What are considerations for the use of chemotherapy in the treatment of 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

See the list below:

  • Concurrent chemoradiation typicalliy is mainly used for extremity and trunk soft tissue sarcoma, as use in intra-abdominal/retroperitoneal sites has more significant toxicities.

  • Doxorubicin can be administered as a flat dose of 30 mg daily for 3 d, with concurrent radiation therapy.

  • Radiotherapy with ifosfamide is associated with significant toxicities, and full doses are difficult to administer beyond two cycles.

  • A single trial reported safe administration of gemcitabine at 700 mg/m2 along with 50 Gy over 25 fractions

  • There are sparse data on oral temozolomide 50 mg/m2 once daily for 7 d with radiation therapy (dose of 50.4 Gy)

  • Combination chemotherapy regimens (MAID [mesna, doxorubicin, ifosfamide, and dacarbazine]) with concurrent radiation therapy have higher response and prohibitive toxicities and therefore should be performed at centers with adequate experience with these regimens; there are no prospective studies comparing chemoradiation to radiation therapy alone

  • Consider adjuvant chemotherapy for chemosensitive, extremity/trunk, and high-risk lesions; consider age, performance status, size, grade, location, type of initial surgery, and margin status when discussing initiation of adjuvant therapy


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