Service de médecine, Institut Bergonié, 180, rue de Saint-Genès, 33076 Bordeaux Cedex, France.
Important improvements in local control with increasing function-sparing treatment have been achieved in adult soft tissue sarcomas (STS). However, the global prognosis of these diseases remains poor and 40% of patients with STS currently die of metastases within 5 years. In fact, the impact of chemotherapy remains debated, particularly in the adjuvant setting. Thirteen randomized clinical trials with no-treatment control arms have been published to assess adjuvant chemotherapy. A benefit has been demonstrated in 2 studies for overall survival, and in 5 studies when considering disease-free survival (DFS). Globally, despite large differences between studies (patient selection and treatment modalities), overall survival, DFS and local control of the chemotherapy arm were always better than those of the observed arm. These effects were also confirmed in 3 meta-analyses on published data. However, according to the preliminary results of a meta-analysis on individual patient data, overall survival does not appear to be significantly affected. Therefore, adjuvant chemotherapy for STS remains investigational. Randomized studies have to be pursued on the basis of previously performed trials in order to assess which patient group really benefits from adjuvant chemotherapy.