Adjuvant chemotherapy may lead to improved outcomes among patients with soft-tissue sarcoma (STS) even among those with poor prognostic factors, according to a study published in the European Journal of Oncology.1

A previous study investigating the effects of adjuvant chemotherapy — not a standard treatment for patients with STS — showed that treatment improved metastases-free survival (MFS) and overall survival (OS) in patients with STS and other high-risk factors.

For the current study, researchers evaluated the effects of doxorubicin 60 mg/m2 plus ifosfamide 6 g/m2 for 6 cycles among 150 patients with STS. Eligible patients had high-risk STS, which was defined as high-grade morphology, vascular invasion, or as having 2 of the following prognostic factors: large tumor size, infiltrative growth, and necrosis. Patients also received postoperative radiotherapy between cycles 3 and 4.

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The median follow-up was 3.9 and 4.4 years for the MFS and OS analyses, respectively.

Results of the study showed that 5-year MFS was 70.4% (95% CI, 63.1-78.4). Of the 25% of patients (38) who developed metastases, 28 had first site of metastasis in the lung, 3 in the bone, and 7 in various sites.  Further analyses showed that tumor depth, dose of chemotherapy, and tumor size were significantly associated with MFS.

The 5-year local recurrence rate was 14.0% (95% CI, 7.8-20.2), and the 5-year OS was 76.1% (95% CI, 68.8-84.2). Only tumor depth was borderline significantly associated with OS (P = .027).

Frequently reported adverse events included neutropenia with or without fever, thrombocytopenia, and infection.

The authors concluded that “patients with STS and poor prognostic factors according to the [size, invasion, necrosis, growth] system may benefit from adjuvant doxorubicin and ifosfamide with maintained dose intensity.”


  1. Hall KS, Bruland OS, Bjerkehagen B, et al. Adjuvant chemotherapy and postoperative radiotherapy in high-risk soft tissue sarcoma patients defined by biological risk factors—A Scandinavian Sarcoma Group study (SSG XX) [published online June 19, 2018]. Eur J Oncol. doi: 10.1016/j.ejca.2018.05.011