Open AccessShould Patients with High‐Risk Soft Tissue Sarcoma Receive Adjuvant Chemotherapy?
Author(s) -
Schuetze Scott M.,
Patel Shreyaskumar
Publication year - 2009
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2009-0007
Subject(s) - medicine , sarcoma , soft tissue sarcoma , ifosfamide , soft tissue , chemotherapy , regimen , oncology , doxorubicin , surgery , pathology , etoposide
Learning Objectives After completing this course, the reader will be able to: Describe the type of patient with soft tissue sarcoma most likely to benefit from adjuvant chemotherapy. Select the chemotherapy regimen most likely to benefit a patient with high‐risk soft tissue sarcoma. Evaluate the impact of adjuvant chemotherapy on risk of soft tissue sarcoma recurrence analyzed in the sarcoma meta‐analyses.This article is available for continuing medical education credit at CME.TheOncologist.com Soft tissue sarcoma is a malignant connective tissue tumor that may arise anywhere in the body and from diverse mesenchymal elements. Its incidence is approximately 30 per million persons. The majority of patients with soft tissue sarcoma present with potentially life‐threatening disease, and complete resection to obtain specimen margins free of tumor and radiation offer the best chance for local disease control. The risk of relapse and death from disease rises with increasing tumor stage, grade, and size. Adjuvant chemotherapy has been studied as a means to decrease the risk for disease recurrence in patients with localized soft tissue sarcoma at diagnosis, but the majority of trials reported on have been hampered by patient heterogeneity, low patient accrual, and short follow‐up. Meta‐analysis and reviews of institutional large series, in efforts to overcome some of the limitations, suggest that doxorubicin with ifosfamide reduces the risk for sarcoma recurrence and death in selected patients with high‐grade, large, and chemotherapy‐sensitive sarcoma subtypes to a clinically meaningful degree. In multiple analyses, patients with high‐risk soft tissue sarcoma treated with chemotherapy have a >10% absolute lower risk for disease recurrence and longer disease‐specific survival than patients treated without chemotherapy. In the absence of conclusive results from an adequately powered, randomized, controlled clinical trial, the available data support the use of chemotherapy in the management of high‐risk, localized, soft tissue sarcoma.