Adjuvant chemotherapy for soft-tissue sarcoma: a critical appraisal.

Adjuvant chemotherapy, established in the treatment of osteogenic sarcoma, Ewing's sarcoma, and rhabdomyosarcoma, currently remains controversial in adult soft-tissue sarcoma. Because the survival of the control arms in randomized studies is significantly better than historical controls, only randomized studies with nontreatment control arms will be analyzed here. None of the 11 reported adjuvant studies showed a significant survival advantage for chemotherapy overall. Although subset analyses are less reliable, the National Cancer Institute reported a significant prolonged survival and disease-free survival for the subset of chemotherapy-treated extremity primaries. The M.D. Anderson and Italian studies observed a significant disease-free survival advantage; however, survival was not significantly different in the former and survival statistics were not provided in the latter study. In the subset of central body lesions none of the studies revealed a significant survival advantage for chemotherapy. Adjuvant chemotherapy should be considered investigational for adult soft-tissue sarcomas.