Chemoradiation treatment strategies for localized sarcoma: conventional and investigational approaches

Current chemoradiation treatment strategies have largely evolved out of the experience reported by Eilber and colleagues from the University of California, Los Angeles (UCLA). The favorable local control rates they reported using intra-arterial doxorubicin-based concurrent chemoradiation have been confirmed by several other groups with some groups reporting local control rates in excess of 95% with this approach. This has led to further studies designed to evaluate: 1) the optimal route for chemotherapy administration--intra-arterial vs. intravenous, 2) the possible advantage of protracted infusion of the radiosensitizer vs. brief infusion, 3) the efficacy of other intravenous and oral radiation sensitizers, and 4) the efficacy of sequential chemoradiation using multi-agent chemotherapy alternating with radiotherapy. The results of these investigations are reviewed as the basis for ongoing research evaluating chemoradiation strategies for the treatment of patients with localized sarcoma.