Evidence for using adjuvant chemotherapy as standard treatment of soft tissue sarcoma.

The role of adjuvant chemotherapy in the treatment of patients with soft-tissue sarcomas remains controversial. The initial observation that extremity tumors might benefit more than tumors of other primary sites prompted careful review of published data. Eight of 9 studies showed improved disease-free and overall survival for the adjuvant chemotherapy group. A meta-analysis of published data showed statistically significant improvement in both disease-free survival and overall survival for adjuvant chemotherapy patients. This analysis prompted a more accurate meta-analysis of individual patient data, which confirmed the results of the meta-analysis of published data. These positive results reflect the efficacy of the chemotherapy of the 1970s and 1980s. The only study of contemporary adjuvant chemotherapy, reported by the Italian Cooperative Group, showed a statistically significant advantage in both disease-free survival and overall survival for patients treated with adjuvant chemotherapy. The studies, taken as a whole, serve as proof of principle that chemotherapy, given early to patients with primary soft-tissue sarcomas of the extremities who are at high risk of developing local recurrence or metastatic disease, can delay and/or prevent relapse and improve cure rate.