The Role of Chemotherapy in Soft Tissue Sarcomas

The progress in management of localized soft tissue sarcomas in recent years has resulted in improved functional status and overall outcome, but advancement in metastatic disease has been less than impressive. Doxorubicin and dacarbazine-based chemotherapy programs have resulted in response rates of up to 50% with a small but finite cure fraction, especially in conjunction with surgical resection of residual abnormalities. In the 1980s ifosfamide plus mesna was identified as an effective salvage regimen. Studies evaluating the role of ifosfamide as a frontline agent in combination with doxorubicin have reported increased toxicities without a significant additive or synergistic therapeutic benefit. High-dose chemotherapy for sarcomas is now feasible with the advent of growth factors and/or peripheral blood progenitor cell reinfusion for bone marrow support. While these approaches seem promising with improved complete and overall responses, survival benefit is yet to be seen.