Chemotherapy

The use of chemotherapy in soft tissue sarcomas is controversial in tumors other than Peripheral neuroectodermal tumors and Rhabdomyosarcomas. The prognosis of other soft tissue sarcomas is poor in high-grade sarcomas and this had prompted the use of chemotherapy in high grade tumors.

Prognosis in soft tissue sarcomas

·      High grade     50% 5-year survival

·      Low grade      90% 5-year survival

 Previous studies had shown certain histological subtypes to respond better than others to chemotherapy.

·      Good reaponders:     Malignant fibrous histiocytoma and Synovial sarcoma

·      Bad responders:        Liposarcoma and leiomyosarcoma

 

Therefore the contraindications to chemotherapy would reasonably be:

·      Low grade

·      Intermediate grade (<10cm)

·      High grade (< 5 cm)

·      Localized cutaneous or subcutaneous sarcomas

·      Poor histology

·      Poor medical health

·      65 years or older

·      Advanced disease????

 

 A reasonable consideration for chemothrapy would be:

·      Deep, intermediate grade (≥ 10 cm)

·      Deep, high grade (≥ 5cm)

·      Locally recurrent

·      Metastatic

 

Evidence for chemotherapy in soft tissue sarcomas:

1. Sarcoma meta-analysis collaboration: adjuvant chemotherapy for localized resectable soft-tissue sarcoma of adults: meta-analysis of individual data (Lancet 1997)

·      14 trials of doxorubicin based adjuvant chemotherapy

·      Significantly improved time to local and distant recurrence and overall recurrence-free survival

·      Improved overally survival in only 4% at 10 years

·      However,

·      The 14 studies were from the 70’s and 80’s

·      Improvements in supportive care including erythropoietin, G-CSF, thrombopietin now allow more aggressive chemotherapeutic regimes

·      Many centers have moved to neoadjuvant studies

 

2. Adjuvant chemotherapy for adult soft tissue sarcomas of the extremitites and girdles: Results of the Italian Randomized cooperative trial (J Clin Oncol 2001)

·      Statistically significant improvement in both disease-free and overall survival

·      19% survival benefit at 4 years


3. Neo-adjuvant chemotherapy for primary high-grade extremity soft tissue sarcoma(Ann Oncol2004 )

·      21% survival benefit with ifosfamide based regimes at 3 years