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