The role of systemic chemotherapy in multimodality therapy of soft tissue sarcoma

Abstract

Background In spite of effective local treatment, i.e. surgery alone or surgery combined with radiotherapy, the overall prognosis of soft tissue sarcomas is poor. This is caused by the high likelihood of later occurring metastatic disease which is almost never curable. Thus, an effective systemic therapy which can eradicate microscopic metastases early on in the disease is highly warranted. Methods The literature has been reviewed with respect to studies on adjuvant chemotherapy in soft tissue sarcoma. Results Only randomized studies with a no treatment arm can lead to meaningful conclusions. Overall, these studies, using either single agent doxorubicin or doxorubin-based combination chemotherapy, did not result in improved overall survival. Some studies indicated a reduction in local recurrence. Conclusions Based on the results, the routine application of adjuvant chemotherapy in soft tissue sarcoma can presently not be justified. Currently, trials are exploring combinations of agents which are the most effective in metastatic disease. Also, neo-adjuvant chemotherapy trials are being conducted. It is anticipated that in the near future chemotherapy will be combined with hematopoietic growth factors to allow for intensification of the therapy.