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
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