[Chemotherapy of metastatic soft tissue sarcoma]

The chemosensitivity of bone sarcomas contrasts sharply with the comparative initial chemoresistance of soft tissue sarcomas. The lack of new effective cytotoxic agents, delayed treatment due to a clinical presentation which is often innocuous and the absence of a consensus about the role of adjuvant chemotherapy after adequate surgery account for the slow progress achieved in the treatment of these tumours and for such an appalling prognosis. Chemotherapy is still purely palliative except for certain specific metastatic lesions, and median overall survival is more often than not below 12 months. However, the optimization of the therapeutic index of the most active antimitotic drugs, the ever-increasing acceptance of the concept of a dose-effect for the majority of these lesions, the particularly promising objective response rates with intensive drug combinations and a better understanding of the development process of certain lesions and histologic subtypes make it possible to envisage a rapid improvement in their still far too dismal prognosis.