Dose-intensive chemotherapy with stem cell support as a treatment strategy for bone and soft-tissue sarcomas.
Whether high-dose chemotherapy with stem cell support improves the long-term outcome for patients with bone and soft-tissue sarcoma is debatable and controversial. Prognosis of patients with unresectable or advanced metastatic sarcoma remains poor with a disease-free survival at 5 years less than 10%; treatment is generally considered to be palliative. Doxorubicin, epirubicin and ifosfamide are the most active single agents with response rates above 20%. Although drug combinations result in higher response rates, superiority against single agent chemotherapy in terms of survival could not have been demonstrated yet. As a dose-response relationship has been shown for the anthracyclines and especially for ifosfamide, high-dose chemotherapy with stem cell support has been evaluated by several investigators. However, all studies were not randomized, comprised small patient numbers and included heterogeneous histological subtypes of soft-tissue sarcomas. Nevertheless, higher doses of chemotherapy result in higher remission rates, which could correlate with longer survival. Well-designed randomized trials should be performed. In this review article, we overview the literature and on the basis of our own data we emphasize the value of high-dose chemotherapy as a treatment option for younger patients with a good performance status in complete or partial remission prior to high-dose chemotherapy.
Kasper
Bernd
B
University of Heidelberg, Department of Internal Medicine V, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany. mail@berndkasper.de
Ho
Anthony D
AD
Egerer
Gerlinde
G
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012512:Sarcoma, Ewing / Q000628:therapy; D033581:Stem Cell Transplantation; D016019:Survival Analysis
D000970:Antineoplastic Agents