How I treat soft tissue sarcoma

Soft tissue sarcomas are mesenchymal malignancies with heterogeneous biological behavior and response to therapy. Surgery remains the gold standard approach for localized disease, with perioperative radiotherapy recommended for high-risk extremity tumors. The benefit of perioperative chemotherapy remains controversial. In the metastatic setting, anthracycline-based chemotherapy has been the first-line treatment for decades. Chemotherapy regimens upon progression to anthracyclines offer very limited disease control. Immune checkpoint inhibitors and T-cell receptor therapies have shown promising clinical activity in some histology subtypes. Advances in molecular profiling have revealed novel actionable targets, and several tailored therapies have proven to be highly effective in tumors harboring specific mutations. This review provides a comprehensive overview of current treatment strategies for soft tissue sarcomas, with emphasis on multidisciplinary management and the importance of developing histology-specific clinical trials to improve outcomes in these rare malignancies.