Chemotherapy after removal of soft tissue sarcoma (STS)

Adjuvant chemotherapy is a term for chemo that is given after tumor resection. The goal is to eradicate disease that may have been left behind or had already spread. A meta-analysis of  published trials 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 (how long the patients lived) this was not statistically significant. That there is some benefit has 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. European Society of Medical Oncology(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…”.

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