Palliative chemotherapy of adult soft tissue sarcomas

Sarcomas represent approximately 1% of adult malignancies. Surgery and local radiotherapy are the mainstays of therapy, as treatment of metastatic disease is palliative in intent in most cases. The value of adjuvant chemotherapy is controversial. Most adjuvant trials using single-agent doxorubicin have failed to show improved relapse-free and overall survival. Minor advantages in relapse-free survival have been reported in some adjuvant chemotherapy trials using combination chemotherapy. Further research is needed to develop effective adjuvant regimens. Surgery also may be important in the treatment of metastatic disease, as approximately 20% of patients with pulmonary metastases amenable to resection may be rendered disease free for prolonged periods. Chemotherapy is of modest value. Only three drugs (doxorubicin, dacarbazine, and ifosfamide) have clear activity in the treatment of adult soft tissue sarcomas. Combination chemotherapy may be associated with higher objective response rates than single-agent chemotherapy, but toxicity also is greater with combination regimens and no survival advantage for the more aggressive alternatives has been reproducibly reported. In patients over the age of 50 years, single-agent chemotherapy may be preferable to combination chemotherapy. Combination chemotherapy, often with aggressive supportive measures, may be considered in younger patients with a good performance status. New active agents need to be identified if therapy of this group of diseases is to be improved.