What are the UK treatment guidelines for advanced soft tissue sarcoma (STS)?

Updated: Sep 02, 2018
  • Author: Steven C Katz, MD, FACS; Chief Editor: Edwin Choy, MD, PhD  more...
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Answer

Answer

Recommendations are as follows:

  • Systemic anticancer therapy for the majority of cases of advanced STS is not curative; median survival time is 12-18 months, which varies by subtype. Chemotherapy response rates range from 10%-50%, depending on the treatment regimen, patient selection, tumor grade, and histologic subtype.
  • Treatment recommendations should be guided by patient performance status, disease extent, rate of progression, and potential sensitivity to treatment.
  • Standard first-line treatment is single-agent doxorubicin.
  • Ifosfamide may be used as first-line treatment if anthracyclines are contraindicated, and it is a standard option for second-line therapy.
  • Although the combination of doxorubicin and ifosfamide has not been demonstrated to improve survival in comparison to single-agent doxorubicin as first-line treatment, response rates are higher, and it may be considered in individual patients where a response would improve symptoms or facilitate other treatment modalities.
  • Additional second-line agents include trabectedin and the combination of gemcitabine and docetaxel. The choice of agent depends on histology, toxicity profile, and patient preference.
  • A number of other agents, such as dacarbazine and pazopanib, can be considered beyond second-line, depending on patient fitness and funding constraints.
  • Surgical resection of locally recurrent disease should be considered where feasible. For patients with oligometastatic disease, surgery, RT, or ablative therapies should be considered in individual cases, although data on survival benefit are limited.

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