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Who should receive adjuvant chemotherapy after definitive surgery for soft tissue sarcomas?

The subject of who should receive post –operative chemotherapy for localised soft tissue sarcoma has been a controversial one for over a decade.
The subject has been overviewed at the 2000 American Society of Clinical Oncology meeting. The concensus view is that routine adjuvant chemotherapy is established best standard care for small cell types viz. Ewing’s sarcoma, primitive neurectodermal tumours and rhabdomyosarcoma. It remains controversial for other histological types, and the overview of the trials does not support the routine practice, although a recent Italian trial using iphosphamide and adriamycin chemotherapy is supportive of chemotherapy and it may be such modern chemotherapy will prove useful in the routine adjuvant situation – watch this space.
Other groups are looking at dose escalation of standard drugs to try to find effective adjuvant chemotherapy – but only within a properly constructed trial.