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Indian Journal of Medical and Paediatric Oncology
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Year : 1997  |  Volume : 18  |  Issue : 3  |  Page : 70-79

Current Status of chemotherapy in soft-tissue sarcomas


Department of Melanoma Sarcoma Medical Oncology, The University of Texas, Houston

Correspondence Address:
SR Patel
Department of Melanoma Sarcoma Medical Oncology, The University of Texas, Houston

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Source of Support: None, Conflict of Interest: None


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The Management Of Localized soft tissue sarcomas has evolved over the last several years resulting in improved functional status and overall outcome, however, progress in metastatic disease has been less than impressive. Adriamycin and DTIC based chemotherapy programs have resulted in response rates of upto 50 percent with a small but finite cure fraction, especially in conjunction with surgical resection of residual abnormalities. The decade of the 80's experienced a considerable amount of residual abnormalities. The decade of the 80's experienced a considerable amount of enthusiasm in re-exploring the role of Ifosfamide and mesna, and identified its definite usefulness as an effective salvage regimen with response rates of approximately 2530 percentage in Adriamycin failures. Studies evaluating the role of Ifosfamide as a front line agent in combination with Adriamycin have met with increased toxicities without a significant additive or synergistic therapeutic benefit, probably due to compromised dose intensity of each individual agents. The theoretical rationale for the use of high-dose chemotherapy in sarcomas is based on the linear dose response relationship of alkylating agents and Adriamycin. Such an approach has now become feasible with the advent of growth factors and/or peripheral blood progenitor cell reinfusions fore bone marrow support. While these approaches seem promising in its infancy, with improved complete and overall responses, survival benefit is yet to be accomplished. The limited experience available in the literature with even more aggressive approaches like myeloablative doses of chemotherapy followed by autologous bone marrow transplantation, have been uniformly disappointing, with extremely short lived responses and lack of prolongation of overall survival, significant morbidity and cost. As clinical research continues to improve our understanding and ability to implement the currently available therapeutic armamentarium, the search for newer and better drugs needs to continue. Patients should be encouraged to enroll in research protocols, if we are to answer relevant questions and hopefully impact on this otherwise lethal problem.


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