Medical management of unresectable, recurrent low-grade retroperitoneal liposarcoma: integration of cytotoxic and non-cytotoxic therapies into multimodality care

Liposarcomas of the retroperitoneum are rare tumors, and best managed by an expert multidisciplinary team consisting of a surgical oncologist with app ropriate medical oncology and radiation oncology collaboration. For large t umors, surgical excision with wide margins is difficult to achieve, and eve n wide margins cannot ensure that microscopic remnants of residual disease will not grow back in the,future. For these reasons, even following expert resection, local recurrence is common. For patients with recurrent and unre sectable liposarcoma, treating the sarcoma while maintaining quality of lif e becomes the major therapeutic goal. Importantly, patients with advanced r ecurrent disease demonstrate the need for multidisciplinary team involvemen t, with timely consideration of palliative surgical, radiation therapy, and chemotherapy options. Such patients also represent ideal candidates for in vestigational approaches aimed at identifying new agents with which to trea t this disease. In addition to the development of new cytotoxic agents, pat ients may be candidates for novel strategies such as differentiation therap ies or anti-angiogenic approaches. The recent explosion of knowledge regard ing the cytogenetics, molecular, and cellular biology of liposarcomas allow s us to remain positive that new translational therapies will be developed to improve the clinical outcomes of patients with these diseases. Current s trategies, such as the use of PPAR gamma ligands to differentiate liposarco mas, will soon be tested in major national collaborative trials, and the co operation of surgeons and medical oncologists at all levels of community an d academic practice will be crucial to obtain answers in this field. This r eview will summarize an illustrative case in the process of describing the natural history and potential interventions which should be considered for patients with this disease. (C) 2000 Published by Elsevier Science Ltd.