Adjuvant chemotherapy for soft tissue sarcoma – pro

A meta-analysis published in 1997 reported an improvement in local control and progression free survival after adjuvant chemotherapy, however although there was a trend towards an overall survival benefit this was not statistically significant. These data have been supported by two more recent overviews but data from the EORTC 62931, the largest trial of adjuvant chemotherapy for STS, has failed to demonstrate any benefit from chemotherapy in local control, progression free survival or overall survival in patients treated with adjuvant chemotherapy. ESMO in 2009 wrote: “Therefore, adjuvant chemotherapy is not standard treatment in adult-type soft tissue sarcomas, and can be proposed as an option to the high-risk individual patient (having a G2–3, deep, >5 cm tumor) for shared decision-making in conditions of uncertainty [II, C]. The histological type may be considered in the decision-making, since some types are felt to be more chemosensitive, whereas others are less so.” NCCN on p. MS-8 reviews all this evidence and appears to accept adjuvant chemotherapy as an option, on p. EXTRASARC-3 but with a footnote that explains that “there is limited and conficting data…”.

 Robert Grimer, Ian Judson, David Peake, and Beatrice Seddon Sarcoma Guidelines for the Management of Soft Tissue Sarcomas
Volume 2010 (2010)

P. G. Casali et al, Soft tissue sarcomas: ESMO Clinical Recommendations for diagnosis, treatment and follow-up Ann Oncol (2009) 20 (suppl 4): iv132-iv136.

F. Tierney, “Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults: Meta-analysis of individual data,” Lancet, vol. 350, no. 9092, pp. 1647–1654, 1997.

“Adjuvant chemotherapy for localised respectable soft tissue sarcoma in adults: sarcoma meta-analysis collaboration (SMAC),” Cochrane Database of Systematic Reviews, no. 4
N. Pervaiz, N. Colterjohn, F. Farrokhyar, R. Tozer, A. Figueredo, and M. Ghert, “A systematic meta-analysis of randomized controlled trials of adjuvant chemotherapy for localized resectable soft-tissue sarcoma,” Cancer, vol. 113, no. 3, pp. 573–581, 2008.
P. J. Woll, M. van Glabbeke, P. Hohenberger, et al., “Adjuvant chemotherapy with doxorubicin and ifosfamide in resected soft tissue sarcoma: interim analysis of a randomised phase III trial,” Journal of Clinical Oncology, vol. 25, p. 18S, 2007, ASCO Annual Meeting Proceedings.

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