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Significant clinical benefit of first‐line palliative chemotherapy in advanced soft‐tissue sarcoma
Author(s) -
Karavasilis Vasilios,
Seddon Beatrice M.,
Ashley Susan,
AlMuderis Omar,
Fisher Cyril,
Judson Ian
Publication year - 2008
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.23332
Subject(s) - medicine , synovial sarcoma , liposarcoma , sarcoma , chemotherapy , soft tissue sarcoma , leiomyosarcoma , doxorubicin , rhabdomyosarcoma , localized disease , oncology , palliative care , soft tissue , surgery , cancer , pathology , nursing , prostate cancer
BACKGROUND. The efficacy of palliative chemotherapy was investigated in a large group of patients with advanced soft‐tissue sarcomas (STS) treated on routine palliative protocols. METHODS. Patients with STS who had first‐line chemotherapy for advanced and/or metastatic disease between 1991 and 2005 were identified from the Royal Marsden Hospital's sarcoma database. Patients with Ewing sarcoma, rhabdomyosarcoma, desmoplastic small round cell tumor, and gastrointestinal stromal tumors were excluded from the study. RESULTS. In all, 488 patients (242 male, 246 female) fulfilled the study criteria. The median age was 49 years and the majority (83%) received chemotherapy for metastatic disease. The most common histologic subtypes were leiomyosarcoma (35%) synovial sarcoma (13%), liposarcoma (10%), and malignant fibrous histiocytoma (10%). In all, 61% received single‐agent chemotherapy, usually doxorubicin. An objective response was reported in 33% of patients (53% in those with synovial sarcoma); 22% had stable disease and 45% derived ‘clinical benefit’ (objective responses + stable disease for ≥6 months). Median duration of response was 9 months and median posttreatment overall survival (OS) was 12 months. In multivariate analysis, age <40 years, liposarcoma, and synovial histology were found to be positive, and bone involvement to be negative, independent prognostic factors. Patients treated with combination chemotherapy experienced longer OS than those treated with a single agent. CONCLUSIONS. Palliative chemotherapy may be beneficial in approximately half of patients with advanced STS. Synovial sarcoma and liposarcoma subtypes have a better prognosis. However, the overall poor outcome of these patients indicates the need to continue the search for more effective agents. Cancer 2008. © 2008 American Cancer Society.