[Adjuvant chemotherapy in soft-tissue sarcomas?].

PURPOSE

Patients with high-grade soft-tissue sarcomas have a bad prognosis because of frequent generalisation especially with lung metastases. The question is if there is a chance to modify the prognosis of these high risk patients by any form of adjuvant chemotherapy.

PATIENTS AND METHODS

Published randomised studies with a no-chemotherapy control arm are reviewed. The most important criteria are disease-free survival and especially overall survival.

RESULTS AND CONCLUSIONS

Postoperative adjuvant chemotherapy for high-grade soft-tissue sarcomas is still investigational. This holds true for all localisations: e. g. extremities, head and neck, trunk. More clinical studies are needed to establish any indication for routine application of cytostatic drugs in this setting. Other experimental procedures are also not yet prepared for widespread use outside of clinical trials: pre-operative ("neoadjuvant") induction chemotherapy, regional perfusion with cytostatics (+/- hyperthermia) or externally applied deep regional tumor hyperthermia with systemic chemotherapy. From the actual knowledge it should be concluded that the uncontrolled adjuvant treatment of soft-tissue sarcomas with cytostatic drugs might provoke more risks of side effects than gain in survival.