[Adjuvant chemotherapy in early soft tissue sarcoma and palliative chemotherapy in advanced soft tissue sarcoma in...

Adjuvant chemotherapy (chth): The place of postoperative adjuvant chth after complete resection of a primary tumor (R0) is not well established. 13 adjuvant chemotherapy trials with a variety of combinations and most often doxorubicin alone in different regimens were compared to a control group without chemotherapy. Only 2 reports showed a difference in overall survival and 4 some gain in disease-free survival. New studies began with defined inclusion criteria and a control arm without chemotherapy. There are only some risk factors coming into consideration: deep seated tumors with histologic grade 2 and all grade 3 cases. Adjuvant chemotherapy appears justified only within these studies. The potential side effects of adjuvant chemotherapy outside of these trials are detrimental (e.g. 10% cumulative risk of cardiomyopathy after ADM; risk of secondary leukemias) and a benefit is not known. Primary induction chth: Preoperative neoadjuvant chth has to be reserved for studies. They are performed in case of deep seated large primary tumors, not suitable for R0-resection without mutilation. Palliative Chth: In metastatic or locally not curative resectable disease treatment is palliative. The aim of treatment is the relief of existing symptoms or the avoidance of threatening complaints and possibly prolongation of life. The combination of ADM and Ifosfamide (IFO) is commonly used although its superiority to ADM monotherapy is not proven. As second line chemotherapy in case of tumor resistance high dose IFO-monotherapy can be put up for discussion. Myeloablative high-dose-poly-chth with stem cell transplantation remains an experimental approach.