Adjuvant therapy of sarcomas of soft tissue.

Adjuvant chemotherapy for rhabdomyosarcomas, osteosarcomas, and Ewing's sarcomas is established, but remains controversial in other adult sarcomas. Of the 14 reported adjuvant studies, the largest study from the European Organization for Research and Treatment of Cancer showed a significant improvement in local control for adjuvant chemotherapy in nonextremity sarcomas, but not overall survival benefit. Two studies show a significant overall survival advantage for chemotherapy. A meta-analysis of individual patient data by the Medical Research Council Cancer Trials Office reported a trend but no significant difference in survival (although differences were significant for disease-free survival and local control). Adjuvant chemotherapy should not be offered for low-grade lesions because of their low probability of metastatic spread, nor should it be offered for small (< 5 cm) high-grade sarcomas because of their good prognosis. Oncologists should discuss the adjuvant data with patients who have soft tissue sarcomas. Patients informed of a difference in disease-free survival but a 4% absolute difference in survival may or may not wish to receive adjuvant chemotherapy.