What is the role of chemotherapy in the treatment of soft-tissue sarcomas of the extremities?

Updated: Dec 03, 2018
  • Author: Vinod B Shidham, MD, FRCPath; Chief Editor: Omohodion (Odion) Binitie, MD  more...
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Answer

Even after local control is achieved in patients with intermediate- and high-grade soft-tissue sarcomas, the risk of metastatic disease following multimodality treatments without amputation is as high as 50%. The risk is even greater if stage IIIB tumors are included.

Thus, effective systemic, adjuvant chemotherapy is desirable after definitive treatment of local disease. However, conclusive evidence that adjuvant chemotherapy for extremity sarcomas increases overall survival rates is lacking. Randomized trials have not demonstrated that higher overall survival rates occur with surgery and adjuvant doxorubicin therapy than with surgery alone.

In randomized clinical trials, multiagent chemotherapy with doxorubicin, cyclophosphamide, and methotrexate following surgery improved disease-free survival rates for patients with high-grade extremity sarcomas (except when the lesions were associated with the trunk or retroperitoneum). [44] However, the toxicity associated with this regimen was substantial. [45]

Preoperative chemotherapy, also called neoadjuvant chemotherapy, is an option for most patients with osteosarcomas of the extremity. However, it has not been established that this treatment is superior to conventional chemotherapy for soft-tissue tumors. Preoperative chemotherapy may be used alone or with preoperative or postoperative radiation therapy.

A significant hypothetical advantage of neoadjuvant chemotherapy is that it allows treatment effectiveness to be monitored through evaluation of the degree of necrosis in the resected primary tumor. However, no evidence exists that this results in improved clinical prognosis.


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