Background. Pleomorphic
sarcoma is an aggressive
soft tissue sarcoma. In patients with high-risk extremity
sarcomas, the significant survival benefits conferred by an intense regimen of
neoadjuvant chemoradiotherapy and surgery were reported. To our knowledge, this is the first report in the literature of the neoadjuvant use of
trabectedin in a patient with high-grade pleomorphic
sarcoma, ineligible for standard neoadjuvant combination
therapy with an
anthracycline-based regimen. Case Presentation. Here we present a 58-year-old White male with a large
tumor in the left thigh, but with no signs of
metastases. Owing to the history of severe
heart attack, three cycles of neoadjuvant
trabectedin were administrated to achieve surgically wide margins. After two cycles, an 18F-FDG-PET showed a large proportion of the central
tumor area was without metabolic activity. According to RECIST and Choi criteria, the
tumor was stable. After the third cycle of
trabectedin, the patient underwent a complete resection, which revealed completely necrotic high-grade pleomorphic
sarcoma (stage pT2b), with only a small vital area. Conclusion. The present paper on a promising treatment with neoadjuvant
trabectedin of patients with high-grade pleomorphic
sarcoma might suggest that such treatment approach may provide a greater chance of cure and survival of such patients.