Retroperitoneal sarcoma, regardless of the histopathologic grade of malignancy, has a high incidence of local recurrence that is usually fatal. Surgical resection is mandatory and resectability may be improved by a midline transabdominal approach. However, even with total tumor excision, recurrence is high. A preliminary study, combining resection and preoperative adriamycin, found to be effective for established disease, suggests potentially improved prognosis. Further clinical trials employing combined with adjuvant chemotherapy are warranted.

Between 1971 and 1991, 247 patients with stage I osteosarcoma were treated at UCLA. Patients were treated in four sequential groups, with group 1 receiving surgery alone, and groups 2 through 4 receiving various adjuvant chemotherapeutic regimens. The incidence of lung metastases in these patients decreased from 92% (group 1) to 31% (group 4), while the proportion of patients undergoing pulmonary resection increased (17% vs 82%). Overall 5-year survival rate among patients with pulmonary metastases increased from 0 in group 1 to 41% (actuarial) in group 4. No clinical factor correlated significantly with outcome using univariate analysis, although there was a trend toward prolonged survival in those with longer disease-free intervals. Adjuvant chemotherapy and resection of pulmonary metastases have transformed a uniformly fatal condition into one with a reasonable expectation of long-term survival.

A review of results obtained from numerous clinical trials of immunotherapy for various histological types of cancer serves to emphasize the many discrepancies in the various protocols. Even so, adjuvant immunotherapy in both man and animals has been shown to be relatively nontoxic and to have systemic activity. Definitive results must await long-term follow-up of patients, although in general some therapeutic benefit has been obtained by patients with melanoma and by selected patients with carcinoma of the lung. Adjuvant immunotherapy trials for other types of cancer are still in the preliminary phases. Because therapeutic benefit has not been definitely established, this treatment must he considered highly experimental. Clearly, adjuvant immunotherapy in its present form is not a panacea, but when criteria for methodology, immunologic agents, route, and schedule of administration have been thoroughly identified, it may prove to be a most beneficial adjunctive treatment for selected patients with cancer.