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Sarcomas

Should Patients with High-Risk Soft Tissue Sarcoma Receive Adjuvant Chemotherapy?

^aUniversity of Michigan, Ann Arbor Michigan, USA; ^bMD Anderson Cancer Center, University of Texas, Houston, Texas, USA

Key Words. Soft tissue sarcoma • Adjuvant • Neoadjuvant • Chemotherapy

Correspondence: Scott Schuetze, M.D., Ph.D., University of Michigan, C342 Med Inn, SPC 5848, 1500 E Medical Center Drive, Ann Arbor, Michigan, 48109-5848, USA. Telephone: 743-936-0453; Fax: 734-647-7279; E-mail: scotschu{at}umich.edu

Received January 15, 2009; accepted for publication September 4, 2009; first published online in THE ONCOLOGIST Express on October 6, 2009.

Disclosures

Scott M. Schuetze: None; Shreyaskumar Patel: Honoraria: Novartis, Amgen.

Section editors Laurence Baker and Jaap Verweij have disclosed no financial relationships relevant to the content of this article.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias.

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.

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