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Adjuvant therapy of sarcomas of
soft tissue.
Antman KH.
Columbia
University, New York, NY, USA.
Adjuvant chemotherapy for
rhabdomyosarcomas, osteosarcomas, and Ewing's sarcomas is established,
but remains controversial in other adult sarcomas. Of the 14 reported
adjuvant studies, the largest study from the European Organization for
Research and Treatment of Cancer showed a significant improvement in
local control for adjuvant chemotherapy in nonextremity sarcomas, but
not overall survival benefit. Two studies show a significant overall
survival advantage for chemotherapy. A meta-analysis of individual
patient data by the Medical Research Council Cancer Trials Office
reported a trend but no significant difference in survival (although
differences were significant for disease-free survival and local
control). Adjuvant chemotherapy should not be offered for low-grade
lesions because of their low probability of metastatic spread, nor
should it be offered for small (< 5 cm) high-grade sarcomas because
of their good prognosis. Oncologists should discuss the adjuvant data
with patients who have soft tissue sarcomas. Patients informed of a
difference in disease-free survival but a 4% absolute difference in
survival may or may not wish to receive adjuvant
chemotherapy.
Publication Types:
PMID: 9344322 [PubMed - indexed for
MEDLINE]
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