Prognostic impact of circulating tumor cells in patients with soft-tissue sarcomas:a prospective study

Dear Editor,Sarcomas represent a heterogenous group of tumors accounting for about 1%of cancer in adults and 15%in children[1].However,despite adequate locoregional treatment,up to 40%of patients develop metastatic disease.Drugs used in the advanced setting have very limited efficacy,with a response rate of<10%and progression-free survival of<4 months and are mainly used for palliative purposes[1].It is,therefore,important to monitor individual therapy responses to avoid inefficient therapy and unnecessary toxicity.Such monitoring is currently based on repeated CT imaging which may represent an important burden for patients with advanced disease[2].

Clinical utility of circulating tumor DNA sequencing with a large panel in patients with advanced soft-tissue sarcomas

To the editor Soft-tissue sarcomas(STS)represent a very heterogeneous group of rare tumors including more than 100 different subtypes[1].Surgery and neo/adjuvant radiation therapy represent the cornerstone of treatment for STS.However,despite an optimal resection of the tumor,up to 40%of patients will develop metastatic relapse and will die from the disease[1].Doxorubicin represents the first-line standard of care for patients with advanced disease since the 1970s,despite several attempts to identify better regimens.The median overall survival(OS)of patients with metastatic disease is<18 months and has only modestly improved over the past 20 years[2].

The diagnosis, classification, and treatment of sarcoma in this era of artificial intelligence and immunotherapy

Soft-tissue sarcomas(STS)represent a group of rare and heterogeneous tumors associated with several challenges,including incorrect or late diagnosis,the lack of clinical expertise,and limited therapeutic options.Digital pathology and radiomics represent transformative technologies that appear promising for improving the accuracy of cancer diagnosis,characterization and monitoring.Herein,we review the potential role of the application of digital pathology and radiomics in managing patients with STS.We have particularly described the main results and the limits of the studies using radiomics to refine diagnosis or predict the outcome of patients with soft-tissue sarcomas.We also discussed the current limitation of implementing radiomics in routine settings.Standard management approaches for STS have not improved since the early 1970s.Immunotherapy has revolutionized cancer treatment;nonetheless,immuno-oncology agents have not yet been approved for patients with STS.However,several lines of evidence indicate that immunotherapy may represent an efficient therapeutic strategy for this group of diseases.Thus,we emphasized the remarkable potential of immunotherapy in sarcoma treatment by focusing on recent data regarding the immune landscape of these tumors.We have particularly emphasized the fact that the development of immunotherapy for sarcomas is not an aspect of histology(except for alveolar soft-part sarcoma)but rather that of the tumor microenvironment.Future studies investigating immunotherapy strategies in sarcomas should incorporate at least the presence of tertiary lymphoid structures as a stratification factor in their design,besides including a strong translational program that will allow for a better understanding of the determinants involved in sensitivity and treatment resistance to immune-oncology agents.

Gene expression profiling improves prognostication by nomogram in patients with soft-tissue sarcomas

Dear Editor,Surgery remains the cornerstone of treatment for softtissue sarcomas(STS)[1].However,despite adequate locoregional treatment,30%-40%of the patients eventually develop metastases[2,3].Accurate risk assessment is crucial to tailor therapeutic strategies and to identify high-risk patients who may benefit from perioperative chemotherapy.Hence,several efforts have been made to develop prognostic nomograms that enable individual prognosis prediction;representing an important decision-making aid for oncologists and surgeons involved in sarcoma care[4-6].