Therapeutic decision making in BMT/SCT for soft tissue sarcomas

Disease classification page 189 Results with high-dose therapy followed by autologous stem cell transplant 190 Neuroblastoma 190 Ewing sarcoma and other soft tissue sarcomas 191 Further reading 193 Disease classification Guidelines about the staging and treatment of soft tissues sarcomas can be found in the recommendations of the National Comprehensive Cancer Network (www.nccn.org) and the specialized pediatric oncologic literature (for neuroblastomas, Ewing sarcomas, and osteosarcomas). Results with high-dose therapy followed by autologous stem cell transplant Owing to the multiple types of soft tissue sarcomas and because of the different prognosis of adult versus pediatric sarcomas, few concrete data exist to validate the role of high-dose therapy. Theoretically, patients with relapsed disease or high-risk metastatic disease would benefit from an increased dose intensity by overcoming drug resistance to standard-dose therapy. In pediatric soft tissue sarcomas, the published studies do not show a clear benefit for consolidation with high-dose therapy. The recommendation was given that future trials of high-dose therapy must define rigorous eligibility criteria; must have an appropriate, preferably randomized, control group; and must be designed with sufficient power to evaluate the hypothesis that high-dose therapy results in a better outcome than standard chemotherapy (Meyers, 2004). The only exception to this statement is neuroblastoma where two randomized studies showed an advantage for high-dose therapy (Matthay et al., 1999; Berthold et al., 2005). Pedrazolli et al. (2006) gave an extensive review about the bone marrow transplant (BMT) trials for solid tumors in adults (excluding breast cancer).