Adjuvant Therapy for Sarcomas in Adults

Abstract

The treatment considered optimal for primary soft-tissue sarcomas is operative resection with adequate margins of normal tissue around the neoplasm. This approach has been fully illustrated earlier in this volume for a variety of primary sites and clinical presentations. With this approach, the overall “cure rate” for localized soft-tissue sarcomas in adults has been in the range of 40%. More recent reports do suggest a somewhat higher figure, but this may be due to better initial staging methods and the resulting separation of patients with clinically unsuspected metastatic disease. Unfortunately, local control of the sarcoma is not always achieved by operative resection, despite an attempt to follow the surgical principles that have been outlined. In some instances, local failure may occur due to employment of a less than radical approach in order to maintain a viable extremity or because of other anatomic limitations associated with sarcomas arising from the trunk, retroperitoneum, or the head and neck. Nonoperative adjuvant therapies have been employed to deal with both problems associated with treatment failure—local recurrence and hematogenous metastases. An attempt will be made to assess the value of these additional approaches to clinical management.