CHEMOTHERAPY FOR BONE AND SOFT-TISSUE SARCOMAS OF THE EXTREMITIES

Operative management remains the principal modality of therapy for patients who have a bone or soft-tissue sarcoma. For patients who have a low-grade malignant lesion, a properly executed resection continues to offer the best chance for cure. For those who have a high-grade malignant lesion of bone, the nature and scope of the operation have changed as a consequence of advancements in adjuvant therapies, principally chemotherapy, resulting in improved local control of the tumor, functional preservation, and higher rates of cure. The effectiveness of adjuvant chemotherapy in the treatment of osteosarcoma and Ewing sarcoma is well established. Current multi-agent regimens have resulted in improvement in the rates of disease-free and over-all survival. The role of these agents in the treatment of other primary high-grade malignant lesions of bone, however, is less well defined. Currently, evidence for the long-term efficacy of adjuvant chemotherapy in the treatment of high-grade soft-tissue sarcomas, except for rhabdomyosarcoma in children, is lacking.