Current perspectives in the management of soft-tissue sarcoma. The role of chemotherapy in multimodality therapy.

The role of chemotherapy in adult soft-tissue sarcomas is controversial. In this review, the author examines the effectiveness of single-agent and combination chemotherapy to manage advanced disease and the role of adjuvant combination chemotherapy to control primary tumours and prevent the spread of the disease. Doxorubicin (Adriamycin) is still considered the most effective single agent for advanced soft-tissue sarcoma. Ifosfamide has given similar results and may have greater potential in combination therapy than cyclophosphamide. A current study using trimetrexate shows early positive results. Doxorubicin, cyclophosphamide, vincristine and dacarbazine is currently the most efficacious combination. The efficacy of adjuvant chemotherapy remains to be established. The majority of studies indicate some benefit with chemotherapy, particularly in the relapse-free survival rate, but no consistent improvement in overall survival has been noted.