Cardiovascular and Oncological Aspects of Chemotherapy in Patients with Locally Advanced Soft Tissue Sarcomas

Abstract

Background: Soft tissue sarcomas (STS) are a heterogeneous group of rare malignant tumors that require individualized multimodal
treatment. Anthracyclines, particularly doxorubicin, remain a cornerstone of systemic therapy; however, their use is associated with a
clinically important risk of cardiotoxicity, especially at high cumulative doses.
Objective: This article reviews the cardiovascular effects of systemic therapies used in patients with locally advanced and metastatic
STS, with particular emphasis on anthracycline-associated cardiotoxicity, its risk factors, prevention, monitoring, and long-term
cardiovascular outcomes.
Methods: The article discusses available clinical evidence regarding anthracycline-based chemotherapy and other systemic treatment
modalities used in STS, including tyrosine kinase inhibitors, alternative cytotoxic agents, and immune checkpoint inhibitors. Current
approaches to cardiovascular risk assessment, prevention, monitoring, and survivorship care are also reviewed.
Results: Anthracycline-associated cardiac dysfunction represents an important treatment-related complication in patients with STS,
particularly in those receiving high cumulative doses. Continuous infusion, dexrazoxane, liposomal formulations, cardiovascular riskfactor
management, and appropriate cardiac monitoring may reduce the risk of cardiotoxicity. Other systemic therapies may cause
distinct cardiovascular complications, including arterial hypertension, left ventricular dysfunction, QTc prolongation, thromboembolic
events, and immune-mediated myocarditis.
Conclusion: Cardiovascular risk assessment and monitoring should be integrated into the management of patients with STS from
the initiation of systemic therapy through long-term survivorship. A multidisciplinary cardio-oncology approach may facilitate early
detection and management of treatment-related cardiovascular complications while allowing effective oncological therapy to continue.