Standard treatment options for metastatic childhood soft tissue sarcoma (STS) include the following:
- Combination therapy using chemotherapy, radiation therapy, and surgical resection of pulmonary metastases.
The prognosis for children with metastatic STSs is poor,[1,2,3,4,5,6] and these children should receive combined treatment with chemotherapy, radiation therapy, and surgical resection of pulmonary metastases. In a prospective randomized trial, chemotherapy with vincristine, dactinomycin, doxorubicin, and cyclophosphamide, with or without dacarbazine, led to tumor responses in one-third of patients with unresectable or metastatic disease. The estimated 4-year survival rate, however, was poor, with fewer than one-third of children surviving.[6,7,8]
Children with isolated pulmonary metastases should undergo a surgical procedure in an attempt to resect all gross disease. For patients with multiple or recurrent pulmonary metastases, additional surgical procedures can be performed if the morbidity is deemed acceptable. In a retrospective review, patients with synovial sarcoma and pulmonary metastases for whom it was possible to completely resect all metastatic lung lesions had better survival than did patients for whom it was not possible to achieve complete resections.[Level of evidence: 3iiiA] An alternative approach is focused radiation therapy (fractionated stereotactic radiation therapy), which has been successfully used in adults to sterilize lesions. The estimated 5-year survival rate after thoracotomy for pulmonary metastasectomy has ranged from 10% to 58% in adult studies. Emerging data suggest a similar outcome after the administration of focused radiation therapy in adults. Formal segmentectomy, lobectomy, and mediastinal lymph node dissection are unnecessary.
Treatment Options Under Clinical Evaluation
The following agents are being studied for the treatment of certain metastatic STSs:
Table 9. Agents With Selective Activity Against Subtypes of Soft Tissue Tumors
|Agent||Soft Tissue Sarcoma Subtype|
|Sunitinib[12,13]||Alveolar soft part sarcoma|
|Cediranib||Alveolar soft part sarcoma|
|Sunitinib||Solitary fibrous tumor|
|Sirolimus||Perivascular epithelioid cell tumor (PEComa)|
|Crizotinib||Inflammatory myofibroblastic tumor|
|Imatinib||Tenosynovial giant cell tumor|
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with metastatic childhood soft tissue sarcoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
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