Liposarcoma Treatment & Management

Updated: Mar 23, 2018
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

Liposarcoma has a number of different subtypes (ie, well differentiated, dedifferentiated, myxoid/round cell, pleomorphic), and their response to chemotherapy is not well documented. [29] Thus, the response rates to chemotherapy of the different histological subtypes and overall and progression free survival were investigated; survival according to histological grade was also assessed. This retrospective analysis suggested that myxoid liposarcoma is relatively chemosensitive in comparison to a combination of other liposarcomas, in particular dedifferentiated and well-differentiated tumors.

In the case of well-differentiated liposarcoma, grade provides no incremental information over other histological subtypes in terms of response to therapy. In myxoid/round cell liposarcoma, the presence of a round cell component may be an adverse prognostic sign. Tumor site, a high proliferative fraction noted with MIB-1 labeling, and TP53 missense mutations are also adverse prognostic factors in myxoid/round cell tumors. [30]

For liposarcomas, radiation therapy may be a valuable adjunct to surgery, especially in those of the myxoid variant.

The use of chemotherapy in liposarcomas remains experimental.

Although surgical resection is the mainstay of curative treatment, patients with large high-grade liposarcomas may benefit from multimodality treatment with chemotherapy and radiation. [31]

Treatment of an atypical lipoma using liposuction has been described. [32]

Trabectedin (Yondelis) was approved in November 2015 in the United States for unresectable or metastatic liposarcoma or leiomyosarcoma in patients who have received a prior anthracycline-containing regimen. It is an alkylating drug that binds guanine residues in the minor groove of DNA. Approval was based on a phase 3 trial (n=518) that showed a statistically significant improvement in progression-free survival compared with dacarbazine (4.2 mo vs 1.5 mo; P< .0001). No improvement in overall survival was observed. [33]

In January 2016, eribulin (Halaven), a microtubule inhibitor, [34]  was approved by the US Food and Drug Administration (FDA) for unresectable or metastatic liposarcoma in patients who received a prior anthracycline-containing regimen. The FDA approval is based on the results from the subgroup of 143 patients with liposarcoma. In this subgroup, the results show a 7-month improvement in survival (15.6 months with eribulin compared with 8.4 months with dacarbazine). The median progression-free survival, a secondary endpoint, was 2.9 months with eribulin compared with 1.7 months with dacarbazine. However, eribulin was more toxic than dacarbazine. Treatment-emergent adverse events included neutropenia (44% vs 24%), pyrexia (28% vs 14%), peripheral sensory neuropathy (20% vs 4%), and alopecia (35% vs 3%) for eribulin compared with dacarbazine, respectively. [35]

Comprehensive genomic profiling may facilitate targeted therapy for individual liposarcomas in the future. [36]

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Surgical Care

The rationale for wide surgical excision of atypical lipomatous tumors is the prevention of recurrence and dedifferentiation.

Wide and deep surgical excision, along with local radiation and/or chemotherapy, may be necessary for high-grade lesions.

Given the favorable outcome with wide surgical excision alone, regardless of the histologic type of the tumor, some authors believe that adjuvant radiation therapy is unjustified.

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Consultations

Consultation with the following specialists may be warranted:

  • Oncologist: When malignancy is strongly suspected or when previous incisional biopsy reveals liposarcoma, consultation with an oncologist prior to the definitive surgical procedure is recommended.

  • Radiation oncologist: Adjuvant therapy may be indicated in cases in which excision is incomplete. In such cases, consultation with a radiation oncologist is recommended.

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