Soft tissue sarcomas

Although the reported experience with adjuvant chemotherapy in soft tissue sarcomas indicates a potential beneficial effect in certain patient populations, this must be substantiated in a larger number of patients. Several large-scale phase III studies testing Adriamycin alone or in combination in adjuvant set-up are still in process. Studies aimed at the refinement of primary management include modifications of the UCLA regimen of the infusion of Adriamycin and preoperative radiation therapy and refinements of preoperative radiation therapy alone. A study that would compare the use of preoperative and postoperative irradiation in combination with conservative surgery is highly desirable but may be difficult to implement. The use of neutron therapy in soft tissue sarcomas continues to be tested. Encouraging preliminary results need to be confirmed. The past two decades have witnessed remarkable progress in the management of sarcomas. Major contributions include an increasing use of conservative surgery in conjunction with preoperative radiation therapy and chemotherapy. It has become clear that in most patients radical surgery resulting in mutilation can be obviated by the judicious use of adjuvant modalities. What the optimal combined modality approach is, however, is still under investigation. The timing of radiation therapy, the extent of the surgical procedure, and the timing and format of adjuvant chemotherapy must be defined more precisely