What are the treatment recommendations for metastatic soft tissue sarcoma?

Updated: Apr 29, 2019
  • Author: from Memorial Sloan-Kettering - Mrinal M Gounder, MD; Chief Editor: Edwin Choy, MD, PhD  more...
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Answer

Answer

In metastatic disease, it is important to differentiate between limited and disseminated metastases

Limited metastasis involves only one organ and should be considered for resection for improved disease-free survival (DFS) and overall survival (OS)

Disseminated metastases can be managed with palliative therapy (radiation, chemotherapy, surgery, or supportive care alone)

Initiation of palliative chemotherapy should be based on histology, tumor growth rate, chemosensitivity, and associated symptoms

Adjuvant chemotherapy (in patients without metastasis and after surgical resection of a primary tumor) is not generally considered as first-line therapy [12, 13, 14]

Several single-agent and combination chemotherapies are used in metastatic disease; compared with single-agent chemotherapies, many combination therapies have higher response rates but greater toxicities and no survival advantage

The decision for combination therapies should be individualized and take age, performance status, and organ function into account

Combination therapies may require prophylactic growth factor support

Refer patients for clinical trials whenever possible

If the patient is asymptomatic and the tumor has a slow growth rate, then observation with close monitoring is a reasonable option

Patients with limited metastatic disease or recurrent disease after primary therapy should be considered for surgery, radiofrequency ablation (RFA), embolization, or radiation therapy with curative intent

There are no clear guidelines for metastatic and recurrent disease, as treatment depends on the disease-free interval, performance status, and histology

In stage IV sarcoma, patients with limited disease should also be considered for resection or other definitive intervention, as this is associated with improved disease-free survival

Consider re-resection for positive or close margins [15]

Prevention of local recurrence may require additional radiation and/or chemotherapy


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