Chemotherapy of soft tissue sarcoma : A clinical evaluation of treatment over ten years

• The aim of the study was to evaluate the effect of palliative chemotherapy on soft tissue sarcomas given outside controlled trials. Therapy and response rates of 77 patients with non-resectable sarcoma treated with different regimens between 1991 and 2000 were reviewed. Thirty-six patients were treated with first-line chemotherapy comprising cyclophosphamide+vincristine+doxorubicin+dacarbazine (CYVADIC), with a response rate of 28% (median response duration 5.5 months). Etoposide and ifosfamide (IVP, or VIG, which also includes granulocyte colony-stimulating factor (G-CSF)) were used in the treatment of 18 patients. The response rate was 22% (median response duration 4.5 months), Nineteen patients were treated with doxorubicin+ifosfamide and one patient responded. Four patients received other first-line treatments. Thirty-eight patients were given second-line chemotherapy and 4 (10%) patients responded. Thirteen patients were given third-line treatment and 5 patients received fourth-line treatment, but without any response. Disease progression was the dominant reason for discontinuation of therapy. The response rate in the present study was lower than the best published results, probably due to the fact that our soft tissue sarcoma patient material was unselected. Treatment with CYVADIC yields at least as high a response rate as the more recently described doxorubicin+ifosfamide combination, but third- and fourth-line therapy is not beneficial. Clinical trials with more active drugs are needed, as are more predictive and prognostic tests and a better selection of patient groups suited for different treatment options for soft tissue sarcomas.

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