Chemotherapy in advanced soft tissue sarcomas

Abstract

Although surgery still constitutes the basic treatment modality of soft tissue sacomas, we have to consider that the local recurrence rate following surgery alone, was as high as 40–80% [1], while most relapses occur within 3 years [2]. The introduction of postoperative high-dose radiotherapy has reduced this local recurrence rate in extremity lesions [3–6], but still distant metastases wil occur in a major number of these patients. Moreover, because soft tissue sarcomas necessitate high doses of irradiation for effective treatment, this precludes adequate application of this technique in truncal lesions. Metastases of soft tissue sarcomas mainly develop by hematogeneous spreading, while their first site of appearance will frequently be the lungs. The frequent development of metastatic disease has stimulated the use of chemotherapy since the identification of doxorubicin (DX) as an active drug in the early seventies [7]. Later, DTIC and more recently Ifosfa-mide (IFX) have been identified as active drugs for the treatment of soft tissue sarcomas [8]. A complete remission can only be achieved in a limited number of patients, but there are indications that some of them may be cured [9]. This again stimulates the search for new active drugs. From previous studies it appeared that stratification for histologic subtypes and performance score would offer a more proper evaluation of the results of clinical trials, but unfortunately stratifications of such trials seems hardly feasible [10].