Refer to the Treatment Option Overview section of this summary for a more detailed discussion of the roles of surgery, radiation therapy, and chemotherapy.
In the setting of lung metastasis, resection of metastatic tumors may be associated with long-term disease-free survival in patients selected for optimal underlying disease biology (i.e., patients with a limited number of metastases and slow tumor growth).[1,2,3] It is not clear to what degree the favorable outcomes are attributable to the efficacy of surgery or to careful selection of patients based upon factors that are associated with less-virulent disease.[1,2,3] The value of resection of hepatic metastases is unclear.
Newcastle disease virus (NDV) is a virus that is of interest because it replicates (makes copies of itself) more quickly in human cancer cells than in most normal human cells and because it can kill these host cells (see Question 1).
NDV can be used to directly kill cancer cells, or it can be given as a cancervaccine. Cancer vaccines cause the body's natural immune system to seek out and destroy cancer cells (see Question 4).
The results of clinical trials (research studies with people)...
As noted in the Treatment Option Overview section above, doxorubicin is the standard systemic therapy in the management of metastatic sarcomas.[4,5] Other drugs that are felt to have clinical activity as single agents are ifosfamide, epirubicin, gemcitabine, and paclitaxel.[6,7,8,9] Their clinical activity relative to single-agent doxorubicin is not clear, and they are not known to have superior activity. There is controversy about whether adding drugs to doxorubicin offers clinical benefit beyond what is achieved by doxorubicin as a single agent. For older patients to avoid severe toxicity, sequential use of single agents may be the preferred strategy for palliation.
Standard treatment options
Single-agent chemotherapy, with subsequent single agents for disease regrowth.[4,5,6,8,9,10] Doxorubicin is generally the first-line agent. Ifosfamide also has substantial single-agent activity.
Doxorubicin-based combination chemotherapy. A variety of regimens have been used, but none has been proven to increase overall survival compared to doxorubicin alone.[4,5] There is some evidence that the addition of ifosfamide increases response rates (but not survival). Toxicity is increased with the addition of drugs to doxorubicin. No quality-of-life studies have been reported in comparisons of single-agent therapy versus combination therapy.
Resection of pulmonary lesions may be performed if the primary tumor is under control.[1,2,3]
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV adult soft tissue sarcoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.