Adjuvant Chemotherapy Following Complete Resection of Soft Tissue Sarcoma in Adults: A Clinical Practice Guideline

Abstract

Purpose. To review the literature and make recommendations for the use of anthracycline-based adjuvant chemotherapy in adult patients with soft tissue sarcoma (STS).Patients. The recommendations apply to patients >15 years old with completely resected STS. Methods. A systematic overview of the published literature was combined with a consensus process around the interpretation of the evidence in the context of conventional practice to develop an evidence-based practice guideline. Results. Four meta-analyses and 17 randomized clinical trials comparing anthracycline-based adjuvant chemotherapy versus observation were reviewed. The Sarcoma Meta-Analysis Collaboration (SMAC) was the best analysis because it assessed individual patient data and had the longest follow-up. The results of the SMAC meta-analysis together with data from more recently published randomized trials, as well as our analysis of the toxicity and compliance data, are incorporated in this systematic review. Discussion. It is reasonable to consider anthracycline-based adjuvant chemotherapy in patients who have had removal of a sarcoma with features predicting a high likelihood of relapse (deep location, size >5 cm, high histological grade). Although the benefits of adjuvant chemotherapy are most apparent in patients with extremity sarcomas, patients with high-risk tumours at other sites should also be considered for such therapy.

Impact of Margin Status and Local Recurrence on Soft-Tissue Sarcoma Outcomes

“…The present study found both radiation and chemotherapy to have a negative prognostic influence on distant metastasis, which eventually leads, in turn, to a decrease in disease-specific survival; although these findings are ostensibly due to a selection bias in our cohort, the multivariate analysis was unable to compensate for this putative bias. Attempts were made to control for this effect by removing the stage variable e151(5) 16,2013 from the multivariate model while retaining all relevant, stagedetermining variables. Despite this, the negative treatmentrelated effect persisted, suggesting that other factors normally not taken into account when studying this rare disease may be of prognostic relevance.…”

Adult Soft Tissue Sarcoma Local Recurrence After Adjuvant Treatment Without Resection of Core Needle Biopsy Tract

“…Because patients with Stage III tumors receive adjuvant therapies, in addition to wide resection, to treat microscopically positive margins and/or satellite lesions, it is believed this would also treat any potential tumor cells in the core needle tract. The effect of chemotherapy on outcomes of sarcoma treatment is still debatable; however, a few systematic reviews and meta-analyses have demonstrated improvement in local control rates and, in some cases, overall survival with the use of chemotherapy and radiation [2,19,42,45]. A recent report had no local recurrences from a fine needle aspiration biopsy in 20 patients with high-grade soft tissue sarcomas [28].…”

Trabectedin: Safety and Efficacy in the Treatment of Advanced Sarcoma

“…Close to half of STS patients with intermediate or high grade develop metastatic disease. The majority of these patients are being treated with chemotherapy, but the 5-year survival remains only about 50% 2,3…”