Stage IV Adult Soft Tissue Sarcoma
Nodal Disease
Visceral Disease
Current Clinical Trials
Note: Some citations in the text of this section are followed by a level of
evidence. The PDQ editorial boards use a formal ranking system to help the
reader judge the strength of evidence linked to the reported results of a
therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more
information.)
Nodal Disease
Stage IV sarcomas are tumors that have metastatic involvement of regional lymph
nodes or have spread to distant organs. Soft tissue sarcomas that more
commonly spread to lymph nodes include synovial cell sarcomas, epithelioid
sarcomas, and rhabdomyosarcomas. For stage IV sarcomas, local control of the
primary tumor is probably best obtained by resection with negative margins,
lymphadenectomy when appropriate, and postoperative external-beam radiation
therapy.[1] For gastrointestinal stromal tumors (GISTs), preliminary evidence
indicates that imatinib mesylate, a tyrosine kinase inhibitor,
induced sustained tumor response in patients with unresectable or metastatic
tumors.[2-6][Level of evidence: 3iiiDiv]
Standard treatment options:
- Surgical resection and lymphadenectomy for patients with clinically positive
lymph nodes with or without postoperative radiation to the primary site may be used.
- In some centers, radiation therapy may be used prior to and following
surgical extirpation.[7]
- Adjuvant chemotherapy may be considered for patients eligible for clinical
trials.[8-11]
Visceral Disease
With distant metastases, surgery with curative intent is possible
for patients with limited pulmonary metastases who are also undergoing or have
undergone complete resection of the primary tumor.[12-14] The role of adjuvant
therapy for pulmonary nodules is under clinical evaluation in trials such as the EORTC-62933 trial.
The value of
resection of hepatic metastases is unclear. Doxorubicin alone or with
dacarbazine is considered one of the most frequently used chemotherapeutic
regimens for advanced sarcoma.[15-17] When used as single agents, only
doxorubicin and ifosfamide show greater than 20% response rates; less active
drugs include dacarbazine, cisplatin, methotrexate, and vinorelbine.[18] A
randomized trial of 340 patients with advanced sarcoma showed a higher response
rate (32% vs. 17%, P < .002) and longer time-to-progression (6 months vs. 4
months, P < .02) for doxorubicin, dacarbazine, ifosfamide, and mesna versus
doxorubicin and dacarbazine alone.[19][Level of evidence: 1iiDiii] For older
patients, sequential use of single agents with each recurrence is a better
strategy for palliation. High-dose chemotherapy (with or without
transplantation) has not influenced disease-free survival or overall survival in
published studies so far, but it remains under clinical evaluation for patients
with metastatic disease in first complete remission, after resection of
pulmonary nodules, or for inoperable large primaries.[20][Level of evidence: 3iiiDiv]
For GISTs, preliminary evidence indicates that imatinib mesylate,
a tyrosine kinase inhibitor, induced sustained tumor response
in patients with unresectable or metastatic tumors.[2-4][Level of evidence: 3iiiDiv]
Standard treatment options:
- Surgical resection of the primary tumor with radiation therapy. Resection
of pulmonary lesions may be performed following definitive therapy of the
primary tumor.[12-14]
- Surgical excision with negative tissue margins may be used.
- If the tumor is resectable but wide margins cannot be obtained,
radiation therapy may be added.
- If the tumor is unresectable, high-dose radiation therapy may be
used, often with chemotherapy.
- For tumors of the retroperitoneum, trunk, and head and neck,
surgical resection with preoperative and/or postoperative radiation
therapy, and sometimes chemotherapy, may be used.
- For palliation of patients with unresectable visceral disease, chemotherapy
with the following agents may be used:
- Doxorubicin.[15]
- Doxorubicin + dacarbazine.[15,16]
- Doxorubicin + ifosfamide.[21]
- Doxorubicin + dacarbazine + ifosfamide + mesna.[19,22]
- High-dose ifosfamide regimens.[23-25]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IV adult soft tissue sarcoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References
-
Eilber FR, Eckhardt J, Morton DL: Advances in the treatment of sarcomas of the extremity. Current status of limb salvage. Cancer 54 (11 Suppl): 2695-701, 1984.
[PUBMED Abstract]
-
Joensuu H, Roberts PJ, Sarlomo-Rikala M, et al.: Effect of the tyrosine kinase inhibitor STI571 in a patient with a metastatic gastrointestinal stromal tumor. N Engl J Med 344 (14): 1052-6, 2001.
[PUBMED Abstract]
-
Blanke CD, von Mehren M, Joensuu H, et al.: Evaluation of the safety and efficacy of an oral molecularly-targeted therapy, STI157, in patients (pts) with unresectable or metastatic gastrointestinal stromal tumors (GISTs) expressing c-kit (CD117). [Abstract] Proceedings of the American Society of Clinical Oncology 20: A-1, 1a, 2001.
-
Van Oosterom AT, Judson I, Verweij J, et al.: STI 571, an active drug in metastatic gastro intestinal stromal tumors (GIST), an EORTC phase I study. [Abstract] Proceedings of the American Society of Clinical Oncology 20: A-2, 1a, 2001.
-
Debiec-Rychter M, Sciot R, Le Cesne A, et al.: KIT mutations and dose selection for imatinib in patients with advanced gastrointestinal stromal tumours. Eur J Cancer 42 (8): 1093-103, 2006.
