Adjuvant treatment of soft tissue sarcoma in children and adults

The past experience has shown, that the sole use of even extensive surgery may be inadequate in the management of soft tissue sarcomas. Although there is suggestive evidence, that radiotherapy may eradicate microscopic residual disease, and wide local excision with pre- or postoperative radiotherapy +chemoimmunotherapy replace amputation, the number of patients treated in this way has been small, duration of follow-up short and no prospective randomised trials have been carried out comparing a group given adjuvant treatment with a group managed by radical surgery alone. High radiation doses (6000 rad in 6 weeks) have been recommended by most authors, lower doses producing less consistent effects. There does not seem to be any statistically significant difference in the response of various histological types of soft tissue sarcoma to combination chemotherapy or radiotherapy. The chances of local recurrence and metastasis seem to depend less on histological type than on initial size, site and grade of the tumor. Many of the studies of adjuvant chemotherapy used drugs and regimes of unproven value in adult soft tissue sarcoma and the use in adjuvant trials of the CYVADIC regime (Adriamycin, Cyclophosphamide, Vincristine, DTIC) that has been extensively studied in metastatic disease seems more logical. Meanwhile, more thorough investigation of cyclophosphamide, high dose methotrexate and actinomycin D as single agents would be valuable, and phase II trials of newer agents such as cis-platinum are required. Large multicentre collaborative trials will be necessary to accrue sufficient patients to produce reliable information on the efficacy of adjuvant therapy. However, despite the many difficulties, there is every reason to hope that adjuvant therapy will be of considerable value. (Dr J. Sugar - Budapest - Hung.)