C. Gennigens MD, PhD

State of the art in the treatment of soft tissue sarcomas

SUMMARY

Soft tissue sarcomas represent 75% of all sarcomas and constitute a group of more than 50 different histological subtypes, with an even greater number of molecular subtypes. Localised STSs are generally treated by surgery followed, or preceded, by radiotherapy and according to criteria linked with the risk of local recurrence. Metastatic STSs are principally treated by systemic treatments such as chemotherapy and targeted drugs. The most important drugs used are doxorubicin, ifosfamide, dacarbazine, gemcitabine/docetaxel, eribulin and trabectedin; but also pazopanib. The place of localised treatments (surgery, radiotherapy, radiofrequency, etc.) in this setting is reserved for oligometastatic disease. A multidisciplinary approach is mandatory, with centralisation of all cases in reference centres, as early as at the time of clinical diagnosis of a suspected sarcoma. This ‘centralised’ approach, for this rare and complex disease, has an impact on the oncologic outcomes (quality of resection and overall survival) of patients.

(BELG J MED ONCOL 2019;13(6): 227–233)

Leptomeningeal carcinomatosis from solid tumours: a systematic review of the literature

SUMMARY

Leptomeningeal carcinomatosis (LC), or neoplastic meningitis, is a disastrous complication of advanced cancer. This disease occurs in approximately 5% of patients with solid tumour and results from the dissemination of tumour cells from the cerebral spinal fluid (CSF) flow throughout the entire central nervous system (CNS). LC is characterized by multiple and fluctuant neurologic symptoms and signs. Useful tests for the diagnosis include magnetic resonance imaging (MRI) and CSF analysis. Unfortunately, the diagnosis remains challenging due to pleomorphic symptoms and false negative results of diagnostic procedures. For most patients, the aim of the treatment is to control symptoms, by using targeted radiotherapy and corticosteroids. More aggressive therapeutic approaches, such as intrathecal (IT) or systemic chemotherapy, should be restricted to highly selected and good-risk patients. Moreover, only few randomized clinical trials are available in the field and studies using more recent targeted therapies or immunotherapy should always be considered in these patients, as outcome with standard of care is disappointing.

(BELG J MED ONCOL 2017;11(6):259–264)

Management and systemic treatment of clear cell metastatic renal cell carcinoma: BSMO expert panel recommendations

Almost 30% of patients with renal cell cancer present initially with advanced stage IV disease. In the past decade, the management of the metastatic renal cell cancer has been revolutionised by the knowledge of its molecular biology and development of targets against vascular endothelial growth factor and mammalian target of rapamycin pathways. In this paper we present recommendations based on a thorough review of available guidelines and data from the phase III randomised controlled trials that evaluated new agents in patients with advanced metastatic renal cancer.
(BELG J MED ONCOL 2015;9(1):16–24)