¿Patients with inoperable, advanced soft-tissue sarcoma have considerably low cure rates. Less than 10% of these patients survive for 5 years following current standard treatment. Recent results from a clinical trial, published in the Journal of Clinical Oncology show a significant improvement in the duration of survival in adults with advanced soft tissue sarcomas following treatment with high-dose chemotherapy (HDC) and an autologous stem cell transplant.
Soft-tissue sarcomas are characterized by the growth of cancer cells in the soft tissues of the body. Soft tissues include muscles, tendons, fibrous tissue, fat, blood vessels, nerves, or the tissues surrounding the joints. There are many different types of soft-tissue sarcomas that can develop in children, adolescents and adults. Treatment for soft-tissue sarcomas varies, depending on the specific type of cancer, the place in the body where the cancer started, and the extent of the disease. Treatment may include surgery to remove the cancer, chemotherapy and/or radiation. Advanced sarcoma means that cancer has spread from its site of origin to other places in the body. Patients with advanced sarcoma are often treated with more aggressive or intensive treatments to achieve optimal chances of a cure.
Chemotherapy targets and kills rapidly dividing cells, such as cancer cells. High-dose chemotherapy (HDC) kills more cancer cells than lower-dose or conventional chemotherapy. Although HDC delivers chemotherapy in doses sufficient to kill the majority of cancer cells; it unfortunately also kills more normal cells, especially the blood-producing stem cells in the bone marrow. Stem cells are immature cells produced in the bone marrow (spongy material inside bones) and eventually become either red blood cells, which provide oxygen to tissues, white blood cells, which fight infection, or platelets, which aid in blood clotting. When stem cells reach critically low levels following HDC, complications such as anemia, infection and bleeding can occur. Thus, it is imperative to restore stem cell levels as quickly as possible following HDC treatment. During an autologous stem cell transplant, the patient’s own stem cells are collected before HDC treatment, frozen, and then reinfused back into the patient after HDC treatment to “rescue” the bone marrow. Therefore, stem cells are collected before HDC and used to replace the depleted cells reduced to dangerously low levels following HDC.
Researchers from France recently conducted a clinical trial evaluating the use of HDC and stem cell transplantation in patients with advanced sarcoma. All of these patients were unable to undergo surgery to remove their cancer. All patients were treated with standard chemotherapy to induce a partial or complete disappearance of cancer. Overall, 23% of patients in this study were alive 5 years following treatment with HDC and stem cell transplantation. Seventy-five percent of patients treated with HDC following a complete disappearance of cancer after standard chemotherapy were still alive 5 years following HDC treatment.
These results appear to demonstrate a significant improvement in the duration of survival for patients with advanced, inoperable sarcoma following treatment with HDC and stem cell transplantation. This treatment strategy appears particularly promising for patients who achieve a complete remission following standard therapy. Further clinical trials will be conducted to evaluate this treatment strategy in patients with advanced sarcoma. Patients with sarcoma may wish to speak with their doctor about the risks and benefits of HDC and stem cell transplantation or about the participation in a clinical trial utilizing other promising therapies. ( Journal of Clinical Oncology, Vol 18, Number 12, pp3643-3650, 2000)