Ann Thorac Surg 2001;71:1639
© 2001 The Society of Thoracic Surgeons
Invited commentary
David R. Jones, MDa
a Department of Thoracic and Cardiovascular Surgery, University of Virginia, PO Box 800679, Charlottesville, VA 22908-0679, USA
e-mail: djones{at}virginia.edu
While primary thoracic sarcomas are rare, their treatment remains difficult for the thoracic surgical oncologist. The primary treatment for thoracic sarcomas has gradually evolved into a multimodal approach, with many patients undergoing induction chemoradiotherapy followed by surgical resection with or without brachytherapy. Despite this aggressive approach, these tumors frequently have locoregional recurrence at the resection margins and may have distant metastasis as well.
Tumor angiogenesis is involved in both the growth and metastatic potential of many malignancies. As part of a tumor’s survival response it increases transcription of several angiogenic genes of which vascular endothelial growth factor (VEGF) and its subtypes are one. VEGF has been shown to increase tumor vascularity and promote metastasis in a number of solid tumors, and therefore is a putative marker of metastatic potential in these tumors. In this report by Dr Iyoda and colleagues, thoracic sarcomas that have strong immunohistochemical overexpression of VEGF had a significantly decreased disease-free and overall survival compared to sarcomas with less VEGF expression. Perhaps more importantly the degree of VEGF expression was found to be a significant prognostic indicator in multivariate analysis. The finding that VEGF overexpression in solid tumors portends a poor prognosis is supported by similar observation in other tumors including lung, renal cell, and certain brain malignancies.
Perhaps the most important observation made by this study is that VEGF expression appears to directly correlate with high-grade thoracic sarcomas. This suggests that antiangiogenic or angiostatic agents may be effective in treating these tumors. The era of using antiangiogenics or angiostatic agents to treat solid tumor malignancies is already here. There are currently over twenty novel antiangiogenic agents being evaluated in at least twenty clinical trials of which six are phase III studies. Thus, the use of these agents is likely to increase, and their efficacy in treating thoracic malignancies will likely be the focus of future clinical trials. Therefore, while this report has identified VEGF expression in thoracic sarcomas as an important prognostic variable, perhaps the most important finding is that in the future these tumors may be treated with novel antiangiogenic agents in addition to current modalities.
Related Article
-
Expression of vascular endothelial growth factor in thoracic sarcomas
- Akira Iyoda, Kenzo Hiroshima, Masayuki Baba, Takehiko Fujisawa, Toshikazu Yusa, and Hidemi Ohwada
Ann. Thorac. Surg. 2001 71: 1635-1639.
[Abstract]
[Full Text]
[PDF]
