STS in approximately 50% of patients. The remaining 50% of patients with STS develop metastases. The standard of care for such advanced disease is chemotherapy, and for many years doxorubicin and ifosfamide were the only two main active agents for all sarcoma subtypes. However, today, doxorubicin and ifosfamide are not the only agents available for STS, if only the histological subtype is taken into account. Management of STS is unquestionably multidisciplinary, and is becoming increasingly complex as more sophisticated surgical skills and specific targeted drugs are introduced. In this context, the need for specialized centers has been recognized, and a process leading to concentration of sarcoma care in a limited number of centers in Europe is ongoing. It is well known that sarcoma treatment in Japan has several unique features in comparison with other countries. Orthopaedic surgeons, who operate about 2/3 of all STS cases, perform chemotherapy. Sarcoma patients are treated in many university hospitals and regional cancer center hospitals. In contrast to concentration, treatment of sarcoma patients in Japan is widely dispersed, and under these circumstances, a close community of orthopaedic oncologists possessing knowledge and skills in the treatment of sarcomas has been established. Consequently, treatment outcomes of patients with STS in Japan are now as good as, if not better, than those in European countries and the USA. However, it is unclear whether this unique style of treatment will continue to be efficient in the increasingly complex multidisciplinary approach to STS. Therefore, there is still a need to consider the ideal style of treatment for STS patients in Japan. Soft tissue sarcomas (STS) are a rare and highly heterogeneous group of tumors of mesenchymal origin. There are particular challenges in managing patients with these rare cancers, necessitating specialized multidisciplinary surgical and medical treatment. Adequate surgery can cure localized STS in approximately 50% of patients. The remaining 50% of patients with STS develop metastases. The standard of care for such advanced disease is chemotherapy, and for many years doxorubicin and ifosfamide were the only two main active agents for all sarcoma subtypes. However, today, doxorubicin and ifosfamide are not the only agents available for STS, if only the histological subtype is taken into account. Management of STS is unquestionably multidisciplinary, and is becoming increasingly complex as more sophisticated surgical skills and specific targeted drugs are introduced. In this context, the need for specialized centers has been recognized, and a process leading to concentration of sarcoma care in a limited number of centers in Europe is ongoing. It is well known that sarcoma treatment in Japan has several unique features in comparison with other countries. Orthopaedic surgeons, who operate about 2/3 of all STS cases, perform chemotherapy. Sarcoma patients are treated in many university hospitals and regional cancer center hospitals. In contrast to concentration, treatment of sarcoma patients in Japan is widely dispersed, and under these circumstances, a close community of orthopaedic oncologists possessing knowledge and skills in the treatment of sarcomas has been established. Consequently, treatment outcomes of patients with STS in Japan are now as good as, if not better, than those in European countries and the USA. However, it is unclear whether this unique style of treatment will continue to be efficient in the increasingly complex multidisciplinary approach to STS. Therefore, there is still a need to consider the ideal style of treatment for STS patients in Japan.