Stage II and III Adult Soft Tissue Sarcoma
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.)
High-grade localized soft tissue sarcomas have an increased potential for
metastatic spread. For sarcomas of the extremities, local control comparable
to that obtained with amputation may be achieved with limb-sparing surgery that
involves wide local excision in combination with preoperative or postoperative
radiation therapy and in some instances, chemotherapy.[1-4]
Several prospective randomized trials have been unable to confirm conclusively
whether doxorubicin-based adjuvant chemotherapy benefits adults with resectable
soft tissue sarcomas. The majority of these studies accrued small numbers of
patients and did not demonstrate a metastasis-free survival or an overall survival
(OS) benefit for adjuvant chemotherapy.[5] Interstudy variability was wide
among the numerous trials, including differences in therapeutic regimens, drug
doses, sample size, tumor site, and histologic grade. A quantitative
meta-analysis of updated data from 1,568 individual patients from 14 trials of
doxorubicin-based adjuvant therapy showed an absolute benefit from adjuvant
therapy of 6% for local relapse-free
interval (95% confidence interval [CI], 1–10), 10% for distant relapse-free interval (95% CI, 5–15), and 10% for recurrence-free survival (95% CI,
5–15); however, there was no OS
benefit at 10 years.[6][Level of evidence: 1iiDii] Patients with high-grade
tumors (grades 3 or 4) larger than 5 cm in diameter have the greatest
tendency for disease to metastasize and are eligible for prospective clinical
trials of adjuvant chemotherapy.
Complete surgical resection is often difficult for sarcomas of the
retroperitoneum because of their large size before detection and anatomical
location.[7,8] As opposed to soft tissue sarcomas of the extremities, local
recurrence is the most common cause of death in patients with retroperitoneal
soft tissue sarcomas. Complete surgical resection (i.e., removal of all gross tumor)
is the most important factor in preventing local recurrence and, in many
instances, requires resection of adjacent viscera. The role of adjuvant radiation therapy in the treatment of patients with retroperitoneal sarcoma has not been clearly defined. Prospective randomized
trials have not shown improved survival with preoperative or adjuvant
chemotherapy for this subgroup.[6,9]
Standard treatment options:
- Surgical excision with negative tissue margins of several centimeters in all
directions may be used.
- If the tumor is greater than 5 cm in diameter, surgical excision with negative tissue margins of several centimeters in all
directions followed by radiation therapy may be used.
- If the tumor is unresectable, high-dose radiation therapy may be used, but
poor local control is likely to result.
- In some situations, radiation therapy or chemotherapy
may be used prior to surgery to convert a marginally resectable tumor to one
that can be adequately resected with limb preservation; this treatment may be
followed by postoperative radiation therapy.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II adult soft tissue sarcoma and stage III 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
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Schmidt RA, Conrad EU 3rd, Collins C, et al.: Measurement and prediction of the short-term response of soft tissue sarcomas to chemotherapy. Cancer 72 (9): 2593-601, 1993.
[PUBMED Abstract]
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Temple WJ, Temple CL, Arthur K, et al.: Prospective cohort study of neoadjuvant treatment in conservative surgery of soft tissue sarcomas. Ann Surg Oncol 4 (7): 586-90, 1997 Oct-Nov.
[PUBMED Abstract]
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Watson DI, Coventry BJ, Langlois SL, et al.: Soft-tissue sarcoma of the extremity. Experience with limb-sparing surgery. Med J Aust 160 (7): 412-6, 1994.
[PUBMED Abstract]
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Cormier JN, Huang X, Xing Y, et al.: Cohort analysis of patients with localized, high-risk, extremity soft tissue sarcoma treated at two cancer centers: chemotherapy-associated outcomes. J Clin Oncol 22 (22): 4567-74, 2004.
[PUBMED Abstract]
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O'Byrne K, Steward WP: The role of adjuvant chemotherapy in the treatment of adult soft tissue sarcomas. Crit Rev Oncol Hematol 27 (3): 221-7, 1998.
[PUBMED Abstract]
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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]
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Heslin MJ, Lewis JJ, Nadler E, et al.: Prognostic factors associated with long-term survival for retroperitoneal sarcoma: implications for management. J Clin Oncol 15 (8): 2832-9, 1997.
[PUBMED Abstract]
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Jaques DP, Coit DG, Hajdu SI, et al.: Management of primary and recurrent soft-tissue sarcoma of the retroperitoneum. Ann Surg 212 (1): 51-9, 1990.
[PUBMED Abstract]
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Eilber FC, Eilber FR, Eckardt J, et al.: The impact of chemotherapy on the survival of patients with high-grade primary extremity liposarcoma. Ann Surg 240 (4): 686-95; discussion 695-7, 2004.
[PUBMED Abstract]
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