[PUBMED Abstract]
-
Blanke CD, Rankin C, Demetri GD, et al.: Phase III randomized, intergroup trial assessing imatinib mesylate at two dose levels in patients with unresectable or metastatic gastrointestinal stromal tumors expressing the kit receptor tyrosine kinase: S0033. J Clin Oncol 26 (4): 626-32, 2008.
[PUBMED Abstract]
-
Schwartz DL, Einck J, Bellon J, et al.: Fast neutron radiotherapy for soft tissue and cartilaginous sarcomas at high risk for local recurrence. Int J Radiat Oncol Biol Phys 50 (2): 449-56, 2001 Jun 1.
[PUBMED Abstract]
-
Antman KH: Adjuvant therapy of sarcomas of soft tissue. Semin Oncol 24 (5): 556-60, 1997.
[PUBMED Abstract]
-
Adjuvant chemotherapy for localised resectable soft-tissue sarcoma of adults: meta-analysis of individual data. Sarcoma Meta-analysis Collaboration. Lancet 350 (9092): 1647-54, 1997.
[PUBMED Abstract]
-
Buesa JM, López-Pousa A, Martín J, et al.: Phase II trial of first-line high-dose ifosfamide in advanced soft tissue sarcomas of the adult: a study of the Spanish Group for Research on Sarcomas (GEIS) Ann Oncol 9 (8): 871-6, 1998.
[PUBMED Abstract]
-
Patel SR, Vadhan-Raj S, Burgess MA, et al.: Results of two consecutive trials of dose-intensive chemotherapy with doxorubicin and ifosfamide in patients with sarcomas. Am J Clin Oncol 21 (3): 317-21, 1998.
[PUBMED Abstract]
-
van Geel AN, Pastorino U, Jauch KW, et al.: Surgical treatment of lung metastases: The European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group study of 255 patients. Cancer 77 (4): 675-82, 1996.
[PUBMED Abstract]
-
Casson AG, Putnam JB, Natarajan G, et al.: Five-year survival after pulmonary metastasectomy for adult soft tissue sarcoma. Cancer 69 (3): 662-8, 1992.
[PUBMED Abstract]
-
Putnam JB Jr, Roth JA: Surgical treatment for pulmonary metastases from sarcoma. Hematol Oncol Clin North Am 9 (4): 869-87, 1995.
[PUBMED Abstract]
-
Santoro A, Tursz T, Mouridsen H, et al.: Doxorubicin versus CYVADIC versus doxorubicin plus ifosfamide in first-line treatment of advanced soft tissue sarcomas: a randomized study of the European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group. J Clin Oncol 13 (7): 1537-45, 1995.
[PUBMED Abstract]
-
Zalupski M, Metch B, Balcerzak S, et al.: Phase III comparison of doxorubicin and dacarbazine given by bolus versus infusion in patients with soft-tissue sarcomas: a Southwest Oncology Group study. J Natl Cancer Inst 83 (13): 926-32, 1991.
[PUBMED Abstract]
-
Borden EC, Amato DA, Rosenbaum C, et al.: Randomized comparison of three adriamycin regimens for metastatic soft tissue sarcomas. J Clin Oncol 5 (6): 840-50, 1987.
[PUBMED Abstract]
-
Demetri GD, Elias AD: Results of single-agent and combination chemotherapy for advanced soft tissue sarcomas. Implications for decision making in the clinic. Hematol Oncol Clin North Am 9 (4): 765-85, 1995.
[PUBMED Abstract]
-
Antman K, Crowley J, Balcerzak SP, et al.: An intergroup phase III randomized study of doxorubicin and dacarbazine with or without ifosfamide and mesna in advanced soft tissue and bone sarcomas. J Clin Oncol 11 (7): 1276-85, 1993.
[PUBMED Abstract]
-
Elias AD: High-dose therapy for adult soft tissue sarcoma: dose response and survival. Semin Oncol 25 (2 Suppl 4): 19-23; discussion 45-8, 1998.
[PUBMED Abstract]
-
Edmonson JH, Ryan LM, Blum RH, et al.: Randomized comparison of doxorubicin alone versus ifosfamide plus doxorubicin or mitomycin, doxorubicin, and cisplatin against advanced soft tissue sarcomas. J Clin Oncol 11 (7): 1269-75, 1993.
[PUBMED Abstract]
-
Elias A, Ryan L, Sulkes A, et al.: Response to mesna, doxorubicin, ifosfamide, and dacarbazine in 108 patients with metastatic or unresectable sarcoma and no prior chemotherapy. J Clin Oncol 7 (9): 1208-16, 1989.
[PUBMED Abstract]
-
Patel SR, Vadhan-Raj S, Papadopolous N, et al.: High-dose ifosfamide in bone and soft tissue sarcomas: results of phase II and pilot studies--dose-response and schedule dependence. J Clin Oncol 15 (6): 2378-84, 1997.
[PUBMED Abstract]
-
Reichardt P, Tilgner J, Hohenberger P, et al.: Dose-intensive chemotherapy with ifosfamide, epirubicin, and filgrastim for adult patients with metastatic or locally advanced soft tissue sarcoma: a phase II study. J Clin Oncol 16 (4): 1438-43, 1998.
[PUBMED Abstract]
-
van Oosterom AT, Mouridsen HT, Nielsen OS, et al.: Results of randomised studies of the EORTC Soft Tissue and Bone Sarcoma Group (STBSG) with two different ifosfamide regimens in first- and second-line chemotherapy in advanced soft tissue sarcoma patients. Eur J Cancer 38 (18): 2397-406, 2002.
[PUBMED Abstract]
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