Single institution and national trials of adjuvant chemotherapy have failed to demonstrate an overall survival benefit for patients treated with adjuvant chemotherapy following resection of STS, although several prospective randomized studies suggest that it may prolong disease free survival. A recent meta-analysis suggests that adjuvant chemotherapy provides a minimal benefit in terms of disease free survival in patients with localized completed resected STS but no improvement in overall survival.16 The use of adjuvant chemotherapy remains an area of significant controversy, and its use should be restricted, whenever possible, to patients participating in prospective clinical trials.
Patients at particularly high risk for death from their disease should be entered into investigational trials of neoadjuvant (preoperative) or adjuvant chemotherapy. These include patients with large (> 8 cm), high grade extremity, retroperitoneal or visceral tumors. As a rule, these patients have a probability of long-term survival of 20% or less. Likewise, patients with an excellent long-term prognosis should not be included in investigational trials. These include patients with completely resected low grade sarcomas and adults with small (< 5 cm) high grade extremity sarcomas.17
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