What is the role of chemotherapy in the treatment of postradiation sarcoma (PRS)?

Updated: Jul 01, 2020
  • Author: Nagarjun Rao, MD, FRCPath; Chief Editor: Omohodion (Odion) Binitie, MD  more...
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The selection of chemotherapy agents used to treat patients with PRS is based largely on data from clinical trials of soft-tissue and bone sarcomas. The two most active single chemotherapy agents are doxorubicin and ifosfamide. These agents have roughly equivalent activity. Dacarbazine has modest single-agent activity. MAID (a combination of mesna, Adriamycin [ie, doxorubicin], ifosfamide, and dacarbazine) has been a commonly used combination chemotherapy regimen for the treatment of soft-tissue sarcoma over the past decade.

Three randomized trials compared doxorubicin plus ifosfamide with doxorubicin alone. Two of these trials showed higher response rates in the treatment arms containing doxorubicin and ifosfamide than in those containing doxorubicin alone. However, the doxorubicin and ifosfamide combinations also were associated with significantly higher myelosuppression (including fatal neutropenic sepsis) but no survival advantage. No standard of care has been established for the choice of chemotherapy agents. Therefore, treatment typically is individualized.

Preoperative chemotherapy can be administered with or without radiation therapy and is administered either intravenously (as a bolus or as a continuous infusion) or regionally (via an intra-arterial infusion to an isolated limb). Preoperative chemotherapy generally is considered in order to facilitate a limb-sparing procedure. This approach is considered for patients who otherwise would require amputation for cure or palliation. In some instances, this approach may be considered to convert a marginally resectable lesion into one that is operable.

Consideration of preoperative chemotherapy for PRS must take into account that response rates to chemotherapy are low and that most long-term survivors with PRS are patients who have undergone successful surgical resection.

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