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, highdose 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.
Keywords: Bone sarcomas, soft-tissue sarcomas, high-dose chemotherapy, stem cell support, positron emission tomography, review
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