Adjuvant therapy of soft-tissue sarcomas

Combination surgery and radiation therapy is currently the standard of care for primary treatment of soft-tissue sarcomas. The practice of complete muscle group excision has been replaced by that of achieving a 3- to 4-cm circumferential margin or adding either pre- or postoperative radiation to the surgical therapy. The surgeon can limit the margins to preserve the optimum tissue function but at the same time achieve maximum local control. Investigations continue to define the role of brachytherapy. Achieving therapeutic radiation doses while significantly limiting the treatment time has obvious advantages. Failure to irradiate a field wide enough, however, could result in marginal relapses. The demonstration of Brennan et al that the very high complication rate associated with this technique can be limited by delaying the delivery of radiation through the surgically placed catheters until 5 days after a surgical resection has significant implications for further protocols. The role of adjuvant chemotherapy in the multimodal management of patients with soft-tissue sarcomas is still investigational. Although a few of the randomized trials showed definite disease-free and overall survival benefit in those patients receiving adjuvant chemotherapy, most did not. In general, many authors believe that adjuvant chemotherapy for soft-tissue sarcoma cannot be recommended outside the context of a clinical trial.(ABSTRACT TRUNCATED AT 250 WORDS)